Patient Perceptions of the Palliative Recovery Engagement Program (P-REP) Clinic, a Novel Outpatient Model for Patients With Advanced Illness and Substance Misuse

Substance use disorder in patients with cancer and other advanced illness is increasingly recognized as an emergent problem, and it has been associated with significant morbidity and mortality. The Palliative Recovery Engagement Program (P- REP) at the University of Pittsburgh Medical Center (UPMC), U.S.A, is an interdisciplinary clinic housed within an outpatient addiction program. It was formed in 2020 to care for individuals who have advanced illness, primarily cancer, who also experience substance misuse. We conducted semi-structured interviews with clinic patients to better understand their experience with pain management prior to arrival and while at P-REP. We identified factors that can influence the therapeutic relationship in this setting where conflict often predominates, such as a patient's coping mechanisms, their prior experiences with stigma, recovery programs, buprenorphine, and their ideas about abstinence, recovery, and the safety of their own patterns of opioid use. Notably, we found that clinicians who are familiar with these factors may feel more prepared to facilitate conversations, negotiate through shared decision making, and help maintain the therapeutic relationship, even when the provider and patient strongly disagree.