Medical

• Symptom assessment, diagnosis of reversible causes of pain/symptoms
• Assessment of prognosis
• Exploration of possibilities for disease-specific vs. palliative interventions
• Coordination of HIV and palliative care treatment plans
• Review of potential drug interactions between HIV and palliative care medications

Nursing

• Advance care planning discussions with patients and families
• Address treatment decisions in the context of terminal illness affecting young families
• Education of patients, families, providers about pain management
• Addressing and anticipating concerns about addiction
• Involvement with home care, anticipation and treatment of common problems as disease progresses
• Work with patients about adherence with HIV-specific and palliative therapies

Social Work

• Support and counseling for patients, families, significant others, concerning isolation, stigma, confidentiality, and multiple losses
• Anticipatory guidance about stressors due to chronic and uncertain trajectory of illness ("roller coaster")
• Preparing for death but hoping for "cure"
• Addressing co-existing mental health and substance use-related problems
• Exploring patients' feelings and frustrations about dying in the era of HAART
• Identifying concrete service needs for vulnerable, marginalized patient populations

Psychiatry

• Differentiating depression and other disorders from neuropsychiatric manifestations of HIV disease and chronic substance use
• Exploring refusal/non-adherence with HAART as an informed choice vs. sign of psychopathology
• Determining psychopharmacologic options/strategies in patients with substance use histories
• Addressing family impact of life-threatening illness affecting young adults and children
• Anticipating drug interactions between HIV and psychiatric medications

Medical Ethics

• Assisting in conflict resolution between biological and chosen families regarding care decisions for dying patients
• Advocating for adequate pain management in settings where substance use may be a barrier to treatment
• Addressing concerns about palliative care as less-than-standard care in historically disenfranchised populations mistrustful of the health care system
• Balancing confidentiality, autonomy, and "need to know" in the setting of a highly stigmatized and transmissible infection
• Ensuring that all HIV-infected patients have adequate access to care

Pastoral Care

• Assisting patients with reconciliation with family and religious/spiritual traditions
• Serving as liaison between patients/families/providers and community-based religious/spiritual resources
• Addressing non-acceptance of patients' sexual and drug use behaviors within some faith-based organizations
• Providing ministry of comfort and spiritual support for patients alienated from former religious/ spiritual traditions
• Assisting with funeral rites and arrangements, bereavement services for families

Outreach

• Engaging and following hard-to-reach patients in the community
• Establishing trust and connection with active substance users, homeless patients, and those in other marginalized populations
• Accompanying and advocating for patients within the medical and social service systems
• Making home visits and providing concrete/emotional support for patients and families

[Citation: Selwyn PA, Rivard M, Kappell D, Goeren B, LaFosse H, Schwartz C, Caraballo R, Luciano D, Post LF. Palliative care for AIDS at a large urban teaching hospital: Program description and preliminary outcomes. Innovations in End-of-Life Care. 2002;4(3), www.edc.org/lastacts/]