bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship between perceptions of treatment goals and psychological distress in patients with advanced cancer.
Authors: El-Jawahri Areej , Greer Joseph , Forst Deborah Anne , Nipp Ryan David , Waldman Lauren , Sereno Isabella , Temel Jennifer S. 
Published: November 2018

44 Background: Several studies have demonstrated discordance between how patients perceive their goal of treatment versus how they perceive their oncologist’s goal. Studies evaluating the extent and risk factors of this discordance are lacking. Methods: We conducted a cross-sectional study of 559 patients with incurable lung, gastrointestinal, breast, and brain cancers. We used the Perception of Treatment and Prognosis Questionnaire to assess patients’ perceptions of both their treatment goal and their oncologist’s goal and categorized responses: 1) patients who reported that both their goal and their oncologist’s goal was concordant (either to cure or not to cure); and 2) patients who reported discordant perceptions of their goal versus their oncologist’s goal. We assessed patients’ psychological distress using the Hospital-Anxiety-and-Depression-Scale and used linear regression to assess the relationship between patients’ perceptions of their treatment goal and psychological outcomes. Results: 61.7% of patients reported that both their goal and their oncologist’s goal was non-curative; 19.3% reported that both their goal and their oncologist’s goal was to cure their cancer; and 19.0% reported discordance between their goal and their perception of the oncologist’s goal. Older age (OR = 0.98, P = 0.01), non-Hispanic ethnicity (OR = 0.31, P = 0.049), and higher education (OR = 0.62, P = 0.042) were associated with lower likelihood of reporting discordant goals. Patients with discordant perceptions of their goal and their oncologist’s goal reported higher anxiety (B = 1.56, P = 0.003) compared to those who reported that both their goal and their oncologist’s goal was curative. Patients who reported both their goal and the oncologist’s goal was non-curative had higher depression symptoms (B = 1.06, P = 0.013) compared to those who reported that both their goal and the oncologists’ goal was curative. Conclusions: One-fifth of patients with advanced cancer report discrepancies between their perceptions of their own and their oncologists’ treatment goal which is associated with psychological distress. Tools are needed to identify patients at risk of cognitive dissonance about their prognosis.
A randomized clinical trial of TrialTALK, a communication tool to facilitate treatment-related shared decision making.
Authors: Campbell Toby Christopher , Jasicki Mallory , Kwekkeboom Kristine L , Schwarze Margaret L , Zelenski Amy , Mast Kimberly 
Published: November 2018

45 Background: Cancer treatment decision making involves timely, high-risk, life altering shared decision-making conversations between patients, their families, and their oncologists. As such, these conversations are a prime target for a carefully designed, easy to interpret approach to facilitate preference-sensitive decision making. Patients need several important pieces of information delivered in a way that is easy to interpret. The TrialTALK approach has two core elements: a verbal approach and a pen and paper (P&P) diagram. The P&P diagram includes the diagnosis with prognostic implications, all available treatment options including best supportive care alone, estimates for efficacy, and anticipated impact on daily life. The verbal conversation corresponds to the diagram and includes a phrase to encourage deliberation, and empathic responses. Our trial is evaluating the effectiveness of TrialTALK to influence decision making, in particular clinical trial participation. Here, we report the results of the initial oncologist training. Methods: 28 oncologists volunteered to participate and were randomly assigned to control (Group A, n=13) or intervention (Group B, n=15). Oncologists in the intervention group each received two hours of training, including simulated conversations with feedback and optional 1:1 follow up for troubleshooting. At the conclusion of training, oncologists completed a video-recorded simulated encounter with an actor. Trainers reviewed P&P diagrams in real time and provided feedback. Results: We used a fidelity checklist to assess effectiveness of the training. We considered ≥ 14 points out of a possible 20 as an acceptable use of TrialTALK. The average score was 14.8 ± 2. Scores ranged 10-18. 12 of 15 intervention oncologists demonstrated adoption of the tool after 2 hours of training. Conclusions: Oncologist can effectively learn to use TrialTALK. The ongoing study will estimate preliminary efficacy of the TrialTALK intervention in regards to patient decision making and participation in clinical trials.
Improving communication about prognosis on an academic inpatient solid tumor oncology consult service.
Authors: Landry Chrystal Ann , Kessler Alaina J , Bhardwaj Aarti Sonia , Smith Cardinale B. 
Published: November 2018

46 Background: As the number of patients living with cancer increases, a growing proportion of hospital inpatients will have an advanced cancer diagnosis. Data suggests that an unscheduled hospitalization for a patient with advanced cancer strongly predicts a median survival of less than 6 months. As hospitalists more frequently become the primary team taking care of admitted cancer patients, communication between a patient's oncologic care team and inpatient primary providers is crucial. We sought to implement and assess the impact of improved oncology consult documentation of patient prognosis on outcomes of advanced cancer patients admitted to our hospitalist medicine teaching services. Methods: We implemented an EMR-based oncology consult note template which required documentation of prognosis, potential future treatment options (if available), and advance care planning. We reviewed all patients with stage IV solid tumors admitted to the hospitalist teaching service for 8 weeks prior and 8 weeks post-template implementation for comparison. We utilized descriptive statistics and chi-squared testing as appropriate for analysis. Results: We evaluated 51 patients in the pre- and 36 patients in the post-intervention groups. Post-intervention, there was an improvement in documentation of prognosis (29.4% vs. 52.8%, p = 0.03), advanced care planning (37.2% vs. 83.3%, p < 0.0001), and in number of palliative care consults (58.8% vs. 83.3%, p = 0.02). On average, goals of care conversations occurred 2 days earlier in the post-intervention group (11 vs 9 days). Similarly, there was a decrease in inpatient chemotherapy administration (3 cases vs. 0), unit codes (2 vs. 0) and in-hospital death (23.5% vs. 11.1%). Conclusions: Creation of an oncology consult note template which incorporates current oncologic prognostic information improved documentation of prognosis and advance care planning as well as outcomes for advanced solid tumor oncology patients and enhanced inter-service communication. Based on these results, continued and targeted interventions are planned to further improve interservice communication.
Cancer patients’ perception of usefulness with wearable exercise tracker.
Authors: Ng Amy , Gupta Ekta , Bansal Swati , Fontillas Rhodora C. , Williams Janet L. , Dibaj Seyedeh , Bruera Eduardo 
Published: November 2018

51 Background: Wearable trackers (WT) are known for its popular use in healthy, active persons but limited studies have been conducted in cancer survivors. Methods: Participants were asked to wear the WT and synchronize data. Patients were asked to fill out questionnaire regarding their patient reported perceptions of the WT and their perception of usefulness of the WT. Results: 110 cancer patients were enrolled with 100 evaluable surveys. Median age of patients was 62 years old, females (60, 55%), white (79,73%), married/with significant other (77, 71%), with college education and above (51, 47%). There was no statistically significant association between demographic factors of age, gender, ethnicity, marital status, or education and the perception of usefulness of the WT. Eighty-four percent of outpatient (OP) and 67% of inpatient (IP) cancer patients perceived WT as useful, 96% OP and 94% IP reported wearing WT daily, 64% OP and 55% IP perceived WT as helping to increase physical activity and 76% OP and 59% IP would continue to wear WT after this study. For inpatients, ESAS score of pain (p value <0.001), shortness of breath (p value <0.0002) and feeling of well-being (p value <0.001) improved over the course of rehabilitation. Improvement in FIM scores for transfers to wheelchair, walk assistance, walk distance, walking, stairs assistance, and stairs is significantly improved in rehabilitation (p value<0.05). The average resting heart rate was 77 beats per minute and average number of steps per day was 1,863. For outpatients, the average resting heart rate was 77 beats per minute and average number of steps per day was 3,423. Patients who reported the WT as useful had significantly lower fatigue severity (3.3 vs. 6, p value<0.05). Conclusions: Cancer patients perceived the WT as useful in both the inpatient and outpatient rehabilitation setting. No specific sub-group(s) of patients who expressed a higher level of agreement for usefulness of a wearable exercise tracker. There was an association between lower ESAS fatigue score and patient agreement of usefulness of the WT. These findings justify more research in WT and cancer rehabilitation. Clinical trial information: NCT03042884.
Emergency department visits among patients with advanced solid tumors at a cancer center in Mexico City.
Authors: Araujo Miguel , Alcalde Castro Mirza , Soto Perez De Celis Enrique , De la O Andrea , Reyes Rafael , Chavarri Guerra Yanin 
Published: November 2018

52 Background: Emergency department (ED) visits are a distressing event for patients with advanced cancer, and identifying planned, unplanned and avoidable ED visits is important for providing better cancer care. We studied the causes for ED visits, as well as potentially avoidable ED visits during palliative chemotherapy, among patients with advanced cancer treated at a public cancer center in Mexico City. Methods: Consecutive patients with newly diagnosed advanced solid tumors treated at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán from 10/2015 to 03/2016 were screened. Patients who visited the ED during that period were included, and their demographic and clinical characteristics recorded. Number and reasons for ED visits were obtained from medical records. Among patients who received chemotherapy within the previous 30 days, the following reasons for ED visits were classified as avoidable: anemia, nausea, dehydration, neutropenia, diarrhea, pain, emesis, pneumonia, fever or sepsis (according to Centers for Medicare and Medicare Services Hospital Outpatient Quality Reporting Program). Results: 77 patients were diagnosed with advanced solid tumors during the study period, of which 53 (69%) had at least one ED visit. Median age was 63 years (range, 19-88), and 47% were men (n = 25). 51% had gastrointestinal, 21% genitourinary and 28% other tumors. Median follow-up was 360 days. 95 ED visits were identified; with a median number of ED visits per patient of 1 (range 1-5). The most common causes of ED visits were: infections (n = 20; 21%), gastrointestinal disorders (n = 18; 19%), pain (n = 15; 16%), ascites (n = 14; 15%), anemia (n = 4; 4%), catheter dysfunction (n = 4; 4%), and other causes (n = 20; 21%). 57% of ED visits among patients who received chemotherapy within the previous 30 days were classified as potentially avoidable. Conclusions: Over two thirds of patients with newly diagnosed metastatic cancer had ED visits in the first year after diagnosis. Furthermore, more than a half of ED visits among patients receiving palliative chemotherapy were potentially avoidable. Strategies aimed at reducing ED visits are needed to improve quality of care for patients with advanced cancer.
Pediatric cancer care professionals’ experiences with an interprofessional communication intervention.
Authors: Feraco Angela Marie , McCarthy Sarah R. , Das P. Jeet , Revette Anna , Tulsky James A. , Wolfe Joanne 
Published: November 2018

53 Background: The National Academy of Medicine recommends interprofessional collaboration to promote optimal patient- and family-centered care. We sought to understand whether medical and psychosocial professionals who participated in an interprofessional communication intervention perceived it as distinct from usual clinical care. Methods: Our intervention targeted “medical” (physicians, nurse practitioners) and “psychosocial” (social workers, psychologists) professionals. It consisted of an interprofessional family conference, using a structured conversation guide, conducted during the first 6 months of a child’s cancer care. Conferences aimed to enable families to share hopes and worries and ask questions about their child’s care. Clinicians received a 60-minute training focused on communication skills, such as eliciting families’ hopes and worries, and suggested approaches to collaborating during conferences. Clinicians participated in debriefing interviews after each conference (range 1-3). Three of us conducted thematic analysis of interview data. Results: Twenty-two professionals (6 attending MDs, 4 fellow MDs, 8 NPs, and 8 psychosocial clinicians) gave 34 interviews. Medical and psychosocial professionals described interprofessional family conferences as distinct from usual practice patterns, largely due to their interprofessional colleagues’ presence. This co-presence contributed to “being on the same page.” Conferences sometimes bred a new understanding of a family’s needs and consequent care changes. However, both medical and psychosocial professionals noted that psychosocial professionals often were not vocal contributors to the conference. Some psychosocial clinicians reported being unsure of “the rules.” Conclusions: An interprofessional communication intervention promoted shared understanding between interprofessional colleagues. However, medical professionals were described as more vocal, perhaps due to insufficient role clarity or medical dominance.
A national survey of medical students and educators at Korean medical schools, examining the impact of end-of-life care education provided to Korean medical students based on their attitudes.
Authors: Kim Do Yeun , Kim Kyong-Jee , Shin Sung Joon , Heo Dae Seog , Lee Soon-Nam , Nam Eun Mi 
Published: November 2018

55 Background: This study explored the current state of end-of-life (EoL) care education provided to Korean medical students and their self-rated attitudes toward EoL-related education. Methods: An anonymous survey was given to fourth year medical s tudents and the principle EoL care educators at all 41 Korean medical schools. The medical educators were asked to identify the EoL care-related topics that they usually teach students. Both students and medical educators completed seven items regarding self-perceived attitudes. Results: In total, 23 medical educators (56.1%) and 1,545 medical students (46.3%) responded. Of nine topics related to EoL care, the most frequently taught topics were delivering bad news (100%) and managing physical symptoms (74.1%), whereas setting treatment goals was taught the least frequently (37.0%). Approximately half of the educators taught the withdrawal of life-sustaining devices (59.3%), death and dying (55.6%), and advanced directives (55.6%). When the medical students were dichotomized into groups taught at least six topics (n = 815) versus five or fewer topics (n = 729), the group taught at least six topics expressed more satisfaction with EoL care education and they considered EoL care-related issues during their clerkship rotations. They also had fewer negative answers when they were asked about their readiness to practice EoL care. Conclusions: EoL education is inadequate for Korean medical students. However, medical students who were more fully instructed in this topic reported self-rated competency regarding EoL care-related issues. Further research should develop an education system that provides sufficient knowledge and training in EoL care for Korean medical students.
State-level differences in personality and geographic disparities in access to palliative care: Findings on openness.
Authors: Hoerger Michael , Perry Laura M , Korotkin Brittany D. , Walsh Leah E , Kazan Adina S , Rogers James Louis , Atiya Wasef , Malhotra Sonia , Gerhart James I 
Published: November 2018

57 Background: There are geographic disparities in access to palliative care that cause unnecessary suffering near the end of life in low-access U.S. states. The psychological mechanisms explaining state-by-state variation in access to palliative care are poorly understood. Our objective was to examine whether state-level differences in personality explain state-by-state variation in palliative care access. Methods: We combined four datasets with state-level data for the 50 U.S. states and the national capitol. Palliative care access was measured by the Center to Advance Palliative Care 2015 state-by-state report card. Statewide personality differences were identified from a report on 619,387 adults who completed the well-validated Big Five Inventory, which assesses the five core personality dimensions: openness, conscientiousness, agreeableness, neuroticism, and extraversion. The U.S. Census and Gallup provided data on covariates. Regression analyses examined whether state-level differences in personality predicted statewide access to palliative care, controlling for differences in population size, age, gender, race/ethnicity, socioeconomic status, and political views. Results: Access to palliative care was worse in states that were younger, more racially diverse, lower in socioeconomic status, more politically conservative, and lower in openness. In regression analyses that simultaneously accounted for all predictors and covariates, only lower openness continued to explain worse state-level access to palliative care (β = 0.428, p = 0.008). Conclusions: Palliative care access is worse in states where people are lower in openness, meaning residents who are more skeptical, traditional, and concrete. Personality theory offers specific recommendations for palliative care advocates communicating with hospital administrators, legislators, philanthropists, and patients to expand access in low-openness states.
Does use of total parenteral nutrition in patients with metastatic gastrointestinal cancer impact hospice length of stay?
Authors: Bian Jessica J , Rome Rachel S , Taber Angela Marie 
Published: November 2018

58 Background: The use of total parenteral nutrition (TPN) in metastatic cancer patients is controversial. The impact of TPN use on length of hospice stay in advanced cancer patients is unknown. We hypothesize that patients with metastatic gastrointestinal cancers who receive TPN have a shorter median length of hospice stay as compared to the median hospice length of stay for cancer patients in the United States in 2014 (18 days). The primary objective of our retrospective, single-institution study is to determine the median hospice length of stay in patients with metastatic gastrointestinal cancers who received TPN. Methods: Records of all adult patients with metastatic gastrointestinal cancers who received TPN at The Lifespan Cancer Institute from 2005 through 2014 were reviewed. The primary outcome was median hospice length of stay. Data analysis was conducted using Stata (Version 15.0, StataCorp, College station, Texas). Results: Seventy-nine patients were identified as having received TPN for metastatic gastrointestinal cancer. Forty-eight patients had documented referrals to hospice and 40 patients had assessable durations of hospice admission. Hospice length of stay ranged from one to 196 days with a median of 9.5 days, mean of 24.3 days, and interquartile range of 5.5 to 54 days. Conclusions: Hospice care has been shown to improve quality of life for patients and caregivers. In our retrospective, single-institution study of patients with metastatic gastrointestinal cancer who received TPN, the median hospice length of stay was shorter than the national median length of hospice stay for cancer patients in 2014 (9.5 days versus 18 days). This should be taken into consideration when weighing the risks and benefits of initiating TPN in metastatic gastrointestinal cancer patients. [Table: see text]
Timing of last chemotherapy and the end of life in patients (pts) with metastatic cancer.
Authors: Brollo Marianna , Bratta Massimo , Molinaro Simona , Diana Giannarelli , Ricci Mariannina , Bassanelli Maria , Ceribelli Anna 
Published: November 2018

59 Background: Chemotherapy near the end of life is often associated with increased toxicity and poor outcome. The aim of this study was to assess the outcome of patients (pts) with metastatic cancer who received chemotherapy near the end of life. Methods: We conducted an observational, retrospective analysis of 77 consecutive cancer pts (aged ≥ 18 years) who died in hospice between January 2017 and July 2018. Median overall survival (OS) and the 95% confidence interval (CI) were estimated with the Kaplan -Meier method. Results: Of 77 pts (median age: 72 years [y]; male: 59.7%) with metastatic cancer, 51 pts (66.2%) received chemotherapies for metastatic disease (mean prior lines: 2.1 ) and 26 pts (33.8%) received best supportive care (BSC). The most represented histologies were lung (31.2%) and breast (11.7%) cancer. The median time from the last chemotherapy and the death was 67 days. The median progression free survival (PFS) of the last treatment was 45 days. According to Earle’s criteria, 6.5% of pts started a new chemotherapy regimen in the last 30 days of life and 2.6% of subjects received chemotherapy in the last 14 days of life. 11.7% and 3.9% of pts received chemotherapy within the last 30 and 15 days of life, respectively. Younger pts (< 70 years) had an increased probability of continuing chemotherapy within the last 1 month (p=0.004) and < 2 weeks (p=0.002) before death than elderly (> 70 years). Conclusions: This study shows that end-of-life chemotherapy is associated with poor outcome. The use of chemotherapy within 30 and 15 days before death was correlated with younger age.