bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term collaboration for building sustainable palliative care in Belarus.
Authors: Slater Sarah , Doyle Kathleen 
Published: February 2017

142 Background: The WHO and the Worldwide Palliative Care Alliance have published findings that only 10% of the 20.4 million people who need palliative care currently receive it. A major barrier to meeting that need is insufficient education of healthcare workers in palliative care. Over the last decade, palliative care has attracted significant interest from the government of Belarus, with the first adult hospice founded in 2005 and introduced palliative care into the National Healthcare Law in 2013. However, the country faces a shortage of healthcare providers trained in palliative care. We report on the experience of developing and implementing a palliative care curriculum in Belarus. Methods: We first conducted a needs assessment that examined physician knowledge of and attitudes toward palliative care, the legal status of palliative care, drug availability, and other topics. We utilized past in-country experience, a literature review, a questionnaire, and interviews with Belarusian colleagues. Based on the needs assessment, we developed, modified, and translated a 25-lecture curriculum that was comprehensive, at an adequate difficulty level, and culturally appropriate. A team of four clinicians taught the curriculum in Belarus over to an audience of physicians, and healthcare administrators. Results: The course was well-received—participants were satisfied, reported a better understanding of palliative care, and improved their skills and confidence in managing symptoms and discussing prognosis. Conclusions: We have continued our collaboration with our Belarusian colleagues. New government policies and have passed which promote palliative care. We subsequently held a web-based teleconference with members of the Ministry of Health as well has medical education administrators in Belarus to discuss the structure of palliative care programs in the United States and our model of palliative care education. A second in-person palliative care education workshop for both physicians and nurses is being planned for the fall of 2015. We hope that our experience provides encouragement and resources for the continued promotion of palliative care education and development worldwide.
“She would be flailing around distressed”: Addressing the hidden crisis in the home of patients being treated for cancer.
Authors: Calton Brook , Shepard Nancy , Keyssar Redwing , Thompson Nicole , Patel Kanan , Dzul-Church Virginia , Kao Helen , Ritchie Christine , Rabow Michael W. 
Published: February 2017

147 Background: Metastatic cancer patients who have progressed on multiple lines of chemotherapy and/or have poor functional status are at risk for significant symptoms, ineffective treatments, and hospice under-utilization. Appreciating the full extent these patients’ struggles is challenging during brief oncology clinic visits. We describe Community Bridges (CB), a home-based palliative care program. Methods: The CB pilot featured a 3-person home-based palliative care MD, NP, and RN team. Patients with metastatic cancer and complex care needs ( > 3 chemotherapy lines, ECOG ≥ 3, history of missed PC clinic appointments, and/or clinical trial participation) were offered 2 months of serial home visits and phone support. Symptom severity, satisfaction, and caregiver burden were assessed. Results: 18 patients enrolled. Mean age was 66. At baseline, 79% of patients reported mild-moderate pain, 43% severe fatigue, 38% moderate-severe depression, and 65% poor-fair QOL. Half of patients died within the 2-month program or within 3 months later. 35% of patients enrolled in hospice while in CB, with a LOS of 10 days. Caregiver burden was high. 60% of patients (n = 6) and 100% of caregivers (n = 7) agreed CB provided services not otherwise available. All would recommend the program to others. Participants reported CB helped them navigate the medical system and reduce stress. Caregivers reported CB helped their loved ones regain control of care. The CB team noted key program strengths were accurately identifying the patients’ home needs, communicating findings to oncologists, and intervening quickly when patients were at the end of life and/or actively dying. Conclusions: CB met patients in their final stages, when they were experiencing heavy symptom burden, functional decline, patient/caregiver distress, and risk of death. The CB team was able to assess and respond to changing needs during key transitions points, and report the realities at home to help inform oncologists’ treatments. Although CB was not designed as a “crisis service,” it often served in that role. Home-based palliative care programs like CB may bridge the gap for patients desiring ongoing cancer treatment but in need end-of-life services.
APRN Palliative Care Externship: Potential impact on oncology nursing palliative care delivery.
Authors: Dahlin Constance , Coyne Patrick J. , Cassel Brian 
Published: February 2017

149 Background: Understanding primary palliative care is essential for advanced practice nurses, no matter where they practice. Limitations resulting from the variability of APRN state practice acts, financial considerations, and expenses, challenge post-graduate education for APRNs. With the shortage of health care providers, it is necessary to consider innovative programs to offer this education. Although there are many palliative educational opportunities, there are few abilities to translate the education into practice. Few are focused on the APRN, particularly for community and rural practice where many oncology patients are located and receive care. Methods: The APRN Externship selected 48 externs who completed the week long course. Topics includes pain and symptom assessment and management; fostering communication skills; building understanding of community resources such as hospice, palliative care, and home care; incorporating palliative care into an oncology practice, introducing concepts of business and finance in palliative care; and developing of safe practice with policy, procedure, and guideline development with a focus on rural providers. Externs complete pre course and post course testing along with completing goals to improve patient care. Results: Through an IRB approved process, utilizing both quantitative and qualitative evaluation, we followed the effect of the externship on externs. Externs performed both pre-course as well as 1 month and 6 month post-course testing. They also completed a report on achievement of clinical goals to improve patient care delivery. Conclusions: APRN Palliative Externs reported positive effects from the externship experience to clinical practice. The qualitative and quantitative data has demonstrated sustained effect towards improving palliative care within advanced practice nursing. The APRN palliative externship model could serve as a model to promote better palliative care education for oncology APRNs thereby improving palliative care delivery within oncology nursing.
Frequency, types of interventions and changes in symptoms after consultation with Rapid Access Supportive Care Clinic (RASCC).
Authors: Yennu Sriram , Suravarapu Sruthi , Williams Janet L. , Stephen Saneese , Lu Zhanni , Bruera Eduardo 
Published: February 2017

153 Background: ASCO recommends an integration of palliative care to oncology care so as to improve outcomes. Recognizing the importance our center created a pilot RASCC. The aim of the study was to determine the most frequent interventions by RASCC and symptom change at first follow-up visit. Methods: In this retrospective study all patients seen as a part of RASCC clinic (August 2012- June 2013) were reviewed. Pts with stage 4 NSCLC with oncologist estimated survival of ≤ 6 months were eligible. Delivery of standardized palliative care was ensured using Palliative Care Checklist and weekly meetings. Care followed a standardized management plan. Results: 156 patients were evaluable. The median age was 63, 56% were male, 74% were white. SDS scores improved at follow-up (Table 1). The most common interventions were counseling (including advance cancer planning), medication changes. At the initial consultation, all patients received counseling n = 176 (pts received counseling by more than one IDT member); among the medications, dose initiation and increase of analgesics/opioids n = 122, laxatives n = 123, antiemetics 66, appetite stimulants 18, corticosteroids 10, antidepressants 9, methylphenidate 8, gabapentin 8, neuroleptics 5, sedatives 0. Among analgesics, dose initiation/increased morphine, n = 53, hydrocodone 24, oxycodone 18, hydromorphone12, methadone and fentanyl 6, codeine 1, NSAIDS3. Conclusions: RASCC was associated significant improvement of symptoms and SDS scores at 1st follow-up and the most common interventions were counseling, medication changes related to pain. Further studies are needed. [Table: see text]
A home-based palliative care pilot program for patients with advanced cancer.
Authors: Seitz Rae , Miller Charles F. , Duick Michael , Eubanks Robert 
Published: February 2017

164 Background: Advanced cancer care often lacks a comprehensive approach; in Hawaii most oncology practices do not have access to palliative care teams. This causes high use of acute care services and suboptimal symptom management. Hawaii Medical Service Association (HMSA) created a pilot program called Supportive Care in which home-based palliative care services are offered to members with advanced cancer with goals of improved clinical outcomes and decrease utilization of acute care services Methods: Patients must have stage III or IV malignancy and ECOG PS of 2 or greater. Palliative care services are provided by Medicare-certified hospice agencies, with interdisciplinary teams, 24/7 on-call capacity, and expertise in symptom management. Hospice agencies are paid by HMSA to provide intermittent home visits. DME and pharmaceuticals. Care is coordinated with the patient's treating oncologist and other care providers. Each patient may receive 90 days of Supportive Care services in a 12 month period. Services are suspended during hospitalization or placement in a skilled nursing facility. Results: Patients enrolled in this program utilized hospital services significantly less than other Medicare Beneficiaries during the end-of-life period, suggesting that complex medical and psychosocial needs can be met in the home environment. The table compares findings from cancer patients enrolled in Supportive Care during 2014 with the most recent data available from The Dartmouth Atlas of Health Care. Conclusions: Multiple studies show improved quality of life for cancer patients receiving palliative care. Supportive Care resulted in improved clinical outcomes. Anecdotal feedback indicates high satisfaction among patients, families, and providers. Research to collect data and quantify satisfaction continues. [Table: see text]
Association of timing of palliative care consult on quality care outcomes at a community based hospital.
Authors: Bharadwaj Parag , Yennu Sriram , Helfen Karen M , DeLeon Leo J , Kim Joe , Zimbro Kathie S , Thompson Douglas M , Bleznak Aaron D. 
Published: February 2017

166 Background: Timing of palliative care (PC) consults in hospitalized patients can have an impact on outcomes. Aim: To study the impact of the timing of consults on length of stay (LOS) of PC patients in a community based hospital over a span of 1 year. Additional outcomes included mortality and readmission rates. Methods: We conducted a retrospective review of medical records of consecutive patients who were referred to PC during the time period (November 2012- October 2013). LOS of PC patients consulted within and after 48 hours of admission were analyzed. Based on the timing of consult, mortality ratio of the two patient groups were analyzed. In addition, we analyzed the 30, 60 and 90 day readmission rates pre and post PC consult. Results: The LOS of patients seen by PC within 48 hours (N = 353) of admission was 1.20 (variance from expected) versus after 48 hours (N = 187) of admission was 6.28 (variance from expected). The mean difference in LOS between the groups was 5.08 days. The mortality ratio of the two groups was 1.01 (within 48 hours) versus 1.10 (after 48 hours) (p = .131). In addition the decrease in the 30, 60 and 90 day readmission rate was 61.5%, 47% and 42.1% respectively. Conclusions: Early PC consults were associated with a decrease in LOS and readmission rates with no increase in mortality rate. Further studies are needed to validate these findings in the community setting.
Hot stone therapy in palliative care.
Authors: Parot-Monpetit Anny , Mironnet Stephanie , Monpetit Erik 
Published: February 2017

179 Background: Massage therapy is a popular adjunct to cancer palliation. Hot Stone therapy, a massage method with hot lava stones, is an ancestral native Indian medicine practice. Since 2011, funds permit us to offer Hot Stone therapy as a new Complementary Medicine for inpatients in the oncology unit where Palliative Care is integrated early into oncologic care. We assessed the effect of Hot Stone therapy in patients with advanced cancer on symptom severity. Methods: The study took place at Hopital prive Oceane, a private setting in France, between May 1, 2014 and May 1 , 2015. After physician's check, one nurse who has training in stone therapy method provided massage. We assessed - overall patient's satisfaction - severity of nine common symptoms with Edmonton Symptom Assessment System (ESAS) before and after the massage. We reported - number of each symptom (%) experienced by patient before the massage - number of massages (%) with change score for analyses. Results: Of 156 massages, 113 were assessed (82 patients). Satisfaction rate is 100%. Rate of symptoms before massages: pain, 51%; fatigue, 88%; nausea, 21%; depression, 63%; anxiety, 79%; drowsiness , 72%; lack of appetite, 62%;dyspnea, 36%; no wellbeing, 93%. Decrease of 2 points in change score: pain (71%), fatigue (22%), nausea (25%), depression (42%), anxiety (64%), drowsiness (10%), dyspnea (37%), wellbeing (84%). None increase except in drowsiness (41%) which can be explained by more relaxed patients. No difference in lack of appetite. Conclusions: In our experience, Hot Stone therapy is a type of massage that help patient feel better. A decrease in some very common symptom in palliative care was observed. Stone therapy is a safe method and can be use by training caregivers to alleviate a wide range of cancer symptoms or side effects of treatment with a non-pharmacological approach. Actually, we develop a Hot Stone therapy program's training to offer more massages in our institution.
The Opioid Rotation Ratio (ORR) from transdermal fentanyl (TDF) to strong opioids in cancer patients.
Authors: Reddy Akhila Sunkepally , Yennu Sriram , Reddy Suresh K. , Wu Jimin , Liu Diane D , Bruera Eduardo 
Published: February 2017

182 Background: Despite being the most frequently prescribed strong opioid by oncologists, there is a lack of knowledge of the accurate the opioid rotation ratio (ORR) from transdermal fentanyl (TDF) to other strong opioids in cancer patients. Opioid rotation (OR) from TDF to other strong opioids is performed very frequently in cancer patients for uncontrolled pain or opioid induced neurotoxicity (OIN). The aim of our study was to determine the ORR of TDF to other strong opioids, as measured by morphine equivalent daily dose (MEDD). Methods: In this ad hoc analysis, we reviewed 2471 consecutive patient visits to the supportive care center of a tertiary cancer center in 2008 for an OR from TDF to other strong opioids by a palliative medicine specialist. Information regarding demographics, Edmonton Symptom Assessment Scale (ESAS), and MEDD were collected in patients who followed-up within 6 weeks. Linear regression analysis was used to estimate the ORR between TDF dose and net MEDD (MEDD after OR minus MEDD of breakthrough opioid used along with TDF before OR). Successful OR was defined as 2-point or 30% reduction in pain score and continuation of the new opioid at follow up. Results: 47/2471 patients underwent OR from TDF to other opioids and followed-up within 6 weeks. The median age was 54 years, 53% were male, and 77% had advanced cancer. The median time between OR and follow up was 14 days. Uncontrolled pain (83%) followed by OIN (15%) were the most frequent reasons for OR and 77% had a successful OR with significant improvement in ESAS pain and symptom distress scores. In patients with OR and no worsening of pain at follow-up (n = 41), the median ORR (range) from TDF mg/day to net MEDD was 100 (12.5-217), TDF mcg/hour to net MEDD was 2.4 (0.3-5.2), and correlation of TDF dose to net MEDD was .60 (P < 0.0001). Conclusions: The median ORR from TDF mg/day to MEDD is 100 and from TDF mcg/hour to MEDD is 2.4. Further validation studies are needed.
A nurse communication training curriculum to integrate oncology and palliative care.
Authors: Wittenberg Elaine , Ferrell Betty R. , Goldsmith Joy , Paice Judith A. 
Published: February 2017

19 Background: Quality nurse communication skills are essential to ensure psychosocial care for patients and families, enabling quality of life topics to be addressed across the cancer trajectory and throughout cancer decision-making. However, many oncology nurses are inadequately trained to address patient and family psychosocial concerns. This study describes the development and implementation of an oncology nurse educational program to improve communication about psychological, social, behavior, and spiritual topics. Methods: This interdisciplinary team of authors wrote and published a communication curriculum known by the acronym COMFORT. The curriculum, emphasizing team communication, teaches nurses how to provide life-altering news, assess patient/family health literacy needs, practice mindful communication, acknowledge family caregivers, and address communication openings and goals. With funding from the National Cancer Institute (R25CA174627), the curriculum covers the continuum of cancer care (diagnosis, treatment, survivorship, recurrence, and end of life) and four national courses are planned over the next four years. A pilot study of the two-day communication training course was conducted at one comprehensive cancer center with 27 oncology nurse leaders. Results: Course participants were predominantly female, averaging 19 years nursing experience and 15 years in oncology, and more than half had daily contact with patients and family. Course evaluations were overwhelmingly positive with high mean scores on clarity of presentation (4.82 out of 5), content quality (4.80), and value to clinicians (4.75). The presentation will include a summary of this innovative oncology nurse communication training curriculum aimed at achieving patient-centered communication across the cancer trajectory. Conclusions: This presentation introduces a communication training curriculum focusing on understanding the patient narrative, including the family caregiver, and to provide psychosocial and spiritual care. Improved communication is essential to quality psychosocial nursing interventions.
Efficacy of acupuncture (ACU) therapy for cancer-related pain management in oncology patients (pts).
Authors: Patel Jai Narendra , Miller Katherine , Symanowski James Thomas , Edelen Connie 
Published: February 2017

196 Background: Cancer-related pain negatively affects symptom burden, morbidity, and mortality. Evidence suggests the use of ACU to relieve cancer-related pain. We investigated ACU efficacy and patient-specific factors associated with pain improvement. Methods: Medical charts were reviewed from oncology pts receiving ACU and concurrent palliative medicine management. Pre- and post-ACU pain scores, as assessed by the Edmonton Symptom Assessment Scale (ESAS), were measured at each session. Univariate logistic regression models, including an over-dispersion parameter to account for multiple observations per pt, were used to investigate the association between patient-specific variables (Table) and significant pain improvement, defined as a ≥ 2-point reduction in ESAS pain score, at each session. Results: A total of 122 ACU sessions from 53 pts were included in the analysis. Significant pain improvement was observed in 47% of all sessions (mean reduction 1.8). Baseline non-neuropathic pain was significantly associated with a higher odds of achieving pain reduction (OR 2.351; P = 0.047). Conversely, an opposite association was identified for baseline neuropathic pain (OR 0.421; P = 0.048). Age, stage, number of sessions and tumor type were not significantly associated with pain improvement, although several trends were noted (Table 1). Conclusions: ACU is an appropriate adjunct therapy for cancer-related pain, particularly for non-neuropathic pain. Larger studies to confirm patient-specific variables and further investigation into therapy related side effects will assist in determining a personalized approach to ACU therapy in the oncology population. [Table: see text]
Incorporation of a patient question prompt list into a pancreatic cancer pathway.
Authors: Ellis Peter G. , Lokay Kathleen , Krebs Melinda 
Published: February 2017

20 Background: Metastatic pancreatic cancer is an aggressive disease affording a life expectancy of less than 6 months (Worni et al., 2013). Timely end-of-life discussions are critical. Patient question prompt lists (QPL) have been shown to facilitate discussions around distressing topics and increase patient satisfaction (Brandes et al., 2014; Clayton et al., 2007). We evaluated the use of a QPL embedded in a pancreatic pathway provided by Via Pathways (VP) to enhance communication between oncologists and patients with metastatic disease. Methods: VP are disease-specific decision support algorithms delivered in a web-based portal and used by oncologists at the point of care. Through a committee of oncologists and palliative care specialists, a QPL was developed and incorporated into the VP pancreatic pathway. The goal of the QPL was to empower patients to have informed discussions of available cancer therapies, treatment goals, and personal preferences. Users of the pathway were required to indicate if the QPL was used, then had to provide it to the patient. The QPL prompt was placed in the first line metastatic branch of the pancreatic pathway and piloted from 12/1/14 to 2/28/15. Following the pilot, users were surveyed through email. Results: Results are shown in the table. Conclusions: Based on the results, the pilot had limited success. Although there was an even distribution of those indicating the QPL was and was not provided to the patient, survey results suggested the majority of providers were unaware of the QPL. Our conclusion is that our approach must be less of a burden to the oncologist. Current focus is on automated delivery of advance care planning materials directly to the patient, removing that task from the oncologist workflow. [Table: see text]