bluuebunny/crossref_metadata_2025_split huggingface dataset:
Integration and expansion of palliative care work force.
Authors: Bowlby Lynn , Turner Robin , Casarett David , Johnson Fred , Boulware Ebony , Webb Jason , Bain Morgan 
Published: November 2017

126 Background: The specialty of Hospice and Palliative Medicine has grown out of the need for care of patients who are living longer with cancer and other serious illness and struggle with symptoms, decisions and care. Cancer patients and others often do not have access to Palliative Care services due to availability or accessibility of PC services. Since 2012, fellowship training is required for board eligibility but available programs do not meet the workforce need. As described by Weissman and Meier, viewing Palliative care services in the context of a primary, secondary or tertiary focus , allows for the expansion of these services outside of the traditional fellowship training. With additional intensive training, it is possible that experienced physicians can fill workforce gaps by providing primary palliative care in the providers practice area such as a clinic. Methods: The faculty member who will participate in a yearlong training program based in the Palliative Care Clinic is the Director of the Outpatient Clinic. This clinic is the center of the Duke resident ambulatory experience for the duration of their training. The complexity of these patients is high and often the DOC is the only place that these patients receive care. The Palliative Care training program will provide the faculty member the opportunity to see patients in the cancer center with board certified palliative care physicians. There will be 3 areas of focus for the trainee: clinical experience, didactic information and mentorship from a board certified palliative care provider around faculty identified cases from her own practice. Results: We have developed a yearlong intensive training program for experienced faculty to gain skills in Palliative Care. Conclusions: 1. It is hoped that this will allow for integration of primary palliative care into patient care areas where there is no formal palliative care program. 2. Integration of Palliative Care principles in the clinic to address symptoms of chronic severe illness as well as difficult conversations with more confidence and skill. 3. Earlier palliative care management–develop a systematic approach to assessing needs in high risk populations ie. Hospital Discharge reviews, now commonly done at the clinic.
Impact of palliative care (PC) consultation on quality of end-of-life (EOL) care in advanced cancer patients receiving care at a tertiary cancer center (TCC).
Authors: Watanabe Sharon , Faily Viane , Tarumi Yoko , Fainsinger Robin , Sinnarajah Aynharan , Potapov Alexei , Baracos Vickie 
Published: November 2017

129 Background: Early integration of PC with oncological care has been shown to improve outcomes in patients with advanced cancer, including quality of life and mood. It has also been suggested to have a positive impact on quality of EOL care. The purpose of our study was to examine how occurrence and timing of PC consultation are associated with quality of EOL care in advanced cancer patients receiving care at a Canadian TCC. Methods: In this retrospective study, patients who died between April 1, 2013 and March 31, 2014, had advanced cancer while receiving care at our TCC, and lived in the catchment area of our urban comprehensive integrated PC program were eligible. Date of death, demographics, and cancer type were obtained from the cancer registry. Date of diagnosis of advanced cancer was determined from electronic medical records. Occurrence and date of PC consultation were identified from the PC database. Data on quality of EOL care indicators were retrieved from the cancer registry, including, in the last 30 days of life: emergency room visits, hospital admission, hospitalization > 14 days, ICU admission, death in hospital, and chemotherapy use. Results: Of 1414 eligible patients, 1101 (77.9%) received PC consultation in hospital, outpatient clinic, or community. Patients who received PC consultation were younger than those who did not receive PC consultation (age 68.8 vs. 71.0, p = 0.01), and differed in the frequency of cancer types (p < 0.001), but not sex, marital status, or income. 679 patients (48.0%) had at least 1 indicator of quality of EOL care. Patients who did and did not receive PC consultation did not differ in the frequency of any indicators of quality of EOL care. There were also no differences in frequency of quality of EOL care indicators between patients who received their first PC consultation > 3 months vs. ≤3 months or > 6 months vs. ≤6 months before death. Conclusions: Among advanced cancer patients receiving care at our TCC, occurrence and timing of PC consultation did not affect quality of EOL care. Methodological and healthcare system differences may explain the discrepancy between our results and those of other investigators. Further research is needed.
The outcome of outpatient palliative care service at Yonsei Cancer Center, a tertiary cancer center in Korea.
Authors: Lee Si Won , Choi Hye Jin 
Published: November 2017

131 Background: The importance of palliative care in cancer patients continues to be emphasized and studies are proving its importance. Several studies proved the improvement of quality of life in advanced cancer patients. The efficacy of symptom control based on outpatient palliative care service has not yet been reported in Korea. The objective of this study is to review the outcome of outpatient palliative care service at Yonsei Cancer Center, a tertiary cancer center in Korea. Methods: We retrospectively reviewed 155 cancer patients who used outpatient clinic at Yonsei Cancer Center in Korea between April 2014 and December 2014. Symptom severity was measured by modified Korean version of Edmonton Symptom Assessment System. Twelve symptoms were assessed: pain, fatigue, nausea, depression, anxiety, drowsiness, dyspnea, sleep disorder, anorexia, constipation, wellbeing, financial distress. Higher score means worse symptom. ESAS scores at baseline and follow-up assessments were analyzed. Results: The 155 patients had following characteristics: female 52.3%, median age 65 years (range 58-75), Hepatobiliary-pancreatic cancer and lung cancer patients accounted for the largest portion (n = 37, 23.9%; n = 36, 23.2% respectively). Most patients were Eastern Cooperative Oncology Group performance status 1 (n = 28, 18.1%) or 2 (n = 24, 15.5%). Ninety-two (59.4%) patients were referred to the palliative care team after anti-cancer treatments were all finished. Overall the symptoms did not change significantly from baseline to 2 consecutive follow up assessment except anorexia ( p value = 0.0195). Patients who were on active anticancer treatment had tendency of higher ESAS score than those finished with the anticancer treatment. However, all symptoms except nausea were not statistically significant. Conclusions: Most patients in this study did not have severe symptom scores that would show the differences of the symptom changes. Nevertheless, although not statistically significant, we found that patients on active anticancer treatment had higher symptom burden than those who were finished with the anticancer treatment. More meticulous symptom management is necessary to improve the symptom control.
Objective smartphone measurements of physical activity and fitness in patients with cancer.
Authors: Douma Joeri A.J. , Verheul Henk M.W. , Buffart Laurien 
Published: November 2017

132 Background: Optimal (study) treatment for patients with advanced cancer is influenced by their performance status (PS) before initiation of systemic therapy. An objective assessment of a patient’s physical function is difficult to make and is currently heavily depending on the estimation of their PS by the treating physician. Objectively measured physical activity (PA) and physical fitness (FIT) may be more predictive for survival and treatment tolerability than their PS. We hypothesize that an objective measurement may provide more accurate estimates of a patient’s physical function and thereby a better outcome of (study) treatment. Unfortunately, routine objective measurements are time consuming and costly. Therefore, we aimed to investigate the validity and reliability of smartphone measurements of PA and FIT in patients with cancer. Methods: At present, 56 ambulant patients with various types of cancer participated. Patients wore an accelerometer for 7, and an IPhone for 14 consecutive days to measure the mean number of steps per day. Patients performed a 6MWT twice with the use of an smartphone application in their home environment and once in a test environment in the hospital. To assess the validity, we calculated the intraclass correlation coefficient (ICC) between the accelerometer and the first week of the IPhone for PA, and between the 6MWT in the hospital and the home environment for FIT. To assess reliability, we calculated the ICC between the IPhone week 1 and 2 for PA, and between the first and second 6MWT in the home environment for FIT. Results: Validity was excellent for PA (ICC = 0.96,p < 0.05) and low for FIT (ICC = 0.33,p < 0.05). We found excellent reliability for PA (ICC 0.94,p < 0.05) and FIT (ICC = 0.93,p < 0.05). Conclusions: In this study we found that objective smartphone measurements of PA are valid and reliable. FIT assessments were reliable, but in its present form its validity was low. A prospective study has been initiated to investigate whether objectively measured PA and/or FIT, better predicts early trial discontinuation and survival than PS or patient-reported physical function.
Early integration of supportive oncology consultation for hospitalized cancer patients.
Authors: Woodfield Kellie , Adelson Kerin B. , Horton Jay , Smith Cardinale B. 
Published: November 2017

136 Background: Integration of Palliative Care (PC) for patients with cancer is associated with improved symptom control, clearer understanding of prognosis, lower utilization of health care resources, and increased hospice use. Yet few studies identify which elements of a PC consultation are most associated with improved outcomes, particularly in the inpatient setting. This study describes the processes of a specialized, interdisciplinary, inpatient PC consultation service that utilized standardized referral criteria and demonstrated improved 30-day readmission, oncology service mortality, and hospice utilization. Methods: We implemented a 3-month intervention on the solid tumor oncology service requiring an automatic PC consultation for patients with one or more of the following criteria: stage IV disease, Stage III lung or pancreatic cancer, hospitalization within 30 days, > 7 day hospitalization, or uncontrolled symptoms. Descriptive statistics were used to identify specific processes associated with the consultation. Results: A total of 52 patients were evaluated. The median time of initial consult was on hospital day 2 and patients were followed for an average of 9 days (±11). The majority of patient encounters were by a physician (47%) or advanced practice nurse (42%), with 48% of encounters lasting 35-60 minutes. Integrative services (massage, yoga etc.) were offered in 72% of consults. The most common issues addressed throughout the consultation were pain (85%), non-pain symptoms (85%), transition planning (85%), and plan of care (82%). Overall, consulting teams addressed more PC needs than were initially identified by chart review. Conclusions: Implementing standardized PC consultations in patients with solid malignancies requires the full support of an interdisciplinary team. PC consultations are time-consuming undertakings, often addressing needs broader in scope than initially identified and requiring the use of specialty level PC in the majority of cases. Future efforts to implement similar interventions can use these data to identify specific staffing needs and to ensure cancer patients receive quality care.
Palliative care in hematologic oncology: A needs assessment.
Authors: Decastro Gene , Earle Bridget 
Published: November 2017

137 Background: As patients with hematologic malignancies further enter the scope of practice for palliative medicine physicians, it is important to have an accurate view of their needs. Historically, there is a paucity of research examining symptom burden in this cohort. Even fewer studies explore the experience and perceptions of frontline hematology providers. As our Geriatrics and Palliative Medicine team at North Shore University Hospital (NSUH) embarked upon a collaborative Supportive Care model on our hospital’s dedicated Leukemia and Bone Marrow units, it was important to gain insight from providers about this population. Methods: We conducted a supportive care needs assessment survey of the staff (faculty, fellows, nurse practitioners, nurses, social workers, and case management) from the Leukemia and Bone Marrow units. The survey encompassed eighteen domains and attempted to assess their prevalence in patients according to the Hematology team. It included symptom burden, social and functional complexities, advance care planning, and goals of care. Free text responses were used to capture staff input about challenges in caring for this population Results: We received a response rate of 30% (30/101) with respondents primarily being nurses. It revealed the domains most commonly seen in this patient population by the team. Domains selected as “frequently” or “almost always” were fatigue (97%), nutritional issues (96%), gastrointestinal issues (93%), anxiety (80%), goals of care (69%), and advance directives (69%). We learned that symptom management was a challenge for the staff. They expressed that patients’ expectations about the impact of chemotherapy is a key area of importance. Lastly, communication with patients throughout treatment and caregiver support were consistent concerns from the team. Conclusions: Determining the four most prominent issues encountered by hematology staff were fatigue, nutritional, gastrointestinal, and anxiety can help to refine the symptom assessment. Moreover, communication and decision making concerns were important. These results underscore the necessity of assessing provider perspectives while treating those with hematologic malignancies to guide future initiatives.
Advance care planning in community: Evaluation of a two-session workshop.
Authors: Rabow Michael , McGowan Marilyn , Small Rebecca , Keyssar Redwing , Rugo Hope S. 
Published: November 2017

14 Background: Engaging patients in advance care planning (ACP) is challenging. Group visits and multiple patient-clinician interactions appear to promote advance directive (AD) completion. We evaluated the effectiveness of a two-session ACP workshop. Methods: We conducted a nurse-led ACP workshop for patients and their family caregivers in a comprehensive cancer center. Patients were invited by their outpatient palliative care physician and an assistant helped coordinate attendance. Monthly sessions were 2 hours long and 2 weeks apart. The first session detailed the ACP process, featured the “Go Wish” card game, and introduced the “Five Wishes” AD. In the time between sessions, patients were encouraged to play Go Wish with family and to begin filling out their AD. The second session included questions and discussion, and helped patients complete, notarize, and scan their AD into the EMR. Workshop evaluation included the validated 4-question Sudore ACP Readiness Survey as well as semi-structured participant interviews. Results: Ten of 11 participants from 4 workshop offerings completed surveys. Median age was 48 years (range 41-72). Most patients (10/11, 90.9%) had breast cancer. Mean pre-workshop ACP readiness was 4.0 out of 5; post-workshop readiness increased nearly significantly to 4.325 (p = .057). Eight of the workshop participants (72.7%) had a new notarized AD scanned into the EMR. Participants most appreciated the chance to talk with other patients (“The most important thing was having a group there. I don’t think I ever would have read that packet if it had just been handed to me.”) and the chance to include their family caregivers (“My family and I had a rich and bonding talk, which was helpful for their own thinking about the AD for themselves as well.”). Two family caregivers completed their own AD. Patients who declined a workshop invitation most commonly reported they “did not have time” because of medical appointments. Conclusions: The ACP workshop was well received by participants and increased ACP readiness, discussion, and completion. The opportunities for group discussion and inclusion of family caregivers were important to participants. Barriers to attending workshops must be explored.
Successful integration of palliative care services into the multidisciplinary multiple myeloma clinics: An observational study based on a single institution experience.
Authors: Nagovski Neil , Brahim Amanda , Reynolds Patrick Taylor , Ruiz Marco 
Published: November 2017

142 Background: The pain syndromes, both acute and chronic are prevalent and often the only complaints affecting the patients’ quality of life and functional capacity. Here we describe our experience of successful integration of palliative care service into multiple myeloma (MM) management in a form of the disease specific multidisciplinary clinic. Methods: We have established a dedicated monthly multidisciplinary clinic for all patients diagnosed with symptomatic MM as a pilot project to incorporate different specialties involved in MM care with the goal to improve on disease management, increase compliance with office visits, reduce emergency department visits and benefit a healthcare system. Patients were able to have the same day visits with medical oncologist, radiation oncologists, palliative care physician, integrative medicine and medical psychologist. Over the course of two years (April 2015 through March 2017), we provided care to 39 unique MM patient. Results: After medical/transplant oncology encounters (N = 601), the most encountered specialists were palliative care (N = 208), followed by radiation oncology (N = 34) and integrative medicine/medical psychology (N = 33). The rate of missed office visits for multidisciplinary clinic was 5%, compared to average 7% for all cancer patients at our center. The rates of emergency department visits were rising in proportion to non-compliance with multidisciplinary clinic visits (correlation coefficient 0.43) Conclusions: Patients with MM cared for at the multidisciplinary clinic had better compliance with office visits and fewer unplanned emergency department visits in comparison patients with other oncologic disorders. The rates of emergency departmentvisits were proportional to non-compliance with multidisciplinary clinic visits. The degree of utilization of integrative medicine and psychology was comparable to radiation oncology encounters suggesting that psychological, behavioral, dietary interventions, complementary, physical therapies and rehabilitation have an important and growing role in MM management.
Implementation of a multidisciplinary palliative and supportive care education lecture series.
Authors: Chan Shawna , Liao Solomon , Randall Leslie M. , Kheriaty Aaron , Dayal Rakhi , Kuo Jeffrey V. , Nguyen Joseph , Vega Charles , Bota Robert , Barrios Cris , Dabral Mudit , Wei Randy 
Published: November 2017

144 Background: Nationwide surveys of residents including those in oncologic specialties reveal that trainees perceive their palliative and supportive care (PSC) educational curriculum as inadequate. For residents, PSC education varies from none at all to an organized department lecture series given by Palliative Medicine physicians. There have been no published experiences of institutional wide PSC lecture series open to all residents, fellows, and medical students. Methods: We piloted a monthly palliative care lecture series from August 2016 to June 2017 at UC Irvine. 12 physicians from 9 clinical departments provided monthly lectures on management of physical symptoms, psychosocial issues, cultural considerations, spiritual needs, care coordination, ethical/legal issues, communication/goals of care, and advance care planning. Lectures were advertised in advance to program directors and emails were sent the week prior to all trainees. At the end of each lecture, attendees were given a voluntary survey that consisted of 10 questions on self-perceived competency in PSC skills and 4 questions on attitudes toward PSC. Results: 143 (45 medical students, 98 residents) responses were received. Most residents (90.8%) and medical students (84.4%) viewed palliative care as an important competency. Only 16 responses from heme/onc, radiation, and gynecology oncology residents and fellows were received, comprising 11.2% of total responses. Residents characterized themselves as “not at all/minimally/somewhat confident” in their ability to care for patients with PSC issues in the following areas: management of opioids (44.2%), fatigue (82.7%), anorexia (79.6%), depression (65.3%), and prognostication (75.5%) Medical students characterized themselves as “not at all/minimally/somewhat confident” in the following areas: management of opioids (79.3%), fatigue (86.7%), anorexia (91.1%), depression (71.1%), and prognostication (91.1%). Conclusions: These findings suggest a need to further improve domains of palliative care training in residency programs and identify innovative ways to increase participation of residents and fellows from all oncologic specialties.
Areas for quality improvement in pediatric supportive oncology services.
Authors: Reichek Jennifer , Weldon Christine B. , Suh Eugene , Trosman Julia Rachel , Sanford Stacy D. , Dighe Dipti , Berardi Rosa , Downing Kim , Choi Daniel K. , Roggenkamp Betty , Pillay Smiley Natasha , Brown Melanie , Owen Erika D , Ganesan Rani 
Published: November 2017

146 Background: In 2013, the Institute of Medicine report recommended that supportive oncology services be initiated at time of diagnosis. Providers of pediatric cancer care in the Chicagoland community, supported by The Coleman Foundation, sought to define areas for quality improvement of supportive oncology delivery to children. Methods: Focus groups and surveys with clinicians providing pediatric cancer care and supportive services at 14 sites were used to prioritize areas needing improvement. Results: 100% (14/14) of sites participated. Of the eligible sites, 6 were pediatric cancer treatment sites and 8 cancer care community organizations. Sites demonstrated consistent agreement for 8 of the 12 areas of focus for improvement. Over 50% of sites reported areas of focus (table) as important or very important. Conclusions: Sites identified the need for quality improvement in delivery of psychosocial, survivorship and palliative care for pediatric cancer patients. Survey results demonstrate a need for collaboration and efforts to guide care delivery improvement across sites. [Table: see text]