Evaluation Tools for Interdisciplinary Palliative Care Learning Experiences: A Literature Review.

Background: Expert communication skills are essential for the delivery of effective palliative care across the domains of care. However, few health care providers receive formal communication training. To promote communication education for interdisciplinary palliative care teams, a train-the-trainer course for interdisciplinary hospital-based palliative care teams was developed to prepare them to teach other health care professionals communication skills. Course Design: The curriculum was organized by the eight domains of the National Consensus Project Guidelines for Quality Palliative Care and provided communication skills training for California-based teams. The two-day train-the-trainer course included skill-building exercises and interactive discussions to assist participants in integrating communication skills building into their clinical settings. Using a goal-directed method of teaching, faculty assisted teams in developing three institutional goals for providing palliative care communication training to other health care professionals. Evaluation of the course included immediate postcourse evaluation and follow-up evaluation at six and nine months. Results: The first statewide interdisciplinary communication training took place in January 2018 with 26 palliative care teams consisting of primarily nurses, followed by social workers, chaplains, and physicians. The 46 course participants' postcourse evaluations demonstrated high satisfaction with the course. On a scale of 1 to 5 (1 = lowest), the course met participants' expectations and objectives (4.8). The teams' precourse goals focused on (1) staff education, training, and mentorship, and (2) institution-wide system changes. Conclusion: Palliative care interdisciplinary teams can incorporate communication skills into their practice and provide communication skills training to their institutions.

Early Interdisciplinary Palliative Care in Patients with Previously Untreated Metastatic Oesophagogastric Cancer: A Phase 3 Randomised Controlled Trial

Is There a Role for Herpes Zoster Vaccine in Chronic Pain Management?

Apoyo con Carino: RCT of Patient Navigation to Improve Palliative Care Outcomes (FR417-C)

Introduction: The American Board of Surgery expects competence in interdisciplinary palliative care, and dealing with advancing chronic conditions and end-of-life scenarios are part of Accreditation Council for Graduate Medical Education general surgery milestones. Despite established standards, surgical trainees receive limited amounts of formal palliative care training, if any. Objective: The study purpose was to evaluate baseline knowledge and test effectiveness of an educational session for surgical residents focused on palliative care, hospice care, advance care planning (ACP), and related topics. Methods: The study was completed at Northeast Ohio Medical University with participation from general surgery residents, students, and faculty at Northside Regional Medical Center in Youngstown, Ohio. Participation involved a pretest, lecture, and posttest surrounding palliative and hospice care, ACP, and related topics to teach and assess baseline knowledge and usefulness of an educational session based on test comparison. Mean group scores for pre/post-tests were calculated. A paired one-tailed t-test was used to assess effective change in mean scores. Results: Twenty participants completed the session. The mean pretest score for the group was 60%. The mean posttest score for the group was 75%. Results show that, after the 30-min presentation, there was statistically significant improvement between means (P = 0.00002). Conclusions: Palliative care, hospice care, and ACP are not utilized to potential due to poor residency education as indicated by low mean pretest score. Statistically significant improvement between tests indicates that education focused on these topics can remedy the knowledge gap and presumably improve patient care involving these topics. The following core competencies are addressed in this article: Practice-based learning and improvement, Interpersonal and communication skills, Professionalism.

9068 Background: Palliative cancer care is the integration into cancer care of therapies that address multiple issues that cause suffering for patients and their families and impact their life quality. Challenges and barriers continue to hinder the integration of palliative care into comprehensive, ambulatory oncology care. This paper aims to describe how symptoms, distress, and quality of life (QOL) data from the usual care phase of a NCI-supported Program Project (P01) informed the development of an interdisciplinary palliative care intervention for patients with metastatic non-small-cell lung cancer (NSCLC). Methods: Patients receiving usual care for metastatic NSCLC were recruited into this prospective longitudinal study. A total of 130 patients with stage IV NSCLC were accrued, and 114 patients had evaluable data. Upon informed consent, patients completed outcome measures that assessed physical function/cognitive status, social activities and support, symptom characteristics, psychological distress, and overall QOL. Patient-reported outcomes were completed at baseline, 6, 12, and 24 weeks post-accrual. Results: Subjects were primarily female (64%), ranged in age from 40-84 years, and 39% were ethnic minorities. The majority were former smokers (66%). KPS, IADL, and Cognitive scores deteriorated significantly over time (p=.001, .009, and .042, respectively). Patients reported higher severity scores with symptoms such as dyspnea, fatigue, insomnia, lack of appetite, peripheral neuropathy, pain, dry skin, nail changes, and problems with sexual interest in all four time periods. Global Symptom Distress Index and Total Symptom score both significantly worsened at 24 weeks (p=.003 and .017, respectively). Physical Well-Being worsened significantly (p=.036), while overall QOL, spiritual well-being, and psychological distress scores remained statistically stable over time. Conclusions: Patients with metastatic NSCLC continue to experience high symptom burden and diminished physical well-being over time while receiving treatments. An interdisciplinary palliative care intervention is currently being tested to improve symptom burden and overall QOL.

Characteristics and Outcomes of Psychology Referrals in a Palliative Care Department

Interprofessional education allows students to collaborate with students and professionals of multiple disciplines. An Interdisciplinary Palliative Care (IPC) Seminar, held in the Midwest, involves students from disciplines of medicine, nursing, pharmacy, social work, and chaplaincy. The curriculum of the seminar incorporates asynchronous and synchronous didactic presentations, experiential learning through group exercises and discussion, along with home visits by students in interdisciplinary dyads. The purpose of this study was to determine whether students' participation in a 3-week IPC seminar would positively influence their socialization and value of interprofessional collaboration with the ultimate goal of developing skilled professionals who engage in interprofessional practice in hospice and palliative care settings. This descriptive study invited participants to take a pre- and postseminar online survey using the Interprofessional Socialization and Valuing Scale-21 (ISVS-21) to assess shifts in students' perceptions of interprofessional socialization and the value of collaborative health-care practice. In their pre-and postseminar scores, 71 participants reported they more strongly agreed with all items on the ISVS-21 after completing the seminar. The results from this study suggest the IPC Seminar is an effective educational model for advancing the value of interprofessional socialization and collaborative practice in hospice and palliative health-care.

Purpose: To examine differences in site of death and costs of services by primary diagnosis for patients receiving home-based palliative care as compared to usual care at the end of life verity of illness, service use, and site of death. Design and Methods: A nonequivalent group design was employed with 298 terminally ill patients diagnosed with cancer, CHF, or COPD enrolled. The treatment group received an interdisciplinary home-based palliative care program and the comparison group received usual Kaiser Permanente services. Data collected included patient demographics, se- Results: Among all diseases, patients enrolled in palliative care were more likely to die at home. Enrollment in palliative care was significant associated with cost reductions for patients with cancer, COPD, and CHF. No significant difference was found between diagnostic groups in terms of magnitude of cost savings. Implications: Provision of interdisciplinary home-based palliative care at end of life can effectively increase the likelihood of dying at home for patients with CHF, COPD, and cancer while realizing significant COSt savings.

Background: Since 2013 medical faculties in Germany have to teach and assess palliative care issues. Objective: Evaluation of a one-week intensive seminar in palliative care with regard to cognitive and affective learning objectives. Methods: Exploratory prospective naturalistic study with pre (T1) and post (T2) measurement, investigating medical students' (N=31) knowledge, opinions and attitudes as well as estimation in self-efficacy regarding palliative care issues. The sample contains of undergraduate medical students before and after an interdisciplinary palliative care course (40 teaching units) held at the Medical Faculty of Heinrich Heine University Dusseldorf, Germany. Results: Upon completion of the seminar, students demonstrated a significant increase of palliative care-related knowledge and a positive self-estimation in competence and self-efficacy with regard to treating and caring for dying patients. However, no changes were found on the subject of a greater acceptance and reduced fear of death and dying. Conclusions: The acquisition of affective learning objectives with regard to essential attitudes towards death and dying may require a longer learning process and thus a longitudinal implementation into medical school curricula.

Cervical cancer is the most common cause of cancer-related deaths among economically disadvantaged women. The symptoms of pain, discharge, constipation, foul smell, insomnia and depression can be controlled with inexpensive medicines such as oral morphine, maintenance oral metronidazole, antidepressants and laxatives. These medications should be prescribed according to the palliative care guidelines and titrated to the individual patient’s clinical response, pathophysiology, and metabolic parameters. A hypothetical clinical scenario illustrates some aspects of pain and symptom management, inter-disciplinary palliative care, medical ethics and communication needs in low-resource settings. Palliative radiotherapy is a cost-effective intervention to reduce vaginal discharge, bleeding, pressure effects and nociceptive or neuropathic pain caused by pelvic and para-aortic disease. The role of palliative radiotherapy in patients with malignant fistulae is discussed and the literature on hypo-fractionated pelvic radiotherapy is briefly reviewed.

Multiple randomized controlled trials have underscored the importance of timely referral to palliative care for patients with advanced cancer. Outpatient palliative care can facilitate timely referral and is increasingly available in many cancer centers. The key question is which model of outpatient palliative care is optimal. There are currently many variations for how palliative care is delivered in the outpatient setting, including (1) Interdisciplinary Specialist Palliative Care in Stand-Alone Clinics, (2) Physician-Only Specialist Palliative Care in Stand-Alone Clinics, (3) Nurse-Led Specialist Palliative Care in Stand-Alone Clinics, (4) Nurse-Led Specialist Palliative Care Telephone-Based Interventions, (5) Embedded Specialist Palliative Care with Variable Team Makeup, and (6) Advanced Practice Providers-Based Enhanced Primary Palliative Care. It is important to make a clear distinction among these delivery models of outpatient palliative care because they have different structures, processes, and outcomes, along with unique strengths and limitations. In this review article, we will provide a critical appraisal of the literature on studies investigating these models. At this time, interdisciplinary specialist palliative care in stand-alone clinics remains the gold standard for ambulatory palliative care because this approach has the greatest impact on multiple patient and caregiver outcomes. Although the other models may require fewer resources, they may not be able to provide the same level of comprehensive palliative care as an interdisciplinary team. Further research is needed to evaluate the optimal model of palliative care delivery in different settings.

eP240: Pursuit of a diagnosis for severe skeletal dysplasia: Case of a compound MYH3 VUS heterozygote after negative exome sequencing

Pulmonary rehabilitation is an interdisciplinary program of care for patients with chronic respiratory disorders, created individually and aimed at physical and social indicators and autonomy optimizing. Physical therapists in an interdisciplinary palliative care team are key to the success of pulmonary rehabilitation for palliative patients, focusing on the physical functioning.Objective — to review the data from literature references regarding the characteristics and usage frequency of pulmonary rehabilitation for patients with respiratory diseases who require palliative and hospice care, and to specify respiratory diseases in palliative care patients for which pulmonary rehabilitation is currently used. As a result of the literature review, it was established that pulmonary rehabilitation in patients with chronic respiratory diseases who require palliative and hospice care is aimed at improving pulmonary symptoms (shortness of breaths) and functional status, reducing the intensity of accompanying symptoms, even in the late stages of the disease, which ultimately contributes improving the quality of life and survival of patients, reducing the burden on those who care for them. But access to physical (pulmonary) rehabilitation for patients with chronic respiratory diseases who need palliative and hospice care, is currently not routine in practice and not used enough around the world, unfortunately. It was found that today pulmonary rehabilitation in palliative patients is used only for chronic obstructive pulmonary diseases, interstitial lung diseases, cystic fibrosis, sarcoidosis, idiopathic pulmonary fibrosis and bronchiectasis. At the same time, the literature does not describe the use of physical therapy methods, including pulmonary rehabilitation, in patients with bronchial asthma who require palliative treatment. Pulmonary rehabilitation in patients with chronic respiratory diseases who require palliative and hospice care is a relevant and effective method of treatment, but needs wider implementation in the modern health care system.

Over the past two decades, opioid use and overdose have increased substantially. Naloxone, an opioid overdose reversal agent, has been one of many risk mitigation strategies for preventing mortality due to overdose. Most literature describing naloxone utilization has been about populations of illicit drug users and patients in hospitals, primary care, and pharmacies. There is limited information regarding naloxone prescribing and training for opioid users in specialty pain management clinics. Furthermore, there are no known publications concerning patients receiving palliative care services and overdose prevention. Pain and palliative care patients are commonly at risk of opioid overdose. In an interdisciplinary outpatient pain and palliative care clinic, pharmacists implemented naloxone prescribing and education. Eleven patients at increased risk for overdose were prescribed naloxone and educated on overdose risk factors, recognition, and management. Seven patients reported picking up their naloxone prescription from the pharmacy, and none reported using it within two weeks of the initial education. This intervention was deemed successful within the clinic, but small sample size and the pharmacist role may not be replicable within other pain and palliative care settings. It encourages further research of overdose risk and prevention in pain management and palliative care.