P-3 Systemic processing of grief: engaging a multidisciplinary team in a schema therapy model

PurposeThe purpose of this paper is to determine the cost effectiveness of palliative care on patients in a home health and hospice setting. Secondary data set was utilized to test the hypotheses of this study. Home health care and hospice care services have the potential to avert hospital admissions in patients requiring palliative care, which significantly affects medicare spending. With the aging population, it has become evident that demand of palliative care will increase four-fold. It was determined that current spending on end-of-life care is radically emptying medicare funds and fiscally weakening numerous families who have patients under palliative care during life-threatening illnesses. The study found that a majority of people registering for palliative and hospice care settings are above the age group of 55 years old.Design/methodology/approachDifferent variables like length of stay, mode of payment and disease diagnosis were used to filter the available data set. Secondary data were utilized to test the hypothesis of this study. There are very few studies on hospice and palliative care services and no study focuses on the cost associated with this care. Since a very large number of the USA, population is turning 65 and over, it is very important to analyze the cost of care for palliative and hospice care. For the purpose of this analysis, data were utilized from the National Home and Hospice Care Survey (NHHCS), which has been conducted periodically by the Centers for Disease Control and Prevention’s National Center for Health Statistics. Descriptive statistics, χ2 tests and t-tests were used to test for statistical significance at the p<0.05 level.FindingsThe Statistical Package for Social Sciences (SPSS) was utilized for this result. H1 predicted that patients in the age group of 65 years and up have the highest utilization of home and hospice care. This study examined various demographic variables in hospice and home health care which may help to evaluate the cost of care and the modes of payments. This section of the result presents the descriptive analysis of dependent, independent and covariate variables that provide the overall national estimates on differences in use of home and hospice care in various age groups and sex.Research limitations/implicationsThe data set used was from the 2007 NHHCS survey, no data have been collected thereafter, and therefore, gap in data analysis may give inaccurate findings. To compensate for this gap in the data set, recent studies were reviewed which analyzed cost in palliative care in the USA. There has been a lack of evidence to prove the cost savings and improved quality of life in palliative/hospice care. There is a need for new research on the various cost factors affecting palliative care services as well as considering the quality of life. Although, it is evident that palliative care treatment is less expensive as compared to the regular care, since it eliminates the direct hospitalization cost, but there is inadequate research to prove that it improves the quality of life. A detailed research is required considering the additional cost incurred in palliative/hospice care services and a cost-benefit analysis of the same.Practical implicationsWhile various studies reporting information applicable to the expenses and effect of family caregiving toward the end-of-life were distinguished, none of the previous research discussed this issue as their central focus. Most studies addressed more extensive financial effect of palliative and end-of-life care, including expenses borne by the patients themselves, the medicinal services framework and safety net providers or beneficent/willful suppliers. This shows a significant hole in the current writing.Social implicationsWith the aging population, it has become evident that demand of palliative/hospice care will increase four-fold. The NHHCS have stopped keeping track of the palliative care requirements after 2007, which has a negative impact on the growing needs. Cost analysis can only be performed by analyzing existing data. This review has recognized a huge niche in the evidence base with respect to the cost cares of giving care and supporting a relative inside a palliative/hospice care setting.Originality/valueThe study exhibited that cost diminishments in aggressive medications can take care of the expenses of palliative/hospice care services. The issue of evaluating result in such a physically measurable way is complicated by the impalpable nature of large portions of the individual components of outcome. Although physical and mental well-being can be evaluated to a certain degree, it is significantly more difficult to gauge in a quantifiable way, the social and profound measurements of care that help fundamentally to general quality of care.

Abstracts from theCenter to Advance Palliative Care National Seminar Pathways to Quality Palliative Care<i>November 13–15, 2014</i><i>Orlando, Florida</i>

252 Background: Despite a strong evidence base and increasing calls for integration, oncologists find it difficult to deliver primary palliative care concurrent with standard oncology care. Solutions that promote practical integration of palliative care in oncology are needed. In an AHRQ-funded pilot, ASCO and the American Academy of Hospice and Palliative Medicine are developing the Virtual Learning Collaborative (VLC) to develop and test a scalable model for quality improvement and dissemination of best practices in palliative care within the oncology setting. Methods: The VLC will be a web-based learning and collaboration system built upon existing ASCO technology resources. We will select at least 25 oncology practices to participate in regular, facilitated learning sessions, collaborative discussions, and sharing of best practices. The VLC will equip each practice with the knowledge, tools, and coaching to select, test, and adopt a quality improvement intervention relevant to their own palliative care needs. Development of the VLC is ongoing; oncology practices begin participation in Spring 2014. Results: We will assess the VLC using protocol-driven evaluation methods common to technology development, quality improvement, implementation science, and educational initiatives. VLC usability, feasibility, and acceptability will be assessed through surveys of participating practices and focus groups. Longitudinal changes in conformance to palliative care metrics will be assessed using ASCO’s Quality Oncology Practice Initiative (QOPI) system. We will use mixed qualitative and quantitative evaluation methods to assess ongoing changes in clinician knowledge and self-efficacy in applying palliative care principles. Conclusions: We aim to develop and test a novel method for facilitating quality improvement and palliative care learning in oncology. Through this pilot, we will refine the VLC for implementation in the greater oncology community. Ultimately, this effort supports other ASCO and AAHPM quality improvement initiatives focused on clinician education and dissemination of best practices.

Few studies have evaluated the role of a clinical pharmacist in hospice and palliative care in oncology. We aimed to describe the intervention of a clinical pharmacist in hospice and palliative care at a comprehensive oncology center in Jordan. A retrospective descriptive study at a comprehensive oncology center in Jordan between 2006 and 2019. Quantifi® pharmacy documentation system was used to retrieve the clinical pharmacists' interventions in three hospice and palliative care settings, inpatient hospice and palliative care, outpatient hospice and palliative care clinics and home health care. Where clinical pharmacists document their interventions, significance and acceptance of the interventions by the physician is done using Quantifi®. Over 13 years, 27,720 documented interventions were retrieved in the three settings of hospice and palliative care: inpatient hospice and palliative care, outpatient hospice and palliative care clinics and home health care setting. The most common reported interventions were drug therapy recommendation/discontinuation (41%), followed by medication reconciliation (21.7%) and patient counseling (16.8%). The medication classes most commonly associated with the hospice and palliative care clinical pharmacist interventions were analgesics (20.9%), antibiotics (19.7%), followed by medications for the nervous system (12.4%). The acceptance rate of the interventions by physicians was around (90%) and 100% of the interventions were considered significant. Our study showed the high impact of the hospice and palliative care clinical pharmacist in oncology providing the high number of clinical pharmacists' interventions.

Recent research and professional guidelines support expanded use of outpatient subspecialty palliative care in oncology, but provider referral practices vary widely. We sought to explore oncologist factors that influence referrals to outpatient palliative care. Multisite, qualitative interview study at three academic cancer centers in the United States with well-established palliative care clinics. Seventy-four medical oncologists participated in semistructured interviews between February and October 2012. The interview guide asked about experiences and decision making regarding outpatient palliative care use. A multidisciplinary team analyzed interview transcripts using constant comparative methods to inductively develop and refine themes related to palliative care referral decisions. We identified three main oncologist barriers to subspecialty palliative care referrals at sites with comprehensive palliative care clinics: persistent conceptions of palliative care as an alternative philosophy of care incompatible with cancer therapy, a predominant belief that providing palliative care is an integral part of the oncologist's role, and a lack of knowledge about locally available services. Participants described their views of subspecialty palliative care as evolving in response to increasing availability of services and positive referral experiences, but emphasized that views of palliative care as valuable in addition to standard oncology care were not universally shared by oncologists. Improving provision of palliative care in oncology will likely require efforts beyond increasing service availability. Raising awareness of ways in which subspecialty palliative care complements standard oncology care and developing ways for oncologists and palliative care physicians to collaborate and integrate their respective skills may help.

Amaç: Metropol bir kentte yer alan hastanenin onkoloji kliniğinde çalışmakta olan ve palyatif bakım deneyimi olan hemşirelerin mesleki yaşam deneyimlerinin incelenmesidir. Gereç ve yöntem: Bu araştırma niteliksel bir çalışma deseni olan fenomenolojik bir temele dayanmaktadır. Çalışmanın örneklemini, metropol kentte yer alan bir hastanenin onkoloji kliniğinde ve palyatif bakım ünitesinde çalışan ve palyatif bakım hemşirelik deneyimi olan toplam 7 hemşire oluşturmuştur. Çalışmanın verileri, Mayıs–Haziran 2017 tarihleri arasında toplanmıştır. Bulgular: Katılımcıların tamamı kadınlardan oluşmaktadır. Yaş ortalamaları 32.7 olarak hesaplanmıştır. Katılımcıların %71.5’i evli, %57.4’ü eşi ile birlikte yaşamakta, tamamı lisans mezunudur. Meslekte çalışma yılı ortalamaları 12.8 yıl, palyatif bakım hemşireliği ortalamaları 5.2 yıl aralığındadır. Katılımcıların yaşadıkları meslek deneyimleri incelenmiş, verilerin betimleyici ve yorumlayıcı analizlerinin ardından oluşturulan üç ana tema ve 7 alt tema oluşturulmuştur. Zorluklar temasının; yorgunluk, baş etmede zorlanma / tükenmişlik, iletişim sorunlarından oluşan üç alt teması, kazanımlar temasının; profesyonelleşme/ doyum, hayatı anlamlandırma: yaşam ve ölüm, ekip uyumun yer aldığı üç teması ve başetme yöntemleri temasının; alana özel deneyim/eğitim bir alt teması belirlenmiştir. Sonuç: Çalışmamızda, onkoloji palyatif bakımda çalışan hemşirelerin, meslek deneyimleri sonucunda bir takım zorluklara maruz kaldıkları, buna ek olarak kazanımlarınında olduğu ve bunlarla baş etme becerilerinin yakın ilişkili olduğu saptanmıştır. Bu konuda daha fazla çalışmaya ihtiyaç bulunmaktadır. Anahtar Kelimeler: Palyatif bakım, palyatif bakımda hemşirelik deneyimleri, nitel çalışmalar.

Although much evidence has accumulated demonstrating its benefit, relatively little is known about outpatient palliative care in patients with cancer. This paper reviews the literature and perspectives from content experts to describe the current state of outpatient palliative care in the oncology setting and current areas of innovation and promise in the field. Evidence, including from controlled trials, documents the benefits of outpatient palliative care in the oncology setting. As a result, professional medical organizations have guidelines and recommendations based on the key role of palliative care in oncology. Six elements of the practice sit at the frontier of outpatient oncology palliative care, including the setting and timing of palliative care integration into outpatient oncology, the relationships between primary and specialty palliative care, quality and measurement, research, electronic and technical innovations, and finances. Evidence of clinical and health care system benefits supports the recommendations of professional organizations to integrate palliative care into the routine treatment of patients with advanced cancer.

PC-FACS

A Framework for Integrating Oncology Palliative Care in Doctor of Nursing Practice (DNP) Education.

BackgroundMoving palliative care from a solely clinical focus to a more population based and community orientated approach is the hallmark of a much advocated public health approach to palliative care. Young adults are a vital cohort of the public, yet their understanding of palliative care has not been investigated. This study aimed to explore young adults’ understanding of palliative care and identify factors that influence their engagement.MethodsA purposive sample of young adults (n = 24) aged 18–29 years were recruited from one UK University. Semi-structured interviews were undertaken face to face or via telephone or Skype between November 2017 and February 2018. Thematic analysis using a framework approach and underpinned by a socioecological perspective was used to analyse the interviews.ResultsThree thematic categories were identified relating to intrapersonal and interpersonal influences, cultural and social influences and organisational and public policy influences. Palliative care was understood as supportive comfort care, delivered in the absence of cure, associated with the end of life and specifically focused on death and dying. Negative attitudes related to the context of care, which represented a static and hopeless situation. Whilst some reported positive attitudes, potential engagement was seen to be governed by a lack of knowledge and protective cultural norms. In terms of demonstrating readiness to engage with palliative care, participants requested clear information and suggested a normalising of palliative care through the education system.ConclusionYoung adults in this study were ready to find out more about palliative care and identified social media as a platform upon which to engage this population. However, their perception of a society that views palliative care as a subject for those directly affected, creates a barrier to engagement. This study identified the ingredients of a public health message and mediums for disseminating the message. However, findings also suggest that a cultural shift is required to recognise the potential of engaging young adults in health issues that cross the life span, empowering them not only as individuals but as vital members of community and society.

PURPOSEThe burden of cancer disproportionately affects low- and middle-income countries. Low 5-year survival figures for children with cancer in low-income countries are due to late presentation at diagnosis, treatment abandonment, absence of sophisticated multidisciplinary care, and lack of adequate resources. The reasons for late presentation are partly due to limited awareness of cancer symptoms, high treatment costs, and facility-level barriers to timely access to treatment. Given the systemic challenges, the regional need for palliative oncology care for children care is high. Despite the enormity of the need for palliative oncology for children with cancer in Africa, its level of development remains poor. This paper presents the evidence on the status of palliative oncology care for children in sub-Saharan Africa.METHODSThis review provides an overview of the current status of palliative oncology care for children in sub-Saharan Africa, using the WHO building blocks for health systems strengthening as reference points, before proposing a forward-looking prioritized agenda for its development.RESULTSWe noted that survival rates for children with cancer remain much poorer in Africa compared with developed countries and palliative oncology care resources are scant. Our results also show low coverage for palliative oncology care services for children, lack of a critical mass of health workers with the skills to deliver the care, a lack of robust documentation of the burden of cancer, widespread lack of access to essential controlled medicines, limited funding from government and limited coverage for palliative oncology care in most cancer control plans.CONCLUSIONThis review highlights priority areas for action that align to the WHO health system building blocks for strengthening health systems.

We present a novel Virtual Reality (VR) life review therapy system. Life review therapy is an intervention used by clinical psychologists, counselors, and social workers for patients under palliative care to systematically examine various life experiences to resolve conflicts and complete life tasks. The goal of the therapy is to narrativize the patient’s life before death in order to come to terms with their mortality. Our VR life review therapy system allows therapists to perform their interventions in customized virtual spaces designed to encourage the patient to reflect and reminisce about their life experiences. Our system is also developed in response to mobility restrictions and COVID-19 pandemic-related quarantine measures that have separated patients under palliative care from family and friends, resulting in emotional and psychological distress. As VR systems related to health are increasingly being used by therapists in their interventions, it is of utmost importance that the health professionals who will be the end users of these systems are involved in the design process to create ethical healthcare technologies. In response, we initiated the participatory design and evaluation of our VR life review therapy system prototype with six clinical psychologists who have practical experience delivering life review therapy to patients in palliative care in the Hong Kong hospital system. In the study, each participant experienced the VR life review therapy system and evaluated its strengths and weaknesses through semi-structured interviews. The qualitative data gathered from these interviews was coded according to nine different categories; avatars, content design, evaluation, haptic sensations, interaction, gesturing and gaze direction, movement and navigation, non-verbal communication, soundtrack. These conceptual categories were chosen based on our analysis of common themes reported by the clinical psychologists’ experience of the system. Feedback from clinical psychologists on each of these categories was incorporated into the redesign and update of the final system. Overall, participants generally evaluated the system as feasible and effective for use with patients under palliative care, while movement and interaction were the features requiring the most improvement.

In the palliative care setting, existential issues circulate—implicitly or explicitly, among patients, significant others and clinicians. Different disciplines, such as philosophy, anthropology or theology address existential issues of man. These...

C-L Psychiatrists Bring Expertise to End-of-Life Care

BackgroundIn 2018, Palliative Care Australia issued a report outlining nine standards which intended to guide and support the delivery of high-quality palliative care in Australia. Standard 8 encouraged services to...