An abstract of a study by Peachey et al reviewing the challenges and needs of homebound patients unable to reach appropriate palliative care resources is presented. They discuss the common needs home ...health practitioners have when dealing with serious illness and end-of-life situations. They also share the development of a "smart-device-driven" pilot program to connect homebound patients with palliative care resources.
Abstract Palliative care (PC) services are integral to the care of patients with advanced medical illnesses. Given the significant morbidity and mortality associated with cardiac arrest, we sought to ...measure the use and impact of PC in the care of patients treated with therapeutic hypothermia (TH). We conducted a retrospective study of 317 consecutive patients undergoing TH after cardiac arrest. We compared intensive care unit (ICU) characteristics and clinical outcomes of subjects who received PC consultation (n = 125) to those who did not (n = 192). The proportion of TH patients with PC consultations increased to greater than 60% by 2013, corresponding to our institution’s expansion of PC services, development of a dedicated PC unit, and integration of this service into our published TH protocol. In the TH population, time to return of spontaneous circulation (ROSC) was associated with higher inpatient mortality (p < 0.001) and placement of a PC consult (p = 0.011). TH patients who received PC consultation had longer ICU stays (p = 0.034), more ventilator days (p < 0.001), and higher inpatient mortality (p < 0.001). When these measures were analyzed cohort-wide comparing all TH patients pre- and post-2013, at which time the frequency of PC consultation had dramatically increased, there were no statistically significant differences in ICU care or outcomes. In our population of cardiac arrest patients undergoing TH, the utilization of PC services has increased over time, particularly for those patients with high morbidity and mortality. Future randomized studies may further delineate optimal patient selection for PC consultation to better facilitate goals of care discussions and timely medical decision-making.
The impact of specialist palliative care intervention in patients undergoing surgery for cancer has not been studied extensively. The SCOPE randomized controlled trial will investigate the effect of ...specialist palliative care intervention in cancer patients undergoing surgery for selected abdominal malignancies. The study protocol of the SCOPE Trial was published in December 2019.
The SCOPE Trial is a single-center, single-blind, prospective, randomized controlled trial that will investigate specialist palliative care intervention for cancer patients undergoing surgery for selected abdominal malignancies. The study plans to enroll 236 patients that will be randomized to specialist palliative care (intervention arm) and usual care (control arm) in a 1:1 ratio.
The primary outcome of the study is the Functional Assessment of Cancer Therapy-General (FACT-G) Trial Outcome Index (TOI) at 90 days postoperatively. Secondary outcomes of the study include the total FACT-G score at 90 days postoperatively, days alive at home without an emergency room visit within 90 days of operation, and all-cause mortality at 1 year after operation. Time frames for all outcomes will start on the day of surgery.
This manuscript serves as the formal statistical analysis plan (version 1.0) for the SCOPE randomized controlled trial. The statistical analysis plan was completed on 6 April 2021.
ClinicalTrials.gov NCT03436290 . Registered on 16 February 2018.
Senior adult oncology Hurria, Arti; Browner, Ilene S; Cohen, Harvey Jay ...
Journal of the National Comprehensive Cancer Network
10, Številka:
2
Journal Article
1. Utilizing audience participation technology, participants will be able to describe the steps to develop a collaborative educational program to teach cancer-specific primary palliative care that ...leverages didactics, case discussions and experiential learning.
2. Utilizing case-based discussions, participants will identify the strengths and limitations of different types of assessment tools to gauge learning.
Palliative care training is deficient for healthcare professionals, including advanced practice providers (APPs). With the objective to teach Hematology/Oncology APPs primary palliative care, we developed a scalable, comprehensive educational curriculum amidst the COVID-19 pandemic. This included virtual didactics, experiential components, and a clinical assessment with real-time feedback.
At a large academic institution in the Southeast United States with well-established palliative care and oncology programs, we identified a lack of intentional collaboration as well as knowledge and experiential gaps in Hematology/Oncology Advanced Practice Providers (APPs). Previously, palliative care education was led by APPs rather than specialty- trained palliative care providers and did not allow for experiential training or continued educational development. As a result, APPs expressed discomfort in subject areas such as advance care planning, cancer prognostication, hospice, and serious-illness communication.
Our objective was to develop an iterative educational program to provide palliative care education to APPs collaboratively with palliative care specialists and oncologists.
We identified leadership from both oncology and palliative care to develop a cancer-specific palliative care certificate program. Participation was voluntary and no APP exceeded their normal work hour expectation as all clinical experiential time was scheduled on protected non-clinical days. The program consisted of 6 didactic lectures on core palliative care principles with parallel case studies and 40 hours of experiential time on the inpatient Palliative Care service. To achieve certification, all participants were required to pass a clinical assessment using a validated tool (ACP-CAT) and medical knowledge exam. During year one, palliative care experts led didactic lectures; in subsequent years, lectures were led by past participants (i.e. Train-the-Trainer model). Participants were subsequently offered two days of additional experiential time after completion of the program to further develop skills.
Over three years we have had 15 participants, all of whom have successfully achieved certification. Participants reported increased confidence in practicing primary palliative care independently.
We have successfully developed a comprehensive educational oncology-specific palliative care program, now in its third year of implementation, that continues to enroll new APP participants and leverages APP graduates to lead discussions as subject-matter experts.
Interdisciplinary Teamwork / Professionalism / Workforce / Career Development
Getting to the Heart of the Matter--An Overview of Advances in Cardiac Palliative Care seminar is highlighted. In this session, multidisciplinary experts in palliative care and cardiology--including ...heart failure, cardiac devices, symptom management, care transitions, and caregiver support--will explore how they approach the evaluation and management of patients with advanced cardiac disease. Each presenter will touch on how they interact with advanced cardiac disease providers at their own institutions, and will give basic to intermediate-level information about how palliative care engages patients with cardiac conditions.
Outcomes
1. Describe how self-deception and dehumanizing can lead to discriminatory practices
2. Outline a framework that individual clinicians can follow to reduce their own personal bias
Objectives
...• Review the darker side of modern medical history and its role in contemporary physician behavior.
• Discuss the prevalence of implicit bias within the field of medicine.
• Review how American medical and scientific communities helped to give credence to pseudoscientific theories such as eugenics and the implications of these efforts in contributing to mass atrocities.
• Discuss ways in which implicit bias can be addressed and its impact reduced, particularly within the medical community.
Few physicians understand the ways in which bias and discrimination have interacted with research and evidence-based practice (EVP) in medicine; the darker side of medicine is rarely formally taught to medical students, much less medical trainees or attending physicians. Even fewer realize that the ideologic foundation for the Holocaust was based on an American pseudoscientific theory known as eugenics and was exported to Europe in the late 1920s through research efforts and collaborations between prominent and influential scientists, philanthropists, and physicians. This is especially relevant to palliative care (PC) teams, whose charge is to maximize quality of life for patients by reducing suffering. If PC specialists remain ignorant in how these discriminatory practices originated and in some places continue, we will be less likely to recognize our own biases. In this discussion, we will review aspects of medical history and how these events, shaped by physicians, enabled atrocities to occur and formulated the scientific basis for discriminatory practices within the field of medicine. We will also relate these events to current medical practice and discuss ways in which each of us can take action to prevent the medical profession at large from perpetuating dangerous biases and dogmas through an interactive and thought-provoking session.
PDF
