Journal of Pain and Symptom Management

Re: Update on Cancer Pain Guidelines

Mark Taubert, Claud Regnard, Ilora G. Finlay, Julie Barnsley — 2010-02-01

Caraceni et al. draw attention to a much needed discussion about the use of opioids in the management of cancer pain, and the work that is being currently undertaken to update the World Health Organization's (WHO) and European Association for Palliative Care's guidelines is timely. Morphine, for instance, one of the most traditional and commonly used opioids, has held a fundamental role in managing cancer pain, yet confusion around starting doses, titration, and maintenance in its use is still widespread. Morphine prescribing has been benchmarked for many years and guidelines produced, which formed the basis of other opioid prescribing advice. Despite this, prescribing errors and criminal overdoses have been responsible for deaths in the UK. This prompted us to review published guidance and identify discrepancies and variations in these texts.

Differences in Performance of Euthanasia and Continuous Deep Sedation by French- and Dutch-Speaking Physicians in Brussels, Belgium

Kenneth Chambaere, Johan Bilsen, Joachim Cohen, Evelien Raman, Luc Deliens — 2010-02-01

Belgium consists of two large, geographically divided language communities: the Dutch-speaking community living in the northern region of Flanders and the French-speaking community living in the southern region of Wallonia. Both language communities are represented in the metropolitan Brussels-Capital Region. Its population of more than one million is culturally diverse, with a large proportion of foreign (non-Western) origin.

Targeting Diuretic Use for Malignant Ascites—Two Case Reports Highlighting the Value of the Serum-Ascites Albumin Gradient in a Palliative Setting

Emma L. Husbands — 2010-02-01

Malignant ascites is a distressing, debilitating, and common complication occurring in up to half of all malignancies. Repeated paracentesis is widely recognized as the mainstay of treatment but benefits tend to be short-lived and the procedure can be associated with fatigue and hypotension. Studies have shown that patients with ascites formed because of liver metastases, termed central ascites, tend to respond to diuretics and that identification of such patients can allow targeted diuretic use. The serum-ascites albumin gradient (SAAG) is a simple test that can accurately distinguish the mechanism of formation of malignant ascites. Two cases are described where the SAAG was successfully used to guide the use of diuretics in the control of ascites.

A New Combination Cream for the Treatment of Severe Neuropathic Pain

David J. Kopsky, Jan M. Keppel Hesselink — 2010-02-01

Neuropathic pain may be quite resistant to drug treatment. In the case of intractable pain, rational polypharmacy is now well established. The treatment of patients suffering from neuropathic pain with rational polytherapy seems to have the highest likelihood of success. A variety of treatment modalities, such as percutaneous electrical nerve stimulation (PENS) or transcutaneous electrical nerve stimulation (TENS), can be administered together with drugs, potentially allowing use of lower and better-tolerated doses. The same outcome may be possible with the use of topical therapies. The following case did not respond well to our rational polytherapy until a novel combination topical cream, consisting of isosorbide dinitrate (ISDN) 0.4%, capsaicin 0.075%, and lidocaine 3%, was added.

Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain

2009-11-06

Abstract: This study compared the efficacy of a tetrahydrocannabinol:cannabidiol (THC:CBD) extract, a nonopioid analgesic endocannabinoid system modulator, and a THC extract, with placebo, in relieving pain in patients with advanced cancer. In total, 177 patients with cancer pain, who experienced inadequate analgesia despite chronic opioid dosing, entered a two-week, multicenter, double-blind, randomized, placebo-controlled, parallel-group trial. Patients were randomized to THC:CBD extract (n = 60), THC extract (n = 58), or placebo (n = 59). The primary analysis of change from baseline in mean pain Numerical Rating Scale (NRS) score was statistically significantly in favor of THC:CBD compared with placebo (improvement of −1.37 vs. −0.69), whereas the THC group showed a nonsignificant change (−1.01 vs. −0.69). Twice as many patients taking THC:CBD showed a reduction of more than 30% from baseline pain NRS score when compared with placebo (23 [43%] vs. 12 [21%]). The associated odds ratio was statistically significant, whereas the number of THC group responders was similar to placebo (12 [23%] vs. 12 [21%]) and did not reach statistical significance. There was no change from baseline in median dose of opioid background medication or mean number of doses of breakthrough medication across treatment groups. No significant group differences were found in the NRS sleep quality or nausea scores or the pain control assessment. However, the results from the European Organisation for Research and Treatment of Cancer Quality of Life Cancer Questionnaire showed a worsening in nausea and vomiting with THC:CBD compared with placebo (P = 0.02), whereas THC had no difference (P = 1.0). Most drug-related adverse events were mild/moderate in severity. This study shows that THC:CBD extract is efficacious for relief of pain in patients with advanced cancer pain not fully relieved by strong opioids.

High Outpatient Pain Intensity Scores Predict Impending Hospital Admissions in Patients with Cancer

Nina D. Wagner-Johnston, Kathryn A. Carson, Stuart A. Grossman — 2009-12-21

Abstract: Context: Pain intensity scores (PIS) are frequently collected in the outpatient setting. The implications for patients with high PIS have not been well-studied.Objectives: This retrospective review was designed to determine whether high outpatient encounter PIS identify patients at risk of hospital admission.Methods: Numerical PIS (0–10) were collected from all outpatient medical and radiation oncology encounters at the Johns Hopkins Comprehensive Cancer Center from 2004 to 2006. These were merged with an inpatient database to identify admissions occurring within 30 days of the outpatient encounter. PIS were categorized as 0–3 (mild), 4–6 (moderate), and 7–10 (severe). Odds ratios for hospital admission were calculated using generalized estimating equations.Results: Of 119,069 encounters, 116,713 (98%) were evaluable, and 5,089 encounters (4.5%) had PIS of 7–10. Twenty-nine percent of these high PIS encounters had hospital admissions within 30 days. Encounters with PIS of 7–10 and 4–6 were 96% and 43%, respectively, more likely to result in hospital admission within 30 days compared with encounters with PIS<4 (P<0.001). Hospital admission rates after encounters with PIS of 7–10 were highest in patients with melanoma (58%), sarcoma (42%), female genital cancer (39%), and upper aerodigestive (36%) cancer.Conclusion: Outpatients with cancer and high PIS are at increased risk of hospital admission within 30 days. This high-risk group should be targeted for early supportive care interventions aimed at reducing hospitalizations and improving quality of life.

Neuroleptic Dose in the Management of Delirium in Patients with Advanced Cancer

2010-02-01

Abstract: Neuroleptics are commonly used in the management of delirium. Limited information is available regarding the dosage requirements and efficacy of neuroleptics in the palliative care setting. We determined the type and dose of neuroleptic use by delirium subtype. The medical records of 99 inpatients with advanced cancer were reviewed retrospectively. The doses of different neuroleptics, expressed as haloperidol equivalent daily doses (HEDDs), were correlated with delirium recall, recalled delirium symptom frequency, and associated distress from the patients', family caregivers', nurses' and palliative care specialists' perspectives. Subtypes of delirium included hypoactive in 20 (20%), mixed in 66 (67%), and hyperactive in 13 (13%). The median HEDD was 2.5mg, interquartile range (Q1–Q3) 1–4.7mg (mean 4.0±5.9mg), and it was significantly higher in agitated and mixed delirium as compared with hypoactive delirium (P=0.008). The neuroleptic dose was low and appeared to be ineffective in preventing patient delirium recall, with 73 (74%) patients remembering their episode of delirium as distressing. HEDD did not correlate with delirium recall, recalled symptom frequency, or distress for patients and family caregivers. However, HEDD increased with nurses' distress related to patients' symptoms (disorientation to place P=0.002, disorientation to time P=0.008, delusions P=0.041, and agitation P<0.001), and palliative care specialists' distress related to patients' hallucinatory symptoms (P=0.006) and agitation (P=0.006). In this study, the administered neuroleptic dose was influenced more by health care professional distress than by delirium symptom frequency. Future studies should examine the efficacy of neuroleptic dose according to individual delirium symptoms.

Fatigue in Gynecological Cancer Patients During and After Anticancer Treatment

Gillian Prue, James Allen, Jacqueline Gracey, Jane Rankin, Fiona Cramp — 2009-12-08

Abstract: Context: Research has indicated that individuals with gynecological cancer experience severe fatigue.Objectives: This longitudinal survey aimed to analyze the fatigue experienced over the course of one year by a gynecological cancer population, to determine if the fatigue was more severe than that reported by females without cancer, and to identify variables associated with cancer-related fatigue (CRF).Methods: Data were collected over a 12-month period before, during, and after anticancer treatment. Fatigue was assessed using the Multidimensional Fatigue Symptom Inventory-Short Form. Participants with cancer also completed the Rotterdam Symptom Checklist.Results: Sixty-five cancer patients (mean age = 57.4 years, standard deviation [SD] = 13.9) and 60 control subjects (mean age = 55.4 years, SD = 13.6) participated. Descriptive analysis and repeated measurements modeling indicated that the cancer participants reported worse fatigue than the noncancer individuals before, during, and after anticancer treatment (P < 0.001) and that the level of fatigue in persons with cancer changed with time (P = 0.02). A forward stepwise regression demonstrated that psychological distress level was the only independent predictor of CRF during anticancer treatment (P < 0.00), explaining 44% of the variance in fatigue. After treatment, both psychological distress level (P < 0.00) and physical symptom distress (P = 0.03) were independent predictors of fatigue, accounting for 81% of the variance.Conclusion: Psychological distress level is an important indicator of CRF in gynecological cancer. Interventions focused on the reduction of psychological distress may help alleviate CRF.

Undertreatment of Symptoms in Patients on Maintenance Hemodialysis

René N. Claxton, Leslie Blackhall, Steven D. Weisbord, Jean L. Holley — 2009-12-07

Abstract: Context: Hemodialysis patients suffer a large symptom burden, and little is known about how effectively symptoms are treated.Objectives: To assess the management of treatable symptoms in hemodialysis patients, we administered a 30-item questionnaire on physical and emotional symptoms to patients receiving outpatient hemodialysis at the University of Virginia.Methods: We asked patients whether they were prescribed therapy for potentially treatable symptoms and assessed who prescribed the therapy. By means of chart review, we also documented whether medications were prescribed for these symptoms.Results: We approached 87 patients and enrolled 62 (71%). The most commonly reported, potentially treatable symptoms included bone/joint pain, insomnia, mood disturbance, sexual dysfunction, paresthesia, and nausea. Only 45% of patients with bone/joint pain reported receiving an analgesic medication. Twenty-three percent of patients with trouble falling asleep and 53% of patients with nausea reported receiving a medication to alleviate this symptom. Chart review revealed that 58% of patients who reported the presence of bone/joint pain were prescribed an analgesic, 23% of patients with trouble falling asleep were prescribed a sleep aid, and 42% of patients with nausea received an antiemetic. Primary care providers were more likely than nephrologists to provide for all symptoms except nausea and numbness or tingling in the feet, and this difference was significant for the treatment of worrying (3/3 vs. 0/3, P=0.05) and nervousness (4/5 vs. 0/5, P=0.02).Conclusion: Potentially treatable symptoms in hemodialysis are undertreated. Pharmacologic therapy, particularly for emotional symptoms, was more commonly prescribed by primary care providers than nephrologists. Additional study of the barriers to symptom treatment and interventions that increase nephrologist and primary care provider symptom management are needed.

Implementation of Computer-Based Quality-of-Life Monitoring in Brain Tumor Outpatients in Routine Clinical Practice

2010-02-01

Abstract: Context: Computerized assessment of quality of life (QOL) in patients with brain tumors can be an essential part of quality assurance with regard to evidence-based medicine in neuro-oncology.Objectives: The aim of this project was the implementation of a computer-based QOL monitoring tool in a neurooncology outpatient unit. A further aim was to derive reference values for QOL scores from the collected data to improve interpretability.Methods: Since August 2005, patients with brain tumors treated at the neuro-oncology outpatient unit of the Innsbruck Medical University were consecutively included in the study. QOL assessment (European Organisation for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire [QLQ-C30] plus the EORTC QLQ-brain cancer module [BN20]) was computer-based, using a software tool called the Computer-based Health Evaluation System.Results: A total of 110 patients with primary brain tumors (49% female; mean [standard deviation] age 47.9 [12.6] years; main diagnoses: 30.9% astrocytoma, 17.3% oligodendroglioma, 17.3% glioblastoma, 13.6% meningioma) was included in the study. On average, QOL was assessed 4.74 times per patient, 521 times in total. The user-friendly software was successfully implemented and tested. The routine QOL assessment was found to be feasible and was well accepted by both physicians and patients.Conclusion: The software-generated graphic QOL profiles were found to be an important tool for screening patients for clinically relevant problems. Thus, computer-based QOL monitoring can contribute to an optimization of treatment (e.g., symptom management, psychosocial interventions) and facilitate data collection for research purposes.

Patterns of Pain and Interference in Patients with Painful Bone Metastases: A Brief Pain Inventory Validation Study

Jackson S.Y. Wu, Dorcas Beaton, Peter M. Smith, Neil A. Hagen — 2010-02-01

Abstract: Bone metastases are prevalent, painful, and carry a poorer prognosis for pain control compared with other cancer pain syndromes. Standard tools to measure pain have not been validated in this patient population, and particular subgroups with more challenging symptoms have yet to be identified and studied. The objectives of this study were 1) to validate the psychometric properties of the Brief Pain Inventory (BPI) and its Pain and Interference subscales in patients with clinically significant metastatic bone pain requiring palliative radiotherapy and 2) to examine differences in BPI subscales among predefined subgroups of bone metastases patients. A total of 258 patients evaluated and treated through a rapid access radiation therapy clinic between July 2002, and November 2006, were included in the analysis. High internal consistency of the BPI subscales of Pain, Activity interference, and Affect interference was demonstrated by Cronbach's alpha between 0.81 and 0.89. Removing sleep interference improved model fit in confirmatory factor analysis. The BPI revealed an alarming pattern in patients with lower body metastases, who reported substantial interference of activity even though pain levels were mild or moderate. Such patients may require prompt clinical attention to better meet their needs. Finally, the allocation of interference from sleep within the BPI framework, in our population of pain patients, requires further study.

A Single Set of Numerical Cutpoints to Define Moderate and Severe Symptoms for the Edmonton Symptom Assessment System

2009-12-07

Abstract: Symptom intensity in cancer and palliative care patients is frequently assessed using a 0–10 ranking score. Results are then often grouped into verbal categories (mild, moderate, or severe) to guide therapy. Numerical cutpoints separating these categories are often variable, with previous work suggesting different cutpoints across different symptoms, which is unwieldy for clinical use. The Edmonton Symptom Assessment Symptom (ESAS) assesses nine common symptoms using this 0–10 scale. The primary aim of this study was to examine the relationship between the numerical and verbal scores using the ESAS and to identify a single cutpoint to separate severe from nonsevere symptomatology. A second goal was to similarly identify a cutpoint to separate moderate or severe from none or mild symptom intensity. Consenting patients (n=400) completed both a standard ESAS and an identical form that replaced 0–10 with none, mild, moderate, and severe. Receiver operating characteristic curves were generated to identify the best fit between sensitivity and specificity. For the “severe” ranking, six symptoms had a best fit of 7, with sensitivity for the remaining three symptoms still greater than 80%. For the combined grouping of moderate or severe, results were less uniform. A cutpoint of either 4 or 5 would be supported by our data, with a greater sensitivity using 4 and improved specificity using 5 as the cutpoint. Across all ESAS symptoms, then, 7 or higher represents a severe symptom by patient definition, whereas a cutpoint of either 4 or 5 could reasonably define combined moderate and severe symptoms.

Evaluating Correlation and Interrater Reliability for Four Performance Scales in the Palliative Care Setting

2010-02-01

Abstract: Performance scales are used by clinicians to objectively represent a patient's level of function and have been shown to be important predictors of response to therapy and survival. Four different scales are commonly used in the palliative care setting, two of which were specifically developed to more accurately represent this population. It remains unclear which scale is best suited for this setting. The objectives of this study were to determine the correlations among the four scales and concurrently compare interrater reliability for each. Patients were each assessed at the same point in time by three different health care professionals, and all four scales were used to rate each patient. Spearman correlation coefficient values and both weighted and unweighted kappa values were calculated to determine correlation and interrater reliability. The results confirmed highly significant linear correlation among and between all four scales. Whether using a reliability measure that incorporates the concept of “partial credit” for “near misses” or a measure reflecting exact rater agreement, no one scale emerged as having a significantly higher likelihood of agreement among raters. We propose that what may be more important than clinical experience or rater profession is the level of training an individual health care professional rater receives on the administration of any particular performance scale. In addition, given that low levels of exact rater agreement could have substantial clinical implications for patients, we suggest that this parameter be considered in the design of future comparative studies.

Retrospective Assessment of Cancer Pain Management in an Outpatient Palliative Radiotherapy Clinic Using the Pain Management Index

2010-02-01

Abstract: Context: The Pain Management Index (PMI) is a simple index linking the usual severity of cancer pain with the category of medication prescribed to treat it. Medication categories are derived from the World Health Organization's “analgesic ladder” approach to cancer pain, and the PMI is an indicator of the extent to which the medication prescribed corresponds to the recommended categories for mild, moderate, and severe pain.Objectives: The aim of this study was to assess prevalence of inadequate pain management in an outpatient palliative radiotherapy clinic using the PMI.Methods: All patients with bone metastases referred for palliative radiotherapy from 1999 to 2006 were retrospectively analyzed for patient-rated pain scores (0–10 scale) and analgesic consumption. Pain scores were assigned 0, 1, 2, and 3 when patients reported no pain (0), mild (1–4), moderate (5–6), or severe pain (7–10), respectively. Analgesic scores of 0, 1, 2, and 3 were assigned when patients were prescribed no pain medication, nonopioids, “weak” opioids, and “strong” opioids, respectively. The PMI score was calculated by subtracting the pain score from the analgesic score. A negative PMI score was considered an indicator of potentially inadequate pain management by the prescriber. Descriptive statistics, Pearson's r correlation, and univariate and multivariate logistic regression analysis were used to determine the relationship of PMI over time, and the relationship with predictive factors.Results: One thousand patients were included from January 1999 to December 2006. A negative PMI was calculated for 25.8% of patients at initial consultation. Prevalence of negative PMI significantly increased over years (P<0.0001). Higher Karnofsky Performance Status (P<0.0001) and breast primary cancer site (P<0.0001) were significantly associated with negative PMI after adjusting for year variable.Conclusion: Despite publication of numerous cancer pain management guidelines, undermedication appears to be a persistent problem for patients with painful bone metastases referred for radiotherapy.

Can Cancer Patients Influence the Pain Agenda in Oncology Outpatient Consultations?

Margaret S. Rogers, Chris Todd — 2009-12-07

Abstract: Pain in cancer patients is common, yet it is often inadequately managed. Although poor assessment has been implicated, how patients contribute to this process has not been explicated. This study aims to uncover patients' contributions to discussions about pain during oncology outpatient consultations. Seventy-four medical encounters were observed and audiotaped. Verbatim transcriptions of pain talk were examined using conversational analysis. Thirty-nine of 74 patients talked about pain with 15 different doctors during consultations for follow-up or active treatment. Patients' talk about pain varied consistently according to how pain talk was initiated. In 20 consultations where pain was put on the agenda by patients, they used communication tactics that emphasized their pain experiences, seemingly to attract and maintain their doctors' attention. These tactics appear necessary, as the cancer treatment agenda restricts opportunities for patients to have supportive care needs addressed. On the other hand, in 19 consultations where doctors elicited information about pain, patients used communication tactics that minimized their pain experiences, seemingly to conceal potential disease progression or recurrence, the very focus of these specialist consultations. Where cancer was implicated as the source of pain, chemotherapy or radiotherapy was offered, and where cancer was suspected, referrals for investigations were made. Two of the 20 patients appeared to influence the treatment-focused agenda and were given referrals to pain clinic rather than further cancer therapy as initially recommended.

The Association Between Autonomic Dysfunction and Survival in Male Patients with Advanced Cancer: A Preliminary Report

2010-02-01

Abstract: Context: Autonomic nervous system dysfunction (AD) is a common syndrome in patients with advanced cancer. It is associated with decreased survival in several patient populations, including diabetes mellitus, heart failure, and neurological diseases. Based on this evidence, we hypothesized that autonomic dysfunction is associated with decreased survival in patients with advanced cancer.Objectives: The objective of this preliminary study was to test the association between AD, as measured by the standardized Ewing test and heart rate variability (HRV) measures, and survival in this patient population.Methods: We examined the relationship between survival and parameters of AD in subjects who participated in a prospective study of autonomic dysfunction and hypogonadism in male patients with advanced cancer. Eligibility criteria were defined based on the prospective study protocol. We collected demographic information, date of death (obtained from the online Social Security Death Index database), date of study entry, and Ewing and HRV scores. We defined survival as the interval between study entry and date of death. A survival analysis was used to test the association between survival (in days) and Ewing test (0–5) and measures of HRV, including time domain (standard deviation of normal to normal beat interval [SDNN]) and frequency domain (ultra low, very low, low, and high). Four patients were still alive at the time of this study and included in the survival analysis as being censored.Results: Forty-seven male patients were included in this study. Median age was 59 years (range: 20–79), and 30 out of 47 (63%) were Caucasians. AD, defined as Ewing score greater than 2, was present in 38 out of 47 (80%) of the patients. Median Ewing score was 3 (1–5), indicating moderate to severe AD. Spearman correlation for Ewing score and SDNN was 0.44 (P = 0.002). There was a significant association between abnormal Ewing score and survival (P < 0.0001) and abnormal SDNN HRV and survival (P = 0.056).Conclusion: AD is associated with shorter survival in male patients with advanced cancer. Further longitudinal research in a large cohort is justified based on.

Palliating a Pandemic: “All Patients Must Be Cared For”

2010-02-01

Abstract: In the event of an overwhelming influenza pandemic, many health care systems will implement a triage system that would potentially deny critical care treatment to some seriously ill patients. Although all triage systems have guaranteed palliative care for those who are denied critical care, no jurisdiction has yet developed a plan to accommodate the anticipated “surge” in demand for palliative care. The authors present a mathematical and ethical justification for a palliative care surge plan and outline some of the key elements that should be included in such a plan.

A Systematic Review of Oxymorphone in the Management of Chronic Pain

Fadia Mayyas, Peter Fayers, Stein Kaasa, Ola Dale — 2010-02-01

Abstract: Opioids are recommended for control of moderate-to-severe, chronic, malignant, and nonmalignant pain. A controlled-release formulation of the opioid oxymorphone has recently been launched. The aim of this review was to assess the effectiveness of oxymorphone as an analgesic in chronic pain. A systematic search for published studies of oral oxymorphone in the management of chronic pain was conducted. The studies were evaluated for their internal validity according to standard criteria. They were also evaluated for their external validity and research ethic aspects. A meta-analysis was performed to examine the effect of oxymorphone compared with placebo. Nine studies were evaluated; three were excluded because of low quality. Six controlled studies (duration 2–12 weeks) included a total of 1489 subjects suffering from chronic low back pain, chronic pain from osteoarthritis, and chronic cancer pain. Three of the studies were of high quality and three of medium quality. External validity was assessed to be high, medium, and low (in one, three, and two studies, respectively). The meta-analysis suggests that daily doses of 40–100mg are superior to placebo; however, the estimate (reduction of pain intensity compared with placebo) of the treatment effect is imprecise (95% confidence interval −17.08, −8.69). Limited evidence suggests that oxymorphone is effective for pain control in patients with cancer. No significant differences between oxymorphone and oxycodone at equipotent doses were found. In conclusion, oxymorphone is superior to placebo. There is no evidence that the efficacy of oxymorphone differs from other opioids.

Opioids, Iatrogenic Harm and Disclosure of Medical Error

Craig D. Blinderman — 2010-02-01

Abstract: The safety of patients in U.S. hospitals is a serious problem, with adverse events because of medical error affecting a significant proportion of hospitalized patients. Patients at the end of life are particularly vulnerable and are at risk of potential adverse events. This article presents a case in which opioids were rapidly titrated to neurotoxic doses in a patient who was terminally extubated. The patient was profoundly sedated and was noted to have Cheyne-Stokes breathing. The possibility of opioid-related iatrogenic harm is raised, and a discussion of what counts as medical error in these circumstances is explored. Palliative care specialists have a unique responsibility to provide guidance and establish a standard of care that clinicians should adhere to. Prevention of harm in dying patients should be a priority in the hospital setting.

Hospice Medical Director Course—Module A: Clinical Skills (P1)

John H. Fullerton, Patricia A. Schmidt, Lyra Sihra — 2010-02-01

Identify the skills required in the role of the hospice medical director.

Social Work Leadership in Palliative Care: Developing Family and Caregiver Support Intervention Models (P14)

Grace Christ, Gary L. Stein, Susan Blacker, Karen Kayser — 2010-02-01

Promote an ability to understand and articulate more clearly across disciplines the diverse roles and skill sets of palliative care social workers in work with patients (eg, reducing isolation), families (eg, strengthening caregivers), and professional teams (eg, promoting effective communication, self care, and resilience).

Generalist Clinical Review: Approved Educators Workshop (P15)

Nancy L. Grandovic — 2010-02-01

Discuss the incorporation of adult learning principles into the preparation of training materials.

Getting Published in the Journal of Palliative Medicine and the Journal of Pain and Symptom Management (P2)

David Casarett, Joan Teno, Charles von Gunten, Russell Portenoy — 2010-02-01

Describe some of the key similarities and differences in the vision and scope of the Journal of Palliative Medicine and the Journal of Pain and Symptom Management.

Communication, Interdisciplinary Care, and Multicultural Education: The Core of Palliative Care Teaching (P3)

Sandra Sanchez-Reilly, Elaine Wittenberg-Lyles, Jeanette Ross, Grace Varas — 2010-02-01

Describe a longitudinal educational intervention in hospice and palliative medicine for medical and nursing students from several institutions.

Building Effective Hospice and Palliative Care Teams (P4)

Toby Cambell, Kristin Behfar, James Cleary, Josh Hauser, Michael Preodor — 2010-02-01

Discuss several key principles of team theory as it applies to medical teams.

Research in Children with Advanced Illnesses: Advancing the Field Together (P5)

Christina Ullrich, Veronica Dussel, Chris Feudtner, Pamela Hinds, Joanne Wolfe — 2010-02-01

Discuss challenges in pediatric palliative care research and strategies for overcoming such challenges.

Improving Spiritual Care as a Domain of Palliative Care (P6)

Christina Puchalski, Betty Ferrell, George Handzo, Shirley Otis-Green — 2010-02-01

Review the National Consensus Project Guidelines and Recommendations for Spiritual Care.

Practical Approaches to Palliative Wound Care (P7)

Aletha Tippett, Frank D. Ferris, Rosene D. Pirrello — 2010-02-01

Discuss the pathophysiology associated with wounds for various etiologies, such as pressure or malignant.

“Yes of Course You can Care for Kids!—Just Need a Little Retooling!” (P16)

Jody Chrastek, Janet Duncan, Donna Eull — 2010-02-01

Discuss the similarities and differences between pediatric and adult palliative care including hospice.

Pharmacopalliation of Pain in Advanced Illness (P17)

Mary Lynn McPherson, Micheal J. LaPenta — 2010-02-01

Discuss a given complaint of pain, perform a subjective assessment, appropriate physical examination, and determine the most likely pathogenesis of the complaint.

Through the Looking Glass: Making Sense of APN Billing (P18)

Constance Dahlin — 2010-02-01

Discuss current updates in APN billing and reimbursement.

The Science and Practice of Contemplative Interventions for Palliative Care Clinicians (P8)

Anthony Back, Susan Bauer-Wu, Joan Halifax, Cynda Rushton — 2010-02-01

Discuss neuroscience research on attention, empathy, and compassion.

Hospice and Palliative Care Billing and Coding Workshop (P9)

Janet Bull, Martha Twaddle, Christopher Acevedo — 2010-02-01

Discuss the new regulatory landscape as it relates to billing and coding issues.

Understanding Normative Coping and Setting the Stage for Psychological Growth at the End-of-life (P10)

Vicki Jackson, Juliet Jacobsen, Jane DeLima-Thomas, Margaret Seaver, Susan Block — 2010-02-01

Discuss normative coping in patients with life-threatening illness, including typical vacillations between hopefulness and realism, as well as the trajectory of the cognitive and emotional integration of illness understanding and prognostic awareness.

The Butcher, Baker, and Candlestick Maker Return: Interdisciplinary Goal-Based Approaches to Delirium Recognition, Work-Up, and Management (P11)

Scott Irwin, Rosene Pirrello, Jeremy Hirst, Gary Buckholz, Frank Ferris — 2010-02-01

Recognize that delirium is under-recognized; understand that it is distressing for the patient, family, and palliative care team; and know how to assess for and diagnose delirium.

Challenging Medication Management Issues at End-of-life (P12)

Mellar P. Davis, Mary Lynn McPherson, Ruth Lagman, Susan B. LeGrand — 2010-02-01

Discuss opioid dosing strategies to safely and effective relieve pain in patients with uncontrolled pain, in both opioid-naïve and opioid-tolerant patients, both when adverse effects are present and not.

Advanced Management of Distressing Non-Pain Symptoms in Pediatric Palliative Care (P13)

2010-02-01

Identify common distressing symptoms experienced by children with life-limiting conditions.

The Natural History and Illness Trajectories of Chronic Heart and Lung Diseases (P19)

Margaret L. Campbell — 2010-02-01

Describe disease trajectories for common, chronic, progressive heart and lung diseases including diagnosis, pathophysiology, natural history, and prognosis.

Initiating and Maintaining a Palliative Care Service for APNs (P20)

Patrick J. Coyne, Constance Dahlin, Kerstin McSteen — 2010-02-01

Discuss the role of a business plan in initiating a palliative care service.

Hospice and Palliative Care in a Changing World: Demands for a Renewed Vision in Long-Term Care (P21)

Beth Werner, Richard Heinrich, James Haefemeyer — 2010-02-01

Describe the evolution of the collaborative relationship between hospice and long-term care including our cultural similarities and differences.

Comfort Zone Camp

Lynne Hughes — 2010-02-01

Discuss national awareness to the unmet need of grieving children.

Compassionate and Mindful End-of-Life Care: A Relational-Contemplative Approach for Clinicians

Roshi Joan Halifax — 2010-02-01

Define challenges in end-of-life care.

End-of-Life Experience of Children Undergoing Hematopoietic Stem-Cell Transplantation: Parent and Provider Perspectives and Patterns of Care

2010-02-01

Describe differences in patterns of care and symptoms and suffering experienced between children for whom stem-cell transplantation (SCT) was the last cancer therapy and those for whom it was not.

Opioid Tapering in Children: A Critical Review of the Literature

Deborah Fisher — 2010-02-01

Name two validated pediatric opioid withdrawal assessment tools.

Quality of End-of-Life Care in the Hospital

Anne Walling, Steven Asch, Karl Lorenz, Carol Roth, Tod Barry, Neil Wenger — 2010-02-01

Discuss the Assessing Care of Vulnerable Elders (ACOVE) quality indicators that apply to end-of-life care.

Emergency Medicine Resident Education in Palliative Care: A Needs Assessment

2010-02-01

Understand the educational needs of emergency medicine (EM) residents in palliative care (PC).

Impact of the Education in Palliative and End-of-Life Care Project on Emergency Medicine Education and Practice

Tammie Quest, Linda Emanuel, Michael Gisondi, Kirsten Engel, Kevin Osgood — 2010-02-01

Identify areas of knowledge and skills desired by emergency medicine educators attending a train the trainer palliative care knowledge and skills conference.

Palliative Care Education during Medical School: A National Survey of Medical School Deans and Graduating Students

Natalie Jacobowski, John Mulder — 2010-02-01

Describe differences between deans' perspectives of the palliative care education that students receive versus students' reports of what they actually have experienced.

Worry as a Significant Predictor of Insomnia among Palliative Care Patients with Advanced Cancer

2010-02-01

Recognize the multidimensional nature of insomnia among palliative care patients, especially for patients at the end-of-life.

Phase Angle is a Better Predictor of Survival than Muscle Mass in Advanced Cancer

2010-02-01

Discuss bioelectrical impedance parameters, resistance, capacitance, and phase angle.

Predictors of Improvement of Symptom Distress in Patients with Advanced Cancer

Sriram Yennu, Diana Urbauer, Eduardo Bruera — 2010-02-01

Discuss the frequency of physical and psychological symptoms in patients with advanced cancer.

Evaluation of Housestaff Knowledge and Perception of Competence in Palliative Medicine

Paula Lester — 2010-02-01

Demonstrate the need for palliative education and training for housestaff in internal medicine (IM) residency and fellowship in hematology/oncology, pulmonary/critical care, and geriatrics through review of the results of recent study to assess the effectiveness of current teaching methods for residents and fellows at four university-affiliated training sites.

Reality Bytes: Teaching Evidence-Based Medicine on a Palliative Medicine Service

Nadia Marsh, Elizabeth Cobbs — 2010-02-01

Use the Patient Intervention Comparison Outcomes (PICO) method to identify answerable clinical questions.

An Innovative Quality Improvement Initiative to Increase Palliative Care Consultation

Rachelle Bernacki, Danielle Ko — 2010-02-01

Describe an innovative quality improvement/pay for performance initiative to increase palliative care consults for defined hospitalized patient populations.

Intermittent Intravenous Lidocaine for the Treatment of Wound Pain

John Mulder, Michael Borgeld, Greg Mervenne — 2010-02-01

Review the literature and support for intravenous lidocaine for neuropathic pain.

Is it Pseudoaddiction? Prescription Sharing, Alcohol, and Street Drug Use to Manage Pain among Veterans

2010-02-01

Identify types of substance misuse reported by veterans to manage pain.

Avoiding Naloxone Use in End-of-Life Care: Challenges and Solutions

Deborah Thorpe — 2010-02-01

Identify the problems inherent in clinical settings with the indiscriminate use of naloxone in opioid-tolerant patients.

ICU by Default: Consequences and Solutions to Deferred Palliative Care

Clareen Wiencek, Beth McLaughlin, Jan Mecklenburg — 2010-02-01

Describe barriers to palliative care consults in the acute-care setting through case report.

Impact of Proactive Palliative Medicine in the Intensive Care Unit at a Community Teaching Hospital

2010-02-01

Describe the screening process for proactive palliative medicine consultation.

Impact of a Communication Intervention Around Goals of Care on Racial Disparities in End-of-Life Care in the Intensive Care Unit

Anne Mosenthal, Patricia Murphy, Sangeeta Lamba, Scott Compton, Jessica Zitter — 2010-02-01

Discuss racial differences in preferences and outcomes in end-of-life care in the ICU.

Addressing Advance Directives with a Critically Ill Homeless Patient: How is it Different?

Winnie Suen — 2010-02-01

(Suen has disclosed no relevant financial relationships.)

How do Hospice Staff Prepare Family Caregivers for Death?

Karen Kehl — 2010-02-01

List at least three elements that are usually included in preparatory information given by hospice staff.

The Experiences of Family Caregivers of Assisted Living Residents Enrolled in Hospice

Miriam Volpin — 2010-02-01

Describe the various roles family members fill in caring for an assisted living residing relative at end-of-life.

Fatal Liver Failure due to Gemcitabine in a Patient with Metastatic Breast Cancer Receiving Palliative Care

Masanori Mori, Allan Ramsay — 2010-02-01

Recognize potential fatal liver toxicity of gemcitabine in cancer patients receiving palliative care.

Prognostic Significance of the Surprise Question in Cancer Patients

Alvin Moss, June Lunney, Stacey Culp, James Abraham — 2010-02-01

Discuss the use of the surprise question.

A Multidisciplinary Approach for Bone Metastases

Masanori Mori, Christina Brus, Avnish Bhatia, Taiga Nishihori, Ronald Blum — 2010-02-01

Describe the multidisciplinary approach for cancer patients with newly diagnosed bone metastases.

My IV Drip or Me? Death from Heart Failure in an Inpatient Hospice Facility

Gwen Dodson, Toni Cutson, Jennifer Gentry — 2010-02-01

Describe important issues in caring for end-stage heart failure patients.

Noncancer Pain and Cognitive Impairment: A Disabling Relationship?

Joseph Shega, Judith Paice, Kenneth Rockwood, William Dale — 2010-02-01

Identify the contribution of noncancer pain and cognitive impairment with functional disability among community-dwelling older adults.

How Long Can an Endotracheal Tube be Left in Place at the End-of-life?

Robin Williams, Stephen Liben, Claudette Bardin, Samara Zavalkoff — 2010-02-01

Outline the viability of leaving an endotracheal tube in place for months in a pediatric palliative care patient.

Computer-Based Patient Reported Outcomes in Outpatient Palliative Care: Feasibility

Elizabeth Kvale — 2010-02-01

Discuss patient reported outcomes as measures of quality in outpatient palliative care.

Benchmarking Outpatient Palliative Care Practices

Alexander Smith, Janet Braun, David Weissman, Michael Rabow — 2010-02-01

Recognize the need for research about the structure and processes of outpatient palliative care practices.

Uncertainty of Advance Care Planning Treatment Preferences among Diverse Older Adults

Rebecca Sudore, Dean Schillinger, Terri Fried — 2010-02-01

Recognize that many patients may not be able to make definitive treatment decisions in advance.

Child Death, Poverty, and Pediatric Palliative Care (310)

Rick Goldstein — 2010-02-01

(Goldstein has disclosed no relevant financial relationships.)

Providing Cross-Cultural Palliative Care to a Diverse Community (311)

Alan Roth, Gina Basello — 2010-02-01

Discuss how culture impacts communication, care, and decisions surrounding chronic illness and death for patients, families, and providers.

Interventional Pain Management Techniques for Palliative Care in Cancer Patients (312)

Benjamin Lee — 2010-02-01

Discuss the incidence of refractory pain for cancer patients with advanced disease and identify potential candidates for interventional pain management techniques.

Balancing Consult Team Staffing Levels and Service Commitments (313)

David Weissman, Lynn Spragens — 2010-02-01

Recognize the impact of palliative care staffing on team health and function.

Is it Futile to Discuss Futility: A Review of the Medical Literature and Legal Precedent (314)?

Nadia Tremonti, Lynne Prybys — 2010-02-01

Define futility in lay, medical, and legal terms.

Pandemic Palliative Care: Time to Plan (315)

Phillip Rodgers, C. Porter Storey — 2010-02-01

Discuss the impact of a pandemic on communities, populations, and healthcare resources, as well as the nature and scale of an effective systemic response.

Update on National Palliative Care News: How the Big Picture Affects You (316)

Diane Meier — 2010-02-01

Identify national issues that affect their practice and the field of palliative care.

The Healing Story: Therapeutic Applications of Narrative Medicine in Primary Palliative Care (317)

Charles Sasser, Sara Sanders, Elizabeth Mazurkiewicz — 2010-02-01

Define and describe narrative theory and epistemology: the story way of knowing.

A Unique Equation: Pediatric Palliative Care+Pediatric Cardiology=Informed Decision-Making in Complex Congenital Heart Disease (318)

Marlene Hardy-Gomez, Sarah Friebert — 2010-02-01

Define full informed consent in pediatric palliative care and explore its limitations in current pediatric healthcare decision-making.

Methadone Boot Camp Revisited (319)

Tara C. Friedman, Kevin Thomas Bain — 2010-02-01

Describe methadone's unique pharmacodynamic and pharmacokinetic properties.

Peer Mentoring: An Innovative Model for Professional Advancement in Hospice and Palliative Medicine (320)

2010-02-01

Describe an innovative and successful mentorship model, the peer mentorship group.

Asking Tough Questions: Career Advice from the Experts (321)

2010-02-01

Identify potential career opportunities and pitfalls they may encounter as they make the transition from fellow to junior attending, and from junior attending forward.

Is it Time to Pull the Plug on the Principle of Double Effect? (322)

Robert Macauley, Catherine Kelso, Margaret Kreher, Patrick Daly, Jeffrey Berger — 2010-02-01

Discuss the four requirements of the Principle of Double Effect.

Palliative Medicine and Bioethics Interface: Collaboration and Cooperation or Codependency and Conflict? (323)

Keith Swetz, Richard Butin, Christine Westphal, Diane Palac, Timothy Quill — 2010-02-01

Identify common “overlap” areas encountered by bioethics consultants and palliative medicine consultants.

What is “Palliative Chemotherapy?” Perspectives from Oncology, Palliative Care, and Hospice (324)

Mary Buss, Michael Levy, Jeffrey Spiess, MD, FAAHPM, Esme Finlay — 2010-02-01

(All speakers have disclosed no relevant financial relationships with the following exceptions: Levy is on the advisory board and is sub-investigator on clinical trials with WyethBuss, and Spiess will discuss off-label use.)

Just Being: An Introduction to Mindfulness and its Role in Tending to the Dying (325)

2010-02-01

Suzana Makowski, MD MMM FACP, University of Massachusetts Memorial, Worcester, MA. Ron Epstein, University of Rochester, Rochester, NY (All speakers have disclosed no relevant financial relationships.)

Decision-making at the Extremes of Pediatric Palliative Care (326)

Jimmie Leleszi, Dianne Fochtman, Renee Boss, Jeanne Lewandowski — 2010-02-01

(All speakers have disclosed no relevant financial relationships.) Objectives

Hospice and Non-Hospice Models of Palliative Care Delivery in Long-Term Care (327)

Amy Corcoran, Deborah Way, Betty Lim, Laura Hanson — 2010-02-01

(All speakers have disclosed no relevant financial relationships.) Objectives

Osteopathic Manipulative Medicine in Palliative Care (328)

Christine Estrada, Grace Varas, Gregory Busch — 2010-02-01

(All speakers have disclosed no relevant financial relationships.) Objectives

Palliative Themes in Music: An Educational and Self-Care Exercise (329)

2010-02-01

Christian Sinclair, MD, Kansas City Hospice & Palliative Care, Kansas City, MO (Sinclair has disclosed no relevant financial relationships.)

Palliative Care in Patients Treated with Left Ventricular Assist Device Destination Therapy (LVAD-DT) (330)

Keith Swetz, Monica Freeman, Winifried Teuteberg, Paul Mueller — 2010-02-01

Recognize the indications for LVAD-DT in advanced heart failure.

Brain Death: Culturally Congruent Palliative Care (331)

Christine Westphal, Stephanie Schim — 2010-02-01

Identify key elements and four processes related to culturally congruent care.

None of Your “Darn” Business!—Taking a Spiritual History while Preserving Your Professional Boundaries, Your Rapport, and Your Pride (332)

Tim Ford — 2010-02-01

Distinguish between spiritual screening, spiritual history, and spiritual assessment.

"Palliative Radiation Oncology" or “How to Teach a Radiation Oncologist to Do What You Need Them to Do” (333)

Jerry Baker — 2010-02-01

Discuss basic principles of radiation oncology, with particular attention to principles that often influence the spectrum of approaches used by radiation oncologists for patients needing palliative therapy.

Managing Neuropathic Pain in Pediatric Palliative Care (334)

Stefan Friedrichsdorf — 2010-02-01

Discuss the concept of broad-spectrum analgesia in pediatric neuropathic pain management.

What Should I Say When…Words that Work in Palliative Care Consults (335)

Helene Starks, Gregg VandeKieft, Stuart Farber — 2010-02-01

Identify two communication strategies to elicit patient concerns and values regarding goals of care.

Clinician Self-Care: The Applications of Mindfulness-Based Approaches in Preventing Professional Burnout and Compassion Fatigue (336)

Ruth Geller, Michael Krasner, David Korones — 2010-02-01

Define burnout and compassion fatigue and review research exploring potential untoward consequences of these phenomena for palliative care clinicians and their patients.

Hospice Revocation and Withdrawal of Care: Addressing Barriers and Offering Solutions for Continuity of Hospice Care (337)

Donna Zhukovsky, Jessica Masterson, Lou Brown, Ronald Crossno, Carmella Wygant — 2010-02-01

List categories of patients discharged alive from hospice.

Should We be using Surveys of Family Members for Accountability and Public Reporting? (338)

David Casarett, Joan Teno — 2010-02-01

Describe at least three concerns that limit the usefulness of family surveys as accountability tools.

IV Lidocaine: An Underutilized Therapy for Refractory Pain at the End of Life

Eve Block — 2010-02-01

Identify how lidocaine infusion can be initiated and maintained in the hospital and at home.

Emergency Management of Severe Opioid-Induced Hyperalgesia

Parminder Sidhu — 2010-02-01

Recognize opioid-induced hyperalgesia.

Ketamine for Treatment of Non-neuropathic Pain from Non-Malignant Sources

Shorin Nemeth — 2010-02-01

Identify the FDA-approved uses of ketamine.

Wounded Warriors: Their Last Battle

Deborah Grassman — 2010-02-01

Describe the emotional, social, spiritual, and moral injuries sustained by veterans and how these impact EOL care.

A REMS for Long-Acting Opioid Analgesics: Anticipated Impact on the Dual Public Health Issues of Non-Medical Use and Patient Pain Care

Aaron M. Gilson — 2010-02-01

Discuss principal characteristics of the FDA's implemented REMS program.

Hidden in Plain Sight: Master the Secrets of Non-Verbal Communication (400)

VJ Periyakoil — 2010-02-01

Recognize the importance of non-verbal aspects of communication.

Addressing Perinatal Palliative Care Program Development (401)

Robin F. Kramer, Sally Sehring, Tina Ratto, Linda M. Hopkins — 2010-02-01

Describe criteria that can be used to define a target population who can benefit from perinatal palliative care.

Hoping for Hope: Translating Hope Theory into Hospital-Based Palliative Care Practice (402)

Todd Cote — 2010-02-01

Discuss the varied definitions of hope in research and discuss the nature of hope in clinical practice.

An Evidence-Based Approach to Cutaneous Treatment of Nausea, Pain, and Neuropathy in Palliative Care (403)

Thomas Smith, Judith Paice, Joseph Ritter, Barton Bobb — 2010-02-01

Review the available evidence for absorption and efficacy for anti-nausea cutaneous gels and treatments, and be able to make evidence-based clinical practice guidelines.

Caring for the Patient with ALS: It Takes a Village (404)

Elizabeth Lindenberger, Maria Wharton, Kathleen Bixby, Karen Blackstone — 2010-02-01

Describe an interdisciplinary treatment approach to common symptoms and functional loss in ALS.

An Interdisciplinary Model of Palliative Care Fellowship Training: From Application Through Graduation (405)

Marsha Joselow, Janet Duncan, Tamara Vesel — 2010-02-01

Describe a model of an interdisciplinary palliative care training program.

Planning for Future Medical Treatment: What's Worked…What's Failed (406)

Bernard Hammes, Gerlyn Brasic — 2010-02-01

List three reasons why the use of traditional advance directives has failed.

CareBeyond: A Chronic Disease Management Model in Hospice Care for COPD Patients (407)

Sumi Misra, Carrie Speck, Tim Lewis — 2010-02-01

Describe an innovative methodology to manage COPD patient enrolled in hospice to ensure optimal outcomes for patient, family, and the healthcare system.

Good to Great: Taking a Palliative Care Program to the Next Level in a Comprehensive, Systematic, Sustainable Way (408)

Mary Hicks, Merry Davis, Elizabeth DiStefano, Richard Payne, Betty Granger — 2010-02-01

List two successful strategies for expanding access to palliative care services.

Decision-Making and Care Provision for the Terminally Ill Patient with Mental Illness

Kerry Case — 2010-02-01

Describe an ethical approach to balancing an incompetent patient's medical needs with the preservation of dignity and maximization of autonomy.

Mindfulness and the Difficult Patient

Seth Roberts — 2010-02-01

Define mindfulness.

Can You Go Home Again? Returning to One's Country of Origin in the Setting of Terminal Illness

Mara Lugassy — 2010-02-01

Discuss the process by which terminally ill patients may be assessed for safety in travel.

We Need More of It…Nurses Lack of Knowledge and Experience with Palliative Sedation at the End-of-Life

Stacie Levine, Bansari Patel, Rita Gorawara-Bhat — 2010-02-01

Recognize nursing attitudes and perspectives on the use of palliative sedation.

Knowledgeable or Not: Nurses' Comprehension of Core Concepts in Palliative Care

Celeste Yanni — 2010-02-01

Identify a reliable and valid tool which can be used to evaluate nurses' baseline knowledge of core palliative concepts.

Sexual Health Assessment of Hospice Patients: An International Nursing Study

Marianne Matzo, Kamal Hijjazi — 2010-02-01

Discuss the perceptions of an international population of hospice nurse regarding their understanding of their patient's concerns regarding sexuality and intimacy.

Pediatric Supportive Care Program: Parents Perspective of Medical Decisions and Palliative Decisions for Children with Cancer

2010-02-01

Describe factors that can help facilitate patient-provider communication by using a Decision-Making Tool.

It's About Time: Interactions between Parents with Advanced Cancer and their Adolescent Children

Denice Sheehan — 2010-02-01

Describe two ways adolescents know their parent is dying.

Can You Hear Me Now? The Experience of a Deaf Family Member Surrounding the Death of Loved Ones

Karen Kehl, Constance Gartner — 2010-02-01

Describe the unique nature of communication with the Deaf.

Palliative Care Partners with the Hematologic Malignancy (HM) Unit

Kathy Selvaggi, Susan Jessell, Sarah Miller, Janet Abrahm — 2010-02-01

Describe the interactions with hematologic malignancy (HM) clinicians enabling the integration of a palliative medicine consult service into the HM unit serving patients with acute leukemias, multiple myeloma, lymphomas, MDS, and post bone marrow transplant patients.

Supportive Care Assessment: Patient Preferences for Disclosure of Palliative Care Information

Sharla Wells-Di Gregorio, Jillian Gustin, Kristen Coller, Robert Taylor — 2010-02-01

Identify five areas of distress assessed by the OSU Center for Palliative Care Supportive Care Assessment.

Evaluation of an Interdisciplinary Faculty Development Program at an Academic Hospice

Annette Vollrath, JJ Nadicksbernd, Matthew Soskins, Charles von Gunten, MD PhD — 2010-02-01

Describe the Interdisciplinary Faculty Development Program (IFDP) as one example of a mentorship-model driven program to develop clinician-educators from all disciplines involved in the delivery of palliative care.

Spiritual Care Needs and Expectations in Outpatient Palliative Care

Elizabeth Kvale — 2010-02-01

Recognize the spiritual needs of palliative care outpatients.

Losing Hope: The Relationship between Hope and Pain, Depression, and Spiritual Well-Being among Ambulatory Cancer Patients

Michael Rabow, Blake Rawdin — 2010-02-01

Review the literature on the associations between hope, depression, and quality of life.

Prevalence of Outpatient Palliative Care Programs Affiliated with Acute Care Hospitals in California

Steven Pantilat, Kathleen Kerr — 2010-02-01

Describe the prevalence of outpatient palliative care services affiliated with California hospitals.

Feasibility of Symptom and Quality-of-Life (QOL) Assessment in a VA Network-Based Palliative Care (PC) Program

2010-02-01

Describe the use of electronic symptom templates in a network setting.

Organizational Challenges to Implementing Hospital-Based Palliative Care

Karra Bikson, Karl Lorenz, Mario Milch — 2010-02-01

Recognize barriers and facilitators to implementing hospital-based palliative care programs.

First Hospital-Based Pain and Palliative Care Program in Hawaii

Meiko Kuriya, Christina Bell, Daniel Fischberg, MD PhD — 2010-02-01

Examine ethnic variations in referral to a hospital-based pain and palliative care service.

Interdisciplinary Staffing Patterns: Do For-Profit and Nonprofit Hospices Differ?

2010-02-01

Recognize how hospices differ in their interdisciplinary staffing patterns.

Longitudinal Changes in Symptom Distress and Quality-of-Life in Patients with End-Stage Chronic Disease

2010-02-01

Describe difference in the longitudinal changes in quality of life (QOL) in those who survived and who didn't with end-stage CHF or COPD in a non-institutional setting.

Increasing Hospice Referrals of Dialysis Patients

Lewis Cohen, Robin Ruthazer, Michael Germain — 2010-02-01

Identify three barriers to hospice referral for patients with end-stage renal disease.

The Longitudinal Use of Hospice Care in U.S. Nursing Homes

Susan Miller, Venkatesh Nathilvar, Julie Lima — 2010-02-01

Describe how rates of hospice use increased between 1999 and 2006 and which United States has the greatest proportions of nursing home decedent who enroll in hospice.

Black and White Differences in Hospice Use among U.S. Nursing Home Decedents

Michael Lepore, Susan Miller, Pedro Gozalo, Zhanlian Feng, Ramona Rhodes — 2010-02-01

Identify individual- and facility-level factors associated with racial disparities in hospice use.

Compassionate Accommodation after the Declaration of Brain Death

Robert Macauley — 2010-02-01

Define “death” by both neurological and cardiorespiratory criteria.

Thoracic Epidural Analgesics, but not Intrathecal Analgesics, Provide Excellent Cancer Pain Relief at the End-of-Life: A Case Report

Paul Sloan — 2010-02-01

Identify how epidural versus intrathecal analgesics may differ in efficacy and side effect profile.

Epidemiology of Cancer Pain and Symptoms among Underserved Ethnic Chinese Patients Treated in a Community Oncology Setting

2010-02-01

Summarize information and methods to measure cancer pain and symptom burden in ethnic Chinese adults diagnosed with cancer.

Quality of Supportive Care among Inpatients Dying with Advanced Cancer

2010-02-01

Recognize Cancer Quality ASSIST, a comprehensive quality indicator set that measures the quality of cancer supportive care provided to patients.

Understanding Chronic Illness: Students' Perspectives on Geriatrics-Home Palliative Care Visits

Lisa Vargish, Deon Cox Hayley, Sandy Smith, Lisa Mailliard — 2010-02-01

Discuss students' perceptions of learning about providing care to patients with chronic illness in the home setting.

Implications of Interdisciplinary Palliative Care when Caring for Older Adults with Advanced Cancer

Tarik Hadid, Sandra Sanchez-Reilly — 2010-02-01

Compare an interdisciplinary approach and standard of care approach when caring for older adults with advanced cancer and learn about effects of either one on patient care.

Effectiveness of a Geriatric Palliative Care Consult on Pain Management and Advance Directives among Older Adults

Angelica Davila, Mary Garza, Shuko Lee, Jeanette Ross, Sandra Sanchez-Reilly — 2010-02-01

Discuss how a geriatric palliative care consult can improve pain management in older adults.

End-of-Life Care Discussions: A Survey of Dialysis Patients and Professionals

Sheila Weiner — 2010-02-01

Discuss patients' and professionals' perceptions of end-of-life care discussions, including the topics they wish to discuss, when they would like to have conversations, and with whom, in dialysis units.

Once Married, Still Married: Is Marital Status Associated with Variation in End-of-Life Concerns, Preferences, and Attitudes?

Beverly Williams, Patricia Sawyer, Richard Allman — 2010-02-01

Discuss the relevance of marital status for older adults' perspectives and preferences regarding end-of-life care in the event of late-stage, life-threatening illness.

End-of-Life Decision-making for African Americans with Cancer in a Public Hospital

Catherine Deamant, Joshua Baru, John H. Stroger, William Trick, Nandini Ignatius — 2010-02-01

Discuss impact palliative care consultation can have on rate of hospice enrollment for African American cancer patients.

Palliative Sedation and Existential Suffering: A Dialogue Between Medicine, Nursing, Philosophy, and Psychology (420)

Timothy Kirk, Nessa Coyle, Shannon Poppito, Rebecca Bigoney — 2010-02-01

Explain the major ethical questions at the heart of the current debate surrounding palliative sedation for existential suffering.

Pain Management in Children with Severe Neurological Impairment (421)

Benjamin Lee — 2010-02-01

Identify common causes of pain in neurologically impaired pediatric patients.

Blue's Clues: Differentiating between Grief and Depression in Patients with Serious Life Limiting Illnesses (422)

VJ Periyakoil — 2010-02-01

Recognize the various clinical presentations of preparatory grief and depression in patients with serious, life-limiting illnesses.

Assessing Pain in Persons with Advanced Dementia: Clinical and Research Issues (423)

Mary Ersek, Keela Herr, Joseph Shega — 2010-02-01

Describe the challenges in assessing pain in persons with advanced dementia who are unable to self report.

Management of Thromboembolic Disease in Hospice and Palliative Care (424)

Jeffrey Spiess, Janice Scheufler — 2010-02-01

Describe the risk factors and impact of venous thromboembolic disease in the clinical context of hospice and palliative care.

An Interactive Educational Exchange: Sharing Innovative Teaching Materials and Methods (425)

Laura Morrison, Shirley Otis-Green, Pamela Fordham, Elise Carey, Eva Chittenden — 2010-02-01

Identify model programs of palliative care education from different health professions disciplines.

Palliative Care in the Patient-Centered Medical Home (426)

Phillip Rodgers — 2010-02-01

Discuss the origins and principles of the Patient-Centered Medical Home (PCMH) concept and its fundamental resonance with hospice and palliative care.

Physician Compensation Models (427)

Edward Martin, Charles Wellman, Tim Cousounis — 2010-02-01

Identify the new duties and time commitment required of hospice medical directors by the proposed regulations.

New Drugs and Drug News: The 411 and Implications for Palliative Care (428)

Mary McPhersonPharmD — 2010-02-01

List new drugs approved by the FDA in 2009. For each drug, the participant will be able to describe the approved indication, unapproved uses of the medication, common adverse effects, and drug interactions.

“God Will Heal My Foot”: Evaluating Religious Aspects of Medical Decision-Making

Julie Childers — 2010-02-01

Develop strategies for discussing medical decision-making with patients and families who are hoping for a miracle.

A Series of Odd Requests: A Closer Look at Grief and Its Impact on the Interdisciplinary Team

Alexandra Leigh — 2010-02-01

Discuss the challenge of addressing acute grief in the inpatient setting.

How Do I Tell My Children?

Kathleen Doyle — 2010-02-01

Identify tools to use when discussing cancer and death with children.

Management of Refractory Pain in Palliative Care (430)

Russell K. Portenoy, Judith Paice — 2010-02-01

Review best practices for the pharmacological management of severe cancer-related pain in patients who do not respond adequately to first-line opioid-based pharmacotherapy.

When East Meets West and West Meets East—Cultural Considerations in Pediatric Palliative Care (431)

Joanne Wolfe, Donna Eull — 2010-02-01

Discuss the scope of cultural considerations among staff and families.

State of the Science: Update in Hospice and Palliative Care (103)

Nathan E. Goldstein, Wendy Gabrielle Anderson — 2010-02-01

Summarize selected important, peer-reviewed articles from the last year.

Leveraging External Resources to Grow and Sustain Your Palliative Care Program (500)

Steven Pantilat, Kathleen Kerr, Michael Rabow, Jean Kutner, Frank Ferris — 2010-02-01

Describe the importance and role of external resources in starting, growing, and expanding a palliative care service

Evaluation of the FICA Spiritual Assessment Tool (501)

2010-02-01

Describe the FICA Spiritual Assessment Tool and its application in the clinical setting.

What Children Learn About Death from Film (502)

Marianne Matzo — 2010-02-01

Examine the relationship between children's films and children's comprehension of death.

Am I Going Crazy? Managing Anxiety in Palliative Care—An Interdisciplinary Approach (503)

Jeffrey Alderman, Mary Martin, Ashlie Casey, Polly Robinson — 2010-02-01

Discuss the variety of ways in which anxiety disorders may present in patients with serious illness.

An Update on Elder Mistreatment for Hospice and Palliative Care Clinicians (504)

Solomon Liao, Shelley Beckham — 2010-02-01

Apply the latest research to suspected cases of elder mistreatment.

Anatomy of a Family Meeting: Fact, Fiction, and Controversies (505)

Myra Glajchen, Donna Zhukovsky — 2010-02-01

Identify the salient clinical skills involved in family meetings at the end-of-life and provide a framework from which to conduct family meetings.

Dying Badly at Home: Preventing and Managing Symptomatic Crises (506)

Ira Byock, Yvonne Corbeil — 2010-02-01

Discuss common lapses in communication and information transfer, and gaps in transitions of care from a regional referral hospital to the home that result in symptom crises for hospice patients.

Palliative Case Management—Alpha to Omega (507)

Leslie Piet, Linda Dunbar, Sydney Dy — 2010-02-01

Describe how case management and palliative care share many principles and key elements.

Mentoring the Mentoring Relationship in Palliative Care: A Practical Guide (508)

Susan Cohen — 2010-02-01

Review goals and roles of mentors and mentees.

When Integrity is Threatened: Ethical Conflicts at the End-of-life (509)

Cynda Hylton Rushton, Alvin Moss — 2010-02-01

Recognize the boundaries between palliative care and ethics consultation.

Promoting Perinatal, Neonatal, and Pediatric Palliative Care Nursing Education (510)

Hollye Harrington Jacobs, Betty Ferrell, Lizabeth Sumner, Pam Malloy — 2010-02-01

Identify a national project to coordinate nursing efforts in perinatal, neonatal, and pediatric palliative care.

Legislative and Health Policy Update (511)

Howard Tuch, Judith Buckalew — 2010-02-01

Describe recent legislative activity and inquiries into the hospice Medicare benefit.

Palliation for the Homebound: Home-Based Primary Care and Palliative Medicine: A Collaborative Approach (513)

Sumi Misra, Barbara Snook, Georgia Carruth, Jennifer Crane, Dana Franklin — 2010-02-01

Illustrate and understand the unique profiles and needs of the homebound populations.

PC-FACS: A Year in Review (514)

Amy Abernethy, Donna Zhukovsky — 2010-02-01

Identify new evidence published outside the palliative care literature in 2009 relevant to hospice and palliative care clinical practice.

Can My Patient Make That Decision? Assessing Capacity to Make Decisions About Clinical Care and Research Participation (516)

Elizabeth Vig, Scott Irwin, MD PhD, David Casarett — 2010-02-01

Describe when an assessment of decision-making capacity is needed.

Intimacy in Hospice and Palliative Care: The Journey We Cannot Overlook (517)

Linda Tavel — 2010-02-01

Describe barriers to providing patients with optimal quality of life as it applies to intimacy and sexuality.

Palliative Care Research Issues and Methods: Pain Assessment, Prognostication, and CAM (518)

Erik Fromme, Karl Lorenz, Jean Kutner — 2010-02-01

Discuss and critique research methods in terms of design, measurement, and implementation.

New Approaches to Calculating Financial Outcomes for Hospital-Based Palliative Care Programs (519)

Kathleen Kerr, Brian Cassel, Steven Pantilat — 2010-02-01

Summarize how hospital variables like payer mix and occupancy rate influence financial outcomes analyses.

Conceptual Analysis of Post Mortem Care (520)

Marilyn Stoner — 2010-02-01

Describe the complexities of post mortem care.

Update in Quality and How to Use New Resources for Quality Measurement in Palliative Care (521)

Sydney Dy, Karl Lorenz, Janet Bull, Amy Abernethy — 2010-02-01

Discuss the current state of quality measurement for palliative care, including relevance to health policy and healthcare reform.

Symptoms and Suffering at the End-of-Life in Children with Brain Tumors (522)

David Korones — 2010-02-01

Define the epidemiology, symptoms, signs, and toxicity of therapy in children with brain tumors.

Medical and Interventional Approaches to Managing Dyspnea—An Inter-Disciplinary Approach (523)

Mary Buss, Gaetane Michaud, Deidre Keogh — 2010-02-01

Identify common barriers and challenges in assessing dyspnea.

Use of Anesthetic-Based and Interventional Pain Management Techniques for Intractable Pain in Pediatric Cancer Patients (524)

Benjamin Lee — 2010-02-01

Identify pediatric cancer patients with intractable pain who would be candidates for anesthetic-based and interventional pain management techniques.

Working with Families in Crisis: A Strength-Based Approach (525)

Todd Hultman, Vicki Jackson, Todd Rinehart — 2010-02-01

Describe key constructs of resiliency as related to families.

RN Residency: Transitioning to Geropalliative Care (526)

Susan Lee, Constance Dahlin, Penny Carleton, Edward Coakley — 2010-02-01

Describe the components of an RN residency program in geropalliative care at Massachusetts General Hospital, a large AMC in Boston.

Using Metrics to Grow Your Palliative Care Program (527)

David Weissman, Sean Morrison — 2010-02-01

Describe the essential operational, customer, and clinical metrics that a non-hospice palliative care program should measure.

Last Acts: How Should Our Patients Use Whatever Time They Have Left? (528)

David Casarett — 2010-02-01

Cite examples of the ways in which people facing death in a variety of circumstances have chosen to use the time that they had left.

Rounding with the Stars: International Opportunities (529)

Betty Ferrell, Frank D. Ferris — 2010-02-01

Discuss a case example which illustrates the challenges and opportunities for palliative care internationally.

End-of-Life Care as an Illusion—Wish-Fulfillment, but Whose Wishes and Why?

Holly G. Prigerson — 2010-02-01

Discuss the correlates and consequences of end-of-life discussions for patients and family members.

Palliative Strategies for Breathlessness at the End-of-Life (104)

Jeannine M. Brant — 2010-02-01

Describe the physiologic and behavioral factors of dyspnea.

The Impact of a Palliative Care Consult Service on the Functions of a Medical Ethics Committee (701)

2010-02-01

Compare and contrast the purposes and roles Palliative Care Consult Services and Medical Ethics Committees have in end-of-life care.

The Impact of a Palliative Care Consult Service on Patient Code Status and Discharge Outcomes (702)

Teresa Albanese, Hallie Mason, Steven Radwany — 2010-02-01

Discuss Palliative Care Consult Service functions with regard to Advance Directives and provider documentation of code status.

Inpatient Palliative Care Consult Services and the Need for Acute Palliative Care Unit Beds (703)

Teresa Albanese, Steven Radwany, Hallie Mason, Chizor Eruchalu — 2010-02-01

Discuss the mutual impact of having an inpatient palliative care consult service and an acute palliative care unit on requests for palliative care consults and beds.

Do Older Adults with Completed Advance Directives Really Understand Them? (704)

Cody Andrews, Jignesh Patel, Sandra Sanchez-Reilly, Jeanette Ross — 2010-02-01

Discuss the most common reasons why older adults might complete advance directives.

Attitudes among Physicians Regarding Palliative and Hospice Care in an Oncology Center: Results of a Physician Survey (705)

Maha Arnaout, Dima Ezmigna, Laila Khoulli — 2010-02-01

Identify physicians' attitudes towards palliative and hospice care.

Nursing Documentation of Pain Assessment in a Pediatric Oncology Unit (706)

Maha Arnaout, Dima Ezmigna, Laila Khoulli, Rasha Deebajah — 2010-02-01

Identify defects in nursing documentation of pain.

Identifying Complementary Therapies that Demonstrate Efficacy to Reduce Symptoms Common among Hospice/Palliative Care Patients and Their Caregivers: A Review of the Research (707)

Karen Whitley Bell — 2010-02-01

Recognize the scope of complementary therapy usage, the impact of utilization on limited patient, family, and agency resources, and the value of accurate information to support informed decision-making.

On Borrowed Time: What Families of Nursing Home Residents with Organ Failure and Frailty Can Learn from Those with Cancer (709)

Mercedes Bern-Klug — 2010-02-01

Describe the context of medical decision-making from the point of view of family members of nursing home residents with cancer.

Family Meetings: Impact on Length of Stay and Disposition (710)

Maria Bertucci, Anne Wiedemann, Mary Summer — 2010-02-01

Review the correlation of family meetings with length of stay and patient disposition.

The Family Member's Perspective on the Hospitalized Patient's Death (711)

2010-02-01

Identify an approach to measuring bereaved family members' quality of the dying and death experience.

Providing Palliative Care in the Outpatient Setting: Successful Collaboration with a Pancreatic Cancer Interdisciplinary Team (712)

Paula Caron, J. Marc Pipas, Terry Fisher, Margaret Bishop, Ira Byock — 2010-02-01

Describe strategies for the continued growth of a thriving outpatient Palliative Care program.

Medical Management of Malignant Bowel Obstruction: Case Discussions and Review of Literature (713)

2010-02-01

Discuss three causes of malignant bowel obstruction.

Force Perception, Effort, Strength, and Dynamic Muscle Function in Cancer-Related Fatigue (CRF) (714)

Mellar Davis, Dilara Seyidova-Khoshknabi — 2010-02-01

Discuss objective correlates to cancer related fatigue.

Web-Based Electronic Portfolio for a Hospice and Palliative Medicine Fellowship (715)

Rony Dev, Akhila Reddy, Egidio Del Fabbro, Eduardo Bruera, Suresh Reddy — 2010-02-01

Identify the strengths and limitations of electronic portfolios in education of trainees in a Hospice and Palliative Medicine Fellowship.

Sitting Here by Myself: Experiences of Serious Illness in Patients Hospitalized at an Urban Public Hospital (716)

Virginia Dzul-Church, Jenica Cimino, Shelley Adler, Piera Wong, Wendy Anderson — 2010-02-01

Identify that hospitalized urban underserved patients often lack social support and have experienced frequent difficult life events—estrangement, homelessness, substance abuse, and imprisonment—that shape the end-of-life experience.

Nursing Evaluation of Palliative Resources in an Acute Care Setting: Perceptions, Satisfaction, and Educational Needs (718)

Sara Fohn — 2010-02-01

Describe nursing perceptions of palliative care.

Do-Not-Resuscitate Orders in Cancer Patients with Metastatic Spinal Cord Compression: Timing Relative to Death and Communication-Training Implications (719)

Ying Guo, Benedict Konzen, Josephine Bianty — 2010-02-01

Recognize that patients with metastatic spinal cord compression have limited life span.

Mood and Anxiety Symptoms among Advanced Cancer Patients: Kids Matter (720)

2010-02-01

Review literature on depression and anxiety among advanced cancer patients with dependent children.

When Death Doesn't Come Easily: A Palliative Care Services Experience with Palliative Extubation (721)

Rose Anne Indelicato, Daniel Pomerantz, Cornelia Fleming — 2010-02-01

Identify the uncertainties complicating accurate prognostication of patients after palliative extubation.

Efficacy of Palliative Care Medical Education in One U.S Medical School (722)

Opemipo Johnson, Jennifer Gentry, Anthony Galanos — 2010-02-01

Evaluate the level of confidence of Duke University School of Medicine students in managing patients in need of palliative care or end-of-life care.

Retrospective Chart Review of a Clinical Pharmacist's Interventions during Rounds in a Hospice Inpatient Unit (723)

Katherine Juba, Aaron Rigali — 2010-02-01

Evaluate the types of drug-related interventions made by a clinical pharmacist during weekly interdisciplinary care rounds.

The Utility of an Acute Hospitalization and Interdisciplinary Family Meeting to Resolve Disagreements over Hospice: The Case of a 99-Year-Old Patient with Dementia (724)

Robert Kaiser, Elizabeth Cobbs, Karen Blackstone — 2010-02-01

Recognize those circumstances in which admission of the patient can be useful in protecting the patient and establishing identifying the best setting for care.

Use of Universal Catheter Access Port for Management of Leaking Tubes in the Palliative Care Setting (725)

Cathy Kalinski, Jeanne Nusbaum, Martin Wendelkin — 2010-02-01

Discuss photos demonstrating use and application of universal catheter access port.

Readability of Hospice Materials to Prepare Families for Death (726)

Karen Kehl, Kayla McCarty — 2010-02-01

Discuss the current readability levels of written materials used by hospices to provide information to family caregivers.

The Reason for Failure of Participation in Physical Therapy and Occupational Therapy During Cancer Inpatient Rehabilitation and the Effect of a Simple Intervention (727)

Benedict Konzen — 2010-02-01

Recognize what limits cancer patients from participating fully on an inpatient rehabilitation unit.

Spiritual Care Assessments for Palliative Care Patients (728)

Susan Kristiniak, Eric Holmstrom, Anne Wiedemann — 2010-02-01

Demonstrate how a palliative care consulting service in an acute care setting established a collaborative effort with pastoral care staff to complete spiritual care assessments for palliative care patients.

Ethics Rounds: Surprising Outcomes Toward Best Practices (729)

Mary Kay Kusner, Janeta Tansey — 2010-02-01

Learn about the significance of providing a safe and educational format for discussion of ethical dilemmas in the clinical setting.

Comorbidity Does Not Predict Symptom Burden in Palliative Care Outpatient (730)

2010-02-01

Discuss the importance of symptom burden with regard to health services planning.

Absorbing Information about a Child's Incurable Cancer Prognosis (731)

Patricia Lannen, Ulrika Kreicbergs, Joanne Wolfe, Jennifer Mack, Erik Onelov — 2010-02-01

Discuss information about a child's incurable disease more likely to be absorbed by parents if the information is given in an appropriate manner.

Effect of Prior Experience with a Dying Person on Medical Students' Communication Skill with Terminally Ill Patients (732)

Ashlei Lowery, Shuko Lee, Sandra Sanchez-Reilly, Jeanette Ross — 2010-02-01

Discuss healthcare provider's recognition of the impact, both positive and negative, of their prior personal experience on their communication with their patients.

Theory into Practice: Withdrawal of Artificial Life Support in the ICU (733)

Karen Lukacs, Steve Cagle, Vince Bacarri, Jane Senseney, James Vail — 2010-02-01

Review concise medication order set for physicians to guide withdrawal of life support in ICU.

Culturally Competent Care: An Imperative for Effective Outcomes in Palliative Care (734)

Sara Martin, Sumathi Misra, Mohana Karlekar — 2010-02-01

Recognize and acknowledge cultural differences.

A Journey to Remember (735)

Polly Mazanec, Elizabeth Pitorak, Maureen Klinc — 2010-02-01

Describe the triumphs and challenges along the cancer disease trajectory as narrated by a patient who died from lung cancer.

Impact of Opening an Inpatient Hospice Center On Site of Death for Elderly Residents in Cheyenne, Wyoming (736)

Robert Monger, Kristina Stefka — 2010-02-01

Describe the impact of opening an inpatient hospice center on site of death for elderly residents in Cheyenne, WY.

Engaging Palliative Specialty Advanced Practice Nursing Students in the Online Environment (737)

Lana Nealand, Pamela Fordham, Gail Acre — 2010-02-01

Describe one method to apply active learning in the online environment with Advance Practice Nursing students.

Acute Abdominal Pain: A Case Study of Multi-Service Collaboration in Palliation (738)

James Nunnery, Sumathi Misra, Joshua Fessel — 2010-02-01

Discuss how early collaboration among services can lead to enhanced ability to provide palliative care to patients and families.

Characterizing Care Cost and Intensiveness of Hospice Patients in the Hospital Setting (739)

Molly Olsen, Ann Bartlett, Timothy Moynihan — 2010-02-01

Identify the most common reasons hospice patients presented for hospital-based care (ie, chief complaints leading to hospitalization in our study population).

A Cause for Concern: Chronic Propoxyphene Use among Older Adults with Pain (740)

Taral Patel, Jeff Tabares, Mary Jo Pugh — 2010-02-01

Determine the prevalence of chronic propoxyphene use among older adults.

The Impact of Opioids on the Endocrine System: Implications for Hospice and Palliative Care (741)

Eric Prommer — 2010-02-01

Discuss how opioids affect the endocrine system.

Opioid-Induced Pain: When is it Present? (742)

Eric Prommer — 2010-02-01

Recognize between opioid tolerance and opioid-induced pain.

3M: A Tool for Teaching Symptom Assessment and Management to Medical Students (743)

Matthew Russell — 2010-02-01

Describe the 3M teaching approach and what it stands for.

Initial Development and Content Validation of the Knowledge of Care Options (KOCO) Instrument (744)

2010-02-01

Describe the purpose of developing and content validating an instrument to measure individual's knowledge of care options.

Rapidly Escalating Intrathecal Opioid Dosing for Cancer Pain: A Case Report of Catheter Malposition Not Hyperalgesia (745)

Paul Sloan, Jay Grider — 2010-02-01

Discuss how to evaluate possible hyperalgesia related to intrathecal opioid administration in a patient with cancer pain.

Sitting with You in Your Suffering: Lessons about Intractable Pain at the End-of-Life (746)

Rebecca Sudore, Patrice Villars, Elise Carey — 2010-02-01

Identify multiple medical and procedural modalities to relieve suffering at the end-of-life.

Predictors of Suicidal Ideation among Palliative Care Patients (747)

2010-02-01

Review literature on predicators of suicidal ideation among advanced cancer patients.

Evaluation of Palliative Extubation Protocol after Education of ICU Residents and Staff (748)

Anne Wiedemann, Maria Bertucci, Carol Ann Parente — 2010-02-01

Evaluate the knowledge and use of the newly created palliative extubation protocol by the ICU physicians and staff for palliative extubations.

Early Integration of a Pediatric Supportive Care Program in Pediatric Oncology (749)

2010-02-01

Discuss the importance of early referral to a palliative and supportive care program.

Transitioning to Internship: Development of a Palliative Care Boot Camp for Graduating Medical Students: A Qualitative Analyses of a Pilot Program (750)

Shellie Williams, Joseph Shega — 2010-02-01

Discuss the feasibility of introducing end-of-life care communications to graduating medical students.

Internal Medicine Residents Perceptions of Death and Dying: What Do We Know? (751)

Shellie Williams, Scott Sherman — 2010-02-01

Gain better understanding of internal medicine residents' perceptions of death and dying.

Dynamic Aspects of Decision-making (752)

Daniel Wollman — 2010-02-01

Review how societal aspects of decision-making have shifted between the extremes of paternalism and autonomy.

Fact-Opinion-Hope: A Structured Approach to Consistent Communication (753)

Daniel Wollman — 2010-02-01

Discuss the reasons for difficulty in patient-medical team communication.

Palliative Symptom Burden in an Urban Homebound Population (754)

Meng Zhang, Ania Wajnberg, Katherine Ornstein, Julian Baez, Theresa Soriano — 2010-02-01

Identify palliative symptom burden in the homebound.

Intervention Program for Improving Informed Medical Decision in Seriously Ill Patients (755)

Jessica Zitter — 2010-02-01

Recognize the importance of including patients and surrogates in the healthcare decision-making process and modify their own practices accordingly.

Author Index

2010-02-01

Abernethy, Amy, MD (514) PC-FACS: A Year in Review, Saturday, March 6, 2010, 11:15 am–12:15 pm

Editorial Board

2010-02-01

Table of Contents and Subscription Info

2010-02-01