When Calling 911 Is the Answer: Leveraging Resources in EMS to Deliver Emergency Hospice and Palliative Care (TH321)
A distressed call to EMS from families or caregivers of hospice patients in crisis can significantly alter end-of-life care. Hospice patients may have acute symptom management needs exceeding their resources at home, but may not desire to go to the emergency department (ED). However, traditional EMS protocols may not align well with hospice patients' goals of care. While EMS may be able to administer controlled substances in the home setting, this usually requires the patient to then be transported to the ED for further treatment. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Justin K. Brooten, Lisa Evans, David Wang, Joanne G. Kuntz, Crystal T. Wilfong, Jennifer Price Source Type: research

Does Advance Care Planning Actually Reduce Hope in Advanced Cancer? (TH322A)
One of the principal reasons providers cite for deferring advance care planning (ACP) is fear of “taking away hope” from patients. However, research is lacking on the relationship between ACP and hope in advanced cancer. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Michael Cohen, Andrew Althouse, Robert Arnold, Edward Chu, Douglas White, Yael Schenker Tags: Paper Sessions Source Type: research

The Process and Impact of a Stakeholder Driven Adaptation of the Serious Illness Conversation Guide for AYAs and Parents of Children with Serious Illness (TH322B)
Early conversations about advance care planning (ACP) are associated with better outcomes for seriously ill adults. Despite a parental desire for earlier and more ACP, large scale adoption of ACP for seriously ill children, adolescents, and young adults (AYAs) remains unrealized. There are few rigorously developed interventions to support clinicians in pediatric ACP communication to ensure care is aligned with family goals and values. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Danielle DeCourcey, Lindsay Partin, Anna Revette, Rachelle Bernacki, Joanne Wolfe Source Type: research

Development and Validation of the ACP-CAT for Assessing the Quality of Advance Care Planning Communication (TH322C)
High quality advance care planning (ACP) discussions are important to ensure patient receipt of goal-concordant care, however there is no existing tool for assessing communication quality in ACP encounters. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Jacqueline Yuen, Amy Kelley, Laura Gelfman, Elizabeth Lindenberger, Cardinale Smith, Robert Arnold, Brook Calton, Jane Schell, Stephen Berns Source Type: research

The Patient Dignity Question in Routine Palliative Care Consultation: Implementation and Implications (TH322D)
The Patient Dignity Question (PDQ) is a validated psychometric tool designed to assess priorities and stressors relevant to care planning at all stages of illness. Administration of the PDQ has been demonstrated to improve patient and provider perceptions of empathy and communication. The PDQ has been tested in various settings, but never routinely as a component of palliative care consultation. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Rachel Hadler, Matthew Goldshore, Judith Nelson Source Type: research

‘Rehab’ vs Hospice, Let's Seriously Talk; Can Jack Weight-Bear, Will Jill Walk? The Impact and Benefit of Sponsored Physical Therapy Consults for Hospice Enrollees (TH323A)
Medicare covered inpatient rehabilitation ( “rehab”) is a common, and often appealingly expeditious, hospital discharge plan for older patients, despite the fact that many of these people have little capacity to participate in (or gain benefit from) this enterprise. In the past, “rehab” vs hospice enrollment was the frequent choice fa cing patients and families. For the past three years our hospice organization has encouraged our clinicians to utilize the physical therapy division of our visiting nurse sister service to reduce the dichotomy of these two alternatives. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Charles Newton Source Type: research

30-Day Readmission Reduction for Skilled Nursing Facility Readmissions at an Urban Medical Center (TH323B)
Unplanned 30-day hospital readmissions are an important measure of hospital quality and a focus of national regulations. The readmission rate for patients being discharged to skilled nursing facilities (SNF) has been an area of improvement for all healthcare systems. The vast majority of SNF will receive a penalty on their Medicare payments for fiscal year 2019 for poor 30-day readmission rates back to hospitals. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Nidhi Shah Source Type: research

Design and Evaluation of a Pilot Palliative Care Program in the Skilled Nursing Facility (TH323C)
The number of residents in skilled nursing facilities is expected to grow substantially over the next decade. Most SNF residents have serious illnesses that would benefit from Palliative Care intervention but reported data and understanding of best practices are lacking. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Mina Chang, Cheryl Rathje, Haley Sawamura, Jenelyn Lim, Summer Verhines, Neelu Mehra Source Type: research

A National Pilot of Goals of Care Conversations for Seriously Ill Veterans: Patient and Site Variation and Associations with Bereaved Family Survey Outcomes (TH323D)
We examined patient characteristics associated with GoCC and the association of GoCC with Bereaved Family Survey (BFS) data on end-of-life quality. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Marie Haverfield, Ariadna Garcia, Joseph Rigdon, Karleen Giannitrapani, Anne Walling, Derek Boothroyd, David Bekelman, Natalie Lo, Jill Lowery, Mary Beth Foglia, Lisa Lehmann, Karl Lorenz Source Type: research

The Practice of Palliative Medicine in Developing Countries —Part One (TH330)
Please join AAHPM's International Scholars for a panel discussion. Each scholar will present for 10 –15 minutes on the state of the practice of palliative care in their home country, with an emphasis on the roles of physicians, nurses, and other healthcare providers; the status of education and research in the field; and the unique challenges facing patients and providers. There will be time all otted after each presentation to field questions and dialogue from the audience. Prepare to be educated and inspired by these accomplished individuals who are leading and advancing the field of hospice and palliative medicine...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Geoffrey Manda, Sunita Panta, Nasreen Muhammad Saleem, Tashi Dendup Wangdi Source Type: research

PC-FACS: A Year in Review (TH331)
PC-FACS, the highest-rated member benefit of the American Academy of Hospice and Palliative Medicine, offers busy clinicians an efficient way to stay on top of pertinent literature in a field that is growing exponentially. Now in its 12th year, PC-FACS —published in the Journal of Pain and Symptom Management and delivered in a convenient format to the email box of Academy members—provides topical summaries of just published research from more than 100 journals that are not specifically dedicated to hospice and palliative medicine and might not otherwise come to the attention of our readership. (Source: Journal ...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Mellar P. Davis, Robert M. Arnold Source Type: research

Advancing Palliative Nursing Leadership and Professional Development (TH332)
In the next 10 years, the number of patients with serious illness will continue to rise. In order to care for these patients, specialty palliative nurses are essential to lead in ensuring access to quality palliative care. Many clincians lack understanding of the necessary professional development for specialty practice and the linking to leadership. This session will provide an overview of qualifications of specialty palliative nursing practice and identify the areas for palliative nursing leadership. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Marika Haranis, Constance Dahlin Source Type: research

STAMPing Out Antimicrobial Doubt: Collaborative Decisions on End-of-Life Transitions of Care (TH333)
Transitions of care at end-of-life create opportunities for hospice plan of care development. Infections may be present at time of hospice admission or may trigger a transition of care (for example from home to general inpatient care, or hospital to long-term care facility when home is not yet appropriate). Hospice clinicians can interact directly with partner providers at these points of transition, facilitating a patient-centered team approach to decision making. Additionally, patients and caregivers may be more agreeable to modifying infection management treatment plans when a change in level of care is being considered...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Molly R. Sinert, Julie Ann Justo Source Type: research

The Billing Boys Tell All: Preparing to Succeed with Medicare and the Billers at Home (TH334)
Palliative Care (PC) programs are growing nationally. Once niche services well under the fiscal radar, many PC programs now have seven-figure budgets and a dozen or more clinicians. As programs cost more, sponsoring institutions' expectations for clinical revenue grow, leaving PC team members working longer hours to see more patients to help close the yawning budgetary gap. Most PC providers have become accustomed to basic billing and coding practices, but significant opportunities exist, even for seasoned clinicians and program leads, in the rapidly expanding array of billing revenue opportunities. (Source: Journal of Pai...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Christopher Jones, Phillip E. Rodgers Source Type: research

They Said What!? Navigating Conflict with Colleagues Across Specialties (TH335)
A core tenet of Hospice and Palliative Medicine (HPM) is effective communication. While HPM specialty education centers around communication with patients and families, effective communication with colleagues across specialties can be equally challenging. Given increased emotions, various communication approaches, and complexity inherent in caring for seriously ill patients, interpersonal conflict (IPC) between HPM providers and other healthcare team members is not uncommon. IPC is defined as someone experiencing negative emotions due to the perception of disagreement or impediment from another healthcare provider. (Source...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Ethan Silverman, Sara K. Johnson, Jasmine Hudnall, Anne Kelly, Andrew O'Donnell Source Type: research

Teaching Cross-Tolerance for Patients with Opioid Use Disorder Across Settings (TH336)
Palliative care practitioners are increasingly treating patients with comorbid opioid use disorder (OUD), yet guidance is lacking for managing pain in this population. Historically, palliative care clinicians have liberally prescribed opioids to patients with limited prognosis. As medicine has evolved, patients with chronic illnesses, even metastatic cancer, are living longer thanks to immunotherapies and other novel treatments. Thus, palliative care patients are at greater risk of both developing OUD and/or chemical coping while receiving intensive treatments. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Anessa Foxwell, Tanya J. Uritsky, Eleanor Anderson, Rachel Boris Source Type: research

My Pediatric Palliative Care Patient with a DNR Is Going to the Operating Room —Questions to Ask the Anesthesiologist (TH337)
Children with end-stage illness may have DNR orders, which limit common operating room interventions such as intubation, administration of vasoactive medications, and CPR. However, many of these children may still benefit from surgeries, imaging, or other interventions requiring anesthesia, such as radiation therapy to palliate metastases, long-term central venous access for medications or parenteral nutrition, gastric tubes, or pleura or paracentesis to help with breathlessness or abdominal distension. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Sydney Brown, Chris Feudtner Source Type: research

When You Know Less Is More But Need the Patient and Family to Buy In: Using SPIKES for Deprescribing (TH338)
In the United States, the population above 65 years old in 2010 was 13%, and is estimated to be 20% by 2030, and more than 30% in other developed countries by 2030. With the rise of polypharmacy and multi-morbidity in the aging population, polypharmacy has been shown to be associated with an increased risk for adverse drug events, hospitalizations, and falls. Deprescribing is a systematic approach to withdraw or dose reduce medications considered inappropriate in an individual. The American Geriatrics Society has provided an update to the Beer's Criteria in 2019 to guide identification of inappropriate medications in the e...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Sandra DiScala, Shaida Talebreza, Ashlei W. Lowery, Ella H. Bowman, Neris Palunas, Tsewang Ngodup Source Type: research

Grief and Bereavement Support for Families and Healthcare Professionals as Part of Integrated Care in Pediatric/Neonatal Intensive Care Units around the World (TH340A)
Grief and bereavement support (GBS) is important for the wellbeing and functioning of patients, families, and healthcare professionals (HCPs) and is part of the Integrated Model of Care (IMOC) in which ICU personnel address critical and palliative care (PC) needs concurrently. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Michelle Grunauer, Gabriela Bustamante, Kevin Zambrano Tags: Paper Sessions Source Type: research

Prognostic Awareness in Caregivers of Adults with Incurable Cancer (TH340B)
Caregivers' understanding of their loved ones' prognosis is important in helping patients make informed decisions about care. While patients' prognostic awareness is associated with their psychological distress, data are lacking on whether this relationship exists for caregivers. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Tamryn Gray, Deborah Forst, Ryan Nipp, Joseph Greer, Jennifer Temel, Areej El-Jawahri Source Type: research

End-of-Life Experiences for Children with Complex Chronic Conditions and Their Bereaved Parents: Perspectives on Preparedness (TH340C)
Children with complex chronic conditions (CCC) are assisted with technology and receive intensive medical care throughout their lives, resulting in unique end-of-life (EOL) needs. Parent perspectives are necessary to improving care, yet little is known about the lived experience of parents of children with CCC. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Jori Bogetz, Anna Revette, Abby Rosenberg, Joanne Wolfe, Danielle DeCourcey Source Type: research

Experiences of Family Caregivers Providing Support to Individuals Who Voluntarily Stop Eating and Drinking (VSED) to Hasten Death (TH340D)
Voluntarily stopping eating and drinking (VSED) is a method for individuals with serious illness to control the timing and means of their death. The process requires clinical and social support, but no research has investigated the experience of caregivers supporting someone through VSED. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Jane Lowers, Nancy Preston, Sean Hughes Source Type: research

A Quality Improvement Project to Provide Early Referral to Palliative Care Clinic for Advanced Oral Cancer Patients (TH341A)
Recent literature affirms the benefits of early palliative care in advanced cancer patients. The prevalence of oral cancer is high in India and often patients present at advanced stages at the time of diagnosis. Bleak scope of curative treatment and high symptomatic burden detracts from the quality of life of these patients. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Aanchal Satija, Karl Lorenz, Michelle DeNatale, Jake Mickelsen, Odette Spruijt, S.V.S. Deo, Sushma Bhatnagar Source Type: research

Designing an Electronic Point-of-Care Dashboard to Support Serious Illness Clinical Visits: A Multi-Stakeholder Coproduction Project (TH341B)
Healthcare system complexity interferes with effective communication and goal-aligned services for people living with serious illness and their caregivers. Coproduction, a framework for healthcare service production involving real partnership between patients, caregivers, and care teams, may help. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Matthew Wilson, Aricca Van Citters, Inas Khayal, Catherine Saunders, Cathy Ross, Stephanie Tomlin, Amelia Cullinan, Meredith MacMartin, Megan Holthoff, Shoshana Hort, Amber Barnato, Kathryn Kirkland Source Type: research

A Quality Improvement Project on Documentation of Changes in Code Status Using the Electronic Medical Record (EMR) in Pediatrics (TH341C)
In order to provide gold standard patient centered care, discussions regarding advance care planning are essential for patients with serious illnesses. In 2018, a new law was enacted in our state requiring documentation of code status conversations in the inpatient EMR for any code status other than “Full Code.” Prior to this law, many code orders were changed without documentation or adequate communication to incoming providers. Since there was little to nothing documented, parents were being asked to have the same conversation repeatedly and either starting to doubt their decisions or sen sing the lack of com...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Jessica Casas, Joy Hesselgrave, Amy Jeppesen, Leah Peters, Laura Loftis, Nick Ryan Magdoza Source Type: research

Impact of Combining a Code Status Order with Admission Orders for Patients Admitted Through the Emergency Department. (TH341D)
Some have argued that Emergency Physicians (EPs) lack the time, skills, and rapport to effectively engage patients in code status (CS) discussions. And some have claimed that EPs default to full treatment regardless of patient preference. However, identifying patients' code status preference prior to admission can expedite the alignment of treatment with patients' goals of care. In April 2017 we added a mandatory code status order (CSO) for all admissions requested by EPs. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Daniel Miller, J. Priyanka Vakkalanka, Morgan Swanson, Andrew Nugent, Timothy Thomsen, Yuya Hagiwara Source Type: research

State of the Science in Pediatric Palliative Care (TH351)
With the growth of Pediatric Palliative Care, it is essential for practitioners to find ways to stay current on the most recent literature. In the spirit of the State of the Science plenary, which is part of each Assembly, and the prior State of the Science in Pediatric Palliative Care, the presenters will endeavor to review the literature published since January 2019, which should inform the practice of Pediatric Palliative Care. This annual and highly regarded session includes an interdisciplinary team of co-presenters with representatives from medicine, nursing, social work, psychology, and chaplaincy and will look at t...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Katharine E. Brock, Toluwalase A. Ajayi, Kevin Madden, Sarah McCarthy, Maggie C. Root, Caitlin Scanlon, Daniel Webb Source Type: research

Experiences of LGBT Patients and Family Members with Hospice and Palliative Care (TH352)
The lesbian, gay, bisexual, and transgender (LGBT) community experiences discrimination and stigma in accessing health care and social services – including palliative, hospice, and long-term care. Health care providers may fail to recognize or address disparities in care. Providers and institutions may be uncomfortable with sexual orientation and gender identity and expression issues, and often don't inquire about these. Research shows th at LGBT patients fear being open about their identities, not receiving equal or safe treatment, and having their family of choice and designated surrogates disrespected or ignored b...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Cathy Berkman, Noelle Marie Javier, Andrew Lawton, Shail Maingi, Sean O'Mahoney, Gary Stein Source Type: research

Assembly Book Club: Discussion of the Book Just Medicine: A Cure for Racial Inequality in American Health Care (TH353)
Session leaders will be assigned to each table to start and facilitate discussion. This will help to ensure that each table is having a productive dialogue. Conversation-starting questions will be provided at each table and have been vetted by the Humanities and Spirituality SIG. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Chandana Banerjee Source Type: research

Leading with Compassion (TH354)
Palliative and hospice care are fundamentally compassion-centered practices. At the same time,  clinicians often face challenges to maintaining their compassionate centers in the face of complex patient/family dynamics and importantly, with each other in stressful care environments. This presentation will engage participants in self-reflection about personal leadership style and will provid e specific, actionable strategies to develop as a compassionate leader, to embed compassion practices in the workplace, and to support and drive change management to provide compassion-centered care. (Source: Journal...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Joanne Reifsnyder Source Type: research

AAHPM Leadership Forum: Ignite —More Paths to ‘Yes’ in Leadership Conversations (TH360)
AAHPM's Leadership and Career Development Committee and Leadership Forum is excited to bring an Ignite session to the concurrent platform. There are many nuanced skills in leadership. One of those skills is conversations to advocate for the needs of your program, your team, or yourself. While we in HPM pride ourselves in the art of difficult communication, somehow the communication skills that bring us success with patients fall flat in the board room. In this concurrent session, we will identify the most common strengths found in HPM leaders and the strategies in leadership conversations that capitalize on those strengths...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Kathleen Neuendorf, Tammie E. Quest, Christina Rowe Source Type: research

Meeting the Hospice and Palliative Care Registered Nurse Workforce Challenge: Hospice Nurse Residencies as a Case Study (TH362)
Hospice organizations in the United States continue to see dramatic growth in patients served annually, nearly doubling growth between 2004 and 2014. Palliative care services have also significantly increased across the country with now close to 30% of counties and 70% of hospitals across the United States offering palliative care. In order to respond to this growth and the rapidly aging population, hospice and palliative care organizations must maintain a vibrant hospice and palliative registered nurse workforce. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Susan Lysaght Hurley, Constance Dahlin, Nadia Soulouque Source Type: research

Artificial Intelligence, Machine Learning, and Digital Therapeutics in Palliative Care and Hospice: The Future of Compassionate Care or Rise of the Robots? (TH363)
Palliative care finds itself in a conundrum. Our field is rapidly growing, and yet in the coming decades, the need for palliative care and hospice will far outpace the number of specialist clinicians available to provide it. Hence, it is imperative that we develop novel care delivery models in the present to address the needs of our future patients. Digital therapeutics and artificial intelligence represent two innovative means to help extend the reach of palliative care and hospice. Digital therapeutics (DTx) represent an expanding field of evidence-based healthcare interventions that utilize everyday technology, such as ...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Mihir Kamdar, Joshua Lakin, Haipeng Zhang Source Type: research

Breaking Access and Distance Barriers: Using Innovative Modalities of Tele-Palliative Care (TH364)
Patients suffering from incurable and debilitating conditions are in crucial need of interprofessional palliative care services. Palliative care teams monitor, manage, and maintain such patients' performance status while improving symptoms and facilitating goals-of-care discussions. A growing workforce shortage in palliative care professionals as well as access issues in remote areas are significant barriers to patient-centered, serious illness care. Efforts to bring palliative care interprofessional expertise to patients in the community have proven successful in increasing early goals-of-care discussions, improving compl...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Sandra E. Sanchez-Reilly, Katharine L. Cheung, Kimberly Shea, Anjuli Vasquez Source Type: research

New Drugs and Drug News: The 411 and Implications for Palliative Care (TH365)
Up to 100 new drugs and dosage formulations are approved every year by the Food and Drug Administration (FDA). Some of these are new molecular entities, while others are new formulations, new indications, generic drug approvals, or labeling revisions. Even if a drug is a “new” molecular entity, it may not be “improved” over molecular entities already commercially available. In caring for patients with advanced illnesses, practitioners must make prudent drug therapy choices. Part of this decision-making process is a careful assessment of the burden-to-benefit ratio, including the financial burden of ...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Mary Lynn McPherson Source Type: research

To Forgo or Not to Forgo: Nutrition and Hydration in a Child Perceived to Be Suffering Inordinately by Parents (TH366)
The American Academy of Pediatrics (AAP) has deemed forgoing medically administered nutrition and hydration (MANH) for pediatric patients ethically acceptable in selected circumstances, when there is consensus that the provision of fluids and nutrition do not confer a net benefit to the child. The practice, for instance, might be permissible for a child who permanently lacks awareness and ability to interact with the environment or a child in the dying process for whom nutrition/hydration simply may prolong and add morbidity. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Sara Taub, Robert C. Macauley, Fernando F. Serna, Douglas S. Diekema Source Type: research

Lessons from a Therapist's Chair: Optimizing Palliative Communication Through Psychotherapy Best Practices and Skills (TH367)
The use of communication as a therapeutic tool is an essential piece of both palliative medicine and psychotherapy. The approach with which communication is conceptualized and taught, however, is markedly different between the two fields. In hospice and palliative medicine training, we often teach generalized communication tools and strategies. By contrast, communication training in the psychotherapy setting hinges upon the concept of case formulation. A case formulation is a conceptualization of the unique core psychological issue a patient or family may be struggling with. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Danielle M. Chammas, Keri O. Brenner Source Type: research

Not Lost in Translation: Ensuring LGBTQ+ Inclusion in the Palliative and End-of-Life Clinical-Translational Science Spectrum (TH368)
Sexual and gender minority groups living in the United States experience disproportionate rates of serious and life-limiting illness compared with non-minority counterparts. While LGBTQ+ patients and caregivers share similar serious illness and end-of-life (EOL) coping and support needs with non-minorities, they also face additional burdens and uncertainties: provider bias and discrimination, identity and relationship disclosure, acknowledgment of chosen family, and access to safe and affirming care. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Kristin G. Cloyes, Kimberly D. Acquaviva, Carey B. Candrian, Kate L.M. Hinrichs, Tarynn M. Witten Source Type: research

Addressing Global Health Disparities with the Development of a Palliative Care Exchange Program (TH369)
Even countries with robust palliative care programs struggle to offer services to every terminal patient. It's easy to imagine how countries without a substantial program are profoundly challenged. The 2015 Quality of Death Index found that 0.6% of Ecuadorians who qualified for palliative care services actually received them, compared to 52% of Americans. The Index credits these health disparities to limited education, scarce availability of opioids, weak national policy, sub-optimal healthcare spending, and limited community engagement. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Linda Quinlin, Wendy G. Schmitz, David Small Source Type: research

Keeping It Down: A Case-Based Approach to Managing Pediatric Nausea and Vomiting (TH305)
Nausea and vomiting are significant distressing symptoms among children receiving palliative or hospice care due to a variety of potential causes. In many situations children are unable to adequately express their specific discomfort. Most antiemetics block one or more of the receptors involved in the pathophysiology of nausea and vomiting; however, no antiemetic blocks all possible receptors. Unfortunately, the first anti-emetic chosen is often inadequate to manage the patient's nausea and vomiting. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Melissa Hunt, Lisa Humphrey Source Type: research

Decreasing Frequency of Opioid Prescribing on Discharge to Hospice Care (TH370B)
Practices to prevent potential misuse of opioid medications may have unintended prescribing effects for patients with serious illness or at end-of-life. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Jon Furuno, Brie Noble, Erik Fromme, Daniel Hartung, Jennifer Tjia, Mary Lynn McPherson, Joan Teno Tags: Paper Sessions Source Type: research

Cultural Values, Preferences and Goals and of End of Life Care of Family Members of Patients with Life-Limiting Illness in Kumasi, Ghana: A Community-Based Study (TH370C)
Understanding patient and family cultural values, preferences and goals of care in patients with life-threatening illness is the first step in ensuring the provision of goal-concordant care. Palliative care (PC) programs are at their infancy in Ghana, with three PC physicians and four nurses at Komfo Anoyke Teaching Hospital (KATH) in Kumasi, a city of 1.5m people. Ghana has a collectivist culture in which families and communities, not the individual, is central. Little is known about End of Life (EoL) care values, care preferences and goals of care. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Anita Eseenam Agbeko, Ronit Elk, Michael Owusu-Ansah Source Type: research

African American Communities Speak to Palliative Care Clinicians: Evaluation of an Innovative Community-Developed Communication Skills Training Program (TH370D)
Lack of understanding of cultural differences may significantly compromise care at end-of-life (EOL) for minority patients. Cultural competence among clinicians increases the likelihood of providing quality care, leads to higher patient satisfaction, and reduces health disparities. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Ronit Elk, Michael Barnett, Ashley Nichols, Moneka Thompson Source Type: research

Finding the Strength Within: Increasing Spiritual Screening for Inpatient Consults with a Transdisciplinary Team (TH371A)
The American Academy of Hospice and Palliative Medicine (AAHPM), The National Quality Forum (NQF), and the National Consensus Project (NCP) identify spiritual screening as a core element and quality metric for palliative care (PC) consults. This recommendation is based on research showing that patients want their doctors to discuss spirituality and that these discussions change patients' healthcare decisions. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Grant Smith, Joshua Biddle, Olivia Gamboa, Ashwin Kotwal, Ramy Salah, Naomi Saks, Daniel Eison, Giovanni Elia Source Type: research

Improving POLST Utilization for Seriously Ill Patients at a Tertiary Care, Academic Oncologic Hospital (TH371B)
Oncologic patients go through multiple heath care transitions at the end of life. Often, goals of care discussions are initiated but communication of the conversation across settings is challenging. The Physician Orders for Life Sustaining Treatment (POLST) offers the means to successfully communicate patient's preferences across care settings. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Mamta Bhatnagar, Scott Freeman, Dio Kavalieratos, Zachariah Hoydich, Robert Arnold Source Type: research

COMFORTTMSM in the ICU: Advancing ICU Nurses' Role in Primary Palliative Care (TH371C)
Cancer patients are being treated with greater frequency in ICUs, where nurses (RNs) often provide the most consistent clinical presence. Critically ill patients and their families hope for recovery, but may encounter uncertainty, complications, and poor outcomes. Such patients benefit from palliative care (PC) to assist with clarification of goals of care and alignment of treatment choices to wishes. Opportunity exists to engage ICU RNs as primary PC team members to help explore patient and family hopes, promote understanding, and assist with decision-making. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Sarah Thirlwell, Angela Sandberg, Carolin Isler, Tony Winter, Barbara Lubrano di Ciccone, Diane Portman Source Type: research

Is the Fear of Respiratory Depression with Opioids Justified? (TH371D)
Most opioids follow first-order kinetics. Maximum pain relief and risk of side-effects for a given dose occurs at maximum plasma concentration (Cmax). For most intravenous (IV) opioids, the time to Cmax (Tmax) in the pharmacokinetic literature ranges from 6-15 minutes. To ensure safety, we advocate dosing most IV opioids no more frequently than every 15 minutes (Q15min) as needed (PRN). (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Jessica Geiger-Hayes, Britni Lookabaugh, Frank Ferris Source Type: research

Improving Medical Student Training in Palliative Care: A Statewide Collaborative (FR400)
Education in the basic principles of palliative care is inconsistent across U.S. medical schools, despite the development of national competencies in palliative care for medical students. In Massachusetts, we have created an unprecedented collaborative of all four medical schools in the state to improve palliative care education, with an initial focus on serious illness communication. Our goal is to ensure all students acquire the foundational knowledge, skills, and inspiration to care for seriously ill patients, with commitment to lifelong learning and deliberate practice. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Jennifer Reidy, Melissa Fischer, Suzanne Mitchell, Kristen G. Schaefer, Jocelyn Streid, Isabella N. Stumpf, April Zehm Source Type: research

Surgical and Perioperative Palliative Care: Updates from 2019 (FR401)
Seriously ill patients with surgical problems face significant symptom burden, prognostic uncertainty, and complex decisions, and therefore warrant palliative care that is responsive to their surgical and perioperative needs. The core principles of surgery and anesthesiology closely mirror those of palliative care, and the intersection between them is increasingly reflected in the annual volume of emerging research. Examples include communication skills training for surgical providers, embedded inpatient and outpatient surgical palliative care programs, and preoperative advance care planning interventions. (Source: Journal...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Ana Berlin, Christopher D. Woodrell, Rebecca A. Aslakson, Miriam Arnheim Source Type: research

Starting from Scratch: A Master Class in the Management of Refractory Systemic Pruritus (FR402)
Pruritus, or itch, is not the most common symptom seen in palliative care but can be very distressing and adversely affect quality of life. Described as an unpleasant sensation of the skin provoking the desire to scratch or rub, pruritus remains one of the most puzzling symptoms in advanced illness. Despite its rarity, there are a multitude of causes and equally greater number of therapies. Causes of pruritus include skin-specific and systemic causes. Whatever the origin, it has been proposed that itch is akin to pain, as both are thought to be transmitted from skin to central nervous system (CNS) through nociceptive small...
Source: Journal of Pain and Symptom Management - January 25, 2020 Category: Palliative Care Authors: Mary L. McPherson, Mellar P. Davis, Kathryn A. Walker, Ambereen K. Mehta, Eric Prommer Source Type: research