Introduction to a Novel Palliative Care Intervention for Family Caregivers of Children and Adolescents Living with Rare Diseases (TH308)
In the U.S. a rare disease is defined as a condition affecting fewer than 200,000 persons. Pediatric patients with rare diseases experience high mortality. Pediatric advance care planning (pACP), a key component of pediatric palliative care, has been proven to improve communication and spiritual and emotional well-being for children with cancer and HIV and their families. For providers, pACP, involves preparation and skill development to facilitate discussions about goals of care and future medical care choices. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Sarah Friebert, Karen Fratantoni, Lori Wiener, Jennifer Needle, Jamie Fraser, Jessica Gaines, Melissa Alderfer, Maureen Lyon Source Type: research

Tear Down the Wall and Build a Bridge: Understanding Latino Cultural and Spiritual Values to Enhance the Delivery of Palliative Care in the Latino Population (TH309)
The Latino population is currently the largest minority group in the United States and is expected to double by the year 2050. The goal of palliative care is to alleviate physical, psychological, and spiritual pain and suffering. Health systems have an ethical responsibility to provide this service; however, Latinos face significant health disparities and are less likely to receive palliative care in comparison to non-Latino whites. A narrative literature review was conducted to identify unique characteristics, other than language, that contribute to this inequality. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Sandra Alvarez, Sara Munoz-Blanco, Mayra Sanchez, Perla Macip, Jose Fernandez, Lissa Berroa-Garcia Source Type: research

Emergency Department Admission Triggers Sustainably Generate High-Value Palliative Care Consultations (TH310A)
Capturing admitted patients for palliative care (PC) consultation earlier in their hospital course helps achieve better alignment with the quadruple aim. Emergency department (ED) admission triggers have been proposed to facilitate earlier engagement, however their impact is not adequately studied. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: David Wang, Ryan Heidt Source Type: research

Opioid Risk Stratification in an Outpatient Palliative Care Clinic (TH310B)
Approximately a quarter of patients in academic cancer centers are at high risk for opioid abuse.1,2 At Dana-Farber Cancer Institute, we sought to create a high-reliability process within our palliative care clinic that risk stratifies our patients for opioid abuse using the Opioid Risk Tool (ORT). (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Isaac Chua Source Type: research

Assessing End-of-Life Care Quality Across Settings in an Integrated Healthcare Delivery System (TH310C)
Kaiser Permanente has implemented programs aiming to improve care at the end of life. To better understand patient care experience, we adapted existing instruments to develop and test a survey assessing quality of end-of-life care (EOLC) across all care settings. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Margaret Wang, Daniel Johnson, Helene Martel, David Glass, Jim Bellows Source Type: research

Successes and Challenges in One Organization ’s Process of Implementing Multiple System-Wide Primary Palliative Care Quality Improvement Projects (TH310D)
The palliative needs of seriously ill patients will always overwhelm the capacity of palliative care (PC) specialists. As such, a central mission of PC is to develop and disseminate primary PC interventions to relieve the reliance on our already taxed workforce. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Dio Kavalieratos, Judith Resick, Megan Glance, Zachariah Hoydich, Scott Freeman, Robert Arnold Source Type: research

Getting the Results that Matter: Addressing Quality in Hospice and Palliative Care (101)
This session will provide an overview of how quality measurement is evolving to address the shift to value, tools and resources available to providers to focus on quality care at the bedside, and opportunities to provide quality hospice and palliative care. The session will also discuss how to involve patients and families more fully in quality improvement activities. Panelists Martha Twaddle, MD HMDC FACP FAAHPM, and Betty Ferrell, MA CHPN FAAN FPCN, and will join moderator Amy Melnick, MPA, executive director of the National Coalition for Hospice and Palliative Care in a discussion with Dr. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Shantanu Agrawal Source Type: research

Nurses as Sources in Health News: Developing Media Competencies (TH311)
Nurses continue to be left out of dominant media narratives. A recent study, The Woodhull Study Revisited: Nurses Representation in Health News Stories, which replicated the original research published in 1998, reported on nurses' representation in health news. The study found that, although nurses are the largest group of health professionals, they are cited as sources in only 2% of articles published by newspapers, news weeklies and trade publications. A companion study of health journalists provided some explanations, including newsrooms ’ biases about women and nurses, a lack of understanding of what nurses do, a...
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Barbara Glickstein Source Type: research

What ’s the Deal with Blood Cancers? Navigating a New Frontier in Palliative Cancer Care (TH313)
Blood cancers account for over 55,000 annual U.S. cancer deaths, a number higher than the 40,000 expected from breast cancer, yet they receive comparatively little attention in discussions about palliative cancer care. While concurrent palliative care is heralded as a standard for patients with advanced solid tumors, those with blood cancers are less likely to use palliative care services, and are more likely to receive aggressive care at end of life, chemotherapy in their last 14 days, and to die in the hospital. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Thomas LeBlanc, Areej El-Jawahri, Eric Roeland, Jason Webb Source Type: research

Interdisciplinary Team Training at the Art Museum: Breaking Down Hierarchy and Building Resilience (TH314)
Burnout among palliative care practitioners can lead to poor performance and attrition. Museum-based education (MBE) is an innovative strategy that aims to reduce burnout by enhancing perception and empathy, flattening perceived hierarchy, and strengthening interprofessional teams. The goal of this session is to provide palliative care educators with evidence and approaches to use art as a strategy to promote team building and enhance clinically relevant observation and reflective competencies. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Ali John Zarrabi, Gordon Wood, Paul DeSandre, Barbara Reville, Jane deLima Thomas, Laura Morrison, Marsha Joselow, Bryan Brooks Source Type: research

Partnerships in Dialysis and Palliative Care & Hospice: ‘Innovative Models for End-of-Life Care for End-Stage Renal Disease Patients’ (TH315)
As multiple different studies and surveys continue to illustrate, palliative and hospice medicine has failed to have an appropriate impact on the quality of life for the end-stage renal disease (ESRD) population. People with Chronic Kidney Disease (CKD) remain less likely to die at home, spend more time in the hospital and at higher costs in the last 3 months of life. (Kerr M et al, NDT, 2016). (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Keith Lagnese, Jane Schell Source Type: research

No Patient Left Behind: Integrating Addiction Treatment with Buprenorphine into Your Outpatient Palliative Care Practice (TH316)
Patients with serious illness are not exempt from opioid use disorders raging through our communities. Outpatient palliative care clinicians are increasingly challenged to manage patients with both serious illness and active opioid use disorders. In this population, the use of opioids for pain is particularly complicated, and we struggle to provide safe, rational, and appropriate care. Buprenorphine (brand names include Suboxone, Zubsolv, and Bunavail) is a partial opioid agonist that can be used for maintenance treatment of opioid use disorders in the outpatient setting. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Julie Childers, Robert Horowitz, Kathleen Broglio, William Jangro Source Type: research

Psychedelic-Assisted Therapies —Palliative Care Clinical & Research Priorities (TH317)
People with advanced medical illness often experience anxiety, feelings of hopelessness and loss of meaning and value of life. Some conclude that their life is not worth living and desire to hasten their deaths. Currently available treatments for depression, anxiety, and spiritual distress often fail to alleviate suffering among people who are seriously ill. Research involving psilocybin and related compounds have shown significant benefit suggesting that this class of drugs may offer therapeutic potential in treating persistent, non-physical suffering. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Ira Byock, Anthony Bossis, Craig Blinderman Source Type: research

Using PCRC Resources: Patient and Caregiver Assessment Tools for Quality Improvement and Research (TH318)
Palliative care assessment is holistic, covering a broad array of domains important to comfort, quality of life and supportive needs for patients with serious illness and their caregivers. Clinical assessments may be enhanced with validated measurement instruments, yet finding those that are ready for application in clinical quality improvement or in a research project is a “needle in a haystack” problem. Session attendees will learn: 1) to appraise clinical assessment tools using freely available Palliative Care Research Cooperative resources, and 2) to apply selected clinical assessment tools for palliative c...
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Laura Hanson, Antonia Bennett, Betty Ferrell, Jean Kutner Source Type: research

A Quantifiable Spiritual Assessment Model in Palliative Care: Putting Two and Two Together for Improved Spiritual Care (TH320)
Spiritual care is a well-established component of quality palliative care (PC) with board-certified chaplains considered the spiritual care specialist on the PC team. Spiritual assessment is a key activity performed by the chaplain; however, there is no consensus on best practices for spiritual assessment in PC. Currently, most chaplains use locally-developed, narrative models for spiritual assessment that were designed to be used within all clinical contexts. The limitations of these one-size-fits-all narrative models for spiritual assessment are becoming increasingly apparent in clinical practice. (Source: Journal of Pai...
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: George Fitchett, Christine Hoffmeyer, Dirk Labuschagne, Aoife Lee, Anna Lee Hisey Pierson, Karen Pugliese, Stacie Levine Source Type: research

Integrating the ENABLE Early Palliative Care Approach in Community Cancer Centers: Results of an Implementation Trial (TH321A)
Despite national guidelines recommending early palliative care (EPC) for individuals newly-diagnosed with metastatic cancer, it is rarely available in rural community cancer centers serving underserved populations. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Marie Bakitas, James Dionne-Odom, Maria Pisu, Andres Azuero, Dilip Babu, Lucy Gansauer, James Bearden, Keith Swetz, Leigh Minchew, Margaret Sullivan, Rachel Wells, Richard Taylor, Yasemin Turkman, Thomas Ramsey, Lisa Zubkoff Source Type: research

Factors Associated with Community Residence at the End of Life: A Population-Based Study (TH321B)
Residence in the community in the last phase of life has increased substantially in the last two decades and encompasses a range of different types of residential care environments. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Melissa Aldridge, Karen McKendrick, Jennifer Reckrey Source Type: research

Community-Based Conversations About Advance Care Planning Using Patient Navigators (TH321C)
Widespread community engagement in advance care planning (ACP) is achievable in community settings through multi-faceted approaches, as supported by implementation literature. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Regina Fink, Danielle Kline, F. Amos Bailey, Daniel Handel, Hillary Lum, Stacy Fischer Source Type: research

Is Socioeconomic Status a Fundamental Cause of Racial Differences in End-of-Life Care Use? (TH321D)
Racial differences in end-of-life care (EOLC) are well documented. De-medicalized care is now the innovation at EOL. Sociological theories suggests those with more education should be the first to use palliative care/less aggressive care and this will lead to inequities in EOLC. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Sarah Cross Source Type: research

Association of Timing and Type of Advance Care Planning Documentation on End-Of-Life Care for Patients with Serious Illness (TH322A)
It is unclear how the timing of advance care planning (ACP) documentation and type of documentation influence the intensity of end-of-life care for patients with chronic illness. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Seelwan Sathitratanacheewin Source Type: research

What Do Adolescents Want? Values, Goals, and Beliefs of Teens with Cancer (TH322B)
The National Cancer Institute ’s (NCI) 2016 recommendations advise parents to have open and honest communication about cancer with their children. Parents are interested in their adolescents-patient’s voice. Best timing and strategies to structure and facilitate this communication is unknown. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Sarah Friebert, Jessica Gaines, Jennifer Needle, Justin Baker, Yao Cheng, Maureen Lyon Source Type: research

Differences by Race, Religion, and Mental Health in Preferences for Life-Prolonging Treatment in Adverse Health States: Results from a National Sample of Medicare Beneficiaries (TH322C)
Goal-concordant care aligns patients' preferences with their medical treatments and is important for patients with serious illness, whose treatments may hasten death or prolong suffering. We lack population-level data on patient preferences, which can help prepare clinicians for advance care planning or goals of care discussions. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Justin Sanders, Anna Berrier, Leonce Nshuti, Charlotta Lindvall, James Tulsky 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 fiel d; and the unique challenges facing patients and providers. There will be time allotted 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 m edicin...
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Sunilkumar Mupliyath Madhavan, Spandana Rayala, Sayed Ali, Martin Mindeguia Source Type: research

PC-FACS —Year in Review (TH331)
PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care), 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 twelfth 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 otherwis...
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Mellar Davis, Robert Arnold Source Type: research

My Life Matters! Honoring the Voice of the Intellectually and Developmentally Disabled and Other Marginalized Patients (TH332)
Our country is currently engaged in vital conversations about stereotyping and implicit bias. In attempts to root out our collective prejudices, we now appreciate the necessity to talk about the underlying thoughts, beliefs, and values that inform our everyday actions and behaviors. Though many of us are drawn to the work of hospice and palliative care to practice compassion and advocate for patients ’ values, we may not realize how implicit bias influences our practice. The Intellectually and Developmentally Disabled (IDD) population has a history of social injustice and wrongful medical treatment that accentuates t...
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Heather Mikes, Lori Eckel Source Type: research

Walking the Tightrope: Palliative Care and Organ Donation (TH333)
Palliative Care teams often assist patients and families in the full range of end-of-life decision-making. Organ donation is generally omitted from these conversations unless explicitly brought up by the family. It is often through organ donation decision-making that one can turn an otherwise tragic situation into one of meaning and legacy. Palliative Care teams offer a unique opportunity to assure holistic end-of-life care decision-making, including organ donation, regardless of the clinical circumstance. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Paul DeSandre, Joanne Kuntz, Leslie Hunter-Johnson, Jason Lesandrini, Myrick Shinall Source Type: research

Yes, and …Lessons Borrowed from Improvisational Theater to Teach Primary Palliative Medicine Skills (TH334)
Improvisation is a well-defined technique in the theater arts and can have direct application to patient care. While the word improvisation (improve) implies spontaneity and impulsivity, theatrical improvisation consists of an underlying skill set that allows actors to quickly build trust and communication with each another while simultaneously building the narrative of the scene. Through an exploration of themes and interactive skill building, this workshop will apply the framework of improv theater to teaching primary palliative communication skills, with a specific emphasis on self-awareness and listening to engage in s...
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Gitanjli Arora, Isaac Chua, Rachel Rusch Source Type: research

The XYZs of Billing and Clinical Revenue: Going Way Beyond the ABC ’s (TH335)
Once niche services that flew well under the fiscal radar, many Palliative Care (PC) programs now have 7-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 and close yawning budgetary gaps. Most PC providers have become accustomed to basic billing and coding principles, but significant revenue opportunities exist among rapidly expanding breadth of professional fee codes, even for seasoned clinicians and program leaders. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Christopher Jones, Phillip Rodgers Source Type: research

Routinizing Goals of Care Conversations —Improving Patient Outcomes and Satisfaction (TH336)
The Institute for Human Caring (Institute) was founded in 2014 and charged with advancing models of goal-aligned care across the Providence St. Joseph Health system. The Institute has focused on operationalizing a scalable pilot to demonstrate the feasibility of delivering high quality goal-aligned care, while also attending to patients ’ emotional, spiritual, interpersonal, social and mental wellbeing. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Matthew Gonzales, Yvonne Corbeil, Nusha Safabakhsh, Jennifer Kozakowski, Ira Byock Source Type: research

The –ibs, –abs and Beyond—Immunotherapies for Pediatric Cancer Treatment and What They Mean for Pain and Symptom Management and Patient Prognosis (TH337)
Use of Immunotherapy for pediatric cancer treatment is rapidly increasing. Medications such as blinatumomab, dinutuxumab, tisagenleclucel and others are dramatically changing the field of pediatric Oncology, and it is imperative that Pediatric Palliative Care (PPC) providers understand pain and symptom management needs as well as changes in prognosis for patients undergoing intensive immunotherapy. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Lisa Wray, Elissa Miller, Shefali Parikh, Laura Rose Musheno Source Type: research

GeriPal Podcast Live! Podcasting in Hospice and Palliative Care (TH338)
One in four Americans listen to podcasts on at least a monthly basis. Apple features more than 500,000 active podcasts in more than 100 languages. Despite the growing importance of this medium from a clinical, research, and educational perspective, there is a dearth of content on hospice and palliative care. This session aims to change that by giving tools to hospice and palliative care practitioners to develop and disseminate their own podcasts. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Alexander Smith, Eric Widera Source Type: research

“Too Good to be True? No!” Exploring Self, Incorporating a Quick and Easy Reflective Writing Exercise that Anyone Can Do (TH339)
Narrative medicine is defined as clinical practice strengthened by the ability to “recognize, absorb, interpret, and honor the stories of self and other.”[1] In the form of reflective writing, it has been shown to help healthcare providers improve critical thinking, understanding of self, cultural humility, and psychological resilience, as well as to better connect with each other, their patients, and their families.[2,3,4] But reflective writing can feel intimidating or overwhelming to clinicians who have never had any formal experience or training in writing or the reflective practices. (Source: Journal of Pa...
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Kristin Forner, Lucille Marchand, Cory Ingram Source Type: research

Estimating Costs Across Hospice Episodes (TH340A)
Routine home care (RHC) payments under the Medicare Hospice Benefit are intended to align with average costs of providing hospice care. Little is known about variation in costs across hospice enrollment periods. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Sasha Brodsky, Thomas Christian, Michael Plotzke Source Type: research

Comparative Study of Quality of End of Life Between LGBTQ and Non-LGBTQ Hospice Patients (TH340B)
While there is evidence that lesbian, gay, bisexual, transgender, and queer (LGBTQ) people experience health inequities when compared to the non-LGBTQ population, this phenomenon has not been adequately explored in hospice care. Understanding whether disparities exist at the end of life may assist health care providers in supporting LGBTQ patients and family members. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Stephanie Kemery Source Type: research

More Professional Staff Visits in the Last Days of Life Are Associated with Better Hospice Care Experiences (TH340C)
As a person dies, symptoms increase, and family caregivers need both practical and emotional support. Previous research has found striking variation in professional staff visits in the last two days of life, but the association between these visits and patient and family experiences of hospice care is unknown. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Joan Teno, Rebecca Anhang Price, Layla Parast, Ann Haas, Marc Elliott Source Type: research

Pediatric Hospice and Palliative Care: A State-Wide Needs Assessment (TH340D)
As awareness increases regarding the benefits of palliative care services for children, additional studies will be needed to examine the scope of pediatric palliative care (PPC) and hospice services available, gaps in care, and opportunities for improvement. In Georgia, the Children ’s Healthcare of Atlanta’s Palliative Care Team, Georgia Hospice and Palliative Care Organization, and Rollins School of Public Health at Emory University collaborated to conduct a statewide community needs assessment (CNA) of pediatric palliative care (PPC) and hospice resources. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Khaliah Johnson, Katharine Brock Source Type: research

The Construct of Financial Toxicity and Association with Quality of Life in Poor Populations (TH341A)
There is growing recognition that patient reported outcome (PRO) measures complement traditional biomedical measures in conveying important information for cancer care decision making. With increasing cancer care costs understanding how the cost of medical care affects patient outcomes, particularly for patients in vulnerable populations, is imperative. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Farya Phillips, Elizabeth Kvale, Barbara Jones, Jennifer Currin-Mcculloch, Anastasiya Byelousova Source Type: research

Caregiver-Reported Concerns and Challenges with Medications: Findings from Structured Interviews with Primary Caregivers of Patients with Cancer (TH341B)
For patients with cancer, family caregiver-administrated medication is often essential for high-quality care. While previous studies have focused primarily on analgesics, other medication-related issues may pose challenges for caregivers. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Cara McDermott, Ruth Engelberg, J. Randall Curtis, Cossette Woo, Helene Starks Source Type: research

Engaging Primary Care Physicians: Lessons Learned Seeking Buy-In and Patient Referrals for a Home-Based Palliative Care Program (TH341D)
Home-based palliative care (HBPC) is an important model originally developed for managed care. It surpasses the continuity and access barriers plaguing inpatient palliative care by providing palliative care in patients ’ homes in collaboration with primary care. Repeated studies have demonstrated that HBPC can improve patient outcomes while decreasing costs of care, however, replication of this model in fee-for-service has been stymied by a lack of reimbursement structure. To overcome this barrier, a large Calif ornia-based health insurer (Blue Shield of California) has begun to reimburse contracting medical group pr...
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Alexis Coulourides Kogan, Michael Kersten, Torrie Fields Source Type: research

State of the Science in Pediatric Palliative Care Forum (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, the presenters will endeavor to review the literature published since 2017 which should inform the practice of Pediatric Palliative Care. Our interdisciplinary team of co-presenters includes representatives from medicine, nursing, social work and chaplaincy and will look at the academic literature relevant to the multiple disciplines represented. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Katharine Brock, Christopher Collura, Margaret Root, Caitlin Scanlon, Megan Thorvilson, Pat Weikart Source Type: research

Gender Equity and Career Advancement: Implications for Hospice and Palliative Medicine (TH352)
Over the last 25 years, the proportion of physicians who are women has doubled from 17% to 36%. Furthermore, 46% of physicians in training and over half of U.S. medical students are women. While this significant increase in gender diversity has rapidly changed what the physician work force “looks like”, there is a significant and persistent gap in the experience of female physicians. Compared to their male counterparts, studies show that female physicians are paid less across specialties and are disproportionately underrepresented in leadership positons despite their increasing re presentation in the physician ...
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Kimberly S. Johnson, Sean O ’Mahony, Helen Chen, Susan Hingle, Darilyn Moyer Source Type: research

Finding Your Highest and Best Use as a Palliative Nursing Leader (TH354)
Dr. Nessa Coyle found her highest and best use as one of the founders of palliative care in the United States, developing one of the first supportive care programs in 1981. Throughout her career she championed interdisciplinary palliative care practice and research. This presentation will honor Dr. Coyle ’s legacy by discussing how each of us in the successive generations of palliative care clinicians, scholars, administrators, and supporters can find our highest and best use from the “bedside” to the C-suite to inspire the field and move it forward. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Abraham A. Brody Source Type: research

Clinical Practice Guidelines for Quality Palliative Care: The 4th Edition of the NCP Guidelines (TH360)
Palliative care has expanded into new settings and is being offered by diverse types of organizations, such as health systems, office practices, cancer centers, dialysis units, home health agencies, hospices, long-term care providers and more. Driven by this tremendous innovation within the field, the National Consensus Project (NCP) Clinical Practice Guidelines for Quality Palliative Care were revised and the 4th edition was published fall 2018. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Gwynn Sullivan, Betty Ferrell, Martha Twaddle Source Type: research

Drilling It Down: Designing Workshops to Practice Generalist Palliative Care Skills (TH361)
Instructors of athletes, dancers, and musicians have been perfecting the art of practice for years, developing efficient ways to improve skills. Research has shown that the most effective forms of practice always include learner concentration on a specific task, feedback from teachers, and learner introspection. One example is a drill. The goal of drill based practice is to transfer key skills from working memory to long term memory, moving them from being consciously controlled to automatic. Drills differ from other forms of practice because they concentrate on isolated skills and control for other variables, often distor...
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Stephen Berns, Caroline Hurd, Lindsay Dow, Nicole Loving, Laura Morrison Source Type: research

Opportunities and Implications of Payment Reform for Serious Illness Care (TH362)
Serious illness care faces long-standing challenges that are consequences of the fee-for-service reimbursement climate. The hospice care benefit is financially siloed, which clinically has resulted in isolation of hospice care from the rest of the care continuum. This lack of integration has contributed to substantial variation in how hospice care is utilized. Similarly, team-based palliative care is largely regarded as financially unsustainable under a fee-for-service model, despite the abundance of evidence showing palliative care ’s positive impact on patient experience and potential averted downstream utilization...
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Julia Driessen, Turner West, Phillip Rodgers Source Type: research

“I Am Barely Breathing”: Experiences and Outcomes of an Integrated Palliative Care-Pulmonary Clinic Utilizing an Opioid and Benzodiazepine Review Board for Safety (TH363)
Patients with advanced pulmonary disease including COPD report a poor quality of life. These patients also live with a great amount of prognostic uncertainty. Symptoms include dyspnea, pain, fatigue, and mood changes. Patients note changing and diminishing functional status and quality of life. Often, conversations about goals of care are not pursued early. Literature exists to support the treatment of subjective dyspnea in advanced COPD with opioids, however, studies are small and limited. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Lara Skarf, Sohera Syeda, Zachary Sager, Elizabeth Bowers, Marilyn Moy, Tekikil Mekuria, Barbara Hayes, Marina Khait Source Type: research

Image-Guided Palliative Care (TH364)
Image-guided palliative care is an underused therapy that can provide pain and symptom relief. These treatments can be provided by any physician with access to quality ultrasound, fluoroscopy, and computed tomography (CT) equipment. However, the efficacies and risks of the therapies may be different based on the technique and equipment used for the image-guided treatment and the timing of these treatments. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Jay Requarth Source Type: research

The Untold Story of the Opioid Crisis: An Interdisciplinary Approach to Patients with Life-Limiting Complications of Opioid Addiction (TH365)
According to the CDC, in 2016, 62,632 Americans died from drug overdose, with 66% of these deaths related to opioid use. Even with the media's increased attention to the opioid crisis, the stories of patients with recurrent medical complications of addiction remain untold. Medically, these patients are at high risk for recurrent, life-threatening infections, such as endocarditis. Potential survival may entail multiple major surgeries. Surgeons may be reluctant to provide these surgeries, and when surgery is provided, patients suffer post-operative pain that is challenging to control because of patients' opioid tolerance, a...
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Britni Lookabaugh, Jessica Geiger-Hayes, Jill Yahner, Wendy Ungar, Alan Murphy Source Type: research

“It Can’t Be the Dialysis that Kills the Child…” Partnering Pediatric Palliative Care with Care for Children with End-Stage Renal Disease (TH366)
As chronic kidney disease progresses to end-stage renal disease (ESRD), important discussions regarding when and if to initiate dialysis occur. ESRD affects more than 660,000 Americans, less than 10,000 (1.5%) of those are pediatric patients whose time on dialysis is typically meant as a bridge to transplant. In rare circumstances, comorbidities, such as multiorgan failure, progression of other life-threating medical conditions, congenital anomalies, and size restrictions limit pediatric candidates ’ access to transplant. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Melissa Meyers, Christine Breen, Joan Chrastek, Lawrence Copelovitch, Gwenn Laragione, Shefali Parikh, Rachael Stover-Haney, Naomi Goloff Source Type: research

Evaluating Quality of Pain Treatment Among the Seriously-Ill Populations (TH367)
Quality measurement for palliative care is limited by the “denominator problem,” or the inability to identify distinct populations of patients with serious illness in large health data sources, thus limiting the potential for broad system-based measurement of quality. Using claims and clinical data in the OptumLabs Data Warehouse, our goal was to ident ify seriously ill populations and evaluate the feasibility of assessing a pain-related quality measure in these populations. (Source: Journal of Pain and Symptom Management)
Source: Journal of Pain and Symptom Management - January 23, 2019 Category: Palliative Care Authors: Amy Kelley, Laura Hanson, Christine Ritchie, Katherine Ast Source Type: research