Abstracts from Center to Advance Palliative Care National Seminar Palliative Care Everywhere: Bridging the Gaps November 12-14, 2015 San Antonio, TX.

Abstract

Journal of Palliative MedicineVol. 19, No. 5 AbstractsFree AccessAbstracts from Center to Advance Palliative Care National Seminar Palliative Care Everywhere: Bridging the Gaps November 12–14, 2015 San Antonio, TXPublished Online:3 May 2016https://doi.org/10.1089/jpm.2016.0088AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail The topic areas for abstract submission include:Palliative Care Delivery/Operations• Innovative and emerging community-based palliative care models (e.g., home/office/clinic/long-term care)• Innovative hospital-based palliative care models• Integration of palliative care services in cancer centers/dialysis centers, and other special care units• Approaches to palliative care delivery in specific hospital settings (e.g., ICU, ED)• Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty) or in specific settings (ICU, ED)• Innovative pediatric palliative care programs including combined adult/pediatric models• Integrating palliative care services (e.g., across a health system/patient-centered medical home/assisted living/nursing homes)• Successful development of pharmacy roles on a palliative care team• Implementation of standardized interventions such as checklists and screening tools• Successful approaches to conducting an effective needs assessmentPalliative Care Teams• Staffing the interdisciplinary team including staffing benchmarks and maximizing the roles of social workers/chaplains/nursing and medicine• How teams work together to maximize team health and avoid burnout• Demonstrating clinical and financial outcomes for team rolesCommunication• Communication best practices (e.g., teaching goals of care conversations/advance care planning/family meetings)• Implementation of POLST/MOLSTEducation• Methods of training in primary/generalist palliative care• Examples of primary palliative care education approaches to address the workforce shortage• Targeting Education: Pain management and communication skillsData and Outcomes• Using technology to improve efficiency and outcomes• Data demonstrating depth of palliative care integration in ACO/PCMH/bundling and other risk-bearing health care delivery frameworks• Successful use of metrics in community or hospital settingsFinancing and Payer Collaborations• Successful payer/provider collaborations and partnerships• Financing/benefit and payment modelsCoalition and Advocacy• Regional and National Palliative Care Initiatives (e.g., statewide coalitions/political advocacy)Other1. The FM Effect on EoL Decisions for AAs by Medical SurrogatesAbington Hospital, Jefferson HealthAbington, PATeam/Contact Information:Maria Doll Shaw, DNPClinical Nurse Manager, Palliative Care ServiceAbington Hospital, Jefferson Health517 S. Schuylkill AvenueAbington, PA 19403(215) 481-8713mdoll-shaw@abingtonhealth.orgTopics: Communication: Communication best practices (e.g., teaching goals of care conversations/advance care planning/family meetings)Description:A retrospective pilot study of 96 EMRs of incapacitated, hospitalized, AA suffering with life-limiting illnesses whose medical surrogates participated in a PCT-led family meeting to determine decisions for EoL care. Patient median age was 78 years, 72% female; 13.5% had a LW, and 69.2% were upheld by the surrogates. Of the surrogates, 45.8% were the adult daughters. The average LOS was 17 days. For those transitioned to comfort care following the PCT-led family meeting the average LOS was reduced to 10.9 days.Conclusion: PCT-led FMs can be effective interventions for this patient population at EoL. Few in this sample had LWs, but if they did, they were generally upheld by the surrogates; and so they are fairly reliable as a tool to provide the care pathway patients prefer when they are unable to advocate for themselves. The burden of EoL decision making often falls to the adult daughter. Knowing in advance characteristics and priorities of meeting participants can assist PCTs as they prepare for these FMs. Finally, organizations as well as patients can benefit from a decreased LOS in the acute care setting because they transitioned to the comfort-focused care pathway.AA, African American; EoL, end of life; FM, family meeting; LOS, length of hospital stay; LW, living will; PCT, palliative care team.2. Community Palliative Care Reduces Hospital ReadmissionAllina Health Hospice and Palliative CareSt. Paul, MNTeam/Contact Information:Joe Amberg, MDMedical Director Palliative CareAllina Health Hospice and Palliative Care1055 Westgate Drive, Suite 100St. Paul, MN 55114(612) 262-7693Joseph.amberg@allina.comProject Team Members:Pat Peschman, DNP, ManagerJennifer Trygg, Data Analyst, Home Care ServicesTopics: Palliative Care Delivery/Operations: Innovative and emerging community-based palliative care models (e.g., home/office/clinic/long-term care)Description:The Allina Health Community Palliative Care Team has provided service in the Twin Cities, MN, community for 8 years. The team is composed primarily of eight specially trained home health nurses who make home visits, with twice monthly IDT collaboration with MD, social worker, and spiritual care. The team successfully provides expert symptom relief and coordination of care for patients with complex illness who continue life-prolonging treatment, with high rates of referral to hospice when warranted by the patient's condition and goals of care. This year we are collecting data on hospital readmissions, with dramatic reductions measured for patients receiving palliative care. Patients assessed as higher risk and worse prognosis by OASIS screen showed the greatest benefit.Results: For patients with temporary at-risk status with return to normal health, readmission rate is 12.1% with no PC, and 3.7% with PC. For patients at high risk and fragile status, readmission rate is 21% with no PC, and 5.6% with PC. For patients in serious condition and with prognosis less than one year, readmission rate is 33.9% with no PC, and 2.6% with PC. This is the grand total for January to June 2015, and we continue rolling data, which can be updated at the time of poster presentation.3. Inpatient Palliative Care Reduces Hospital ReadmissionsAllina Health Hospice and Palliative CareSt. Paul, MNTeam/Contact Information:Joe Amberg, MDMedical Director Palliative CareAllina Health Hospice and Palliative Care1055 Westgate Drive, Suite 100St. Paul, MN 55114(612) 262-7693Joseph.amberg@allina.comProject Team Members:Jennifer Trygg, Data Analyst, Home Care ServicesTopics: Data and Outcomes: Successful use of metrics in community or hospital settingsDescription:Allina Health Palliative Care staffs inpatient consult teams at four metro hospitals in the Twin Cities, MN, and one regional hospital in Shakopee. The teams are well established, providing expert symptom care, goals of care discussion, and end-of-life care for hospital patients with serious illness, working in close collaboration with hospitalists, intensivists, and other specialists. Three hospital teams (two new in the past year) also provide weekly outpatient clinic consultation and follow-up. One hospital provides training for the University of Minnesota HPM Fellowship. In 2014 the teams provided 4047 consults and 10,453 follow-up visits. For this study we reviewed hospital admissions in 2012 to 2013.Results: We measured number of hospitalizations before and after inpatient palliative care intervention, for 2 years including January 2012 to December 2013. The grand total of measured patients is 7930, with an average of 2.67 hospitalizations before IPPC consult, and 0.82 hospitalizations after IPPC consult. Each of the five hospital teams shows statistically similar results. To address whether these patients were simply being seen at the end of life, further data on patients living 30, 90, 120, and 240 days after discharge are available, all showing similar reductions (e.g., 2.58 versus 1.28 hospitalizations for alive >240 days).4. Palliative Care Reduces Hospital Costs at End of LifeAllina Health Hospice and Palliative CareSt. Paul, MNTeam/Contact Information:Joe Amberg, MDMedical Director Palliative CareAllina Health Hospice and Palliative Care1055 Westgate Drive, Suite 100St. Paul, MN 55114(612) 262-7693Joseph.amberg@allina.comProject Team Members:Lori Motschenbacher, Manager, System Financial AnalysisTopics: Palliative Care Teams: Demonstrating clinical and financial outcomes for team rolesDescription:Study information: Net hospital costs in 2011 were tabulated for patients who died in the hospital, with length of stay of 4 days or greater, and who received palliative care consultation at least 2 days prior to death. Costs were measured for the final 3 hospital days, with data specific to hospital, patient diagnosis, and allocation of costs. A comparison group are patients with the same inclusion criteria, but who did not receive palliative care consultation.Savings per consultNet savingsExpenseTeam sizeAbbott$ 3,702$ 685,000$ 317,0007.3United$ 1,721$ 215,000$ 210,0002.6Mercy$ 1,935$ 122,000$ 104,0003.0Unity$ 1,734$ 110,000$ 124,0001.6TOTAL $ 1,132,000$ 775,000 Results: The table below provides a summary for the four hospitals. The average cost for the final 3 hospital days was always greater for patients with no palliative care, regardless of diagnosis or hospital. There were a total of 475 palliative care consults provided meeting study inclusion criteria, compared with 239 patients who were not seen by palliative care. This study group represents only 13% of total consults seen, and demonstrates cost avoidance that exceeds total program costs.5. Patient and Caregiver Experience with CareAllina HealthMinneapolis, MNTeam/Contact Information:Laura Sutter, MPHResearch CoordinatorAllina Health2925 Chicago Avenue, MR 10039Minneapolis, MN 55407(612) 262-0534laura.sutter@allina.comProject Team Members:Nathan Shippee, MS, PhDTetyana Shippee, MS, PhDKarl Fernstrom, MPHCindy Cain, MA PhDAlissa Jones, MAHeather Britt, MPH, PhDTopics: Palliative Care Delivery/Operations: Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty)Description:Aim: Assess experience in LifeCourse, a late-life supportive care intervention, using a new experience tool for patients and caregivers.Data and analysis: Intervention sample with baseline and 6-month data included 373 heart failure, cancer, and dementia patients and 434 caregivers. Usual care included 201 patients and 163 caregivers. Experience was assessed quantitatively through quarterly administration of a 30-item tool built to study guiding principles as sub-domains, and overall ratings for care and support. Qualitative data came from patient and caregiver interviews, and was used to better understand patterns.Results: Intervention patients trended toward greater improvements in all sub-domains and overall care and support ratings, compared with those in usual care. Findings were more mixed for caregivers.Conclusions: Experience scores showed more positive trends for LifeCourse than for comparison patients (although without significance in most domains by 6 months.) The patterns were slightly more consistent for patients than caregivers, reflecting potential benefits of LifeCourse and challenges to engaging caregivers. We look to perform longer follow-up and other components of assessment. Care delivery and experience tools oriented toward ongoing relationships and later-life care for complex patients may allow for meaningful assessment and better understanding of goals for integrating and streamlining care.6. Patient and Caregiver Quality of LifeAllina HealthMinneapolis, MNTeam/Contact Information:Laura Sutter, MPHResearch CoordinatorAllina Health2925 Chicago Avenue, MR 10039Minneapolis, MN 55407(612) 262-0534laura.sutter@allina.comProject Team Members:Nathan Shippee, MS, PhDTetyana Shippee, MS, PhDKarl Fernstrom, MPHCindy Cain, MA PhDAlissa Jones, MAHeather Britt, MPH, PhDTopics: Palliative Care Delivery/Operations: Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty)Description:Question: Does participation in LifeCourse provide better quality of life (QOL) for late-life patients with chronic conditions and their caregivers compared with usual care controls?Data: Intervention sample with baseline and 6-month data included 373 heart failure, cancer, and dementia patients and 434 caregivers. Usual care included 201 patients and 163 caregivers.Measures: QOL was measured quarterly. Patient QOL was measured using the FACIT-PAL, and caregiver QOL was measured using the PROMIS-29. We also collected qualitative interviews.Results: Stability in QOL for LifeCourse patients versus negative change for usual care, and improvements for LifeCourse patients in emotional and palliative care subscales. Interviews provided examples of a positive impact across subscales. Marginal positive scores for caregivers enrolled in LifeCourse compared with usual care controls.Conclusions: LifeCourse helped maintain and even improve some QOL domains. This is notable because late-life patients face declining health and caregivers often have high caregiving burden. LifeCourse assessments of patient and caregiver QOL meet a need for information about patient and family functioning and the role of health care delivery in whole-person care. Whole-person supportive care interventions are a promising approach for patients and caregivers affected by complex chronic illness at the end of life.7. Late Life Care Approach Decreased Utilization and TCOCAllina HealthMinneapolis, MNTeam/Contact Information:Laura Sutter, MPHResearch CoordinatorAllina Health2925 Chicago Avenue, MR 10039Minneapolis, MN 55407(612) 262-0534laura.sutter@allina.comProject Team Members:Karl Fernstrom, MPHRebecca Prenevost, MPH, PhDTC TongHeather Britt, MPH, PhDTopics: Palliative Care Delivery/Operations: Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty)Description:Aim: Evaluate the effects of LifeCourse, a late-life care approach, on health care utilization and total cost of care in a large health care delivery system.Data: 373 intervention and 201 usual care patients between October 2012 and April 2015. A subset of patients with total cost of care claims data available was selected for cost analysis, with controls selected from the health care system's patient population and matched using propensity scores.Results: LifeCourse patients in their last 6 months of life had half as many inpatient days as usual care controls. No significant difference in the number of ED visits. The proportion of advance directives increased significantly in the follow-up period compared with usual care. LifeCourse patients experienced higher inpatient and community-based palliative care utilization. The proportion of hospice enrollment prior to death was higher in the intervention group than the usual care group, the health care system in general, and the 2013 NHPCO national estimate. Also, average per patient per month total expenditures decreased more in the intervention group.Conclusions: Early signals indicate that using a whole person approach and allowing patients to voice preferences and take part in care decisions may benefit utilization and total cost of care.8. Palliative Care through a Dementia LensAlzheimer's Association, New York City ChapterNew York, NYTeam/Contact Information:Ann Wyatt, MSWAlzheimer's Association, New York City Chapter360 Lexington Avenue, 4th FloorNew York, NY 10017 (646) 744-2963awyatt@alznyc.orgProject Team Members:Tena Alonzo, MANatasha Bryant, MSEdward Cisek, PhDMark Heisler, PharmDRobert Hess, PhDMark Kator, CEOJed Levine, MATony Lewis, CEOCarol O. Long, PhDKaren Mitchell, BSNRobyn I. Stone, DrPHAudrey Weiner, CEOAnn Wyatt, MSWTopics: Palliative Care Delivery/Operations: Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty)Description:Cambia Health Solutions has implemented a health plan-based serious illness services program for the 2.2 million members we serve, with an approach focused on respecting the patient's wishes, from diagnosis to completion of life. This program puts the patient at the center while remaining inclusive of the entire health care community. New health care services, benefits, training, and education have been created to ensure the entire health care system is engaged in putting the patient and their loved ones at the center—supporting the individual and family in their medical, psychosocial, behavioral, and spiritual needs. In addition, we provide necessary support and resources to caregivers and loved ones dealing with the serious illness of a loved one or in need of grief or bereavement counseling. Cambia has focused its efforts in integrating five main areas: benefit expansion, specialized care management, community and member engagement, provider reimbursement and training, and caregiver support. This presentation will provide our framework and implementation of this program, providing a structure for other payers to use in development of palliative care initiatives. We will represent initiatives within and outside of our Accountable Care Organization agreements. Example metrics and baseline statistics will also be presented.9. Cultivating a Culture of Primary Palliative CareBaptist HealthJacksonville, FLTeam/Contact Information:Tasha M. Schoppee, MSNBaptist Health800 Prudential DriveJacksonville, FL, 32207(904) 202-3409Tasha.Schoppee@bmcjax.comTopics: Education: Methods of training in primary/generalist palliative careDescription:Whether in the arena of acute care, the clinic setting, or in the home, comprehensive palliative care requires collaboration among both specialist and generalist clinicians. Developing the infrastructure to support such a cooperative practice requires strategic communications and intentional education across the disciplines. Successful development of such a culture necessitates intentionally targeting, and inviting in, many who have not previously been passionate about palliative care. They must have the opportunity to meet on mutual ground. One hospital system has found establishment of an interprofessional palliative care council to be the environment in which such collaboration can be nurtured. Additionally, there is great value in developing this foundation prior to the building of a formal palliative care program. Therefore, an interdisciplinary council is a powerful tool for both those organizations with mature palliative programs and those who are still in the planning stages.10. An Assessment of Palliative Care Beliefs and KnowledgeBaptist Health of South FloridaMiami, FLTeam/Contact Information:Yvonne PattenBaptist Health of South Florida8900 North Kendall DriveMiami, FL 33176(786) 596-0092yvonnep@baptisthealth.netProject Team Members:Maria M. Ojeda, ARNP, MSN, MPH, DNP, PHDCarolyn L. Lindgren, PhD, RNTopics: Education: Examples of primary palliative care education approaches to address the workforce shortageDescription:This study evaluated the level of perceived competency and knowledge regarding palliative care among health care personnel at a seven-hospital not-for-profit health care system; and determined if there was a significant difference in perceived competency and knowledge, between health care personnel who participated in an intercultural palliative care/end-of-life training program and those who did not.Using a pre-experimental static-group comparison design, a non-randomized sample of health care personnel were administered a demographic questionnaire to assess perceived competence (End-of-Life Professional Caregiver Survey [EPCS]) and a knowledge assessment (Palliative Care Survey [PCS]). The results revealed a significant negative association between perceived competency and knowledge scores, (Spearman's rho = −0.380, n = 330, p = 0.000). Those who did not take the course perceived themselves more competent when compared with those who took the course (Mann-Whitney U = 21,332, z = 4.827, p = 0.000). Participants who took the training course scored significantly higher on knowledge than those who did not (Mann-Whitney U = 10,257.00, z = −3.797, p = 0.000). This study supports the need for ongoing education to increase knowledge of palliative care among health care personnel and further exploration of the underlying reason for the negative association between perceived competency and knowledge.11. Stand By You: An Interprofessional Compassionate ServiceBaptist Health of South FloridaMiami, FLTeam/Contact Information:Rose M. Allen, DNPBaptist Health of South Florida8900 North Kendall DriveMiami, FL 33176(786) 596-0092rosea@baptisthealth.netProject Team Members:Rose Allen, DNP, MSM/HM, RN, CHPNChloe Edinger, BS, MS3Renato Santos, MDiv, BCC, LMHCArlenna Williams, MSW, MBASarita Khanal, ARNP, RNCarol Slinger-Howell, MSN, RN, CNMLTopics: Palliative Care Delivery/Operations: Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty)Description:This poster will outline the collaborative efforts between Herbert Wertheim College of Medicine and Baptist Health South Florida to develop an interprofessional compassionate volunteer service for patients at the end of life, including the program's integration across the health system and the outcomes.The Stand By You (SBY) Volunteer service was developed in 2012 and initially offered at one of the seven hospitals within the system. It is based on the No One Dies Alone (NODA) program started by Sandra Clarke, CCRN, in 2001, with the goal to provide companionship and support for dying individuals, so they don't die alone. The SBY Volunteer program is a unique service where companionship and support is provided by first- and second-year medical student volunteers. Since 2014, the program has been expanded to include hospital volunteers of nurses, social workers, board members, and other community volunteers, who collaborate with the medical students to provide services at our hospitals within the health system.So far, 99 volunteers have been trained (53 medical students, 22 employees, 24 community volunteers) and 16 patients to date at Baptist Health have received services by these volunteers. Satisfaction of the SBY service is measured by survey feedback from staff and family members, if available.12. Examining Use of Advance Directives in Oncology PatientsBaptist Hospital, Inc.Penscola, FLTeam/Contact Information:Kelly C. Markham, MSWPalliative Care CoordinatorBaptist Hospital, Inc.1000 West Moreno StreetPensacola, FL 32501(850) 469-3739kelly.markham@bhcpns.orgTopics: Palliative Care Delivery/Operations: Approaches to palliative care delivery for specific population types (e.g., heart failure/cancer/dementia/frailty)Description:In our cancer center, a retrospective chart review was conducted of stage III and IV lung cancer patients, examining the use of advance directives. The results revealed that only 57% of those patients had completed an advance directive. In almost one-quarter of cases, the chart was silent about documented directives. This prompted our team to seek more information about lack of advance care planning among our patients with this serious illness. Several possibilities were discussed: lack of initiation of discussion by physician and/or staff, patient resistance, or other reasons. To assess these barriers, a survey was compiled to inquire about roadblocks. Currently, it is being used in our radiation oncology clinic. At this time, 26 patients have completed the survey. Initial responses indicate that most patients “just never got around to doing it.” The survey will continue to be utilized to obtain more information about barriers. Results of this survey, when concluded, will direct our cancer center's efforts to increase the understanding and completion of advance directives among our patients. Information already gained during these two projects has led us to expand to plan a system-wide needs assessment about the advance care planning process in our organization. This will be initiated in the spring of 2016.13. CARE: A Model for Doctor-Surrogate Decision MakingBatson Children's HospitalUniversity of Mississippi Medical CenterJackson, MSTeam/Contact Information:Charles Christian Paine, II, MDBatson Children's HospitalUniversity of Mississippi Medical Center402 Hemlock DriveFlowood, MS 39232(601) 842-0930cpaine@umc.eduTopics: Communication best practices (e.g., teaching goals of care conversations/advance care planning/family meetings)Description:Much has been written about the importance of the “Doctor-Patient” relationship and the obligations it demands. A majority of attention has been paid to the various steps, checklists, and algorithms that providers must follow to insure that they allow patients an autonomous voice. Interestingly, although the importance of values such as trust, compassion, and respect are mentioned as vital to this relationship, less attention is given to how to instill and maintain these in practice. Further, although emotion is mentioned as a component of many of these models, it is mostly referenced as merely a reaction to be allowed and affirmed. Finally, the role of family or surrogates in the decision-making relationship is often missed. The CARE Method is an analytical tool to help providers, patients, and families better understand each other's motivations and attitudes. The method examines the means and content of communication, the affect or mood of those communications, the context and reasoning of each party, and the effect and conclusions of each interaction. In this way, one can achieve a better understanding of the emotional roots of a decision and thus have a positive effect on building and sustaining a therapeutic doctor-patient-surrogate relationship.14. Enhancing Care at End of Life through Transition to HospiceBaylor All Saints Medical Center at Fort WorthArlington, TXTeam/Contact Information:Sommer Smith, MSWDirector, Comprehensive Care Management, Supportive and Palliative CarerBaylor All Saints Medical Center at Fort Worth6805 Glen Eagle DriveArlington, TX 76001sommerp@baylorhealth.eduProject Team Members:Shawnta Pittman-Hobbs, MDSommer Smith, LMSW, ACMEllen Pitcher, RN, MSN, MBA NEA-BC FACHELeslie PhillipsKimberly Montgomery, MSN, ACNS-BC, CCRN-CMCDanielle Reed, LMSW, ACHP-SWChuck Wallace, MDiv, MA, BCCTerry Boyd, RRT, RCPApril Jones, BSN, RN, CCTNDiana Stone, MSN, RNTopics: Palliative Care Delivery/Operations: Innovative hospital-based palliative care modelsDescription:Patients who were at the end of life and required planned withdrawal of treatment often had withdrawal take place in the ICU and not in the optimal environment for grieving or allowing them access to the specialized knowledge and support services provided by hospice at end of life. The importance of this need is emphasized in a study in the Journal of Clinical Oncology (Wright, 2010) stating that among caregivers, 21% of those whose loved ones died in the ICU or hospital developed PTSD 6 months later compared with 4.4% of those whose loved ones died at home with hospice. Baylor All Saints Medical Center (BASMC) developed a process for critical care patients to transfer to a more home-like environment of the VITAS Hospice Inpatient Unit (located on the BASMC campus) for withdrawal of life-sustaining treatments. ICU nursing staff was provided with education about the benefits to hospice and processes were put into place that allowed for nursing to be a part of their patient's transfer to hospice. Improvements resulted in an increase of nursing staff understanding of hospice benefits and baseline of 0% of patients/families agreeing to transfer to hospice for planned withdrawal of life-sustaining treatment to 70%+ agreeing.15. ESAS to Improve Symptomatology Management/CommunicationBaylor St. Luke's Medical CenterHouston, TXTeam/Contact Information:Eyitayo O. OdeniyiAdvanced Practice Clinician, Palliative Care ProgramBaylor St. Luke's Medical Center8835 Aspen Meadow DriveHouston, TX 77071(832) 355-5158eodeniyi@stlukeshealth.orgTopics: Palliative Care Delivery/Operations: Implementation of standardized interventions such as checklists and screening toolsDescription:As the cost of health care continues to rise and the American public clamors for improved safety and quality of health care, the Center for Medicare and Medicaid Services has linked patient's evaluation of providers with reimbursement for services. Specific expectations and benchmark scores outlined, and if unmet, providers will be financially penalized. Therefore, hospitals across the nation are implementing efforts to improve patient and family satisfaction.The aim of this project is to answer the following questions. (1) Does the use of the Edmonton Symptom Assessment System improve registered nurses' knowledge of symptom assessment and management of patients with advanced and chronic diseases in an acute care hospital? (2) Will the implementation of the ESAS improve patients' and families' perception of communication with health care practitioners?16. Living with Dying in the PICU: A Nursing PerspectiveBloomsburg UniversityBloomsburg, PATeam/Contact Information:Debbie Stayer, PhDAssistant ProfessorBloomsburg University7 Cotswold StreetDanville, PA 17821(570) 275-9454dstayer@bloomu.eduTopics: Palliative Care Delivery/Operations: Approaches to palliative care delivery in specific hospital settings (e.g., ICU, ED)Description:The purpose of this study was to explore the experiences of pediatric ICU nurses who provide palliative care to children with life-threatening or life-limiting il