Abstract Purpose:Patients with complex head and neck cancer benefit from preoperative education and multidisciplinary support. However, such care may not adequately address the need for advance care planning (ACP) in the preoperative setting. We evaluated the feasibility and impact of “Free Flap Fridays” (FFF), a comprehensive preoperative education program that offers recommendations to patients undergoing head and neck surgery with free flap reconstruction. The program is led by an interdisciplinary team comprised of social work, surgical nursing, speech and language pathology, nutrition, and specialty palliative care. Methods: This study was a quantitative, retrospective chart review analysis at an academic cancer center. We compared demographics pre- and post-surgical engagement with the interdisciplinary team, and ACP outcomes, among 48 patients who participated in FFF and 44 patients who received usual care prior to the launch of the FFF clinic. Results:Preoperative involvement of each of the five disciplines included in the interdisciplinary team increased among the intervention group. Engagement with FFF increased rates of advance care planning discussions (66.7% vs. 4.5%, p<0.0001). Documentation of a durable power of attorney also increased between the groups (72.9% vs. 31.8%, p<0.0001), although there was no difference in completed advance care documents, including advance directives or Physician Orders for Life Sustaining Treatment (POLST) documents. Conclusions:Implementation of an interdisciplinary, preoperative clinic for patients undergoing free flap reconstruction for head and neck cancer is feasible and leads to increased patient engagement and preoperative ACP discussions.

ObjectiveSocially disadvantaged cancer patients have unmet educational needs, but we know little about how educational groups might help. This exploratory study examines how a group education program met underserved patients’ needs. MethodsWe examined a program for US patients in a safety-net hospital that featured English and Spanish language groups. We collected data from 54 group sessions over 28 months, including information on participant demographics, attendance, and satisfaction. Qualitative field notes collected by trained observers were analyzed via a grounded-theory approach to examine group dynamics. ResultsParticipants were underserved, had diverse disease sites and race/ethnicity, and reported that groups met their needs. Emergent analysis identified two themes related to group dynamics. First, members identified with each other as a fictive family, although the meaning of “family” differed in the groups. Second, groups focused on battling cancer not adjusting to life as a survivor—a focus that impaired participants’ ability to discuss coping strategies for managing negative feelings. ConclusionFictive ‘family’ engages participants. The emphasis on ‘family’ and resistance to coping strategies may reflect participants’ social disadvantages. Practice implicationsGroups for the underserved should strive to create a ‘family’ and may have difficulty helping participants cope with their illness.

Pain management continues to pose a challenge to the healthcare profession in the United States. There are a host of barriers and many of these are very well laid out in the article by Dr. Rich. As a hospice physician, I confront these challenges daily.

(1997). Facing Death: Conversations with Caregivers. The Hospice Journal: Vol. 12, No. 1, pp. 73-74.

The authors of this article present a grass-roots approach to the instruction of home health care aides in caring for PWAs. Much of the information presented could be applied to other care providers as well. The goal of the educational process, which advocates facilitating the learning process rather than lecturing, is to better prepare the aides to care for their patients with AIDS. Early emphasis is placed on breaking down barriers to the topic. The curriculum includes "AIDS 101," which begins a determina tion of the home care provider's level of knowledge and comfort as to the disease. Immunologic principles are presented in a simple manner. Infection-control procedures are taught and rational fears are dealt with openly. Symptom management is taught by paralleling the care of the PWA with that of patients with other, more familiar diagnoses. Finally, the issue of caregiver isolation is addressed.

Every community is or will be faced with the challenge of caring for individuals with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC). In most communities in the United States, home health care is an existing alternative to hospitalization. Although there are many potential barriers to home health and hospice care provision, these barriers are not insurmountable. As demonstrated by the community's response in San Francisco, careful planning, cooperation, and education reduce the barriers to allow persons with AIDS/ARC to receive care at home or to identify alternatives when home care is no longer an option. The AIDS Home Care and Hospice Program of the Visiting Nurses and Hospice of San Francisco is used as the model for the article. This program was the first of its kind in the world. It has developed an innovative approach to home and hospice care for persons with AIDS/ARC. Its sensitive and humane approach, offers support from early in the disease process (to assist patients as they struggle with difficult treatment decisions) until long after death occurs (to enable friends and family members to cope with the loss of a loved one). This article identifies the challenges that administrators and staff face in keeping the terminally ill individual with AIDS/ARC at home, offers suggestions to best meet the needs of the person with AIDS/ARC living at home, and suggests alternatives when home care is no longer an option.