Introduction Of Palliative Care Research Articles

Comparison of the Life-Sustaining Treatment, Cardiopulmonary Resuscitation, and Palliative Care Implementation Rates between Homebound Patients with Malignant and Nonmalignant Disease Who Died in an Acute Hospital Setting: A Single-Center Retrospective Study.

This study investigated and compared the implementation of life-support treatment (LST), cardiopulmonary resuscitation (CPR) implementation rates, and the influence of acute illnesses on the introduction of palliative care (PC) to homebound patients with malignant and nonmalignant disease, who subsequently died in an acute hospital setting. Among the homebound patients admitted to the ward in our hospital from 2011 to 2018, we investigated and compared the attributes, underlying diseases, causes of death, and rates of implementation of LST, CPR, and PC between patients with malignant and nonmalignant disease who died in the ward, using data obtained from hospitalization records. Furthermore, acute illnesses related to the introduction of PC were examined. Of the 551 homebound patients admitted to the ward of an acute hospital, 119 died in the ward. Of the deceased patients, 60 had malignant disease and 59 had nonmalignant disease. Patients with nonmalignant disease had higher rates of LST implementation and CPR and a lower rate of PC. Patients with infectious disease, who required antimicrobial drugs, had significantly lower PC introduction rates. Understanding the influence of the timing of PC introduction in acute care for homebound patients with advanced chronic illness are issues to be considered.

The Experiences of Nursing Managers in Implementing Palliative Care in Long-Term Care Facilities.

The purpose of this study was to explore the experiences of nursing managers in implementing palliative care in long-term care facilities and to provide recommendations for managers who plan to introduce palliative care into their facilities. This study used semi-structured interviews and grounded theory methodology, with purposive sampling. A total of 11 long-term care facilities in eastern Taiwan that had implemented palliative care were selected, and 11 facility nursing managers participated in in-depth, face-to-face interviews. The introduction of palliative care in long-term care facilities can be divided into four stages: (1) the opportunity for change, (2) playing a supportive role, (3) a new collaboration model, and (4) facility transformation. The core category shared by the participants may be summed up as "the palliative care captain in the facility". It reflects the spirit of the successful implementation of palliative care by managers in long-term care facilities. The study reveals that during the initial phases of implementing palliative care, the palliative care teams assume a crucial leadership role, while the facilities play a supportive role. At this stage, managers should focus on personnel training and addressing internal issues within the facilities to facilitate successful collaboration with the palliative care teams. In the later stages, the facilities transition from a supportive role to one of independence, marking a critical juncture for the facilities' potential stable development. During this period, managers are tasked not only with establishing the facilities' own palliative care team but also with facilitating the transformation of staff from learners to instructors. Finally, even after successful implementation, managers must contemplate how to innovate and set more ambitious goals.

Intensity at the end of life in pediatric neuro-oncology patients: The case for pediatric palliative care.

10021 Background: Although pediatric cancer is rare, it is the leading cause of death by disease after infancy for children and adolescents in the United States. Children exist in the context of a family; hence, excellent care for a child must also include attention to the needs of the family. Palliative care aims to enhance quality-of-life for these children living with life threatening illnesses and their families. Among pediatric cancers, brain tumors have high disease-related mortality rates; therefore, early introduction of palliative care to these patients is critical. This study aims to evaluate the association of palliative care during the terminal admissions of pediatric neuro-oncology patients and intensity of care provided at the end of life. Methods: Pediatric patients with brain tumors were identified using the Pediatric Health Information System (PHIS). Inclusion criteria were age <18, diagnosis of brain tumor as defined by ICD-10 codes, discharged as deceased, and hospital admission between 1/1/2017 and 12/31/2021. Intensity of care measures included: pediatric intensive care unit (PICU) admission, mechanical ventilation, total parenteral nutrition (TPN), and extracorporeal membrane oxygenation (ECMO). Results: 567 patients met the inclusion criteria. 359/567 (63%) patients had an inpatient palliative care consultation during their terminal hospital stay. Patients receiving a palliative care consultation had a lower percentage of PICU admission (64.9 vs 83.2, p=<0.001), mechanical ventilation use (51.0 vs 76.0, p=<0.001), and TPN use (18.1 vs 25.5, p=0.027). There were no significant differences in length of stay (22.07 vs 22.25 days, p=0.181) and ECMO use (0.28% vs 1.92%, p=0.450). Conclusions: Pediatric patients receiving palliative care consultations during their terminal admission received less intense care while having comparable lengths of stay. Palliative care should be offered to all families, even with aggressive goals, to help incorporate quality of life and comfort in the treatment plan and to ensure bereavement support is available if needed. Similar to data in the adult palliative care literature, this data demonstrates reduced resource utilization among pediatric patients receiving palliative care. Palliative care has been shown to be a supportive service that has the potential to improve the quality of life of patients. The first step toward equitable healthcare is to ensure that all children with a potentially terminal cancer diagnosis have access to full supportive services, including palliative care.

Symptom prevalence, severity, distress and management among patients with chronic diseases

BackgroundAdvanced knowledge, technology, and treatment approaches resulted in longer survival rates for patients suffering from chronic diseases. However, symptoms of these diseases persist and affect the individual’s entire life and normal functioning.AimTo assess symptoms prevalence, severity, distress, and management among patients with chronic obstructive pulmonary diseases (COPD), chronic heart failure (CHF), and end-stage renal disease (ESRD) in Oman.DesignA descriptive cross-sectional design was used.Sample and settingsThe study sample comprised 340 participants who were recruited between May and December 2021 from two referral hospitals and one large dialysis unit in the Sultanate of Oman, Muscat Governate using a convenience sampling technique.ResultsThe highly prevalent symptoms among patients with selected chronic diseases were lack of energy (60.9%), pain (57.4%), numbness (53.2%), difficulty sleeping (49.4%), and shortness of breath (45.9%). The most severe symptoms were shortness of breath (53.2%), problems with urination (51.9%), constipation (50.8%), difficulty sleeping (49.7%), and pain (46.2%). The symptom “problems with sexual interests or activity” was found to be the most frequently occurring and highly distressing symptom out of all reported symptoms.ConclusionsThe current study’s findings showed that symptoms were prevalent and that some symptoms were frequent, severe, and highly distressing. In addition, patients perceived symptom treatment as inadequate. Psychological symptoms received less treatment attention compared with physical symptoms. One of the mainstays for managing symptoms can be the introduction of palliative care. Providing palliative care to these patients can alleviate their suffering and improve their quality of life. In addition, designing chronic disease self-management programmes can make a difference in patients’ life.

Palliative Care across Settings: Perspectives from Inpatient, Primary Care, and Home Health Care Providers and Staff.

Early introduction of palliative care can improve patient-centered outcomes for older adults with complex medical conditions. However, identifying the need for and introducing palliative care with patients and caregivers is often difficult. We aim to identify how and why a multi-setting approach to palliative care discussions may improve the identification of palliative care needs and how to facilitate these conversations. Descriptive qualitative study to inform the development and future pilot testing of a model to improve recognition of, and support for, unmet palliative care needs in home health care (HHC). Thematic analysis of semi-structured interviews with providers across inpatient (n = 11), primary care (n = 17), and HHC settings (n = 10). Four key themes emerged: 1) providers across settings can identify palliative care needs using their unique perspectives of the patient's care, 2) identifying palliative care needs is challenging due to infrequent communication and lack of shared information between providers, 3) importance of identifying a clinical lead of patient care who will direct palliative care discussions (primary care provider), and 4) importance of identifying a care coordination lead (HHC) to bridge communication among multi-setting providers. These themes highlight a multi-setting approach that would improve the frequency and quality of palliative care discussions. A lack of structured communication across settings is a major barrier to introducing and providing palliative care. A novel model that improves communication and coordination of palliative care across HHC, inpatient and primary care providers may facilitate identifying and addressing palliative care needs in medically complex older adults.

Identifying the palliative care needs of frail, older, housebound patients in the community: A cross-sectional study.

The early introduction of palliative care can have a positive impact on the quality of life of patients suffering from life-limiting diseases. However, the palliative care needs of older, frail, housebound patients are still mostly unknown, as is the impact of frailty on the importance of these needs. To identify the palliative care needs of frail, older, housebound patients in the community. We conducted a cross-sectional observational study. This study took place in a single primary care center and included patients who were ≥65years old, housebound, followed by the Geriatric Community Unit of the Geneva University Hospitals. Seventy-one patients completed the study. Most patients were female (56.9%), and mean age (SD) was 81.1 (±7.9). The Edmonton Symptom Assessment Scale mean (SD) score was higher in frail patients as opposed to vulnerable patients for tiredness (p=0.016), drowsiness (p=0.0196), loss of appetite (p=0.0124), and impaired feeling of well-being (p=0.0132). There was no difference in spiritual well-being, measured by the spiritual scale subgroup of the Functional Assessment of the Chronic Illness Therapy-Spiritual Well-Being scale (FACIT-sp) between frail and vulnerable participants, although scores in both groups were low. Caregivers were mainly spouses (45%) and daughters (27.5%) with a mean (SD) age of 70.7 (±13.6). The overall carer-burden measured by the Mini-Zarit was low. Older, frail, housebound patients have specific needs that differ from non-frail patients and should guide future palliative care provision. How and when palliative care should be provided to this population remains to be determined.

Parkinson's disease and Covid-19: Is there an impact of ethnicity and the need for palliative care.

Under the traditional models of care for People with Parkinson's Disease (PD, PwP), many of their needs remain unmet and a substantial burden of motor and non-motor symptoms they experience may not be tackled sufficiently. An introduction of palliative care (PC) interventions early in the course of PD offers profound benefits: it may improve quality of life of patients, their families and caregivers through the prevention and relief of medical symptoms, while, at the same time, emphasizing their emotional needs and spiritual wellbeing, establishing goals of care, and engaging in the advance care planning (ACP).The ongoing Coronavirus Disease 2019 (Covid-19) pandemic poses an unprecedented set of challenges for PwP and has in many ways (both directly and indirectly) magnified their suffering, thus rapidly raising the demand for PC interventions. Covid-19, as well as the repercussions of prolonged mobility restrictions and limited health-care access might exacerbate the severity of PD motor symptoms and interact negatively with a range of non-motor symptoms, with a detrimental effect on quality of life. Greater motor disability, higher amount of levodopa-induced motor fluctuations with an increased daily off-time, fatigue, anxiety, depression, sleep disturbances, pain and worsening of cognitive complaints might dominate the clinical presentation in PwP during the Covid-19 pandemic, alongside raising psychological and spiritual concerns and anticipatory grief.Here, we aim to provide a foundation for pragmatic and clinically orientated PC approach to improve quality of life and relieve suffering of PwP in the context of the current, ongoing Covid-19 pandemic.

Coping with deterioration over months – Glioma

Considering the short life expectancy of malignant glioma patients and their care needs throughout the disease trajectory, coping strategies should be considered a key component in the management of Brain Tumor patients. Patients' coping styles have an important influence in critical aspects of care such as communication of diagnosis and prognosis, discussion with patients and their caregivers about goal of treatments, early introduction of palliative care and advanced planning of patients' preferences concerning end of life treatment and issues. Understanding the coping style along the disease trajectory may help clinicians to personalize communication strategies, to promote adherence to treatment, to assess the time of transition to terminal care and to prepare in advance a shared end of life decision making process. Available data show that, despite the aggressiveness of the disease and the poor prognosis, at diagnosis and during the first line treatment, most of BT patients are able to display functional coping strategies such as combative spirit which favors active participation and adherence to treatment; also, cognitive avoidance coping style preserves the individual from excessive exposure to distress. According to recent studies in advanced cancer, coping style adopted may strongly influence patients' prognostic awareness and patients' availability to participate to prognosis discussions. This data are in line with previous literature on other cancer patients, demonstrating that coping style is not a persistent dimension of personality, but can change depending on the situation.

Coping with deterioration over years - multiple sclerosis

Multiple sclerosis presents with a wide range of physical, mental and psychiatric symptoms. It is also a major cause of disability globally. Studies have demonstrated that patients living with MS often experience physical, mental, social, and spiritual suffering which significantly impacts their health and quality of life. Palliative care can help provide patients with relief from suffering by reducing pain and discomfort, providing emotional support, improving functional ability and quality of life, as well as addressing end-of-life and legacy issues. It is often unclear to physicians, and patients what elements of palliative care should be provided and when. One reason for this is the uncertainty that surrounds the progression of the disease, the wide range of symptoms, and the prognosis of the patient. As a result, patients are often poorly prepared to cope with the impact of new symptoms, disabilities, or loss of function. While little can be done about the uncertainty of MS, the adoption of a care model where palliative care is introduced early and provided alongside neurological care can help patients cope with the suffering experienced with MS. Specific triggers to intensify palliative care can be arranged while EDSS milestones can be used to revise the palliative care plan. Early introduction of palliative care can also allow physicians to gain a better sense of the patient's priorities and care preferences, which is important for the development of a care plan that allows them to achieve their goals, reduce suffering, and improve quality of life over the years.

Palliative care is increasing, but curative care is growing even faster in the last months of life.

The introduction of early palliative care might be hoped to moderate the medicalisation of dying and the increasingly frequent medical and surgical treatment that patients generally receive in the last months of life. Indeed the old concept of an abrupt change from curative to palliative care when a person is terminally ill and imminently dying is giving way gradually to the better concept of a phased introduction of palliative care from diagnosis of a life-threatening illness, as advocated in Figure 1.1 Figure 1. Contrasting the old concept of curative care being suddenly replaced by palliative care to a gradual introduction of palliative care from diagnosis of any life-threatening illness. By 2018, GPs in Scotland recognised 69% of their patients for a palliative care approach by the time …

Como incluir os cuidados paliativos na formação de médicos nefrologistas: Revisão da literatura

Objetivo: O artigo tem como objetivo apresentar as vantagens dos cuidados paliativos (CP) para pacientes com doença renal crônica (DRC) e evidenciar os conhecimentos necessários aos nefrologistas para oferecer um tratamento holístico e adequado a esses pacientes. Metodologia: Essa revisão foi produzida usando a Pubmed (Biblioteca Nacional Americana de Medicina), a Biblioteca Virtual em Saúde (BVS) e a Scientific Eletronic Library Online (SciELO). A busca avançada teve como descritores: cuidados paliativos, doença renal crônica e planejamento antecipado de cuidados. Posteriormente, filtrou-se os artigos em inglês e português com publicações entre 2015 e 2020, sendo selecionados os mais pertinentes. Resultados: A análise das referências elucidou o CP e o seu papel na DRC, as competências inerentes aos nefrologistas e os principais sintomas dos pacientes com DRC. Conclusão: A instituição do CP, precocemente, é necessária para melhorar a qualidade de vida dos pacientes com DRC, sem restringir às medidas de fim de vida e sem excluir procedimentos intervencionistas. Assim, é indispensável investir na capacitação dos nefrologistas para que atendam às demandas da assistência paliativa em DRC.

Nurse-Led Palliative Care Clinical Trial Improves Knowledge and Preparedness in Caregivers of Patients with Idiopathic Pulmonary Fibrosis.

Rationale: Patients with idiopathic pulmonary fibrosis (IPF) and their caregivers experience stress, symptom burden, poor quality of life, and inadequate preparedness for end-of-life (EOL) care planning as the disease progresses. The hypothesis for this study was that the early introduction of palliative care in the course of IPF would improve knowledge and preparation for EOL, patient-reported outcomes, and advance care planning in patients with IPF and their caregivers. Objectives: We sought to determine the feasibility, acceptability, and efficacy of a nurse-led early palliative care intervention entitled "A Program of SUPPORT" (Symptom management, Understanding the disease, Pulmonary rehabilitation, Palliative care, Oxygen therapy, Research participation, and Transplantation) in patients with IPF and their caregivers. Methods: Patients with IPF (diagnosed in the year previous to their initial center visit) from the University of Pittsburgh Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at University of Pittsburgh Medical Center-together with their caregivers-were randomized to receive the intervention "A Program of SUPPORT" or usual care. This included a total of three research visits aligned with their clinic visit over a period of 6 to 8 months. We measured feasibility, acceptability, and efficacy of this intervention. Results: A total of 136 patient/caregiver dyads were eligible, and a total of 76 dyads were enrolled and participated. Participants were predominately White males >65 years old. Thirteen percent did not have an identified caregiver. Feasibility was limited; 56% of eligible dyads were enrolled. Eligible dyads (24%) were interested in participating but too fatigued to stay after their clinic visit. There was high attrition (20% of participants died before the study was completed). "A Program of SUPPORT" was acceptable to participants. Efficacy demonstrated a significant improvement in caregiver's knowledge, disease preparedness, and confidence in caring for the patient as well as an improvement in knowledge and advance care planning completion in patient participants. Conclusions: Patients with IPF and their caregivers have unmet needs regarding knowledge of their disease, self-management strategies, and preparedness for EOL planning. This nurse-led intervention demonstrated acceptability and efficacy in knowledge and advance care planning completion in patients and in knowledge, disease preparedness, and confidence in caregivers. Future research should identify additional strategies, including telemedicine resources to reach additional patients and their caregivers earlier in their disease course. Clinical trial registered with clinicaltrials.gov (NCT02929017).

Building capacity for palliative care delivery in primary care settings: Mixed-methods evaluation of the INTEGRATE Project.

To evaluate an intervention aimed at building capacity to deliver palliative care in primary care settings. The INTEGRATE Project was a 3-year pilot project involving interprofessional palliative care education and an integrated care model to promote early identification and support of patients with palliative care needs. A concurrent mixed-methods evaluation was conducted using descriptive data, provider surveys before and after implementation, and interviews with providers and managers. Four primary care practices in Ontario. All providers in each practice were invited to participate. Providers used the "surprise question" as a prompt to determine patient eligibility for inclusion. Provider attitudes toward and confidence in providing palliative care, use of palliative care tools, delivery of palliative care, and perceived barriers to delivering palliative care. A total of 294 patients were identified for early initiation of palliative care, most of whom had multiple comorbid conditions. Results demonstrated improvement in provider confidence to deliver palliative care (30% mean increase, P < .05) and self-reported use of palliative care tools and services (25% mean increase, P < .05). There was substantial variation across practices regarding the percentage of patients identified using the surprise question (0.2% to 1.5%), the number of advance care planning conversations initiated (50% to 90%), and mean time to conversation (13 to 76 days). This variation is attributable, in part, to contextual differences across practices. A standardized model for the early introduction of palliative care to patients can be integrated into the routine practice of primary care practitioners with appropriate training and support. Additional research is needed to understand the practice factors that contribute to the success of palliative care interventions in primary care and to examine patient outcomes.

Ensino de Cuidados Paliativos nas escolas médicas brasileiras: uma revisão integrativa

The introduction of palliative care in Brazil occurred around the 2000s. Since then, much has been discovered about this approach, which aims to support not only the patient, but their families during the process of illness and death. This study consists of an integrative review that aims to apprehend the development of the teaching of Palliative Care in brazilian medical schools. LiLACS and Scielo databases were used for data collection, resulting in the selection of 12 articles. The analysis of the content allowed the formulation of 2 categories: approach to palliative care in Brazilian medical schools and difficulties that involve the teaching of palliative care in Brazil. As it is a public health issue, it is necessary that the topic be worked on effectively within Brazilian medical schools. However, there was an important lack of conceptual knowledge on the part of students and health professionals, which leads to their unpreparedness to deal with incurability and end of life situations.

Real-World Cost-Effectiveness of Palliative Care for Terminal Cancer Patients in a Japanese General Hospital

Background: The concept of cost-effectiveness is necessary for optimal utilization of limited health care resources. However, few studies have assessed the cost-effectiveness of palliative care using quality-adjusted life years (QALYs), considered common outcomes in health economics. Objective: We aimed to perform a cost-effectiveness analysis of palliative care for terminal cancer patients by using QALYs. Design: A retrospective cohort study was performed. Setting/Patients: We included 401 patients with stage IV cancer, who were hospitalized and died at a Japanese general hospital during the period April 2014 to March 2019. Methods: Using the hospital database, we compared the total admission costs and QALYs based on pain levels of patients admitted to the palliative care (PC) department with those of patients admitted to other usual care (UC) departments. Patients in each group were matched through propensity scores to reduce bias. Bootstrapping estimated the 95% confidence intervals (95% CIs) and the probability that PC was more cost-effective than UC. Results: After matching, 128 patients in each group were selected. Converting 1 U.S. dollar (USD) to 100 Japanese yen, PC reduced mean total admission costs by 1732 USD (95% CI: 1584-1879) and improved mean health benefits by 0.0028 QALYs (95% CI: 0.0025-0.0032) compared with UC. Based on the Japanese cost-effectiveness threshold, there was an 82% probability that PC was more cost-effective than UC. Conclusions: Our results indicated that admission of terminal cancer patients to the PC department was associated with improvement in cost-effectiveness. This finding could support the introduction of palliative care for terminal cancer patients. Our study was approved at St. Luke's International University (receipt number 18-R061 and at the Graduate School of Pharmaceutical Sciences, The Univesity of Tokyo (receipt number 31-29).

Optimization of the quality of life of patients who need palliative care introduction

People suffering from chronic progressive diseases of non-infectious and infectious nature need palliative care. When a condition with an unfavorable prognosis occurs, an integrated approach is required, which involves patient care in the medical, psychological, social, and spiritual aspects. This assistance is aimed at improving the quality of life of such patients and implemented in Russia as part of the provision of palliative care, which aims to improve the quality of life of not only the patient himself but also his family members. This study aims to examine the impact of legal regulation of palliative care as well as the medical, psychological, social, and spiritual aspects of palliative care on the quality of life and needs of the patients and their families. Using content analysis and documentary observation, the results regarding the impact of legal, medical, psychological, social, and spiritual aspects combined in the provision of palliative care on the quality of life of patients in need were examined. The study revealed gaps in the legal regulation of the provision of palliative care for patients, particularly HIV-infected patients and those with chronic tuberculosis. As part of optimizing the provision of palliative care, creating a vertically integrated information system for palliative care (VIMIS Palliative) is necessary. To improve the professional stability of medical staff groups providing palliative care and preventing suicidal behavior among patients, health care organizers should improve the mechanisms of psychological interaction among all the participants in the palliative care system. Organizational and methodological approaches in administering anesthesia must be improved, and the knowledge of medical workers on the theoretical foundations of the formation of pain syndromes and the modern methodology for analgesic treatment is required. The organization of the state system of the artificial ventilation of the lungs at home is required with the aim of long-term respiratory support for patients in need. Additionally, further research is needed to determine the impact of nutritional support as a supportive therapy on the course of treatment and the results of palliative care, allowing to optimize the quality of life of patients in need. Optimization of the quality of life of incurable patients depends on the level of palliative care to achieve and maintain the maximum of their physical, psychological, social, and spiritual potential. Furthermore, palliative care should meet the following requirements: early-onset, continuity, succession, comprehensive, phased, and individual approach. Despite certain existing common problems in the implementation of palliative care and the difficulties caused by the restructuring of the health care system in the fight against coronavirus infection, the system is functioning and has the necessary resources to ensure the quality of life and alleviate persistent painful symptoms of patients.

Palliative care considerations and practices for adolescents and young adults with cancer.

The definition of adolescents and young adults (AYAs) in oncology varies with upper limits up to age 39. Younger AYAs, ages 12-24years, are often cared for within pediatrics. In caring for AYAs with cancer, there are unique considerations that become even more important to recognize, acknowledge, and address in AYAs with life-threatening cancer receiving palliative care. This review highlights important factors such as psychosocial development, cultural considerations, and support structure, which should be considered when providing palliative care to AYAs with cancer during the various stages of care: introduction of palliative care; symptom management; advanced care planning (ACP); end-of-life (EOL) care; and bereavement.

Customised pediatric palliative care: Integrating oncological and palliative care priorities.

To describe the experience involving the early introduction of palliative care (PC) in oncological patients treated within the paediatric oncology unit of the Istituto Nazionale Tumori of Milan and compare this cohort with a cohort of patients resident in the same area treated before the introduction of early palliative care. A virtual team was assembled in 2015. The PC providers operate outside the hospital. Conference calls were scheduled to discuss patients' problems. This sample was compared with the clinical records of patients residing in the same area who died between 2009 and 2014. Between January 2015 and April 2019, 41 patients residing in the Milan area mainly with CNS tumours or sarcomas were referred to the team. Comparing the results with the previous cohort, there was a rise in the number of patients dying at home or in a hospice and the duration of PC increased over time. From 2015, none of the patients died in an intensive care unit. Patients managed by the virtual team were able to continue their cancer treatments, take part in Phase I trials and receive PC. All patients with a poor prognosis should have PC at an early stage.

Introducing palliative care into the intensive care unit: An interventional study

BackgroundMany Intensive Care Unit (ICU) deaths include patient and family suffering. While there is a need to include palliative care in the ICU, such care is often unavailable. ObjectivesTo determine whether a course in ICU Palliative Care was associated with changes in participants' palliative care knowledge, attitudes and practices. MethodsFour cohorts of a national Israeli course in ICU palliative care (N = 122) were followed. Data were collected on the first and last day of a six-month course and 2–5 years later. ResultsStatistically significant differences were found in palliative care attitudes and practices, with knowledge levels and quality of death and dying stable after course completion. Participants reported obtaining knowledge and skills necessary to introduce palliative care but were thwarted by organizational barriers. ConclusionsThe course was successful in building participants capacity to provide palliative care however; barriers made introduction of palliative care into the ICU difficult.

Integration of Neuro-Oncology and Pediatric Palliative Care at Diagnosis in the Outpatient Setting. (FR436)

•Gain knowledge about the common types of life-threatening brain tumors seen in children, cutting edge treatments for these tumors, and why an understanding of neuro-oncology is critical to pediatric palliative care providers.•Describe the barriers to introducing palliative care at the time of diagnosis of a high grade pediatric brain tumor and how the pediatric neuro-oncology and palliative care teams negotiated a patient/family-focused approach that overcame the barriers.•Weigh the advantages and disadvantages of several different models for overcoming the logistical challenges of integrating palliative care into a pediatric neuro-oncology clinic.•Be able to quote data that supports the benefits of early introduction of palliative care in the management of pediatric neuro-oncology patients diagnosed with life-threatening tumors. Brain tumors are the second most common tumor in children accounting for about 1 in 4 tumors. They are also the leading cause of cancer-related death in children. The tumors and their treatments are associated with significant physical symptoms, psychological strain, learning difficulties, and mortality. For these reasons, it is imperative that children with brain tumors have access to palliative care starting at the time of diagnosis. Unfortunately, access to palliative care for these children is not universal and when available is often indroduced late in the couse of disease. The prognosis and treatment of the most common life-threatening brain tumors will be reviewed by a neuro-oncology team. The neuro-oncology team will also share five years of experience embedding palliative care into the pediatric oncology clinic at a large tertiary care hospital. In this setting, it has been shown that families are very open to and appreciative of early palliative care when it is framed by the oncology team as an essential part of the care of children with brain tumors. The neuro-oncology team and the palliative care team will dialogue about the sources of resistance to early introduction of palliative care and how this resistance can be overcome. The practical considerations involved in the implementation of clinic-based palliative care will also be discussed. This will include staffing and the advantages of different clinic models including 1) embedded clinics, 2) floating clinics, and 3) free standing clinics. Finally, a retrospective review of 5 years of clinical data collected on over 60 pediatric neuro-oncology patients concurrently followed in palliative care clinic will be presented. The data will include type of brain tumor, time from diagnosis to palliative consult, symptom frequency, time from POLST completion to death, time from hospice referal to death, and location of end of life care.