Physician Involvement Research Articles

Proportion, Type, and Characteristics of Physician Entrepreneurship in Massachusetts

Although there have been signs of increasing interest in entrepreneurship among physicians as well as claims of a paucity of entrepreneurial activity in health care in general, there is little systematic evidence of the extent, type, and characteristics of entrepreneurship by physicians. Physician involvement in entrepreneurship may result in more innovative and financially successful health care companies. To evaluate the proportion and characteristics of physicians who founded new businesses and the types of businesses that they started. This cross-sectional study was conducted by matching all 33 770 physicians holding a Massachusetts medical license in 2017 with the Massachusetts new business registration records from 1960 to 2017 to identify companies founded by physicians. Data were analyzed from September 2017 to December 2019. The number of physician-founded companies in Massachusetts and the types of businesses as characterized by the stated purpose at the time of founding. Among the 33 770 physicians holding a Massachusetts license in 2017, 13 839 (41.0%) were women and 8029 (23.8%) were international medical graduates; the median year of graduation from medical school was 1994 (interquartile range, 1983-2004). A total of 6494 (19.2%) physicians had founded at least 1 new business, and 831 of the 2448 physicians (33.9%) who graduated from medical school between 1974 and 1978 had founded a business. A total of 9501 companies were founded, of which 6267 (66.0%) were clinical practice, real estate, or practice management companies; 703 companies (7.4%) were in the public interest, including advocacy, public health, and philanthropy; 533 (5.6%) were biotechnology, health care information technology, or medical device companies; and 1759 (18.5%) were other business pursuits. For physician entrepreneurs, the mean (SD) time from medical school graduation to company founding was 20.2 (9.8) years. Regression analysis suggested that female physicians founded companies at lower rates than male physicians (odds ratio [OR], 0.529; 95% CI, 0.494-0.567) and that there was an association between attending a top-10 medical school by National Institutes of Health research funding and starting a clinical practice (OR, 0.687; 95% CI, 0.616-0.766) or biotechnology company (OR, 4.326; 95% CI, 2.951-6.344). The findings of this cross-sectional study suggest that physicians may be substantially involved in entrepreneurship, although there may be disparities by sex. Facilitation of physician entrepreneurship by policy makers, educators, and institutions may enhance medical innovation and public health.

Letter to the Editor: Good Hearing for Ensuring Healthy Aging.

«Healthy aging», defined by the World Health Organization (WHO) as « the process of developing and maintaining the functional ability that enables well-being » (1), needs the involvement of various physicians. The WHO-ICOPE (Integrated Care for Older People) approach was developed to early identify, diagnose and treat older adults’ frailties defined as impairments of at least one of the six intrinsic capacities (i.e., hearing, vision, mood, cognition, mobility and nutrition), which could precipitate functional loss and alter the quality of life (2). Among these intrinsic abilities, hearing is the sense of communication and socialization, and may influence the quality and accuracy of the medical examination and interview. Hearing impairment usually develop insidiously and is unrecognized or insufficiently self-reported by older patients. However, by 2050, the number of people with hearing loss will increase to over 900 million worldwide, mainly due to aging population.

Profile of donors and corneal tissue obtained through hospital cornea retrieval programme in a recently established eye bank of a tertiary care teaching hospital of Eastern India.

Context:There is a global need for quality eye banking practices and sensitization of primary care physicians toward corneal donation.Aims:To evaluate performance of a recently established eye bank (EB) and quality of corneas obtained, and identify areas of improvement during procurement and utilization of donor corneas.Settings and Design:This retrospective observational study is based on records of corneas collected through hospital cornea retrieval programme (HRCP) in the EB of a tertiary care institution during the first 2 years of its establishment.Methods and Material:Data on demographic characteristics of donors, death-preservation interval, specular microscopy parameters of corneas, indications for utilization, and reasons for non-utilization of corneas were collected.Statistical Analysis Used:Means, standard deviation, range, frequencies, and proportions were analyzed. Spearman's correlation coefficient and Kruskal–Wallis test were applied taking P < 0.05 as significant.Results:The EB retrieved 54 corneas from 27 donors with mean age 42.3 ± 24.2 years. All tissues were preserved in Cornisol®. Majority (50%) of transplantable tissues had an endothelial cell density (ECD) between 2,000 and 2,500 cells/mm2. ECD decreased significantly with increasing age (Spearman's ρ -0.747, P < 0.001; Kruskal–Wallis P < 0.001). Overall utilization rate of tissues was 87.04% (47/54), and utilizable corneas (50/54, 92.6%) were mainly used for optical purposes (34/50, 68%).Conclusions:Successful HCRP of the recently established EB has shown considerable promise in terms of quality and utilisation of corneas. There is need for active involvement of primary care physicians in contributing to increasing voluntary eye donation through awareness, advocacy, and social mobilization.

Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms.

Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126-10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520-5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854-2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444-939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.

Teoretyczny rozdział kompetencji pomiędzy dawnymi medykami i chirurgami a codzienna praktyka lecznicza opisana w egodokumentach staropolskich

Theoretical Division of Competences Between Physicians and Surgeons, and the Daily Medical Practice Described in Old-Polish Egodocuments It is predominantly accepted in the historiography of European medicine that, apart from the differences in education, there was a division of competences between physicians educated at universities and barber-surgeons trained in the guild system in terms of their theoretical background. Regardless of the former stereotypes – dating back to the 19th century – relating to the Church-imposed restrictions in teaching surgery at universities, it is believed that the actual differences in terms of competences must have influenced the scope of the undertaken therapeutic activities. A different education model and the predominance of either theoretical or practical knowledge among representatives of these groups resulted in different treatment methods and a different perception of the causes of the disease. Physicians with mainly theoretical knowledge are often put in opposition to practising barber-surgeons. While it seems that the reluctance to bloody operations (sometimes articulated by the surgeons themselves) was a reason for the limited involvement of physicians in the barber-surgeon practice, it is difficult to clearly indicate the factors that would prevent surgeons from dealing with “non-operational” treatment. The article attempts to answer the question to what extent the then-existing differences in education and legal restrictions influenced the actual division of therapeutic tasks and the functioning of various medical professions as viewed from the patient’s perspective.

How Should History of Physician Involvement in the Holocaust Inform How Physicians Approach Employers?

In response to a case involving an advertisement for a physician to work in a private detention center housing asylum seekers and immigrants, this commentary considers ethical obligations of physicians responsible for detainees' health care. The commentary also suggests key points a physician should make during a job interview at a detention center and concerns a physician might articulate about caregiving practices for detainees.

355. Variability in the Current Evaluation and Management of Pediatric Encephalitis: Survey Results from an Emerging Infections Network Survey

BackgroundChildhood encephalitis causes severe morbidity and mortality. Difficulty identifying causative organisms and a lack of effective therapies leads to variability in management. The recent emergence of novel diagnostic tools and the increased recognition of auto-immune encephalitides has the potential to change the approach to this disease. Our objective was to assess the current evaluation and management of childhood encephalitis.MethodsAn 11-question confidential, web-based survey was distributed by the Emerging Infections Network (EIN) of the Infectious Disease Society of America to 370 Pediatric Infectious Disease (ID) physicians between January 29th and February 17th, 2020. Respondents were characterized by practice region, experience since fellowship, place of employment and primary hospital type. Responses were analyzed with SAS, v 9.4.ResultsResponses were obtained from 222 of 370 members (60%) (Table). Of the 222 respondents, 196 (88%) reported caring for children with suspected encephalitis and form the basis for this report. Multi-plex PCR testing of cerebrospinal fluid (CSF) in the initial evaluation of most children with suspected encephalitis was reported by 56% (with 65% of these respondents reporting the use of pathogen-specific confirmatory testing). CSF metagenomic next generation sequencing (mNGS) had been used by 47%, with 74% of all respondents stating they would use this test if likely diagnoses were excluded via standard testing (and 64% of these only using the test if the child was not improving). Variability in the interpretation of negative CSF mNGS results was reported (Fig 1a). Primary involvement of ID physicians in the diagnostic evaluation of auto-immune encephalitis was reported by 33%, yet only 55% of ID physicians reported feeling comfortable diagnosing this condition. Marked variation existed regarding criteria for the use of immunomodulating agents (Fig 1b) and the need for testing for autochthonous tropical viruses in the U.S. (Fig 1c). Background of 222 Respondents to an Emerging Infections Network Survey Assessing the Evaluation and Management of Pediatric Encephalitis. ID=Infectious Disease; VA=Veterans Affairs; DOD=Department of Defense *Respondents were significantly more likely than non-respondents to have <5 years of ID experience (p=0.04).Figure 1 Approaches to the Interpretation of CSF mNGS Results, Use of Immunomodulating Agents and Testing for Autochthonous Tropical Viral Pathogens in Children with Encephalitis ConclusionVariation exists in the evaluation and management of childhood encephalitis, including the application of new diagnostic modalities and management of autoimmune encephalitides. Updated standardized management guidelines may improve implementation of advances in this realm.Disclosures All Authors: No reported disclosures

An Integrated Approach to Selecting a Prepared Medical Decision-Maker

BackgroundWe implemented a systematic multidisciplinary process to engage new outpatients with cancer in selecting and preparing a medical decision-maker. MeasuresTemplated advance care planning notes and medical power of attorney documents were used in the electronic health record by the third office visit. InterventionPatients were coached to meet with social work from a “culture of yes,” viewed a video about the importance of selecting a prepared medical a decision-maker in English or in Spanish, and referenced cards containing simple explanations of advance directives when responding to advance directive questions. OutcomesA total of 351 patients were evaluated. By visit 3, there was no increase in documented social work advance care planning notes in intervention or scanned medical power of attorney documents in the electronic health record. Conclusions/Lessons LearnedThis systematic multidisciplinary approach did not engage new outpatients with cancer in preparing a medical decision-maker. More active physician involvement and varied ways of engagement are needed.

Information gain in environmental monitoring through bioindi-cation and biomonitoring methods ("B &amp; B technologies") and phytoremediation processes – with special reference to the Biological System of Chemical Elements (BSCE) under specific consideration

Different definitions for the concepts of information, information transfer, i.e. communication and its effect and efficiency of false, but also correct information, especially from the environmental sector, are given. "THE TEN ECOLOGICAL COMMANDMENTS" developed by Menke-Glückert at the end of the 1960s and the 9th commandment "Do not pollute information", in particular, are examined in more detail and understood practically as a currently unchanging law in our existing world societies. The "Ethics Consensus", derived from "THE TEN ECOLOGICAL COMMANDMENTS" and developed by Markert at the end of the 1990s, reflects both theoretical and practical levels of action that many people in our highly diverse world societies can support. From a scientific point of view, this article deals in particular with the so-called B &amp; B technologies, i.e. bioindication and biomonitoring of chemical elements, their chemical speciation as well as organic substances.In particular, B &amp; B technologies, which deal with the biological detection of atmospheric deposition of chemical substances on a regional, national and international level, are taken into account. From both an academic and a practical point of view, mosses have prevailed here in the last decades in addition to lichens. The use of mosses is a major focus of international air monitoring, especially in Europe. Furthermore, the phytoremediation of chemical substances in water, soil and air is described as a biological and sustainable biological process, which does not "yet" have the full scope as it is used in bioindication and biomonitoring, as shown in the example of mosses. However, the phytoremediation considers to be an excellent tool to have the leading role in the sustainable pollutant "fight". In the future qualitative and quantitative approaches have been further on developed to fit scientifically and practically B&amp;B Technologies as well the different form of phytotechnological approaches. Finally, the example of lithium, which is optionally derived from the Biological System of Chemical Elements (BSCE), becomes a chemical example that the administration of lithium to ALL mentally conditioned diseases such as manic depression up to smoking of cigarettes become one of the most valuable service for the recovery of our human society on a global level.As a conclusion of these tremendous effects of lithium can be considered: pulled out, in order to make clear that only this chemical element beside a psychiatric care and the involvement of family members, friends, physicians, psychologists and psychiatrists. In addition it is a must, that there is a strong relationship in between patient, psychiatrist(s) and strongly related persons to the patient. First an intensive information transfer via communication has to be guaranteed. After it a psychological support by doctors and, only if it seems necessary Lithium is to be given in a patient specific dose.Keywords. Bioindication, Biomonitoring, B&amp;B Technology, Phytotechnology, The Biological System of Chemical Elements (BSCE), Lithium. Neurological diseases, Functional Food.

The effectiveness of interventions to improve pain assessment and management in people living with dementia: A systematic review and meta-analyses.

To synthesize and evaluate the effectiveness of interventions for nurses to improve the assessment and management of pain in people living with dementia. Systematic review and meta-analyses of randomized controlled trials. CINAHL, Joanna Briggs Institute (JBI) EBP, Cochrane Library, PubMed, and Scopus databases were searched for all journal articles published between 2009 -2019. Papers were included under population intervention comparator outcome (PICO) framework for: (a) people living with dementia aged 65years and over; (b) interventions developed for nurses or other health professionals; (c) comparison group of standard care or control; and (d) outcome that measures the intervention effects on nurses and people living with dementia. Independent reviewers undertook critical appraisal, data abstraction, and synthesis. Meta-analyses were performed to determine the effectiveness of interventions. Of 2099 titles and abstracts screened, six interventions with low-to-moderate risk of bias met inclusion criteria. Studies that implemented a routine pain assessment tool showed no effect on nurses' analgesic management. Studies that developed a comprehensive pain model involving multidisciplinary health professionals showed overall effects on pain assessment and management in dementia care. Physician involvement had an impact on analgesic management. Comprehensive pain models improve nurses' pain assessment and management. A lack of balance between analgesia use and non-pharmacological pain management in dementia care is evident. Multidisciplinary health professionals' involvement is essential for effective intervention design for pain management in dementia. Various pain assessment tools have been considered to assist identification and management of pain in people living with dementia. Nevertheless, challenges exist when caring for people living with dementia in pain. These findings support the development of a comprehensive pain model, which may be a more effective strategy than routine use of a pain tool alone for nurses to improve pain management in dementia care.

Assessing perspectives on artificial intelligence applications to gastroenterology

Assessing perspectives on artificial intelligence applications to gastroenterology

Early-onset scoliosis: challenges and current management options

Early-onset scoliosis is one of the most challenging conditions facing spinal and paediatric surgeons and clinicians. The ultimate goal of treatment is to improve the children's quality of life and to give them the best chance to develop to independent adults. However, the road to these goals is not an easy one. There are obstacles to be overcome, risks to be encountered; and difficult decisions to be inevitably made. The young age of the patients means they have significant growth potential. Managing the growing child means not only controlling and correcting the spinal deformity; but also preserving the motion and development of the spine, chest cavity and the cardiopulmonary system. Different treatment modalities exist to help these ambitions. These include observation, casting, bracing and surgery. However, nothing is more worthy of emphasis than the importance of a multi-team approach; with the involvement of surgeons, physicians, neurologists, nutritionists and physiotherapists. In this review we aim to shed some light on different management strategies; examining the principles behind them, their advantages and drawbacks; and some of the results reported in the literature. We will also explore some currently promising advances that might play a future role in managing early-onset scoliosis.

Social Media in Minimally Invasive Gynecologic Surgery: What Is #Trending?

Study Objective Surveys report seven-in-ten Americans use some form of social media1. Risks of social media platforms include spread of misinformation and information overload. Patients share and obtain health-care related information on such platforms. We aim to evaluate content and authorship of popular gynecological topics posted on Instagram. Design Retrospective content analysis. Setting Instagram. Patients or Participants N/A Interventions N/A Measurements and Main Results A query of endometriosis, adenomyosis, fibroids, and hysterectomy yielded 237 hashtags. The top 10 and most recent 20 posts (determined by Instagram's internal algorithm) for 10 popular hashtags were quantitatively (likes, comments) and qualitatively (content, authorship) reviewed. Posts cross-tagged with infertility, other chronic diseases; videos; or foreign language posts were excluded. The 10 popular hashtags investigated were linked to 2,301,238 posts: #endometriosis (N=1,461,668), #endometriosisawareness (N=324,041), #fibroids (N=143,197), #adenomyosis (N=98,101), #hysterectomy (N=87,176), #endometriosiswarrior (N=52,503), #endometriosisawarenessmonth (N=47,728), #hysterectomyrecovery (N=35,124), #endometriosissucks (N=26,568), #endopain (N=25,132). Of 300 posts evaluated, 97.3% were by non-healthcare authors (patients, 55%); 1.6% were authored by verified physicians/professional society. The most common content for non-healthcare authored posts was personal experience (30.67%). Educational content accounted for 4.6% posts; none were authored by a health-care profile (p Conclusion Over 2 million posts on gynecological conditions were identified on Instagram. The majority were authored by patients sharing their personal experience. The most popular topic was endometriosis. Few educational posts were identified. Official healthcare presence was significantly lacking. Physician involvement in social media may lead to improvements in patient education, physician-patient relationship, and knowledge in MIGS.

Patient and caregiver experiences with advanced cancer care: a qualitative study informing the development of an early palliative care pathway

BackgroundPalliative care is an approach that improves the quality of life of patients and families facing challenges associated with life-threatening illness. In order to effectively deliver palliative care, patient and...

Elephant in the room - Family members´ perspectives on advance care planning

Objective To explore family members’ experiences of advance care planning in nursing homes. Design Individual interviews. Thematic analysis. Setting Four nursing homes in Sweden. Subjects Eighteen family members of deceased nursing home patients. Main outcome measures Family members’ experiences of advance care planning in nursing homes. Results Family members’ experiences of advance care planning in a nursing home context involved five themes: Elephant in the room, comprising end-of-life issues being difficult to talk about; Also silent understanding, e.g. patient’s preferences explicitly communicated, but also implicitly conveyed. In some cases family members had a sense of the patient’s wishes although preferences had not been communicated openly; Significance of small details, e.g. family members perceive everyday details as symbols of staff commitment; Invisible physician, supporting nurse, e.g. nurse being a gatekeeper, providing a first line assessment in the physician’s absence; and Feeling of guilt, e.g. family members wish to participate in decisions regarding direction of care and treatment limits, and need guidance in the decisions. Conclusion Our study stresses the significance of staff involving the patient and family members in the advance care planning process in nursing homes, thereby adapting the care in line with patient’s wishes, and for the patient to share these preferences with family members. Education in communication related to the subject may be important to shape advance care planning. Key points Knowledge on advance care planning (ACP) in a nursing home (NH) context from the perspective of family members is limited. Role of the nurse in ACP is seen as central, whereas physician involvement is often perceived to be lacking. Significance of small details, perceive to symbolize staff competence and respect for patient autonomy. To limit family members’ feeling of guilt, communicating end-of-life issues is important in order to align ACP with patient preferences.

Paediatric/congenital cardiology physician scientists-An endangered species.

Producing excellent physician scientists starts with the active discovery of talent and dedication, supported by the strong belief that physician involvement in biomedical research is essential to make fundamental discoveries that improve human health. The revolution of surgical and interventional therapy of structural heart disease has had 'profoundly positive effects on survival and quality of life over the decades. (…) Small increments in clinical improvement will still be possible in the future, but for the most part, the potential for major advancement using these techniques has been exhausted' (Frank Hanley, MD; Stanford). Personalized medicine, rapid genetic diagnostics, RNA and extracellular vesicle biology, epigenetics, gene editing, gene and stem cell-derived therapy are exemplary areas where specialized training for paediatric/congenital cardiology physician scientists will be increasingly needed to further advance the field. About a decade ago, a series in Circulation discussed academic career models and highlighted the major challenges facing the cardiovascular 'clinician scientist' (syn. physician scientist), which have not abated since. To develop the skills and expertise in both clinical congenital cardiology and basic research, the training of fellows must be focused and integrated. The current pandemic COVID-19 puts additional pressure and hurdles on fellows-in-training (FIT) and early career investigators (ECI) who aim to establish, consolidate or expand their own research group. Here, we discuss the major challenges, opportunities and necessary changes for academic institutions to sustain and recruit physician scientists in paediatric/congenital cardiology in the years to come.

Medical Students Envision Mental Health in Post-COVID World

Medical Students Envision Mental Health in Post-COVID World

Genetic counseling service delivery models: A study of genetic counselors’ interests, needs, and barriers to implementation

As demand for genetic services grows, innovative genetic counseling service delivery models (SDMs) are needed. However, there is limited research on the barriers and needs of genetic counselors (GCs) interested in implementing new SDMs into their practice. In fall 2017, the National Society of Genetic Counselors (NSGC) Access and Service Delivery Committee's SDM Subcommittee sent an online survey to the NSGC membership regarding the use of SDMs, which aimed to update the understanding of current SDM use and how this has changed over time. The survey included several questions with open-response components assessing the need for new SDMs and barriers to implementation. Inductive thematic analysis was used to identify common themes. Among 517 usable responses (16% response rate), more than half (54.4%) of respondents indicated their current SDM was inadequate to address the patient need in their area. Nearly two-thirds (64.8%) indicated they were in the process of or planning to make changes to their SDM, although 40.6% did not have a specific timeline. Three major themes related to expanding access, reimbursement for services, and lack of support were identified from responses to questions about implementation of additional SDMs. Access included subthemes of geographic and physical location limitations, addressing long wait times, and the need to expand services. Reimbursement for services included issues with billing, genetic counselor licensure, and limitations due to the need for physician involvement in billing. The lack of support was evident with issues related to understaffing; difficulty gaining support at the administrative, institutional, or physician level; time constraints; and funding concerns. This study shows that GCs need education, tools, and resources to overcome barriers in implementing new or adapting current SDMs, and there is a need for policy change, including new billing and coverage models.

1187P Characterization of the gastroenteropancreatic neuroendocrine tumour patient journey

With increasing incidence and prevalence of gastroenteropancreatic neuroendocrine tumours (GEP-NETs), there is a need to identify inefficiencies in patient management. To provide a view of the journey for patients with GEP-NETs, healthcare professionals (HCPs) and patients from the USA and EU4 (France, Italy, Spain, UK) were interviewed with responses analyzed to determine consensus views. Fifty-four interviews were completed (49 HCPs, five patients). Time to first diagnosis of GEP-NET takes 5–7 years on average and misdiagnosis is common. Multidisciplinary team (MDT) structure and dynamics vary by practice type, institution, and country. In academic settings, GEP-NET is discussed in gastroenterology and/or hepatobiliary tumour boards, but centres with large case volume may hold NET-specific MDTs. Nuclear medicine physicians are increasingly involved in MDTs across many institutions, where they are consulted on patient eligibility for peptide receptor radionuclide therapy (PRRT). In the USA, medical oncologists are the primary treatment decision-makers, while gastroenterologists and endocrinologists are more involved in decisions in Europe, depending on tumour localization. Surgery-ineligible first-line cases are widely managed with somatostatin analogue therapy, and systemic options including PRRT and liver-directed therapies are provided for patients with metastatic disease. While PRRT is commonly used in second-line for low grade, well-differentiated tumors, it can be considered in first-line for patients with poorly differentiated fast-growing, somatostatin receptor-positive tumours. Treatment sequencing depends highly on physician attitudes and logistical barriers. HCP follow-up varies according to treatment and experience with GEP-NET. The rarity of GEP-NET, along with its late diagnosis and misdiagnosis can lead to complexities and uncertainty in sequencing when selecting the right therapy. Differences in management decision vary amongst institutions and countries, and the involvement of nuclear medicine physicians in the decision-making process of MDTs can improve awareness to availability of a treatment option such as PRRT.

Patterns of palliative care consultation among patients with brain metastasis: an opportunity for radiation oncologists to facilitate earlier referral

Early palliative care (PC) physician involvement alongside standard oncologic care has been recommended by the American Society of Clinical Oncology (ASCO) guidelines for all advanced cancer patients, although adherence to these guidelines is variable. Radiation oncologists (ROs) could help facilitate early PC referral for patients treated with palliative radiation, particularly those with brain metastasis (BRM), and the aim of this study was to evaluate the circumstances of PC referral at our institution to better understand the multidisciplinary approaches to facilitate it. Patients diagnosed with BRM from non-small cell lung cancer (NSCLC) from 2012 to 2018 whose primary RO and MO were at our institution were reviewed. Overall survival and time to PC consultation from the first oncologic visit following BRM diagnosis was determined using the KaplanMeier method. Mann-Whitney U and Chi-Squared assessed for predictive factors for shorter time to PC consultation. For these factors, the overall survival, rate of PC consultation, and PC setting was used to determine utilization of early PC. Among 103 eligible patients, only 48% underwent a PC consultation in their lifetime, with the initial evaluation being as an outpatient for 37%, and within 1 month of death for 35%. Median survival from BRM diagnosis was 9.0 months. The median time from oncologic appointment to PC referral was 2.8 months, and from initial PC consultation to death was 1.6 months. Only more recent BRM diagnosis (2016-2018 vs. 2012-2015) was associated with shorter time to PC consultation (1.0 vs. 5.6 months, P=0.013), increased PC consult rate (60% vs. 42%, P=0.105), and increased outpatient PC consultation (56% vs. 26%, P=0.037). The majority of patients did not undergo early PC consultation, though utilization has improved over time. As ROs are commonly involved in BRM management, they may be in a position to proactively support early PC consultations in this patient population.