Outpatient Palliative Medicine Research Articles

Immunoassay Urine Drug Testing among Patients Receiving Opioids at a Safety-Net Palliative Medicine Clinic

Background: Few studies have examined the use of immunoassay urine drug testing of cancer patients in palliative care clinics. Objectives: We examined the frequency of immunoassay urine drug test (UDT) abnormalities and the factors associated with aberrancy at a safety-net hospital palliative medicine clinic. Methods: A retrospective review of the electronic medical records of consecutive eligible patients seen at the outpatient palliative medicine clinic in a resource-limited safety-net hospital system was conducted between 1 September 2015 and 31 December 2020. We collected longitudinal data on patient demographics, UDT findings, and potential predictors of aberrant results. Results: Of the 913 patients in the study, 500 (55%) underwent UDT testing, with 455 (50%) having the testing within the first three visits. Among those tested within the first three visits, 125 (27%) had aberrant UDT results; 44 (35%) of these 125 patients were positive for cocaine. In a multivariable regression model analysis of predictors for aberrant UDT within the first three visits, non-Hispanic White race (odds ratio (OR) = 2.13; 95% confidence interval (CI): 1.03–4.38; p = 0.04), history of illicit drug use (OR = 3.57; CI: 1.78–7.13; p < 0.001), and history of marijuana use (OR = 7.05; CI: 3.85–12.91; p < 0.001) were independent predictors of an aberrant UDT finding. Conclusion: Despite limitations of immunoassay UDT, it was able to detect aberrant drug-taking behaviors in a significant number of patients seen at a safety-net hospital palliative care clinic, including cocaine use. These findings support universal UDT monitoring and utility of immunoassay-based UDT in resource-limited settings.

Opioid Monitoring Using Urine Toxicology Screens in Outpatient Oncology Palliative Medicine.

There is a paucity of real-world data on opioid screening and urine toxicology testing in outpatient oncology palliative medicine. This was a retrospective analysis of adult patients with cancer completing ≥ one outpatient palliative medicine visit and the Edmonton Symptom Assessment Scale (ESAS). Patient demographics, the Screener and Opioid Assessment for Patients with Pain-Short Form (SOAPP-SF), ESAS, medications, and urine toxicology screens (UTSs) were collected at baseline and follow-up visits. The primary end point was the frequency and type(s) of noncompliant UTSs (ie, presence of a nonprescribed substance or absence of a prescribed substance). Secondarily, risk factors for noncompliant UTSs were evaluated using univariate and multivariable logistic regression. Of 189 evaluable patients (632 clinic visits), 113 underwent ≥one UTSs, 125 SOAPP-SF, and 75 had both. The median age was 56 (range, 26-80) years, 56% were female, 58% were White, 40% were Black, 48% had stage IV disease, the median baseline pain score was 7, and the median SOAPP-SF was 3. Oxycodone was the most prescribed drug (n = 125). Of 113 patients who underwent UTSs, 54% (n = 61) had ≥one noncompliant result. Thirty-nine percent (n = 44) had a total of 128 noncompliant results for the presence of a nonprescribed substance; 29% (n = 33) had a total of 53 noncompliant results for the absence of a prescribed substance. SOAPP-SF Q4 (use of illegal drugs) (odds ratio [OR], 3.61; 95% CI, 1.81 to 7.19; P < .001) and prescription with nonopioid adjuvant medications (OR, 2.83; 95% CI, 1.12 to 7.19; P = .029) were associated with increased odds of a noncompliant UTS. More than half of the tested population had noncompliant UTS. Screening and evaluating risk factors for nonmedical opioid use is critical in oncology palliative medicine.

Advance Care Planning Practice Patterns Before and During a Pandemic.

Introduction: The COVID-19 pandemic resulted in introspection of the United States health care infrastructure, especially with advance care planning (ACP). Methods: This is a retrospective chart review assessing the frequency of ACP discussions and formal documents reflecting ACP wishes in an outpatient palliative medicine (PM) practice. The study site was at University Medical Center New Orleans from pre-COVID-19 surge (November 2019-February 2020) to months during and post-COVID-19 surge (March-April 2020). Results: Results showed an increase in ACP discussions during the post-COVID-19 months. Patients seen during the surge and post-COVID-19 months were more likely to discuss medical power of attorney (odds ratio [OR] = 1.78, p = 0.045) and preferred code status (OR = 2.82, p < 0.001). Conclusion: Our study showed that more ACP discussions were conducted post-COVID-19 versus pre-COVID-19. However, formal documents reflecting these wishes were lacking. These results can help guide ACP use in crisis periods and improve understanding of ACP discussions in an outpatient PM clinic.

Effectiveness of Long-Term Opioid Therapy for Chronic Pain in an Outpatient Palliative Medicine Clinic.

Background: Despite widespread use of opioid therapy in outpatient palliative medicine, there is limited evidence supporting its efficacy and safety in the long term. Objectives: We sought to improve overdose risk scores, maintain pain reduction, and preserve patient function in a cohort with severe chronic pain as we managed opioid therapy for a duration of four years in an outpatient palliative care clinic. Design: Over four years, we provided ongoing goal-concordant outpatient palliative care, including opioid therapy, using quarterly clinical encounters for a patient cohort with chronic pain. Setting/Subjects: The project took place in the outpatient palliative medicine clinic of a regional cancer center in Orlando, Florida (United States). The subjects were a cohort group who received palliative care during the time period between July 2018 and October 2022. Measurements: Key metrics included treatment-related reduction in pain intensity, performance scores, and overall overdose risk scores. Secondary metrics included cohort demographics, average daily opioid use in morphine milligram equivalents and categorization of type of pain. Results: In 97 patients, we observed a stable mean treatment-related reduction in pain intensity of 4.9 out of 10 points over four years. The cohort showed a 2-point (out of 100) improvement in performance scores and an 81-point (out of 999) reduction in mean overall overdose risk score. Conclusions: We present evidence that providing outpatient palliative care longitudinally over four years offered lasting treatment-related reductions in pain intensity, preservation of performance status, and reduction in overall overdose risk.

Opioid screening and urine toxicology results in outpatient oncology palliative medicine.

e24068 Background: Opioid misuse is a major public health issue. Given widespread opioid prescribing in cancer patients (pts), screening for potential misuse is critical. There is lack of real-world data on opioid screening and urine toxicology testing in outpatient oncology palliative medicine. Methods: This is a retrospective clinical analysis of adult cancer pts previously consented for a pharmacogenomics specimen collection study between August 2019-March 2020. Pts completing ≥ 1 outpatient palliative medicine visit with at least half undergoing urine toxicology screening (UTS) per standard practice were included. Pt demographics, medication(s), UTS results, symptoms using Edmonton Symptom Assessment Scale, and opioid screening using Screener and Opioid Assessment for Patients with Pain - Short Form (SOAPP-SF) were collected at baseline and follow up visits, if available. The primary endpoint was the frequency and type(s) of non-compliant (NC) UTS. Secondarily, risk factors for NC UTS were evaluated using univariate and multivariate logistic regression. Results: Of 189 pts (632 visits), 113 underwent UTS, 125 SOAPP-SF, and 75 had both. The median age was 56, 56% were female, 58% white, 40% black, 48% had stage IV disease, and median pain score was 7. More black pts (72%) underwent UTS compared to white pts (53%) (p = 0.001). The mean age of pts with a UTS was 53 compared to 59 in those without UTS (p = 0.002). Oxycodone was the most prescribed drug (N = 125). Median SOAPP-SF was 3 (range 0-11); 38% had a score ≥ 4 (considered high risk). About half (54%; N = 61) who underwent a UTS were NC. Of these, 32 had 1 NC UTS, whereas 29 had 2 or more. The most common reason was presence of a substance not prescribed (N = 44 pts and 128 results), whereas 33 pts (53 results) were NC for substance(s) not present but prescribed. Four had presence of marijuana only and 21 with marijuana plus another NC substance; presence of cocaine and alcohol were the 2nd and 3rd most frequent aberrant result. Of those with a NC UTS and SOAPP-SF score (N = 44), 59% had a score ≥ 4. In univariate analyses, SOAPP-SF ≥ 4 (p = 0.004), nausea (p = 0.05), depression (p = 0.02), anxiety (p = 0.01), and prescriptions for antidepressants (p = 0.006), acetaminophen (p = 0.03), and/or dronabinol (p = 0.04), were associated with NC UTS. In multivariate analyses, SOAPP-SF Q4 (use of illegal drugs) (OR 2.86, 95% CI 1.64 to 5.02; p &lt; 0.001) and prescription with muscle relaxants (OR 2.90, 95% CI 1.19 to 7.09; p = 0.019) were associated with increased odds of a NC UTS. Conclusions: About half of those undergoing UTS were NC. SOAPP-SF Q4 and prescription with muscle relaxants were associated with a NC UTS. Overall, pt demographics (e.g. younger, more female, more black patients, severe pain) varied from the typical cancer population. Screening using SOAPP-SF, UTS, pain contracts, prescription drug monitoring databases, and evaluating pt-specific risk factors is important to reduce opioid misuse risk.

"If You Call Them, They Will Come": A Telephone Call Reminder to Decrease the No-Show Rate in an Outpatient Palliative Medicine Clinic.

A high outpatient clinic no-show rate affects clinical outcomes, increases healthcare costs, and reduces both access to care and provider productivity. In an effort to reduce the no-show rate at a busy palliative medicine outpatient clinic, a quality improvement project was launched consisting of a telephone call made by clinic staff prior to appointments. The study aimed to determine the effect of this intervention on the no-show rate, and assess the financial impact of a decreased no-show rate. The outpatient clinic no-show rate was measured from September 1 to December 31, 2015. Data from the first 8 months of the calendar year was removed since these could not be verified. Starting January 1, 2016, patients received a telephone call reminder 24 hours prior to their scheduled outpatient appointment for confirmation. No-show rate was again measured for the calendar year 2016. Opportunity costs were calculated for unfulfilled clinic visits. Of the 1224 completed visits from September 1 to December 31, 2015, 271 were no-shows with an average rate of 11.8%. After the intervention, there were 4368 completed visits and 562 no-shows. The no-show rate for 2016 averaged 6.9% (p < 0.001), down 4.9% from the last 4 months of 2015. Estimated opportunity costs were about 396 no-show visits avoided, equivalent to an annual savings of about $79,200. A telephone call reminder to patients 24 hours prior to their appointment decreased the no-show rate in an outpatient palliative medicine clinic. Avoiding unfulfilled visits resulted in substantial opportunity costs.

Outpatient palliative medicine consultations: urgent or routine?

BackgroundAlthough outpatient palliative care clinics (OPCCs) provide a venue for early, pre-emptive referral to palliative care on a routine basis, some patients will continue to require urgent referrals. The purpose...

Supportive Care Needs of Patients with Head and Neck Cancer Referred to Palliative Medicine.

Patients with head and neck cancer (HNC) face a unique set of unmet needs. A subset of these patients experience symptom control challenges related to their disease burden and treatments. A multidisciplinary approach involving palliative medicine is underutilized but crucial to identify and address these concerns. There is limited information on palliative integration with head and neck oncology. Case series with planned data collection. Academic quaternary care center. We provide descriptive analyses of patients with HNC, including psychodiagnostic assessment and validated quality-of-life screening, from patients' first encounter at outpatient palliative medicine. HNC (N = 80) contributed the greatest number of palliative referrals (25%) between 2010 and 2012. This cohort was 74% male and 79% Caucasian with a mean age of 53 years (95% CI, 51.1-54.9) and with stage IV disease of the oral cavity (28%) or oropharynx (31%). Sixty-three percent of patients had no evidence of disease. Seventy-five percent had a psychological history based on DSM-IV criteria (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), and 70% had a history of substance use disorder. The most distressing quality-of-life concerns were pain, housing and financial problems, and xerostomia. Patients with HNC who were referred to palliative medicine are burdened by multiple physical, psychological, substance use, and social challenges. We recommend comprehensive cancer-specific screening, such as the James Supportive Care Screening, to triage patients to appropriate supportive care services. Palliative care is one of many services that these patients may need, and it should be utilized at any point of the disease trajectory rather than reserved for end-of-life care.

Tetrahydrocannabinol and Cannabidiol Use in an Outpatient Palliative Medicine Population.

Palliative medicine physicians are challenged by lack of guidance regarding effectiveness and dosing of cannabis products in the setting of their emerging popularity. The aim of this study was to describe early patterns of tetrahydrocannabinol (THC) and cannabidiol (CBD) use in Florida following passage of the state's first medical marijuana law. We describe here the perceived benefits, side effects, and beliefs expressed by patients in a single outpatient academic palliative medicine practice. A cross-sectional survey was performed of a sequential convenience sample of patients who presented to an outpatient academic palliative medicine clinic over a 3-month period. In all, 24% (14/58) of respondents reported THC use, with half using THC on a daily basis. Patients reported improvements in pain, appetite, and nausea. In all, 71% (10/14) began using THC after the diagnosis of their chronic illness, and the most common form of usage was vaping. In all, 24% (14/58) of patients reported CBD use. Patients reported improvements in pain, and the most common form of usage was topical application. None of the patients had used CBD prior to the onset of their chronic illness. In all, 21% (3/14) of THC users and 21% (3/14) of CBD users thought that their substance was helping to cure their illness. Individual reported side effects in both groups were minimal. Approximately a quarter of outpatient palliative care patients use THC or CBD, often on a daily basis. Palliative care providers should be aware of the frequency, diverse usage, and beliefs behind cannabis product use in this patient population.

Rapid Access Service for Symptom Management: An Out-Patient Palliative Medicine Clinic Initiative in a Cancer Institute (QI730)

Rapid Access Service for Symptom Management: An Out-Patient Palliative Medicine Clinic Initiative in a Cancer Institute (QI730)

A Telephone Call Reminder to Decrease the No-show Rate in an Outpatient Palliative Medicine Clinic

A Telephone Call Reminder to Decrease the No-show Rate in an Outpatient Palliative Medicine Clinic

Destination Therapy: Standardizing the Role of Palliative Medicine and Delineating the DT-LVAD Journey

ContextDestination therapy (DT) patients face significant challenges as they transition from chronic left ventricular assist device (LVAD) support to comfort-oriented care. Integration of palliative medicine (PM) into the multidisciplinary team is important to facilitate advanced care planning (ACP) and improve quality of life (QoL). ObjectivesWe evaluated the impact of a structured programmatic approach to the end-of-life (EOL) process in DT patients as measured by QoL surveys and the utilization of ACP. MethodsWe instituted a four prong intervention approach: 1) delineated the path from implant to EOL by defining specific stages, including a transitional phase where care limits were agreed upon, 2) standardized the role of PM, 3) held transitional care meetings to support shared decision-making, and 4) held multidisciplinary team debriefings to facilitate communication. Preintervention and postintervention outcomes were measured for patients/caregivers by using the QUAL-E/QUAL-E (family) QoL instrument. Wilcoxon signed-ranks test compared nonparametric variables. ResultsAll patients (n = 41)/caregivers (n = 28) reported improved QoL measures (patient P = 0.035/caregiver P = 0.046). Preparedness plans increased from 52% to 73% after implementation and advance directives increased from 71% to 83%. Fifty-nine percent of the patients completed an outpatient PM clinic visit; 51% completed/scheduled a second visit. Clinician outcomes improved including satisfaction with multidisciplinary team communication/expectations, ACP processes, and EOL management. ConclusionA programmatic approach that standardizes the role of PM and delineates the patient's path from implant to EOL improved quality outcomes and increased implementation of ACP. A defined communication process allowed the multidisciplinary team to have a clear patient management approach.

Impact of pharmacy interventions on pain management in an oncology palliative medicine (PM) outpatient clinic.

119 Background: PM can improve the quality of life and survival for cancer patients (pts); however, the demand for PM challenges providers with delayed follow ups resulting in less than one-third of pts achieving significant pain improvement between clinic visits. Engaging pharmacists in the provision of PM may help improve pain management in cancer pts. Methods: Adult cancer pts starting a new pain regimen or requiring changes to an existing regimen at baseline were referred for pharmacy follow up in 3-7 days (assessment #1). The pharmacist evaluated each pt using the Edmonton Symptom Assessment Scale and recommended changes to the referring PM provider, prompting a 2nd follow up in 3-7 days (assessment #2). If no changes were required, pts continued therapy and returned for the final clinic visit (day 28 +/- 7). The primary endpoint was the proportion of pts achieving significant pain improvement (≥ 2-point decrease in pain score on a scale of 0-10) from baseline to final visit, which was compared to historical controls using Fisher’s Exact test. Changes in pain severity from baseline to final visit were compared using Generalized McNemar’s test, and descriptive statistics were used to describe characteristics at assessment #1. Results: Of 102 pts evaluable for the primary endpoint, 76% had stage IV disease, 58% were female, and median age was 57 yrs. Significantly more pts achieved pain improvement from baseline to final visit compared to historical controls (49% v 30%; P &lt; 0.001). Changes in pain severity from baseline to final visit are described in the table. At assessment #1, 70% of pts required an intervention, primarily due to uncontrolled pain (72%), side effects (26%), and/or lack of response to non-pain medications (22%). The most common types of interventions were dose adjustments (62%), education (36%), and/or adding a new medication (30%). Over 90% of recommendations were accepted by the referring PM provider. The median time of assessment was 15 mins. Conclusions: Routine inclusion of pharmacists in the outpatient PM interdisciplinary team improves the effectiveness of pain management. [Table: see text]

Demographics and disposition of patients in an academic outpatient palliative care practice.

166 Background: Outpatient PC clinics strive to improve value by improving quality of care for patients while reducing cost. Justifying investment in outpatient PC necessitates characterizing the demographics and disposition of the patients whom these clinics serve. We sought to detail our outpatient palliative care practice in an urban academic medical center in the Southeast to serve a model for other institutions building a financial case for outpatient palliative medicine. Methods: A retrospective analysis from 2014-2017 was conducted on clinical and administrative data from the outpatient supportive oncology cohort at an urban Southern academic center. We performed multivariable logistic regression, t-tests, and chi square analyses to assess associations among variables of interest for patients. Results: Of our outpatient palliative care cohort of 3137 patients, 151 identify as white (51%) and 1377 as black (48%). Among whites 140 (9%) expired and 91% went to hospice compared to 151 (11%) nonwhites expired and 89% nonwhites went to hospice. Furthermore, 21% of non-whites were enrolled in commercial insurance while 79% were enrolled in government insurance compared to 28% whites in commercial insurance and 72% enrolled in government insurance. There were significant correlations among race, age, length of stay (LOS), and discharge disposition (p &lt; 0.05) and race and payer mix (X2= 17.67 df=2, p = .0001). White patients and older patients (P &lt; 0.05) were more likely to enter hospice care compared with minority patients (t = -.655, P &lt; 0.0001). Finally, 2942 patients (94%) received opioid pain medications, and over 90% had &gt; 5 readmissions. Conclusions: In our academic outpatient palliative care clinic we found most patients had governmental insurance, most were prescribed opiates, and older patients and white patients had significantly greater LOS and hospice enrollment compared to black patients. These data illustrate the diversity, payer mix, and disposition to expect when building a case to develop an outpatient palliative care practice in an academic urban medical center.

State-Mandated Prescribing Agreements for Patients with Chronic Non-malignant Pain in a Palliative Medicine Outpatient Clinic: Year Two (S754)

•Understand the history of the mandate for prescribing agreements in patients with chronic non-malignant pain.•Identify the most common symptoms and diagnoses in patients who participated in mandated prescribing agreements.•Identify the violation rate for urine drug screens and possible risk factors for violating prescribing agreements. In response to an epidemic of deaths from opioid overdoses, Florida enacted laws that restricted prescribing of controlled pain medications for chronic non-malignant pain. Although hospice physicians were exempted from this mandate, physicians practicing palliative care in non-hospice settings were required to use prescribing agreements. We studied the impact of state-mandated prescribing agreements on patients with chronic non-malignant pain receiving care in an outpatient palliative medicine clinic. We studied all patients participating in mandated prescribing agreements from 2012 through 2013. We recorded patients' demographic information, pain-related diagnoses, duration of enrollment, and results of required urine drug profiles (UDPs). We examined relationships between these variables to identify risk factors for agreement violations. 28 patients participated in prescribing agreements during 2012, while 26 patients participated in 2013. The most common diagnosis was sickle cell disease, affecting 41% of patients. The most pain symptoms were back pain (39%) and arthralgia (32%). The rate for UDP violations was 18% in 2012 and 15% in 2013; the overall UDP violation rate for the study was 17%. Cannabinoids (89%) accounted for all but one UDP violation. Although males had 80% of UDP violations in 2012, only half of UDP violations involved males in 2013. During 2012, 8 patients had delays in submitting UDPs, and half experienced UDP violations, compared to just 2 of 20 patients who submitted UDPs on time. There were no delayed UDP results in 2013. The most common diagnoses were sickle cell disease and osteoarthritis. Most patients complied with their prescribing agreements, but 17% had UDP violations. Delay in submitting a UDP was a risk factor for violations, but 2013 results suggested male gender is not a risk factor.

Building a patient-centered model: Palliative medicine and cancer care.

75 Background: Palliative medicine (PM) improves outcomes for cancer patients. Still, there is limited evidence around components of an efficient, patient-centered model for integrating PM into oncologic care. While PM is committed to aligning with a patient's goals of care, very few programs incorporate their input into design or evaluation. The aim of this project is to combine best practice in PM with perspectives of patients, families and providers to develop an empathic PM service. We hypothesize that collaboration with stakeholders and user experience experts will result in a feasible, impactful and translatable model of care that aligns with patient and family goals. Methods: We are conducting semi-structured interviews with 30 patients, family members and 30 oncologists. Patient interviews assess needs and coping mechanisms. Provider interviews assess perceptions and experiences around PM. We will conduct observations to understand how patients and providers interact and how current protocols are operationalized. Data will be coded and analyzed for major themes. An expert panel of patients, family members, health care providers and design experts will assimilate the data and make recommendations for the prototype care model design. The model will be piloted and evaluated in fall 2014. Outcome metrics include patient satisfaction, symptom management, utilization, mortality, and others identified during development. Data from the pilot will inform intervention improvements in preparation for a large-scale, 12- month pilot in an outpatient PM clinic. Results: Preliminary work includes the development of a novel patient and family interview protocol that integrates cutting-edge research on PM with best practices for conducting empathic interviews. We will present initial results from these interviews at the symposium, as well as our iterative design process. Conclusions: This project integrates data on patient and family experience with known best practices to develop a patient-centered model for palliative cancer care. The development process and potential outcomes hold significant promise for the design of patient and provider-centered care models, especially those related to chronic and serious illnesses.

Outpatient palliative care for chronic obstructive pulmonary disease: a case series.

Patients with chronic obstructive pulmonary disease (COPD) have well-documented symptoms that affect quality of life. Professional societies recommend palliative care for such patients, but the optimal way of delivering this care is unknown. To describe an outpatient palliative medicine program for patients with COPD. Retrospective case series. Thirty-six patients with COPD followed in a United States academic outpatient palliative medicine clinic. Descriptive analysis of sociodemographic data, disease severity and comorbidities, treatments, hospitalizations, mortality, topic discussion, and symptom assessment. Thirty-six patients (representing 5% of the total number of patients with COPD seen in a specialty pulmonary clinic) were seen over 11 months and followed for 2 years. Seventy-seven percent of patients were Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 3-4 and 72% were on oxygen at home. No patients had documented advanced directives at the initial visit but documentation increased to 61% for those who had follow-up appointments. The most commonly documented topics included symptoms (100%), social issues (94%), psychological issues (78%), and advance care planning (75%). Of symptoms assessed, pain was the least prevalent (51.6%), and breathlessness and fatigue were the most prevalent (100%). Symptoms were often undertreated prior to the palliative care appointment. During the 3-year study period, there were 120 hospital admissions (median, 2) and 12 deaths (33%). The patients with COPD seen in the outpatient palliative medicine clinic had many comorbid conditions, severe illness, and significant symptom burden. Many physical and psychological symptoms were untreated prior to the palliative medicine appointment. Whether addressing these symptoms through a palliative medicine intervention affects outcomes in COPD is unknown but represents an important topic for future research.

Improving Medication Reconciliation in an Outpatient Palliative Medicine Clinic: A Quality Improvement Study (717)

Improving Medication Reconciliation in an Outpatient Palliative Medicine Clinic: A Quality Improvement Study (717)

Palliativmedizin und Palliativstation – Aufgaben, Organisationsformen und Bedeutung für die Chirurgie

About 160 palliative care units with 1228 beds or 15 beds / 1 million inhabitants were available in German hospitals in the year 2008. Demand analyses consider 35 beds / 1 million inhabitants as necessary. Whether the additional demand could be reduced by a greater use of home- and hospice-based end-of-life care is discussed. For general hospitals the establishment of an acute palliative care unit within a medical (oncology) ward is recommended due to costs, organisation facilities and attitudes of physicians toward referral. The establishment of an acute palliative care unit may be costly for the hospital, nevertheless, outpatient palliative medicine and hospices are a cost-effective health service from a socioeconomic point of view, avoiding unnecessary hospital admissions and freeing up hospital beds by early discharge. An analysis of consultants demonstrates a minor interest of surgeons in specialisation in palliative medicine. However, data suggest that prior experience in palliative care alters the selection of treatment recommendations by surgeons with respect to more supportive or aggressive interventions in patients with advanced cancer. Ethical decision-making regarding therapy and counselling of patients at the end of life and discussing the prognosis with patients and their families require education in palliative medicine. A core curriculum to teach palliative care for surgical residents therefore has been presented.

Measuring Outcomes in Outpatient Palliative Medicine: Who, What, When, Where, Why, and How (523)

Measuring Outcomes in Outpatient Palliative Medicine: Who, What, When, Where, Why, and How (523)