Management Of Physical Symptoms Research Articles

Perceptions of the care received from Australian palliative care services: A caregiver perspective.

Our aim was to explore caregiver perceptions of the care received from Australian specialist palliative care services. Caregivers of patients receiving palliative care in services registered with Australia's Palliative Care Outcomes Collaboration were invited to participate in a caregiver survey. The survey included the FAMCARE-2 and four items from the Ongoing Needs Identification: Caregiver Profile questionnaire. Surveys were completed by 1,592 caregivers from 49 services. Most respondents reported high satisfaction and positive experiences. Caregivers receiving care from community-based palliative care teams were less satisfied with the management of physical symptoms and comfort (odds ratio [OR] = 0.29; 95% confidence interval [CI95%] = 0.14, 0.59), with patient psychological care (OR = 0.56; CI95% = 0.32, 0.98), and with family support (OR = 0.52; CI95% = 0.35, 0.77) than caregivers of patients in an inpatient setting. If aged over 60 years, caregivers were less likely to have their information needs met regarding available support services (OR = 0.98; CI95% = 0.97, 0.98) and carer payments (OR = 0.99; CI95% = 0.98, 1.00). Also, caregivers were less likely to receive adequate information about carer payments if located in an outer regional area (OR = 0.41; CI95% = 0.25, 0.64). With practical training, caregivers receiving care from community services reported inadequate information provision to support them in caring for patients (OR = 0.60; CI95% = 0.45, 0.81). While our study identified caregivers as having positive and satisfactory experiences across all domains of care, there is room for improvement in the delivery of palliative care across symptom management, as well as patient and caregiver support, especially in community settings. Caregiver surveys can facilitate the identification and evaluation of both patients' and caregivers' experiences, satisfaction, distress, and unmet needs.

Emotional freedom techniques (EFT) as a practice for supporting chronic disease healthcare: a practitioners’ perspective

Purpose: The objective of the present study was to explore Emotional Freedom Techniques (EFT) practitioners’ experiences of using EFT to support chronic disease patients. This was part of a larger study exploring chronic disease patients’ and EFT practitioners’ experiences of using EFT to support chronic disease healthcare.Methods: A qualitative approach was deemed suitable for this study. Eight practitioners were interviewed using semi-structured interviews via telephone or Zoom (an online video-conferencing platform). Interviews were transcribed verbatim and data was analyzed using Interpretative Phenomenological Analysis methodology.Results and conclusion: This article presents two super-ordinate themes which explore application of EFT for addressing emotional issues faced by chronic disease patients, and for management of physical symptoms, respectively. Chronic disease patients may benefit from a holistic biopsychosocial, patient-centered healthcare approach. EFT offers potential as a technique that may be used by health practitioners to support the psychosocial aspect of chronic disease healthcare.Implications for RehabilitationRehabilitation professionals should incorporate suitable psychological interventions (e.g., EFT) to improve coping and acceptance in physical chronic disease patients and alleviate their fears about the future.Rehabilitation professionals are also recommended to address in chronic disease patients, long-standing or unresolved emotional issues, including past traumas from early life, using EFT or another suitable intervention.Rehabilitation professionals should help improve patients’ emotional states using EFT to enhance physical symptom management.

Symptom incidence, distress, cancer-related distress, and adherence to chemotherapy among African American women with breast cancer.

There is a persistent racial survival disparity between African American (AA) and white women with breast cancer. There is evidence that symptom incidence, associated distress, and overall cancer-related distress may be unexplored, important contributing factors. The purpose of the current study was to: 1) describe and compare the number of chemotherapy-related symptoms and associated distress among AA women with breast cancer over the course of chemotherapy at 3 time points (at baseline before initiating chemotherapy, midpoint, and at the completion of chemotherapy); and 2) to describe the relationship between the number of chemotherapy-related symptoms and overall cancer distress compared with the ability to receive at least 85% of the prescribed chemotherapy within the prescribed timeframe. Descriptive, comparative, and correlational analyses of symptom incidence, symptom distress, cancer-related distress, and prescribed chemotherapy dose received among a cohort of AA women receiving chemotherapy for breast cancer were performed. AA women (121 women) experienced worsening symptoms from baseline to midpoint in chemotherapy and then stabilized for the duration of therapy. The inability to receive 85% of the prescribed chemotherapy within a prescribed time point was found to be significantly correlated with midpoint symptom distress. The main findings of the current study were that AA women experience a deterioration in symptom distress over the course of chemotherapy from baseline (before chemotherapy) to the midpoint, which was found to be associated with less adherence to chemotherapy overall. Thus, the incidence and management of physical and emotional symptoms, as measured through a multidimensional symptom measurement tool, may be contributing to breast cancer dose disparity and should be explored further. Cancer 2017;123:2061-2069. © 2017 American Cancer Society.

Development and validation of an individualized survivorship care plan (ISCP) for women with endometrial cancer during the transition of the end of active treatment to the cancer survivorship.

The after-treatment phase is a distinct phase that is still neglected in the oncological continuum of care. It is the transition between two phases in the care trajectory-treatment and survivorship-that gives rise to many challenges for survivors, care providers and the healthcare system alike. Aiming to facilitate the transition between the end of active treatment and the cancer survivorship phases, we pursued two objectives: 1) Develop an individualized follow-up care plan (IFCP) based on both the literature and the perspective of WEC, healthcare professionals involved with the target clientele and oncology outreach managers, and 2) Have this IFCP validated by an interdisciplinary team. For the first objective, WEC-related needs at the end of active treatment (immediate end, three months and six months), as well as the perceptions of health professionals and oncology outreach managers were gathered by interview and group discussion on the benefit of an IFCP, its content and desired format. A content analysis of the interview data was performed using the Miles and Huberman approach (2003). For the second objective, an iterative consultation process with health professionals allowed for validation by consensus. These two objectives are the first qualitative phase of a mixed-methods sequential exploratory design that will make the development of an IFCP possible. In the second phase, we conducted a feasibility study of the implementation of the IFCP during the end of active treatment transition to cancer survivorship transition. This will be the subject of a second article. The interviews (n=47) revealed WECs' lack of preparation for the transition from the end of active treatment to the cancer survivorship. The following needs were specified: information (80%), emotional support, particularly to overcome their fear of recurrence (75%), the management of physical symptoms (45%), and support for adapting to change (45%). The data gathered from healthcare professionals and outreach managers support the utility of an IFCP in meeting these needs. The iterative validation process by the interdisciplinary team made consensus on the format and content possible. The final version of the IFCP is seen as a tool for information and communication in the survivorship phase. Some obstacles to its transfer to clinical practice are reported. This study presents the entire process that led to the development of an IFCP that integrates both the needs of endometrial cancer survivors and the opinions of healthcare professionals and the oncology outreach managers organizing this care. Indications on how the IFCP could be implemented within this organization are also formulated.

Systematic Review of Occupational Therapy and Adult Cancer Rehabilitation: Part 1. Impact of Physical Activity and Symptom Management Interventions.

This article is the first part of a systematic review of evidence for the effectiveness of cancer rehabilitation interventions within the scope of occupational therapy that address the activity and participation needs of adult cancer survivors. This article focuses on the importance of physical activity and symptom management. Strong evidence supports the use of exercise for cancer-related fatigue and indicates that lymphedema is not exacerbated by exercise. Moderate evidence supports the use of yoga to relieve anxiety and depression and indicates that exercise as a whole may contribute to a return to precancer levels of sexual activity. The results of this review support inclusion of occupational therapy in cancer rehabilitation and reveal a significant need for more research to explore ways occupational therapy can positively influence the outcomes of cancer survivors. Part 2 of the review also appears in this issue.

Posttreatment survivorship care needs of Spanish-speaking Latinas with breast cancer

A comprehensive assessment of Spanish-speaking breast cancer survivors' (SSBCS) survivorship needs is lacking. Assess SSBCS' post-treatment symptom management, psychosocial, and informational needs. 118 telephone surveys and 25 in-person semi-structured interviews with SSBCS, and semi-structured interviews with 5 support providers and 4 physicians who serve SSBCS from 5 Northern California counties. Surveys identified the most bothersome (bothered by it in the past month "somewhat/quite a bit/a lot") physical symptoms as: joint pain, fatigue, hot flashes, numbness in hands/feet, and vaginal dryness. The most bothersome emotional symptoms were thoughts of recurrence/new cancers, depression/sadness, anxieties, and stress. Seven themes emerged from interviews: 1) unmet physical symptom management needs; 2) social support from family/friends often ends when treatment is completed; 3) challenges resuming roles; 5) sense of abandonment by health care system when treatment ends; 6) need for formal transition from active treatment to follow-up care; 6) fear of recurrence especially when obtaining follow-up care; and 7) desire for information on late effects of initial treatments and side effects of hormonal treatments. Based on survey and interview results, we present a conceptual framework for survivorship care interventions for SSBCS. Sample may not represent SSBCS' concerns seen outside of Northern California hospitals. Physical and psychosocial symptoms were common. SSBCS need culturally appropriate survivorship care programs that address symptom management, psychosocial concerns, follow-up care, and healthy lifestyles.

P3.05-001 Psychological Intervention to Treat Distress and Suffering Experienced by People with Lung Cancer Nearing the End-Of-Life: Topic: Symptoms, Therapeutic Interventions

Despite advances in medical interventions, lung cancer continues to be associated with a poor prognosis with approximately 16% of people with lung cancer living five years post diagnosis. This poor prognosis can contribute to depression, anxiety, death anxiety and existential concerns and fears relating to meaning and purpose of life. There is a growing body of evidence indicating that behavioral and psycho-educational interventions are efficacious in treating depression and anxiety in lung cancer patients, however, little is known about how to psychologically treat suffering and distress nearer to the end-of-life. A comprehensive search using PsycINFO and Medline was undertaken to identify existential and meaning centered psychotherapies that were used towards the end-of-life with people with cancer. As the research in the area is in its infancy, all quantitative study designs and qualitative studies were included. Studies that focused on physical symptom management, dyads and bereavement interventions, measurement of psychological distress or existential concerns were excluded. The search yielded a total of 62 articles, of which only 34 examined the use of psychotherapies towards the end-of-life care of people with cancer. The majority of these studies were focused on women with breast cancer, used different outcome measures and included very few, if any, participants with lung cancer. These studies identified and described at least 14 novel psychotherapeutic interventions that could be used towards the end-of-life. These interventions included: Legacy Activities, Life Review Therapy, Meaning-Centered Group Psychotherapy, Individual Meaning-Centered Psychotherapy, Dignity Therapy, Forgiveness Therapy, Meaning-Making Psychotherapy, Outlook Psychotherapy, Supportive Group Interventions, The Healing Journey Intervention, Cognitive Existential Interventions, Re-creating Your Life Therapy, Mindfulness Interventions and Managing Cancer and Living Meaningfully. These interventions varied in the number of sessions and the level of training required to administer the interventions. Some of these interventions were manualized and others were less structured in their approach. Some of these interventions show potential in alleviating distress and suffering, improving life satisfaction, self-esteem and mood. There are only a small number of studies that evaluate the efficacy of psychotherapeutic interventions to be used with people with advanced cancer towards the end-of-life. Although results are promising it is difficult to conclude that one intervention is better than another. Further research is required to trial and adapts these interventions for use with people with lung cancer towards the end-of-life.

Management of Premenstrual Syndrome: Green-top Guideline No. 48.

Management of Premenstrual Syndrome: Green-top Guideline No. 48.

Effect of Inpatient Palliative Care on Quality of Life 2 Weeks After Hematopoietic Stem Cell Transplantation

During hospitalization for hematopoietic stem cell transplantation (HCT), patients receive high-dose chemotherapy before transplantation and experience significant physical and psychological symptoms and poor quality of life (QOL). To assess the effect of inpatient palliative care on patient- and caregiver-reported outcomes during hospitalization for HCT and 3 months after transplantation. Nonblinded randomized clinical trial among 160 adults with hematologic malignancies undergoing autologous/allogeneic HCT and their caregivers (n = 94). The study was conducted from August 2014 to January 2016 in a Boston hospital; follow-up was completed in May 2016. Patients assigned to the intervention (n=81) were seen by palliative care clinicians at least twice a week during HCT hospitalization; the palliative intervention was focused on management of physical and psychological symptoms. Patients assigned to standard transplant care (n=79) could be seen by palliative care clinicians on request. Primary: change in patient QOL from baseline to week 2; secondary: patient-assessed mood, fatigue, and symptom burden scores at baseline, 2 weeks, and 3 months after HCT and caregiver-assessed QOL and mood at baseline and 2 weeks after HCT. Among 160 enrolled patients (mean age, 60 [SD, 13.3] years; 91 women [56.9%]; median hospital stay, 21 days) and 94 caregivers, 157 (98.1%) and 89 (94.7%), respectively, completed 2-week follow-up, and 149 patients (93.1%) completed 3-month follow-up. Patients in the intervention group reported a smaller decrease in QOL from baseline to week 2 (mean baseline score, 110.26; week 2 score, 95.46; mean change, -14.72) compared with patients in the control group (mean baseline score, 106.83; week 2 score, 85.42; mean change, -21.54; difference between groups, -6.82; 95% CI, -13.48 to -0.16; P = .045). Among the secondary outcomes, from baseline to week 2, patients in the intervention group vs those in the control group had less increase in depression (mean, 2.43 vs 3.94; mean difference, 1.52; 95% CI, 0.23-2.81; P = .02), lower anxiety (mean, -0.80 vs 1.12; mean difference, 1.92; 95% CI, 0.83-3.01; P < .001), no difference in fatigue (mean, -10.30 vs -13.65; mean difference, -3.34; 95% CI, -7.25 to 0.56; P = .09), and less increase in symptom burden (mean, 17.35 vs 23.14; mean difference, 5.80; 95% CI, 0.49-11.10; P = .03). At 3 months after HCT, intervention patients vs control patients had higher QOL scores (mean, 112.00 vs 106.66; mean difference, 5.34; 95% CI, 0.04-10.65; P = .048) and less depression symptoms (mean, 3.49 vs 5.19; mean difference, -1.70; 95% CI, -2.75 to -0.65; P = .002) but no significant differences in anxiety, fatigue, or symptom burden. From baseline to week 2 after HCT, caregivers of patients in the intervention group vs caregivers of patients in the control group reported no significant differences in QOL or anxiety but had a smaller increase in depression (mean, 0.25 vs 1.80; mean difference, 1.55; 95% CI, 0.14-2.96; P = .03). Among adults at a single institution undergoing HCT for hematologic malignancy, the use of inpatient palliative care compared with standard transplant care resulted in a smaller decrease in QOL 2 weeks after transplantation. Further research is needed for replication and to assess longer-term outcomes and cost implications. clinicaltrials.gov Identifier: NCT02207322.

Asian and native Hawaiian family caregiver satisfaction with palliative care services in nursing homes.

The aim of this study was to gauge Asian and native Hawaiian family satisfaction with palliative care services in two nursing homes in Hawaii, US. This is a mixed-method study using a convergent design. Nine nursing home family caregivers who had received palliative care services took part. They completed a Famcare-2 satisfaction survey and participated in a 1-hour interview. Descriptive analyses and directed content analysis were completed and results were compared. The Famcare-2 results indicated that family caregivers were satisfied with palliative care services. The interviews provided in-depth information on the major areas discussed in the survey-management of patient physical symptoms and comfort, information, family support, and patient psychological care. There is a need to address family caregiver and interdisciplinary nursing home staff communication based on culturally appropriate approaches for palliative as well as end of-life care services among Asians and native Hawaiians.

Abstract WP348: Palliative Care is Underutilized in Ischemic Stroke Patients With Poor Functional Outcome

Background and Purpose: Palliative care (PC) should be an essential component of stroke care, particularly in patients with severe strokes given their poor prognosis and symptom burden. Despite the potential benefits of PC, a recent AHA scientific statement found that PC use in stroke was understudied and poorly understood. Methods: We performed a retrospective review of consecutive ischemic stroke patients presenting to our comprehensive stroke center (CSC) from 3/14-4/15. Demographic and clinical data were collected. We compared the proportion of patients that received an inpatient PC consult to the proportion of patients with a discharge modified Rankin scale (mRS) score of 4-6 (unable to walk without assistance and unable to attend to own bodily needs without assistance) by NIHSS score on admission. Results: Of the 776 ischemic stroke patients admitted to our CSC, only 6% received a palliative care consult. Even among the 254 patients discharged with a mRS of 4-6, only 16% received an PC consult. Figure 1 displays discharge mRS 4-6 and PC consult proportions by NIHSS severity. Patients that received a PC consult were older (median age 75 vs. 65, p&lt;0.001), had more severe strokes (median NIHSS score 17 vs. 5, p&lt;0.001), and more inpatient complications (56.5% vs. 21.8%, p&lt;0.001). On average, PC consults occurred 3.5 days after admission (IQR 2,9). Of the 43 patients who received a PC consult, 78.3% had “do not resuscitate/do not intubate” (DNR/DNI) orders prior to the PC consult as compared to 95.7% after. Before the PC consult, 30.4% had “comfort care” (CC) orders. After the consult, the proportion with CC orders nearly doubled (58.7%). Conclusions: Our observations suggest that PC may be underutilized in ischemic stroke patients, particularly in those who may benefit from it the most. PC has great potential to diminish suffering through physical and psychological symptom management. Providers should at least consider PC consults for hospitalized stroke patients.

Quality of Care and Satisfaction With Care on Palliative Care Units

ContextThere is little research on quality of care specific to palliative care units (PCUs). ObjectivesTo delineate important aspects of satisfaction with care and quality of care on a PCU, as described by inpatients, family caregivers, and health care professionals. MethodsQualitative interviews and focus groups were conducted across four Toronto PCUs, with a total of 46 patient/caregiver interviews and eight staff focus groups. Interviews and focus groups were semistructured to elicit comments about satisfaction with care and quality of care for inpatients and families on a PCU. Data were analyzed using a grounded theory method, with an inductive, constant comparison approach to identify themes, and were coded to saturation. ResultsKey elements of quality care and patient satisfaction on a PCU were grouped into six domains: 1) interprofessional team: a team of experts comprising multiple disciplines functioning as a unit; 2) communication: developing rapport, addressing expectations, providing information, listening actively, and facilitating end-of-life discussions; 3) attentive, personalized care: anticipatory and responsive compassionate care with tailored management of physical and nonphysical symptoms; 4) family-centered: support of patients and caregivers within a family; 5) accessible and consistent: appropriate resources and adequate staff to provide consistent care; and 6) supportive setting: a bright noninstitutionalized setting allowing both privacy and socialization. ConclusionThe elements identified support the delivery of quality care. They may act as a guide for those planning to develop PCUs and form the basis for measures of satisfaction with care.

Depression moderates between physical activity and quality of life in low-income children

PurposeThis study investigated the relationship between physical activity and health-related quality of life (HRQoL) as moderated by depression in low-income children. MethodsA cross-sectional study was conducted with 149 children ages 10–12 whose families' monthly incomes were at or below 150% of Korea's minimum cost of living. Children's physical activity, depression, and HRQoL were measured with self-administered questionnaires. Multiple regression and simple slope analysis examined the moderating effect of depression between physical activity and HRQoL. ResultsPhysical activity was significantly positively correlated with HRQoL while depression was significantly negatively correlated with physical activity and HRQoL. Physical activity, depression, and their interaction explained 39.3% of variance in low-income children's HRQoL. Simple slope analysis showed that increased physical activity was related to higher QoL among children without depressive symptoms but not significantly related to QoL for children with depressive symptoms. ConclusionThe moderating effect of depression between physical activity and QoL was confirmed in children from low-income families. To improve HRQoL through physical activity interventions, depression screening and symptom management should be performed so that strategies to promote QoL can be effectively applied consistent with depression screening results.

Telerehabilitation for persons with multiple sclerosis.

Telerehabilitation, an emerging method, extends rehabilitative care beyond the hospital, and facilitates multifaceted, often psychotherapeutic approaches to modern management of patients using telecommunication technology at home or in the community. Although a wide range of telerehabilitation interventions are trialed in persons with multiple sclerosis (pwMS), evidence for their effectiveness is unclear. To investigate the effectiveness and safety of telerehabilitation intervention in pwMS for improved patient outcomes. Specifically, this review addresses the following questions: does telerehabilitation achieve better outcomes compared with traditional face-to-face intervention; and what types of telerehabilitation interventions are effective, in which setting and influence which specific outcomes (impairment, activity limitation and participation)? We performed a literature search using the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Review Group Specialised Register( 9 July, 2014.) We handsearched the relevant journals and screened the reference lists of identified studies, and contacted authors for additional data. Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that reported telerehabilitation intervention/s in pwMS and compared them with some form of control intervention (such as lower level or different types of intervention, minimal intervention, waiting-list controls or no treatment (or usual care); interventions given in different settings) in adults with MS. Two review authors independently selected studies and extracted data. Three review authors assessed the methodological quality of studies using the GRADEpro software (GRADEpro 2008) for best-evidence synthesis. A meta-analysis was not possible due to marked methodological, clinical and statistical heterogeneity between included trials and between measurement tools used. Hence, we performed a best-evidence synthesis using a qualitative analysis. Nine RCTs, one with two reports, (N = 531 participants, 469 included in analyses) investigated a variety of telerehabilitation interventions in adults with MS. The mean age of participants varied from 41 to 52 years (mean 46.5 years) and mean years since diagnosis from 7.7 to 19.0 years (mean 12.3 years). The majority of the participants were women (proportion ranging from 56% to 87%, mean 74%) and with a relapsing-remitting course of MS. These interventions were complex, with more than one rehabilitation component and included physical activity, educational, behavioural and symptom management programmes.All studies scored 'low' on the methodological quality assessment. Overall, the review found 'low-level' evidence for telerehabilitation interventions in reducing short-term disability and symptoms such as fatigue. There was also 'low-level' evidence supporting telerehabilitation in the longer term for improved functional activities, impairments (such as fatigue, pain, insomnia); and participation measured by quality of life and psychological outcomes. There were limited data on process evaluation (participants'/therapists' satisfaction) and no data available for cost effectiveness. There were no adverse events reported as a result of telerehabilitation interventions. There is currently limited evidence on the efficacy of telerehabilitation in improving functional activities, fatigue and quality of life in adults with MS. A range of telerehabilitation interventions might be an alternative method of delivering services in MS populations. There is insufficient evidence to support on what types of telerehabilitation interventions are effective, and in which setting. More robust trials are needed to build evidence for the clinical and cost effectiveness of these interventions.

Paediatric palliative care in Canada: A national survey of paediatricians.

Michael, a 16-year-old adolescent, was diagnosed with acute lymphoblastic leukemia at 10 years of age. He experienced a relapse one year after completing his initial treatment and received a bone marrow transplant. He was well until he recently experienced a central nervous system relapse. Michael resided with his parents and two brothers. His primary physician and nurse practitioner spoke with him and his parents regarding his physical status (relapse, no further curative treatment indicated), and he was referred to a small paediatric palliative care (PPC) team (nurses and physician). Michael continued to be followed by the PPC service for six months; their primary focus was to maximize his quality of life. He received home care visits by the nurse for pain management. He continued to receive chemotherapy and platelet transfusions for palliation. The staff nurses continued to provide emotional support to Michael, his parents and his brothers. With various therapies and pain management options, the team helped him to accomplish a few remaining wishes that he expressed during his care, such as visiting his friends at school and celebrating his birthday in less pain. Michael’s physical condition continued to deteriorate and he was hospitalized for pneumonia shortly after returning home. He experienced an increase in pain and bleeding. He was readmitted to the paediatric unit. Morphine was adjusted via patient-controlled analgesia and, later that evening, Michael’s pain was significantly improved, although he still had a restless night. He died the following morning. Michael’s brothers arrived shortly after he died and many other family members and friends followed. The family remained on the paediatric unit for most of the day receiving support from staff. Several PPC team members attended Michael’s funeral service and remained in contact with the family long after his death. The doctors and nurses who followed Michael’s care believed that he could have benefited from other PPC services had they been available in the community. LEARNING POINTS PPC focuses on achieving the best possible quality of life for children and their families with life-threatening conditions. Clinical PPC programs exist in the major Canadian geographical centres; however, published studies indicate that a small percentage (between 5% and 12%) of Canadian children who would benefit from these services actually receive them (1). PPC teams are multidisciplinary and comprise various specialties; however, because of limited resources or access, a team often consists of a physician and nurse as the core team (1). To gain a better understanding of their patients’ needs and their own needs, a one-time survey (2) was sent to Canadian Paediatric Surveillance Program (CPSP) participants in September 2013. The majority of paediatricians (78%) defined palliative care as consistent of end-of-life care and more. Fewer (17%) defined it as end-of-life care only, and 5% did not include a definition. Although paediatricians cited the need for many types of palliative care services, only 35% had referred their patients to a palliative care team and 18% did not have access to such a team. Of a total of 416 respondents (17% response rate), 219 (53%) indicated having cared for a patient(s) with palliative care needs during the month before receiving the survey. More than one-half of respondents (58%) agreed that all four broad groups (commonly known as quadrants) of children would benefit from PPC: progressive conditions in which treatment is exclusively palliative after diagnosis (92%); conditions for which curative treatment is possible but may fail (82%); conditions involving severe, nonprogressive disability, causing extreme vulnerability to health complications (77%); and conditions requiring intensive long-term treatment aimed at maintaining quality of life (75%) (3). Most frequently identified palliative care needs were support for family members (94%), coordination of services in the community (88%), physical symptom management (84%), respite care (81%), support for the patient (80%) and care at the time of death (78%). Only 48% of respondents believed that their patients were receiving all services needed. Paediatricians cited their professional needs, such as more support to manage their palliative patients with multidisciplinary teams (19%), more education about palliative care (14%) and easier access to a palliative care team (13%).

Unveiling the Mysteries of Palliative Care

As the population of aging Americans increases, our nation will inevitably face a healthcare crisis. To meet the increased demands on our healthcare system, we have an opportunity to provide the highest levels of quality care while functioning within the available resources. One such opportunity exists within the philosophy of palliative care. Palliative care services enable individuals with life-limiting illnesses the opportunity to partner with their healthcare providers and receive aggressive management of physical and psychosocial symptoms.

The Healing Power of Hope: For Patients and Palliative Care Clinicians (SA518)

Objectives Distinguish between hope and hopelessness and false hope and false hopelessness, generate a list of attributes regarding domains of hope and hopelessness, and review the research on hope and how maintaining hope has important, positive clinical outcomes. Differentiate hope as a process with key communication facilitators versus hope as outcome. Discuss innovative strategies that foster hope, meaning, and resilience for palliative care clinicians in navigating challenging work situations and cumulative stresses in providing hopeful palliative care. Hospice and palliative medicine clinicians struggle with maintaining hope in the face of life-threatening illnesses. Poor prognosis often highlights the dilemma of maintaining hope in the face of challenging illnesses with limited or no options for curative care. When hope is dependent on a specific health outcome, options may indeed be limited and hopeless. But if hope can be reframed as a dynamic process, then a patient has the potential to see hope and possibility even in the face of dying. Recent studies have demonstrated that the biology of belief and maintenance of hope have positive results for the patient by improving physical, emotional, and spiritual symptom management. Hope may also have positive effects for the clinician. How can we foster authentic hope and not false hope or hopelessness in our communications with patients and families? This session will explore the dimensions of hope, hopelessness, false hope, false hopelessness, and miracles and how they affect the care we provide for our patients. Inspiring hope in ourselves as clinicians also has a healing effect on us and can help prevent burnout and increase

End-of-life care characteristics for young adults with cancer who die in the hospital.

Evidence suggests nonelderly adults with cancer are likely to receive aggressive treatment in their last month of life and less likely to receive hospice and/or palliative services. Young adults with cancer (18-39 years) are a unique population, and little is known about the characteristics of their end-of-life care trajectories when they die in the hospital. The purpose of this descriptive pilot study was to explore the characteristics of death among young adults with cancer who died in a tertiary academic hospital in order to elucidate their end-of-life trajectories. A retrospective chart review was conducted among hospitalized young adults with a primary cancer diagnosis who died in the hospital within a 10-year period. Study variables were abstracted for quantification and medical record notes were reviewed for validation. A review of 61 patient records indicate that young adults commonly received cancer treatment within weeks of death and that do-not-resuscitate orders were frequently written only when death appeared imminent. Palliative care teams were frequently consulted for management of physical symptoms but often within days of death and most commonly on the day of death. Findings suggest palliative care was initiated late in the care trajectory for young adults with cancer who died in the hospital. This study highlights the need for further inquiry into end-of-life care for young adults with cancer so that interventions can be developed to meet the physical, emotional, social, and spiritual needs of this unique group of patients, their families, and friends.

Integration of system-level patient-reported outcome measurement into everyday clinical care: Lessons learned from the cancer care Ontario experience.

159 Background: The goal of the collaborative is to improve the quality and consistency of physical and emotional symptom management across the cancer journey. Objectives are to promote the adoption of electronic symptom assessment using a standardized tool and to increase the clinical use of evidence based guidelines to effectively manage patient identified symptoms. Methods: The actions taken for this initiative are (a) manage cancer symptoms through a patient reported measurement tool; (b) improve the quality of symptom management through the uptake of symptom management guides and algorithms for care; and (c) drive improvement through the adoption of an electronic symptom assessment platform. The following aims were established for this work: (1) aim for symptom screening and assessment (70% of ambulatory cancer clinic patients are screened for symptom severity using ESAS at least once/month); (2) aim for symptom management (evidence from chart audits show intervention as per evidence based guidelines for patients reported symptom scores); (3) aim for patient satisfaction (90% of target population indicates that their health care team took their scores into consideration when developing a care plan); and (4)aim for evidence of use (90% of patients state that their doctor or nurse spoke with them about their symptom screen). Results: 60% of cancer patients are screened each month representing over 28,000 people. Six of fourteen cancer regions are above the provincial target of 70%, with some close to 90%. 92% of patients felt ESAS was important to complete to help health care providers know how they are feeling. Conclusions: Cancer Care Ontario has been able to drive improvements in symptom management through the implementation of system wide electronic symptom assessment. For other jurisdictions interested in adopting this approach, the following areas are critical for success: a) leadership at all levels of the system; b) clinical tools at the point of care; c) engagement of patients in the design of care; d) communications support to spread information to all stakeholders; and e) using to data to drive performance improvement and accountability.

Population-based standardized symptom screening: Cancer Care Ontario’s Edmonton Symptom Assessment System and performance status initiatives.

56 Background: The goal of the collaborative is to improve the quality and consistency of physical and emotional symptom management across the cancer journey. Objectives are: (a) promote the adoption of electronic symptom assessment using a standardized tool and (b) increase the clinical use of evidence based guidelines to effectively manage patient identified symptoms. Methods: The actions taken for this initiative are to manage cancer symptoms through a patient reported measurement tool; improve the quality of symptom management through the uptake of symptom management guides and algorithms for care; and drive improvement through the adoption of an electronic symptom assessment platform The following aims were established for this work: (1) Aim for symptom screening and assessment (70% of ambulatory cancer clinic patients are screened for symptom severity using ESAS at least once/month) (2) aim for symptom management (evidence from chart audits show intervention as per evidence based guidelines for patients reported symptom scores) (3) aim for patient satisfaction (90% of target population indicates that their health care team took their scores into consideration when developing a care plan) and (4) aim for evidence of use (90% of patients state that their doctor or nurse spoke with them about their symptom screen). Results: 60% of cancer patients are screened each month representing over 28,000 people. Six of fourteen cancer regions are above the provincial target of 70%, with some close to 90%. 92% of patients felt ESAS was important to complete to help health care providers know how they are feeling. Conclusions: Cancer Care Ontario has been able to drive improvements in symptom management through the implementation of system wide electronic symptom assessment. For other jurisdictions interested in adopting this approach, the following areas are critical for success. (a.) Leadership at all levels of the system; (b.) clinical tools at the point of care; (c) engagement of patients in the design of care; (d) communications support to spread information to all stakeholders; and (e) using to data to drive performance improvement and accountability.