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Inpatient Hospice: Continuous Quality Improvement to Optimize Care to Patients Dying in an Inpatient Setting (S801)
460
Poster Abstracts
often not available at the point of care. Use of greater than 10 fractions was rated as inappropriate regardless of other factors. Older age and travel distance were factors that lead to favoring 8Gy single fraction treatment. There was less consensus concerning single fraction treatment and favoring of other treatment approaches for lesions located on the spine, especially large lesions, and for patients with oligometastases and a longer prognosis where goals may include local tumor control in addition to palliation.
Conclusions and Implications for Research, Policy, or Practice. Improving specification and communication of prognostic information is an important quality improvement target to enhance the patient-centered nature of care for patients with painful bone metastases.
Implementing Shared Decision-Making in Hospice Interdisciplinary Team Meetings (S800) Karla Washington, PhD, University of Missouri, Columbia, MO. Debra Parker Oliver, PhD MSW, University of Missouri, Columbia, MO. George Demiris, PhD, University of Washington, Seattle, WA. Objectives Discuss the potential of telehealth solutions to support shared decision-making in hospice. List at least two barriers and facilitators to shared decision-making in hospice IDT meetings. Original Research Background. While patient/ family-centeredness is at the core of hospice, barriers exist to involving hospice patients and families in shared decision-making (SDM). Preliminary evaluation of the ACTIVE (Assessing Caregivers for Team Intervention through Video Encounters) intervention, which involves the use of video-conferencing technology to facilitate family caregivers’ virtual participation in hospice interdisciplinary team (IDT) meetings, has revealed its promise as a tool to promote SDM in the hospice setting. Research Objectives. The overarching purpose of the study was to describe SDM as it occurred in ACTIVE IDT meetings. We sought to answer the following research questions: 1) To what extent were the essential elements of SDM present in ACTIVE IDT meetings? and 2) What were the barriers and facilitators to SDM in ACTIVE IDT meetings? Methods. We conducted a content analysis of 100 video-recorded ACTIVE meetings to determine the frequency with which they included elements that have been identified in the literature as essential to SDM. We conducted a deductive thematic analysis of interviews of family caregivers (n¼73), interviews of hospice professionals (n¼78), and research field notes
Vol. 49 No. 2 February 2015
to identify barriers and facilitators to SDM in ACTIVE meetings. Results. Most meetings in which problems were discussed included identification of possible solutions, provider recommendations, final decision-making, and development of follow-up plans. Fewer than half included discussion of the risks and benefits associated with solutions, clear incorporation of patient/family values, assessment of caregiver self-efficacy, or assessment of caregiver understanding. time, technological problems, and communication skill deficits were noted as barriers to SDM, while the interdisciplinary composition of the IDT and designated leadership were identified as facilitators. Conclusions. SDM routinely occurred in ACTIVE IDT meetings and could have been enhanced by addressing barriers and facilitators. Implications for Research, Policy, or Practice. Hospice providers interested in promoting SDM should consider adopting the ACTIVE intervention with adequate supports in place to maximize its full potential.
Inpatient Hospice: Continuous Quality Improvement to Optimize Care to Patients Dying in an Inpatient Setting (S801) Anne Walling, MD, University of California, Los Angeles, Los Angeles, CA. Neil Wenger, MD, University of California, Los Angeles, Los Angeles, CA. Bruce Ferrell, MD, University of California, Los Angeles, Los Angeles, CA. Objectives Understand program for providing inpatient level hospice care in an academic medical center by partnering with a community hospice group. Understand barriers for transition to inpatient hospice care. Original Research Background. We have recently implemented a policy and program for providing inpatient level hospice care in two academic medical centers by partnering with a community hospice group. Research Objectives. We describe the first 5 months of our experience and barriers to transferring to inpatient hospice care among patients dying in the hospital. Methods. An interdisciplinary palliative care team prospectively identified patients as meeting inpatient hospice criteria and followed the standard protocol for transition to hospice care in the inpatient setting. We report rates of transfer to hospice care among identified patients and barriers to transition to hospice care.
Vol. 49 No. 2 February 2015
Poster Abstracts
461
Results. During the first 5 months of this program,
Results. 415 individuals participated in the study, a
sixty-six adult patients were identified as meeting inpatient hospice criteria and were expected to die in the hospital. Almost all 88% (58/66) of these patients died in the hospital, but only 27% (18/66) were transferred to inpatient hospice prior to death. Of the 48 patients who did not receive inpatient hospice services, 16/48 (33%) were due to lack of enough time to complete hospice assessment and transition care to hospice team, 12/48 (25%) were due to refusal of hospice care, 7/48 (15%) were due to family not wanting to wait for hospice evaluation prior to palliative extubation, 6/48 (13%) did not meet criteria for inpatient hospice because symptoms were well controlled, and 4/48 (8%) of families were hesitant to transition care to a new team at the end of life. Conclusions. Partnering with a community hospice to provide inpatient hospice is feasible in an academic medical center, but several barriers to transitioning care have been identified. Implications for Research, Policy, or Practice. Interventions to improve timeliness of hospice evaluation may improve rates of inpatient hospice use.
55% overall response rate. The mean pre-rounds Moral Thermometer (MT) value was 2.83 with a standard deviation (SD) of 2.25 and the mean post-rounds MT value was 2.80 with a SD of 2.22. There was no statistically significant difference between pre and post round mean levels. Conclusions. Moral distress is an issue that affects the spectrum of medical professionals and varies from individual to individual and between disciplines. Implications for Research, Policy, or Practice. Additional research is warranted to explore the long term effects of the SCR upon on moral distress.
The Impact of Schwartz Center Rounds on Moral Distress in a Large Healthcare System (S802) Phyllis Whitehead, PhD MSN APRN ACHPN, Carilion Roanoke Memorial Hospital, Wirtz, VA. Raeva Malik, MD, George Washington University, Potomac, MD. Objectives Define moral distress. Identify the value of the Schwartz Center Rounds upon moral distress. Original Research Background. Moral distress occurs when someone knows the correct thing to do, but, because of some outside factors, is unable to do the right thing. Studies have shown that there is a correlation between moral distress and burnout. No prior studies have proven the impact of any particular intervention on moral distress levels. Research Objectives. The study’s main purpose was to study the immediate effects of the Schwartz Center Rounds, a rounding system that focuses on exploring moral and ethical issues in medicine on moral distress, at one academic medical center. Methods. This study was a longitudinal, quasi-experimental design. The sample used was a convenience sampling of Schwartz Center Rounds participants. The method of data collection was a two-part survey that was comprised of two Moral Distress Thermometer (MDT) readings (pre and post rounds) and demographic data. The rounds were conducted seven times during 2013.
Unused Opioids: Prescribing Practices in Chronic Cancer Pain (S803) Alison Wiesenthal, MD, Memorial Sloan Kettering Cancer Center, New York, NY. Natalie Moryl, MD, Memorial Sloan Kettering Cancer Center, New York, NY. Objectives Recognize the importance of eliciting amount of unused opioids during the clinic visit. Discuss future directions for care of unused opioids. Original Research Background. Most victims of the current epidemic of prescription pain medicine (PPM) overdoses are nonpatients, with 75% of overdoses attributed to opioids prescribed to someone else. Responsible prescribing of PPM should include monitoring the amount of unused PPM and reducing refills accordingly. Research Objectives. The aim of this exploratory study was to estimate the amount of unused opioids prescribed for cancer pain at a comprehensive cancer center (CCC). Methods. At each clinical encounter in one palliative medicine clinic at a CCC over a 3-month period, we documented consecutive patients’ self-reports of adequacy of pain relief and the number of short-acting opioids consumed. The amount dispensed was obtained from the state’s mandatory prescription monitoring program (PMP) and was compared to the patient’s report of the amount of short-acting opioid used, categorized by analgesic adequacy. Results. Out of the seven of 33 (21%) patients reporting adequate analgesia, three patients (43%) reported using all of their short-acting opioids. Of the 26 patients reporting suboptimal analgesia, 16 patients (61%) reported using the entirety of that month’s dispensed opioids. The number of unused pills left in the medicine cabinets of patients with controlled pain ranged from 90 to 333 tablets of short-acting opioids. The remaining patients with uncontrolled pain reported unused opioids ranging from 33%-100% of
Poster Abstracts
often not available at the point of care. Use of greater than 10 fractions was rated as inappropriate regardless of other factors. Older age and travel distance were factors that lead to favoring 8Gy single fraction treatment. There was less consensus concerning single fraction treatment and favoring of other treatment approaches for lesions located on the spine, especially large lesions, and for patients with oligometastases and a longer prognosis where goals may include local tumor control in addition to palliation.
Conclusions and Implications for Research, Policy, or Practice. Improving specification and communication of prognostic information is an important quality improvement target to enhance the patient-centered nature of care for patients with painful bone metastases.
Implementing Shared Decision-Making in Hospice Interdisciplinary Team Meetings (S800) Karla Washington, PhD, University of Missouri, Columbia, MO. Debra Parker Oliver, PhD MSW, University of Missouri, Columbia, MO. George Demiris, PhD, University of Washington, Seattle, WA. Objectives Discuss the potential of telehealth solutions to support shared decision-making in hospice. List at least two barriers and facilitators to shared decision-making in hospice IDT meetings. Original Research Background. While patient/ family-centeredness is at the core of hospice, barriers exist to involving hospice patients and families in shared decision-making (SDM). Preliminary evaluation of the ACTIVE (Assessing Caregivers for Team Intervention through Video Encounters) intervention, which involves the use of video-conferencing technology to facilitate family caregivers’ virtual participation in hospice interdisciplinary team (IDT) meetings, has revealed its promise as a tool to promote SDM in the hospice setting. Research Objectives. The overarching purpose of the study was to describe SDM as it occurred in ACTIVE IDT meetings. We sought to answer the following research questions: 1) To what extent were the essential elements of SDM present in ACTIVE IDT meetings? and 2) What were the barriers and facilitators to SDM in ACTIVE IDT meetings? Methods. We conducted a content analysis of 100 video-recorded ACTIVE meetings to determine the frequency with which they included elements that have been identified in the literature as essential to SDM. We conducted a deductive thematic analysis of interviews of family caregivers (n¼73), interviews of hospice professionals (n¼78), and research field notes
Vol. 49 No. 2 February 2015
to identify barriers and facilitators to SDM in ACTIVE meetings. Results. Most meetings in which problems were discussed included identification of possible solutions, provider recommendations, final decision-making, and development of follow-up plans. Fewer than half included discussion of the risks and benefits associated with solutions, clear incorporation of patient/family values, assessment of caregiver self-efficacy, or assessment of caregiver understanding. time, technological problems, and communication skill deficits were noted as barriers to SDM, while the interdisciplinary composition of the IDT and designated leadership were identified as facilitators. Conclusions. SDM routinely occurred in ACTIVE IDT meetings and could have been enhanced by addressing barriers and facilitators. Implications for Research, Policy, or Practice. Hospice providers interested in promoting SDM should consider adopting the ACTIVE intervention with adequate supports in place to maximize its full potential.
Inpatient Hospice: Continuous Quality Improvement to Optimize Care to Patients Dying in an Inpatient Setting (S801) Anne Walling, MD, University of California, Los Angeles, Los Angeles, CA. Neil Wenger, MD, University of California, Los Angeles, Los Angeles, CA. Bruce Ferrell, MD, University of California, Los Angeles, Los Angeles, CA. Objectives Understand program for providing inpatient level hospice care in an academic medical center by partnering with a community hospice group. Understand barriers for transition to inpatient hospice care. Original Research Background. We have recently implemented a policy and program for providing inpatient level hospice care in two academic medical centers by partnering with a community hospice group. Research Objectives. We describe the first 5 months of our experience and barriers to transferring to inpatient hospice care among patients dying in the hospital. Methods. An interdisciplinary palliative care team prospectively identified patients as meeting inpatient hospice criteria and followed the standard protocol for transition to hospice care in the inpatient setting. We report rates of transfer to hospice care among identified patients and barriers to transition to hospice care.
Vol. 49 No. 2 February 2015
Poster Abstracts
461
Results. During the first 5 months of this program,
Results. 415 individuals participated in the study, a
sixty-six adult patients were identified as meeting inpatient hospice criteria and were expected to die in the hospital. Almost all 88% (58/66) of these patients died in the hospital, but only 27% (18/66) were transferred to inpatient hospice prior to death. Of the 48 patients who did not receive inpatient hospice services, 16/48 (33%) were due to lack of enough time to complete hospice assessment and transition care to hospice team, 12/48 (25%) were due to refusal of hospice care, 7/48 (15%) were due to family not wanting to wait for hospice evaluation prior to palliative extubation, 6/48 (13%) did not meet criteria for inpatient hospice because symptoms were well controlled, and 4/48 (8%) of families were hesitant to transition care to a new team at the end of life. Conclusions. Partnering with a community hospice to provide inpatient hospice is feasible in an academic medical center, but several barriers to transitioning care have been identified. Implications for Research, Policy, or Practice. Interventions to improve timeliness of hospice evaluation may improve rates of inpatient hospice use.
55% overall response rate. The mean pre-rounds Moral Thermometer (MT) value was 2.83 with a standard deviation (SD) of 2.25 and the mean post-rounds MT value was 2.80 with a SD of 2.22. There was no statistically significant difference between pre and post round mean levels. Conclusions. Moral distress is an issue that affects the spectrum of medical professionals and varies from individual to individual and between disciplines. Implications for Research, Policy, or Practice. Additional research is warranted to explore the long term effects of the SCR upon on moral distress.
The Impact of Schwartz Center Rounds on Moral Distress in a Large Healthcare System (S802) Phyllis Whitehead, PhD MSN APRN ACHPN, Carilion Roanoke Memorial Hospital, Wirtz, VA. Raeva Malik, MD, George Washington University, Potomac, MD. Objectives Define moral distress. Identify the value of the Schwartz Center Rounds upon moral distress. Original Research Background. Moral distress occurs when someone knows the correct thing to do, but, because of some outside factors, is unable to do the right thing. Studies have shown that there is a correlation between moral distress and burnout. No prior studies have proven the impact of any particular intervention on moral distress levels. Research Objectives. The study’s main purpose was to study the immediate effects of the Schwartz Center Rounds, a rounding system that focuses on exploring moral and ethical issues in medicine on moral distress, at one academic medical center. Methods. This study was a longitudinal, quasi-experimental design. The sample used was a convenience sampling of Schwartz Center Rounds participants. The method of data collection was a two-part survey that was comprised of two Moral Distress Thermometer (MDT) readings (pre and post rounds) and demographic data. The rounds were conducted seven times during 2013.
Unused Opioids: Prescribing Practices in Chronic Cancer Pain (S803) Alison Wiesenthal, MD, Memorial Sloan Kettering Cancer Center, New York, NY. Natalie Moryl, MD, Memorial Sloan Kettering Cancer Center, New York, NY. Objectives Recognize the importance of eliciting amount of unused opioids during the clinic visit. Discuss future directions for care of unused opioids. Original Research Background. Most victims of the current epidemic of prescription pain medicine (PPM) overdoses are nonpatients, with 75% of overdoses attributed to opioids prescribed to someone else. Responsible prescribing of PPM should include monitoring the amount of unused PPM and reducing refills accordingly. Research Objectives. The aim of this exploratory study was to estimate the amount of unused opioids prescribed for cancer pain at a comprehensive cancer center (CCC). Methods. At each clinical encounter in one palliative medicine clinic at a CCC over a 3-month period, we documented consecutive patients’ self-reports of adequacy of pain relief and the number of short-acting opioids consumed. The amount dispensed was obtained from the state’s mandatory prescription monitoring program (PMP) and was compared to the patient’s report of the amount of short-acting opioid used, categorized by analgesic adequacy. Results. Out of the seven of 33 (21%) patients reporting adequate analgesia, three patients (43%) reported using all of their short-acting opioids. Of the 26 patients reporting suboptimal analgesia, 16 patients (61%) reported using the entirety of that month’s dispensed opioids. The number of unused pills left in the medicine cabinets of patients with controlled pain ranged from 90 to 333 tablets of short-acting opioids. The remaining patients with uncontrolled pain reported unused opioids ranging from 33%-100% of