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Missed Opportunities in Training Third Year Medical Students to Care for Seriously Ill Patients (S761)
Vol. 47 No. 2 February 2014
Poster Abstracts
in Sawtooth Software), a method of utility assessment frequently used in market research. Respondents rated each service option individually followed by a series of trade-off questions between services to refine estimates of the utility of each service vs. others. Results. We interviewed 453 Veterans (97% male, 42% African-American, age 69yo) and 131 caregivers (89% female, age 60yo). >20% of respondents were capable of only limited self-care (ECOG score $3). Both patients and caregivers ranked transportation first, followed by a meal program, family care, nursing care, and care coordination; however, relative utility scores for each service differed between patients and caregivers. Service utility scores did not differ greatly by patient performance status, although older patients showed greater utility for nursing care (p¼0.04), whereas younger patients ranked counseling services higher (p¼0.005). Preferences were relatively uniform among patients. Conclusions. Patients with cardiopulmonary disease and their caregivers have similar preferences regarding palliative home care services, and many such services may enhance patients’ ability for self-care.
Implications for research, policy, or practice. Patient and caregiver-centered palliative care programs should reflect patient preferences. Some highly valued services (e.g., transportation) are not well addressed in current benefits, but enriched home and community services may enhance programmatic impact on patient and caregiver experiences and improve appropriate healthcare use.
Missed Opportunities in Training Third Year Medical Students to Care for Seriously Ill Patients (S761) Grant Smith Cambridge, MA. Kristen Schaefer, MD, Dana-Farber Cancer Institute and Harvard Medical School, Brookline, MA. Objectives 1. Describe missed opportunities to train third year medical students in the care of seriously ill and dying patients during required clinical rotations. 2. Identify missed opportunities in participants’ home institutions to improve third year medical students’ clinical training in palliative care during their required rotations. Background. Few U.S. medical schools have required clerkships dedicated to palliative care. However, required non-palliative care clerkships
503
offer opportunities to train medical students to care for seriously ill and dying patients. Research Objectives. To identify missed opportunities for third year medical students to work with palliative care specialists, care for patients who die, and deliver significant bad news during required non-palliative care clerkships. Methods. All 157 third year medical students at a single institution during the 2012-2013 academic year were invited to complete either an electronic or paper survey during the last four months of their third year. Results. 88 students responded (RR¼56%). Nearly all respondents (93%) felt that it was ‘moderately’ or ‘very’ important to learn about caring for seriously ill and dying patients. Students cared for a median of 1 patient who died, with 26% of students never caring for a patient who died. Over half (55%) never personally delivered significant bad news to a patient, and 38% never worked with a specialist in palliative medicine. Of the students who cared for a patient who died, 56% reported never debriefing a patient’s death. Of students who delivered significant bad news to patients, 31% never debriefed their experience giving bad news, and 17% gave bad news without supervision. Conclusions. Third year medical students have few opportunities to work with palliative care specialists, deliver significant bad news, or care for dying patients during their required clinical rotations. When students do care for seriously ill and dying patients, they rarely debrief or reflect with their primary teams.
Implications for research, policy, or practice. Faculty for required clerkships should include medical students in the care of seriously ill and dying patients and provide debriefing for these experiences. Palliative care specialists should identify opportunities to mentor medical students in the course of palliative care consultation.
Health Services Utilization and Payments in Patients with Cancer Pain: A Comparison of Intrathecal Drug Delivery versus Conventional Medical Management (S762) Jennifer Hinnenthal Minneapolis, MN. Lisa Stearns, MD, Center for Pain and Supportive Care, Phoenix, AZ. Objectives 1. Increase awareness of intrathecal drug delivery for the management of cancer pain.
Poster Abstracts
in Sawtooth Software), a method of utility assessment frequently used in market research. Respondents rated each service option individually followed by a series of trade-off questions between services to refine estimates of the utility of each service vs. others. Results. We interviewed 453 Veterans (97% male, 42% African-American, age 69yo) and 131 caregivers (89% female, age 60yo). >20% of respondents were capable of only limited self-care (ECOG score $3). Both patients and caregivers ranked transportation first, followed by a meal program, family care, nursing care, and care coordination; however, relative utility scores for each service differed between patients and caregivers. Service utility scores did not differ greatly by patient performance status, although older patients showed greater utility for nursing care (p¼0.04), whereas younger patients ranked counseling services higher (p¼0.005). Preferences were relatively uniform among patients. Conclusions. Patients with cardiopulmonary disease and their caregivers have similar preferences regarding palliative home care services, and many such services may enhance patients’ ability for self-care.
Implications for research, policy, or practice. Patient and caregiver-centered palliative care programs should reflect patient preferences. Some highly valued services (e.g., transportation) are not well addressed in current benefits, but enriched home and community services may enhance programmatic impact on patient and caregiver experiences and improve appropriate healthcare use.
Missed Opportunities in Training Third Year Medical Students to Care for Seriously Ill Patients (S761) Grant Smith Cambridge, MA. Kristen Schaefer, MD, Dana-Farber Cancer Institute and Harvard Medical School, Brookline, MA. Objectives 1. Describe missed opportunities to train third year medical students in the care of seriously ill and dying patients during required clinical rotations. 2. Identify missed opportunities in participants’ home institutions to improve third year medical students’ clinical training in palliative care during their required rotations. Background. Few U.S. medical schools have required clerkships dedicated to palliative care. However, required non-palliative care clerkships
503
offer opportunities to train medical students to care for seriously ill and dying patients. Research Objectives. To identify missed opportunities for third year medical students to work with palliative care specialists, care for patients who die, and deliver significant bad news during required non-palliative care clerkships. Methods. All 157 third year medical students at a single institution during the 2012-2013 academic year were invited to complete either an electronic or paper survey during the last four months of their third year. Results. 88 students responded (RR¼56%). Nearly all respondents (93%) felt that it was ‘moderately’ or ‘very’ important to learn about caring for seriously ill and dying patients. Students cared for a median of 1 patient who died, with 26% of students never caring for a patient who died. Over half (55%) never personally delivered significant bad news to a patient, and 38% never worked with a specialist in palliative medicine. Of the students who cared for a patient who died, 56% reported never debriefing a patient’s death. Of students who delivered significant bad news to patients, 31% never debriefed their experience giving bad news, and 17% gave bad news without supervision. Conclusions. Third year medical students have few opportunities to work with palliative care specialists, deliver significant bad news, or care for dying patients during their required clinical rotations. When students do care for seriously ill and dying patients, they rarely debrief or reflect with their primary teams.
Implications for research, policy, or practice. Faculty for required clerkships should include medical students in the care of seriously ill and dying patients and provide debriefing for these experiences. Palliative care specialists should identify opportunities to mentor medical students in the course of palliative care consultation.
Health Services Utilization and Payments in Patients with Cancer Pain: A Comparison of Intrathecal Drug Delivery versus Conventional Medical Management (S762) Jennifer Hinnenthal Minneapolis, MN. Lisa Stearns, MD, Center for Pain and Supportive Care, Phoenix, AZ. Objectives 1. Increase awareness of intrathecal drug delivery for the management of cancer pain.