- Email: [email protected]
Brief Meditation Practices for Caregivers and Patients: An Informational and Experiential Introduction to Mindfulness and Compassion Practice (FR423)
Vol. 47 No. 2 February 2014
Schedule With Abstracts
analysis and stepwise Cox analysis was used to identify prognostic factors. Hazard ratios (HR) were calculated for significant variables . Results. Eighty-one of 83 patients admitted over 2 months were assessable. Variables for worse survival (HR>1) were albumin < 3.1 g/dL, creatinine > 0.93 mg/dL, and male gender. RPA found patients with albumin > 3.1 g/dL had better survival than < 3.1 g/dL (P<0.001). Individuals with a creatinine < 0.91mg.dl had better survival than > 0.91 mg/dL (P¼0.035). Every variation of albumin (continuous, median, RPA, and tertiles) was significant; creatinine was significant by RPA. In multivariable analysis, only albumin and creatinine were prognostic. HR for albumin > 3.1 was 0.28 (95% CI, 0.15 to 0.52) (P<0.001), for creatinine > 0.91 mg/dL the HR was 1.8 (95% CI, 1.01 to 3.21) (P¼0.046). Conclusions. Low serum albumin and increased creatinine are prognostic factors for inpatients in a palliative medicine unit.
Implications for research, policy, or practice. This study found serum albumin and creatinine were prognostically important. Correlations should be made with palliative prognostic indices and other prognostic factors. A prospective study is underway to confirm the significance of albumin as a prognostic factor.
SIG Symposia Effects of Combat and Military Training on End of Life Care (FR422) Kelly Cooke, DO, ProHealth Care, Waukesha, WI. John Franklin, MD, Ralph H. Johnson VA Medical Center, Charleston, SC. John Painter, MDiv PhD, Ralph H. Johnson VA Medical Center, Charleston, SC. Sharon Weinstein, MD, University of Utah, Salt Lake City, UT. James Rodgers, PhD, Veterans Affairs Healthcare, Temple, TX. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Understand the unique veteran culture and its impact on seeking end-of-life care. 2. Describe the psychosocial impact of combat and lethal military training. 3. Describe interventions that assist veterans and families at the end of life. An estimated 25% of all dying Americans are veterans. Only 4% of these veterans are cared for within the Veterans Affairs Healthcare
431
System. Military culture instills stoicism, which is likely to hinder a veteran in seeking help for suffering. Combat training and the psychological scars of lethal training and actual combat can impede a peaceful death or obstruct effective bereavement. Asking permission and then taking a military history with a focus on traumatic events can build trust while enlightening the palliative care team to potential existential suffering. An estimated 70% of veterans may have symptoms that support a diagnosis of post-traumatic stress disorder (PTSD). There is stigma associated with the diagnosis and treatment of PTSD whether the result of combat, military sexual trauma, or other trauma. Because of this stigma, veterans often do not seek treatment, preferring instead to self-medicate. This results in higher than normal rates of substance abuse disorders and homelessness. Barriers to seeking help from medical professionals remain firmly in place but can often be overcome by establishing trust. As a medical professional, establishing an environment of respect and trust is vital to understanding the veteran’s story. Without this understanding, it is impossible to explore the dying veteran’s need for forgiveness or to help them cultivate inner peace. Recall of combat trauma at the end of life may also affect the family and profoundly influence the quality of the bereavement experience of family care givers. All end-of-life choices have complex psychosocial components and consequences that significantly impact suffering and the quality of living and dying. This session will highlight the unique needs of veterans and their families at the end of life. Although these issues are unique to veterans, the concepts of regret, forgiveness, and acceptance are universal.
Brief Meditation Practices for Caregivers and Patients: An Informational and Experiential Introduction to Mindfulness and Compassion Practice (FR423) Steven Rosenzweig, MD, Drexel University College of Medicine, Philadelphia, PA. Lucille Marchand, MD BSN, University of Wisconsin, Madison, WI. (All authors listed above had no relevant financial relationships to disclose.)
432
Schedule With Abstracts
Objectives 1. Review major findings regarding physiological effects and clinical outcomes associated with mindfulness and compassion meditation. 2. Guide participants through three brief mediation practices of benefit to both caregivers and patients. 3. Discuss practical applications of brief meditation practices for care of self and patients. Meditation has historically been considered a spiritual practice and is foundational to certain caregiving traditions. More than three decades of research have shed light on the physiological effects and clinical benefits of meditation; these findings have important implications for providers of palliative care and their patients. Much of that research has examined mindfulness-based stress reduction and related mindfulness-based healthcare interventions. Investigators have also explored the effects of compassion meditation and other practices. Studies have demonstrated an association with biological changes in brain structure and function (Davidson, Kabat-Zinn et al., 2003; Lutz, Brefczynski-Lewis et al., 2008; Desbordes, Negi, Pace, et al., 2012) as well as positive effects on biological markers implicated in multiple disease mechanisms (Greeson, 2009). Clinical outcomes include reduced anxiety, improved mood, less fatigue, and fewer somatic symptoms (De Vibe, Bjørndal, et al., 2012; Grossman, Niemann et al., 2004; Marchland 2012). Research has been conducted among general medical patients and also among patients with cancer (Ledesma, Kumano, 2008), including patients on a bone marrow transplantation unit (Bauer-Wu 2008); these findings have important implications for patients at the endoflife (Carlson, Halifax, 2011). Studies examining the health impact of mindfulness on physicians and nurses have shown significant reduction in indicators of professional burnout. (Krasner, Epstein, Beckman, et al., 2009; Cohen-Katz, Wiley, 2005) Meditation involves the self-regulation of attention and emotion and the cultivation of present-moment awareness. Mindfulness and compassion meditations share a common tradition of practices intended to cultivate calm, kindness, caring, and happiness. This session will present a conceptual foundation of mindfulness and compassion practice and review
Vol. 47 No. 2 February 2014
highlights of research findings. Participants will be guided through three brief meditations that are appropriate for self-care and for the care of patients: body scan, 3-minute breathing space (Segal, Williams, et al., 2013), and compassion practice. Information for ongoing learning will be provided.
3:45e4:45 pm
Concurrent Sessions Can You Tap the Patient at Home? Managing Liver Failure on Hospice (FR425) Rebecca Yamarik, MD MPH, Providence Trinity Hospice, Torrance, CA. Diana Simmer, RN CHPN, Providence Trinity Hospice, Torrance, CA. Shirley Perkins, MSW, Providence Trinity Hospice, Torrance, CA. Martina Meier, MD, Providence Trinity Hospice, Torrance, CA. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Learn to manage liver failure patients, particularly ascites, in the hospice setting with judicious use of diuretics, paracentesis, and opiates. 2. Explore the psychosocial needs of liver failure hospice patients and learn to utilize the interdisciplinary hospice team to meet those needs. 3. Discuss how liver failure patients may be simultaneously on hospice while awaiting liver transplant. Liver failure is a growing diagnosis among hospice patients who are often referred late in the course of their illness. The purpose of this session is to discuss the role of the hospice team in providing care to patients with liver failure, discuss the medical management of cirrhosis for hospice patients, provide prognostic tools, and discuss the interaction of hospice and liver transplant. The use of opiate medications is challenging because of social and medical issues. The session begins with an overview of the disease trajectory of advanced liver failure. Prognostic tools such as the MELD and Childs-Pugh scores will be discussed. The relationship of hospice to liver transplantation will be explored as
Schedule With Abstracts
analysis and stepwise Cox analysis was used to identify prognostic factors. Hazard ratios (HR) were calculated for significant variables . Results. Eighty-one of 83 patients admitted over 2 months were assessable. Variables for worse survival (HR>1) were albumin < 3.1 g/dL, creatinine > 0.93 mg/dL, and male gender. RPA found patients with albumin > 3.1 g/dL had better survival than < 3.1 g/dL (P<0.001). Individuals with a creatinine < 0.91mg.dl had better survival than > 0.91 mg/dL (P¼0.035). Every variation of albumin (continuous, median, RPA, and tertiles) was significant; creatinine was significant by RPA. In multivariable analysis, only albumin and creatinine were prognostic. HR for albumin > 3.1 was 0.28 (95% CI, 0.15 to 0.52) (P<0.001), for creatinine > 0.91 mg/dL the HR was 1.8 (95% CI, 1.01 to 3.21) (P¼0.046). Conclusions. Low serum albumin and increased creatinine are prognostic factors for inpatients in a palliative medicine unit.
Implications for research, policy, or practice. This study found serum albumin and creatinine were prognostically important. Correlations should be made with palliative prognostic indices and other prognostic factors. A prospective study is underway to confirm the significance of albumin as a prognostic factor.
SIG Symposia Effects of Combat and Military Training on End of Life Care (FR422) Kelly Cooke, DO, ProHealth Care, Waukesha, WI. John Franklin, MD, Ralph H. Johnson VA Medical Center, Charleston, SC. John Painter, MDiv PhD, Ralph H. Johnson VA Medical Center, Charleston, SC. Sharon Weinstein, MD, University of Utah, Salt Lake City, UT. James Rodgers, PhD, Veterans Affairs Healthcare, Temple, TX. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Understand the unique veteran culture and its impact on seeking end-of-life care. 2. Describe the psychosocial impact of combat and lethal military training. 3. Describe interventions that assist veterans and families at the end of life. An estimated 25% of all dying Americans are veterans. Only 4% of these veterans are cared for within the Veterans Affairs Healthcare
431
System. Military culture instills stoicism, which is likely to hinder a veteran in seeking help for suffering. Combat training and the psychological scars of lethal training and actual combat can impede a peaceful death or obstruct effective bereavement. Asking permission and then taking a military history with a focus on traumatic events can build trust while enlightening the palliative care team to potential existential suffering. An estimated 70% of veterans may have symptoms that support a diagnosis of post-traumatic stress disorder (PTSD). There is stigma associated with the diagnosis and treatment of PTSD whether the result of combat, military sexual trauma, or other trauma. Because of this stigma, veterans often do not seek treatment, preferring instead to self-medicate. This results in higher than normal rates of substance abuse disorders and homelessness. Barriers to seeking help from medical professionals remain firmly in place but can often be overcome by establishing trust. As a medical professional, establishing an environment of respect and trust is vital to understanding the veteran’s story. Without this understanding, it is impossible to explore the dying veteran’s need for forgiveness or to help them cultivate inner peace. Recall of combat trauma at the end of life may also affect the family and profoundly influence the quality of the bereavement experience of family care givers. All end-of-life choices have complex psychosocial components and consequences that significantly impact suffering and the quality of living and dying. This session will highlight the unique needs of veterans and their families at the end of life. Although these issues are unique to veterans, the concepts of regret, forgiveness, and acceptance are universal.
Brief Meditation Practices for Caregivers and Patients: An Informational and Experiential Introduction to Mindfulness and Compassion Practice (FR423) Steven Rosenzweig, MD, Drexel University College of Medicine, Philadelphia, PA. Lucille Marchand, MD BSN, University of Wisconsin, Madison, WI. (All authors listed above had no relevant financial relationships to disclose.)
432
Schedule With Abstracts
Objectives 1. Review major findings regarding physiological effects and clinical outcomes associated with mindfulness and compassion meditation. 2. Guide participants through three brief mediation practices of benefit to both caregivers and patients. 3. Discuss practical applications of brief meditation practices for care of self and patients. Meditation has historically been considered a spiritual practice and is foundational to certain caregiving traditions. More than three decades of research have shed light on the physiological effects and clinical benefits of meditation; these findings have important implications for providers of palliative care and their patients. Much of that research has examined mindfulness-based stress reduction and related mindfulness-based healthcare interventions. Investigators have also explored the effects of compassion meditation and other practices. Studies have demonstrated an association with biological changes in brain structure and function (Davidson, Kabat-Zinn et al., 2003; Lutz, Brefczynski-Lewis et al., 2008; Desbordes, Negi, Pace, et al., 2012) as well as positive effects on biological markers implicated in multiple disease mechanisms (Greeson, 2009). Clinical outcomes include reduced anxiety, improved mood, less fatigue, and fewer somatic symptoms (De Vibe, Bjørndal, et al., 2012; Grossman, Niemann et al., 2004; Marchland 2012). Research has been conducted among general medical patients and also among patients with cancer (Ledesma, Kumano, 2008), including patients on a bone marrow transplantation unit (Bauer-Wu 2008); these findings have important implications for patients at the endoflife (Carlson, Halifax, 2011). Studies examining the health impact of mindfulness on physicians and nurses have shown significant reduction in indicators of professional burnout. (Krasner, Epstein, Beckman, et al., 2009; Cohen-Katz, Wiley, 2005) Meditation involves the self-regulation of attention and emotion and the cultivation of present-moment awareness. Mindfulness and compassion meditations share a common tradition of practices intended to cultivate calm, kindness, caring, and happiness. This session will present a conceptual foundation of mindfulness and compassion practice and review
Vol. 47 No. 2 February 2014
highlights of research findings. Participants will be guided through three brief meditations that are appropriate for self-care and for the care of patients: body scan, 3-minute breathing space (Segal, Williams, et al., 2013), and compassion practice. Information for ongoing learning will be provided.
3:45e4:45 pm
Concurrent Sessions Can You Tap the Patient at Home? Managing Liver Failure on Hospice (FR425) Rebecca Yamarik, MD MPH, Providence Trinity Hospice, Torrance, CA. Diana Simmer, RN CHPN, Providence Trinity Hospice, Torrance, CA. Shirley Perkins, MSW, Providence Trinity Hospice, Torrance, CA. Martina Meier, MD, Providence Trinity Hospice, Torrance, CA. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Learn to manage liver failure patients, particularly ascites, in the hospice setting with judicious use of diuretics, paracentesis, and opiates. 2. Explore the psychosocial needs of liver failure hospice patients and learn to utilize the interdisciplinary hospice team to meet those needs. 3. Discuss how liver failure patients may be simultaneously on hospice while awaiting liver transplant. Liver failure is a growing diagnosis among hospice patients who are often referred late in the course of their illness. The purpose of this session is to discuss the role of the hospice team in providing care to patients with liver failure, discuss the medical management of cirrhosis for hospice patients, provide prognostic tools, and discuss the interaction of hospice and liver transplant. The use of opiate medications is challenging because of social and medical issues. The session begins with an overview of the disease trajectory of advanced liver failure. Prognostic tools such as the MELD and Childs-Pugh scores will be discussed. The relationship of hospice to liver transplantation will be explored as