- Email: [email protected]
Chemotherapy Near the End of Life: Helping Oncologists and Their Patients with Informed Decision Making (321)
474
Schedule with Abstracts
post fellowship training, specifically including the development of academic, clinical, and administrative career tracks. A major question remains: What is palliative medicine? I consider palliative medicine to have the following seven essential components: 1) communication, 2) decision making, 3) management of complications of advanced disease, 4) symptom control, 5) psychosocial care of patient/family, 6) care of dying, 7) health service delivery (plan of care). It is important to be clear about what does constitute palliative medicine as this has significant implications for fellowship training, leadership development, and subsequent career structure. Obviously components described do not include important academic mission of education and research in those components. Expert physician leadership essential to development of field and this cannot be achieved without clarity of purpose. In the clinical realm I believe palliative medicine experts should have a growing role in development of multidisciplinary clinics e.g. geriatric oncology to fully leverage expertise of skilled palliative medicine professionals. Widespread use of “end of life care” to describe professional endeavors is I believe both misleading and damaging to field. When training young men and women to become palliative medicine experts it is necessary to have expert experienced teachers and appropriate training structures within which to gain stature and expertise in clinical/academic areas. Issue of when people should enter the field (early or mature?). Another question is duration: I believe that two year fellowship is essential for development of trainee. It is also my position joint fellowships e.g. medical oncology/palliative medicine or gerontology/palliative medicine is important initiative in providing experts to the field, but also developing satisfying career structure. In order to allow individuals to succeed over a 30 year career span in a challenging clinical field it is important that joint fellowships produce individuals who are cross trained and able to function in a variety of environments. In addition, development of specific clinician educators, clinician investigators, and clinician administrators as well as novel structure such as palliative medicine hospitalists will ensure the field remains dynamic and grows in influence as our fellowship programs expand. Mentorship is critical to development of trainees, but can be achieved by those who themselves are secure in a defined career structure which allows them the
Vol. 37 No.3 March 2009
time and provides the motivation to ensure the success of the next generation of trainees.
AAHPM PDIA Community Leadership Award Presentation: The Pallimed Blog Drew A. Rosielle, MD, Medical College of Wisconsin, Milwaukee WI; Christian T. Sinclair, MD, Kansas City Hospice and Palliative Care, Kansas City, MO; Thomas Quinn, APRN CHPN. Yale School of Nursing and Yale Cancer Center, New Haven, CT (All speakers in this session have disclosed no relevant financial relationships) Objectives 1. Describe the challenges to staying up to date with contemporary palliative care research 2. Appreciate how online resources can help palliative clinicians stay up to date and build professional communities of interest As the palliative care research base expands, along with the palliative care professional community, there is increased need for innovative technologies to enable busy clinicians to keep up to date with emerging research literature, as well as collaboratively discuss the implications of palliative care research. This presentation will discuss Pallimed: A Hospice and Palliative Medicine Blog, an innovative online resource which encourages the critical discussion of palliative care research as well as national and international events which impact palliative care clinicians and patients.
2:25–3:25 pm Special Interest Group (SIG) Symposia A Fulfilling Practice in Hospice and Palliative Medicine: How Do You Get There? (320) Giovanni Elia, MD, The Institute of Palliative Medicine, San Diego, CA; Jessica Merlin, MD MBA, Hospital of the University of Pennsylvania, Philadelphia, PA; Tina L. Smusz, MD MA MSPH, Carilion Clinic, Christiansburg, VA; Gretchen Brown, MSW, Hospice of the Bluegrass, Lexington, KY; Eduardo Bruera, MD, University of Texas M.D. Anderson Cancer Center, Houston, TX; Christian Sinclair, MD, Kansas City Hospice, Kansas City, MO; Charles F. von Gunten, MD PhD FAAHPM FACP, San Diego Hospice and the Institute for Palliative Studies, San Diego, CA.
Vol. 37 No.3 March 2009
Schedule with Abstracts
475
(All speakers in this session have disclosed no relevant financial relationships with the following exceptions: von Gunten is a consultant, speaker, researcher for Wyeth, Progenesis, Halozyme, and Baxter; von Gunten will discuss off-label uses)
present data, personal experience, and opinions from relevant and representative sources in hospice and palliative medicine. This information will be available for individuals in different levels of training interested in the field.
Objectives 1. Recognize the different settings of practice in hospice and palliative medicine. 2. Identify options tailored to individual preference. Background. An increasing number of dedicated and competent individuals at different levels of medical training are attracted to the new ABMSaccredited subspecialty of palliative medicine. Institutions across the country have very different patient populations, settings, approaches, mentoring opportunities, and financial structures. Such diversity within the specialty creates a wide range of career options but can also be challenging for the newly trained physician. Aim. To provide medical students, primary care specialty residents, fellows in palliative medicine, and physicians looking for a career in hospice and palliative medicine with useful information about career options. Materials and Methods. Roundtable 1. Introduction: The first author will be the moderator and will present a general overview of the status of palliative medicine across the country. This will include statistics on hospices, palliative medicine programs, fellowship programs, and positions across the country. 2. Individual presentations: The following five guests will present their experience and perspectives from their different backgrounds and work settings: Gretchen Brown, MSW, President and CEO, Hospice of the Bluegrass; Eduardo Bruera, MD, Professor of Medicine, University of Texas M.D. Anderson; Christian Sinclair, MD, Associate Medical Director, Kansas City Hospice; Tina Smusz, MD, Medical Director, Carilion Hospice and Palliative Care; Charles von Gunten, MD PhD, Provost, Institute for Palliative Studies, San Diego Hospice and the Institute for Palliative Medicine. 3. Questions from the audience. 4. Final comments. Results. The attendees will experience a session that will enhance their enthusiasm, knowledge, and ability to choose their future involvement in the field. Conclusions. The above-described program will
Domain Structure and Processes of Care
Chemotherapy Near the End of Life: Helping Oncologists and Their Patients with Informed Decision Making (321) Sarah E. Harrington, MD, University of Arkansas Medical Science, Little Rock, AR; Thomas J. Smith, MD, Virginia Commonwealth University, Richmond, VA; Patrick J. Coyne, MSN APRN ACHPN FAAN, Virginia Commonwealth University Medical Center, Rockville, VA; Amy M. Sullivan, EdD, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA (All speakers for this session have disclosed no relevant financial relationships.) Objectives 1. Discuss ways to give truthful information about prognosis and treatment effectiveness to patients. 2. Discuss what cancer professionals should say about hospice as part of routine good care of the seriously ill. 3. Identify practical ways to overcome barriers to communication about prognosis. 4. Discuss incorporation of the National Comprehensive Cancer Network guidelines “stopping rules” into clinical practice. 5. Discuss what palliative care specialists should know about the difficult decision making that cancer patients face near death. Chemotherapy near the end of life is becoming more common with 16% to 23% of patients receiving chemotherapy within 14 days of their death when it is unlikely to benefit and likely to harm. The data suggest that hospice care without chemotherapy compared to nonhospice care including chemotherapy gives survival that is no different or longer for the hospice patients. Patients often have a different perspective because they are not told or do not accept the limited effectiveness of treatment; we tell them they are dying only 31% of the time; and they are willing to take chemotherapy with small chances of benefit and high likelihood of toxicity.1 Studies consistently document that patients want such information
Schedule with Abstracts
post fellowship training, specifically including the development of academic, clinical, and administrative career tracks. A major question remains: What is palliative medicine? I consider palliative medicine to have the following seven essential components: 1) communication, 2) decision making, 3) management of complications of advanced disease, 4) symptom control, 5) psychosocial care of patient/family, 6) care of dying, 7) health service delivery (plan of care). It is important to be clear about what does constitute palliative medicine as this has significant implications for fellowship training, leadership development, and subsequent career structure. Obviously components described do not include important academic mission of education and research in those components. Expert physician leadership essential to development of field and this cannot be achieved without clarity of purpose. In the clinical realm I believe palliative medicine experts should have a growing role in development of multidisciplinary clinics e.g. geriatric oncology to fully leverage expertise of skilled palliative medicine professionals. Widespread use of “end of life care” to describe professional endeavors is I believe both misleading and damaging to field. When training young men and women to become palliative medicine experts it is necessary to have expert experienced teachers and appropriate training structures within which to gain stature and expertise in clinical/academic areas. Issue of when people should enter the field (early or mature?). Another question is duration: I believe that two year fellowship is essential for development of trainee. It is also my position joint fellowships e.g. medical oncology/palliative medicine or gerontology/palliative medicine is important initiative in providing experts to the field, but also developing satisfying career structure. In order to allow individuals to succeed over a 30 year career span in a challenging clinical field it is important that joint fellowships produce individuals who are cross trained and able to function in a variety of environments. In addition, development of specific clinician educators, clinician investigators, and clinician administrators as well as novel structure such as palliative medicine hospitalists will ensure the field remains dynamic and grows in influence as our fellowship programs expand. Mentorship is critical to development of trainees, but can be achieved by those who themselves are secure in a defined career structure which allows them the
Vol. 37 No.3 March 2009
time and provides the motivation to ensure the success of the next generation of trainees.
AAHPM PDIA Community Leadership Award Presentation: The Pallimed Blog Drew A. Rosielle, MD, Medical College of Wisconsin, Milwaukee WI; Christian T. Sinclair, MD, Kansas City Hospice and Palliative Care, Kansas City, MO; Thomas Quinn, APRN CHPN. Yale School of Nursing and Yale Cancer Center, New Haven, CT (All speakers in this session have disclosed no relevant financial relationships) Objectives 1. Describe the challenges to staying up to date with contemporary palliative care research 2. Appreciate how online resources can help palliative clinicians stay up to date and build professional communities of interest As the palliative care research base expands, along with the palliative care professional community, there is increased need for innovative technologies to enable busy clinicians to keep up to date with emerging research literature, as well as collaboratively discuss the implications of palliative care research. This presentation will discuss Pallimed: A Hospice and Palliative Medicine Blog, an innovative online resource which encourages the critical discussion of palliative care research as well as national and international events which impact palliative care clinicians and patients.
2:25–3:25 pm Special Interest Group (SIG) Symposia A Fulfilling Practice in Hospice and Palliative Medicine: How Do You Get There? (320) Giovanni Elia, MD, The Institute of Palliative Medicine, San Diego, CA; Jessica Merlin, MD MBA, Hospital of the University of Pennsylvania, Philadelphia, PA; Tina L. Smusz, MD MA MSPH, Carilion Clinic, Christiansburg, VA; Gretchen Brown, MSW, Hospice of the Bluegrass, Lexington, KY; Eduardo Bruera, MD, University of Texas M.D. Anderson Cancer Center, Houston, TX; Christian Sinclair, MD, Kansas City Hospice, Kansas City, MO; Charles F. von Gunten, MD PhD FAAHPM FACP, San Diego Hospice and the Institute for Palliative Studies, San Diego, CA.
Vol. 37 No.3 March 2009
Schedule with Abstracts
475
(All speakers in this session have disclosed no relevant financial relationships with the following exceptions: von Gunten is a consultant, speaker, researcher for Wyeth, Progenesis, Halozyme, and Baxter; von Gunten will discuss off-label uses)
present data, personal experience, and opinions from relevant and representative sources in hospice and palliative medicine. This information will be available for individuals in different levels of training interested in the field.
Objectives 1. Recognize the different settings of practice in hospice and palliative medicine. 2. Identify options tailored to individual preference. Background. An increasing number of dedicated and competent individuals at different levels of medical training are attracted to the new ABMSaccredited subspecialty of palliative medicine. Institutions across the country have very different patient populations, settings, approaches, mentoring opportunities, and financial structures. Such diversity within the specialty creates a wide range of career options but can also be challenging for the newly trained physician. Aim. To provide medical students, primary care specialty residents, fellows in palliative medicine, and physicians looking for a career in hospice and palliative medicine with useful information about career options. Materials and Methods. Roundtable 1. Introduction: The first author will be the moderator and will present a general overview of the status of palliative medicine across the country. This will include statistics on hospices, palliative medicine programs, fellowship programs, and positions across the country. 2. Individual presentations: The following five guests will present their experience and perspectives from their different backgrounds and work settings: Gretchen Brown, MSW, President and CEO, Hospice of the Bluegrass; Eduardo Bruera, MD, Professor of Medicine, University of Texas M.D. Anderson; Christian Sinclair, MD, Associate Medical Director, Kansas City Hospice; Tina Smusz, MD, Medical Director, Carilion Hospice and Palliative Care; Charles von Gunten, MD PhD, Provost, Institute for Palliative Studies, San Diego Hospice and the Institute for Palliative Medicine. 3. Questions from the audience. 4. Final comments. Results. The attendees will experience a session that will enhance their enthusiasm, knowledge, and ability to choose their future involvement in the field. Conclusions. The above-described program will
Domain Structure and Processes of Care
Chemotherapy Near the End of Life: Helping Oncologists and Their Patients with Informed Decision Making (321) Sarah E. Harrington, MD, University of Arkansas Medical Science, Little Rock, AR; Thomas J. Smith, MD, Virginia Commonwealth University, Richmond, VA; Patrick J. Coyne, MSN APRN ACHPN FAAN, Virginia Commonwealth University Medical Center, Rockville, VA; Amy M. Sullivan, EdD, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA (All speakers for this session have disclosed no relevant financial relationships.) Objectives 1. Discuss ways to give truthful information about prognosis and treatment effectiveness to patients. 2. Discuss what cancer professionals should say about hospice as part of routine good care of the seriously ill. 3. Identify practical ways to overcome barriers to communication about prognosis. 4. Discuss incorporation of the National Comprehensive Cancer Network guidelines “stopping rules” into clinical practice. 5. Discuss what palliative care specialists should know about the difficult decision making that cancer patients face near death. Chemotherapy near the end of life is becoming more common with 16% to 23% of patients receiving chemotherapy within 14 days of their death when it is unlikely to benefit and likely to harm. The data suggest that hospice care without chemotherapy compared to nonhospice care including chemotherapy gives survival that is no different or longer for the hospice patients. Patients often have a different perspective because they are not told or do not accept the limited effectiveness of treatment; we tell them they are dying only 31% of the time; and they are willing to take chemotherapy with small chances of benefit and high likelihood of toxicity.1 Studies consistently document that patients want such information