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Chronic Pain in the Ambulatory Palliative Care Setting: A Distinct Entity from Acute Pain? (S744)
Vol. 51 No. 2 February 2016
Poster Abstracts
regulators, and healthcare systems establish that different modes of survey administration yield similar results. Future research will need to examine the validity and measurement invariance for web-based bereaved family surveys.
Chronic Pain in the Ambulatory Palliative Care Setting: A Distinct Entity from Acute Pain? (S744) Jessica Merlin, MD, University of Alabama at Birmingham, Birmingham, AL. Courtney Williams, MPH, University of Alabama at Birmingham, Birmingham, AL. Malissa Pynes, BS, University of Alabama School of Medicine, Birmingham, AL. Catherine McCarty, BS Candidate 2016, Healthcare Management & Psychology, University of Alabama at Birmingham, Birmingham, AL. Elizabeth Kvale, MD, University of Alabama at Birmingham Center for Palliative and Supportive Care, Birmingham, AL. Objectives Describe the prevalence of acute and chronic pain in an ambulatory palliative care setting. Describe the association between acute and chronic pain and outcomes in our ambulatory palliative care setting. Original Research Background. Acute pain is common in ambulatory palliative care (APC), and includes pain related to progression of serious illness and at the end of life. Chronic pain is pain lasting > 3 months, beyond the period of normal tissue healing. It has a unique pathophysiology, and I negatively impacts health outcomes. Acute pain management typically involves opioids; treatment of chronic pain often limits opioids and focuses on physical therapy, treatment of comorbid mood disorders, and pain self-management/coping. Distinguishing these groups is important clinically. Research Objectives. To characterize individuals with acute and chronic pain in APC. Methods. Clinical surveillance data from 165 consecutive consenting APC patients between 7/18/2012-5/ 22/2015 was examined. Chronic pain was defined as average pain on the Brief Pain Inventory (BPI) $ 4/ 10 at least twice > 3 months apart, acute pain as average pain $ 4/10 once, and depressive symptoms as PHQ-9 $ 10. Multiple regression was used to investigate the cross-sectional relationship between pain category and outcomes (BPI pain interference and depressive symptoms). Results. Among 165 participants, mean age was 52, and 75% were female. Mean number of visits was 2.5. 35% had chronic pain, and 51% had acute pain. Compared to individuals with no pain and after adjusting for age and sex, pain interference was 0.55 points higher on average for individuals with acute pain on a
431
0 to 10 scale, and it was 1.0 points higher for individuals with chronic pain (p¼0.03 and 0.0003 respectively). Odds of depression were 3.7 times higher in acute pain and 4.0 times higher in chronic pain than in individuals without pain. Conclusion. Acute and chronic pain were common and associated with worse outcomes; chronic pain was somewhat more strongly associated with higher levels of pain interference and depression.
Implications for Research, Policy or Practice. Additional research is needed to understand differences between acute and chronic pain in this setting.
Teaching Pediatric Intensive Care Physicians Communication Skills: The Enduring Effects (S745) Jennifer Walter, MD PhD MS, University of Pennsylvania, Philadelphia, PA. Parth Shah, BA, Candidate at the University of Pennsylvania, The Children’s Hospital of Philadelphia (CHOP), Philadelphia, PA. Folasade Odeniyi, MPH, The Children’s Hospital of Philadelphia, Philadelphia, PA. Vanessa Madrigal, MD, Children’s National Medical Center, Bethesda, MD. Chris Feudtner, MD MPH PhD, The Children’s Hospital of Philadelphia, Philadelphia, PA. Objectives Determine feasibility of a communication skills training (CST) to prepare pediatric intensivists for communicating bad news and assessing goals of care in the pediatric intensive care unit (PICU). Describe the impact of CST on intensivist skill in communication. Original Research Background. Families of seriously ill children describe unmet needs for honest information presented empathetically, while intensivists report inadequate training in having difficult conversations. Research Objectives. 1. To determine feasibility of communication skills training (CST) to prepare pediatric intensivists for communicating bad news and assessing goals of care in the pediatric intensive care unit (PICU). 2. To describe the impact of CST on intensivist skill in communication. Methods. Intensivists volunteered to undergo CST with didactics, discussions with simulated parents, and a videotaped OSCE exam. Surveys prior to the intervention and one month after were tabulated for descriptive statistics. Wilcoxon signed-rank tests compared outcomes at 2 time points. 2 independent trained reviewers scored the OSCE using a validated tool. Results. Twelve participants completed training. In the post-CST survey, all participants agreed the
Poster Abstracts
regulators, and healthcare systems establish that different modes of survey administration yield similar results. Future research will need to examine the validity and measurement invariance for web-based bereaved family surveys.
Chronic Pain in the Ambulatory Palliative Care Setting: A Distinct Entity from Acute Pain? (S744) Jessica Merlin, MD, University of Alabama at Birmingham, Birmingham, AL. Courtney Williams, MPH, University of Alabama at Birmingham, Birmingham, AL. Malissa Pynes, BS, University of Alabama School of Medicine, Birmingham, AL. Catherine McCarty, BS Candidate 2016, Healthcare Management & Psychology, University of Alabama at Birmingham, Birmingham, AL. Elizabeth Kvale, MD, University of Alabama at Birmingham Center for Palliative and Supportive Care, Birmingham, AL. Objectives Describe the prevalence of acute and chronic pain in an ambulatory palliative care setting. Describe the association between acute and chronic pain and outcomes in our ambulatory palliative care setting. Original Research Background. Acute pain is common in ambulatory palliative care (APC), and includes pain related to progression of serious illness and at the end of life. Chronic pain is pain lasting > 3 months, beyond the period of normal tissue healing. It has a unique pathophysiology, and I negatively impacts health outcomes. Acute pain management typically involves opioids; treatment of chronic pain often limits opioids and focuses on physical therapy, treatment of comorbid mood disorders, and pain self-management/coping. Distinguishing these groups is important clinically. Research Objectives. To characterize individuals with acute and chronic pain in APC. Methods. Clinical surveillance data from 165 consecutive consenting APC patients between 7/18/2012-5/ 22/2015 was examined. Chronic pain was defined as average pain on the Brief Pain Inventory (BPI) $ 4/ 10 at least twice > 3 months apart, acute pain as average pain $ 4/10 once, and depressive symptoms as PHQ-9 $ 10. Multiple regression was used to investigate the cross-sectional relationship between pain category and outcomes (BPI pain interference and depressive symptoms). Results. Among 165 participants, mean age was 52, and 75% were female. Mean number of visits was 2.5. 35% had chronic pain, and 51% had acute pain. Compared to individuals with no pain and after adjusting for age and sex, pain interference was 0.55 points higher on average for individuals with acute pain on a
431
0 to 10 scale, and it was 1.0 points higher for individuals with chronic pain (p¼0.03 and 0.0003 respectively). Odds of depression were 3.7 times higher in acute pain and 4.0 times higher in chronic pain than in individuals without pain. Conclusion. Acute and chronic pain were common and associated with worse outcomes; chronic pain was somewhat more strongly associated with higher levels of pain interference and depression.
Implications for Research, Policy or Practice. Additional research is needed to understand differences between acute and chronic pain in this setting.
Teaching Pediatric Intensive Care Physicians Communication Skills: The Enduring Effects (S745) Jennifer Walter, MD PhD MS, University of Pennsylvania, Philadelphia, PA. Parth Shah, BA, Candidate at the University of Pennsylvania, The Children’s Hospital of Philadelphia (CHOP), Philadelphia, PA. Folasade Odeniyi, MPH, The Children’s Hospital of Philadelphia, Philadelphia, PA. Vanessa Madrigal, MD, Children’s National Medical Center, Bethesda, MD. Chris Feudtner, MD MPH PhD, The Children’s Hospital of Philadelphia, Philadelphia, PA. Objectives Determine feasibility of a communication skills training (CST) to prepare pediatric intensivists for communicating bad news and assessing goals of care in the pediatric intensive care unit (PICU). Describe the impact of CST on intensivist skill in communication. Original Research Background. Families of seriously ill children describe unmet needs for honest information presented empathetically, while intensivists report inadequate training in having difficult conversations. Research Objectives. 1. To determine feasibility of communication skills training (CST) to prepare pediatric intensivists for communicating bad news and assessing goals of care in the pediatric intensive care unit (PICU). 2. To describe the impact of CST on intensivist skill in communication. Methods. Intensivists volunteered to undergo CST with didactics, discussions with simulated parents, and a videotaped OSCE exam. Surveys prior to the intervention and one month after were tabulated for descriptive statistics. Wilcoxon signed-rank tests compared outcomes at 2 time points. 2 independent trained reviewers scored the OSCE using a validated tool. Results. Twelve participants completed training. In the post-CST survey, all participants agreed the