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D05-A Supportive Cardiology: Early Integration of Palliative Care for Patients with Advanced Heart Failure
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Selected Abstracts
Results: The possibility that the child could die was contemplated by both parents and physicians, but was integrated in either a chaos or a restitution narrative. Most adults found it inappropriate to talk about dying in terms of a quest, a journey of hoping for the best. Children never directly addressed the topic of death. Conclusions: The tension between participation and exclusion in the case of children with progressive cancer has something to do with the larger social discourse on dying as a final life project which seems to constrain the way in which patients and adults can relate to the child’s death.
D03-D Quality of Palliative Care for Children with Cancer
Kimberley Widger1,2, Stefan Friedrichsdorf3, Joanne Wolfe4, Stephen Liben5, Jason D. Pole1,6, Eric Bouffet1,2, Mark Greenberg1,6, Amna Husain1,7, Harold Siden8, James A. Whitlock1,2, Adam Rapoport1,2 1 University of Toronto, Toronto, ON, Canada 2 Hospital for Sick Children, Toronto, ON, Canada 3 Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN, United States 4 Dana-Farber Cancer Institute, Boston, MA, United States 5 The Montreal Children’s Hospital, Montre al, QC, Canada 6 Pediatric Oncology Group of Ontario, Toronto, ON, Canada 7 Mount Sinai Hospital, Toronto, ON, Canada 8 Canuck Place Children’s Hospice, Vancouver, BC, Canada Objectives: Principles of pediatric palliative care (PPC) can and should be incorporated from the time of diagnosis of childhood cancer, concurrent with curative treatments, rather than only being provided as an alternative to those treatments at the end of life. As part of a larger project to enhance PPC provision we assessed the quality of palliative care provided to children with cancer and their families. Methods: Data were collected at 15 of the 16 pediatric oncology programs in Canada from four sources: 1) children age 7 to 19 with active disease or receiving cancer treatments completed the Memorial Symptom Assessment Scale and the Pediatric Quality of Life Inventory; 2) parents of children age 0 to 19 with active disease or receiving cancer treatments completed a survey about symptoms, quality of life, and care quality; 3) review of health records of deceased patients; and 4) surveys with bereaved parents about the quality of their children’s end-of-life care.
Vol. 52 No. 6 December 2016
Results: Adolescents (n¼38) reported more symptoms (8 vs. 5) but similar mean quality of life scores (65/100 vs. 67/100) compared with younger children (n¼ 26). Both groups report being asked frequently about symptoms by health professionals, but 40% reported they are never or almost never asked about quality of life. The lowest quality score from all parent participants (n¼222) was around support of siblings (mean score 2.6/4). Only 43% of bereaved parents were able to look back on their child’s care during the last month of life without regrets. Regrets were mostly around not being able to spend more time at home. Conclusions: There is room for improvement in PPC for children with cancer. Children might benefit from more attention to their quality of life beyond symptom management. Regrets are common among bereaved parents, but may be reduced by finding ways to help families spend more time at home.
D05-A Supportive Cardiology: Early Integration of Palliative Care for Patients with Advanced Heart Failure
Warren Lewin3, Dorothy Sullivan1,2, Nina Horvath1,2, Archna Patel1,2, Shana Haberman1 1 Freeman Centre for the Advancement of Palliative Care, North York General Hospital, Toronto, ON, Canada 2 University of Toronto, Toronto, ON, Canada 3 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, United States Objectives: Congestive Heart Failure (CHF) is a chronic, life-limiting illness that progressively impacts health status and is a leading cause of hospital admissions. We aim to describe the integration of a new model of early palliative care involvement into routine cardiac care for patients with advanced CHF. Specifically, our session will review our team’s journey including concept hypothesis, needs assessment, implementation planning, securing of ‘‘buy-in’’ from hospital leadership and cardiac clinicians, and execution. We will also highlight opportunities for and challenges to future growth. Methods: A referral tool was developed using evidencebased criteria to assist in identifying patients with advanced CHF. A palliative care clinician would provide initial consultation and follow-up care in an outpatient setting. Our team increased awareness of the need for palliative care among the cardiac team through interdisciplinary meetings, in-services, and weekly rounding with the cardiac team. During implementation of the integration 40 patients with advanced CHF were
Vol. 52 No. 6 December 2016
Selected Abstracts
recruited for a quality improvement study, of which 20 had palliative care involvement. Data was collected at initial consultation, and then at 48 hours, 1 month, 3 months and 6 months post-discharge. Results: Observations from the quality improvement study were that with palliative care involvement: Acute care utilization decreased 3-fold once patients received outpatient palliative care Hospital admissions and emergency department visits decreased by 66% Advance Care Planning (ACP) documentation increased from 40% to 100% Conclusions: Early integration of palliative care for patients with advanced CHF demonstrated significant increase in ACP documentation, which was correlated with a dramatic decrease in acute care utilization. The group that had no palliative care involvement had no change in ACP documentation. Although our sample size was small, these findings are likely associated with huge cost-savings representing a high-value based program while simultaneously providing care concordant with patient and family values.
D07-B The Development of the Palliative Care Spiritual Care Competency Scale
Ping-Hwa Chen1, Jeng-Fong Chiou2, Mei Chuan Chu1, Lan-Hsin Fan1, Kuo-Feng Chang1, Ran Zhao3 1 National Taiwan Normal University, Taipei, Taiwan 2 Taipei Medical University Hospital, Taipei, Taiwan 3 National Taiwan University, Taipei, Taiwan This study aims to develop a tool to assess the core competencies of palliative care spiritual care (PCSC) providers in Taiwan. Two studies were conducted to develop the Palliative Care Spiritual Care Competency Scale (PCSCCS). In study 1, 18 PCSC providers with an average of 12.7 years of palliative care experience were recruited. Six focus groups were held to collect data for identifying indicators of core competencies. The content analysis method was applied to analyze the data. Three domains, namely spiritual care knowledge, spiritual care attitude and spiritual care professional skills, and 18 subcategories of core competencies emerged from the analysis. In study 2, 84 preliminary items were generated based on the findings of study 1. Response data to those items were collected from 134 trainees who had attended the PCSC training conducted by Schweitzer Christian and Missionary Alliance (SCMA) in the past two years. After reliability analysis and exploratory factor analysis on those data, 18 items were selected
e33
and constituted the PCSCCS. The result showed that three factors (knowledge and skills of spiritual care, self awareness and attitude of spiritual care, and spiritual care that meets the spiritual needs) corresponded with the finding of study 1. The Cronbach’s was from .80 to .92, providing empirical evidence that the psychometric properties were in an acceptable range. Furthermore, another set of data from 199 participants who received SCMA’s training, was used to conduct confirmatory factor analysis. The result showed that the response data fit reasonably well with the hypothetical structure of PCSCCS, which in turn provides positive evidence for its construct validity. It is proposed that the PCSCCS is an appropriate assessment tool for the competency of PCSC providers in Taiwan. Future studies are needed to assess the suitability of using PCSCCS in other cultures.
D07-C Foundations of Spiritual Care: Evaluation of a New Zealand Hospice Spiritual Care Programme Rod MacLeod1,2, Richard Egan3, Tess Moeke-Maxwell4, Rachael Crombie5 1 University of Sydney, Sydney, Australia 2 HammondCare, Sydney, Australia 3 University of Otago, Dunedin, New Zealand 4 University of Auckland, Auckland, New Zealand 5 Hospice New Zealand, Wellington, New Zealand
Objective: Hospice New Zealand (HNZ) identified a need to increase the capacity for spiritual care within the hospice. An evaluation examined whether subsequent national spiritual care training across all workforce domains (the Foundations of Spiritual Care Programme), had built spiritual health literacy and competency in the hospice workforce. Methods: The evaluation used a mixed methods approach and reflected the bicultural aspect/nature of the programme. It included cross-sectional surveys of programme participants and key informants (facilitators and senior management) within hospices and focus groups of programme participants. It also included information from participants’ post programme reflection forms. Results: The programme provided positive experiences and outcomes for staff and volunteers and organisations as a whole. Participants were positively influenced in two key areas; personal and professional. 100% of hospices involved (n¼21) reported benefits in undertaking the programme, but they also recognised that there were challenges involved (96%). Only one hospice that undertook the
Selected Abstracts
Results: The possibility that the child could die was contemplated by both parents and physicians, but was integrated in either a chaos or a restitution narrative. Most adults found it inappropriate to talk about dying in terms of a quest, a journey of hoping for the best. Children never directly addressed the topic of death. Conclusions: The tension between participation and exclusion in the case of children with progressive cancer has something to do with the larger social discourse on dying as a final life project which seems to constrain the way in which patients and adults can relate to the child’s death.
D03-D Quality of Palliative Care for Children with Cancer
Kimberley Widger1,2, Stefan Friedrichsdorf3, Joanne Wolfe4, Stephen Liben5, Jason D. Pole1,6, Eric Bouffet1,2, Mark Greenberg1,6, Amna Husain1,7, Harold Siden8, James A. Whitlock1,2, Adam Rapoport1,2 1 University of Toronto, Toronto, ON, Canada 2 Hospital for Sick Children, Toronto, ON, Canada 3 Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN, United States 4 Dana-Farber Cancer Institute, Boston, MA, United States 5 The Montreal Children’s Hospital, Montre al, QC, Canada 6 Pediatric Oncology Group of Ontario, Toronto, ON, Canada 7 Mount Sinai Hospital, Toronto, ON, Canada 8 Canuck Place Children’s Hospice, Vancouver, BC, Canada Objectives: Principles of pediatric palliative care (PPC) can and should be incorporated from the time of diagnosis of childhood cancer, concurrent with curative treatments, rather than only being provided as an alternative to those treatments at the end of life. As part of a larger project to enhance PPC provision we assessed the quality of palliative care provided to children with cancer and their families. Methods: Data were collected at 15 of the 16 pediatric oncology programs in Canada from four sources: 1) children age 7 to 19 with active disease or receiving cancer treatments completed the Memorial Symptom Assessment Scale and the Pediatric Quality of Life Inventory; 2) parents of children age 0 to 19 with active disease or receiving cancer treatments completed a survey about symptoms, quality of life, and care quality; 3) review of health records of deceased patients; and 4) surveys with bereaved parents about the quality of their children’s end-of-life care.
Vol. 52 No. 6 December 2016
Results: Adolescents (n¼38) reported more symptoms (8 vs. 5) but similar mean quality of life scores (65/100 vs. 67/100) compared with younger children (n¼ 26). Both groups report being asked frequently about symptoms by health professionals, but 40% reported they are never or almost never asked about quality of life. The lowest quality score from all parent participants (n¼222) was around support of siblings (mean score 2.6/4). Only 43% of bereaved parents were able to look back on their child’s care during the last month of life without regrets. Regrets were mostly around not being able to spend more time at home. Conclusions: There is room for improvement in PPC for children with cancer. Children might benefit from more attention to their quality of life beyond symptom management. Regrets are common among bereaved parents, but may be reduced by finding ways to help families spend more time at home.
D05-A Supportive Cardiology: Early Integration of Palliative Care for Patients with Advanced Heart Failure
Warren Lewin3, Dorothy Sullivan1,2, Nina Horvath1,2, Archna Patel1,2, Shana Haberman1 1 Freeman Centre for the Advancement of Palliative Care, North York General Hospital, Toronto, ON, Canada 2 University of Toronto, Toronto, ON, Canada 3 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, United States Objectives: Congestive Heart Failure (CHF) is a chronic, life-limiting illness that progressively impacts health status and is a leading cause of hospital admissions. We aim to describe the integration of a new model of early palliative care involvement into routine cardiac care for patients with advanced CHF. Specifically, our session will review our team’s journey including concept hypothesis, needs assessment, implementation planning, securing of ‘‘buy-in’’ from hospital leadership and cardiac clinicians, and execution. We will also highlight opportunities for and challenges to future growth. Methods: A referral tool was developed using evidencebased criteria to assist in identifying patients with advanced CHF. A palliative care clinician would provide initial consultation and follow-up care in an outpatient setting. Our team increased awareness of the need for palliative care among the cardiac team through interdisciplinary meetings, in-services, and weekly rounding with the cardiac team. During implementation of the integration 40 patients with advanced CHF were
Vol. 52 No. 6 December 2016
Selected Abstracts
recruited for a quality improvement study, of which 20 had palliative care involvement. Data was collected at initial consultation, and then at 48 hours, 1 month, 3 months and 6 months post-discharge. Results: Observations from the quality improvement study were that with palliative care involvement: Acute care utilization decreased 3-fold once patients received outpatient palliative care Hospital admissions and emergency department visits decreased by 66% Advance Care Planning (ACP) documentation increased from 40% to 100% Conclusions: Early integration of palliative care for patients with advanced CHF demonstrated significant increase in ACP documentation, which was correlated with a dramatic decrease in acute care utilization. The group that had no palliative care involvement had no change in ACP documentation. Although our sample size was small, these findings are likely associated with huge cost-savings representing a high-value based program while simultaneously providing care concordant with patient and family values.
D07-B The Development of the Palliative Care Spiritual Care Competency Scale
Ping-Hwa Chen1, Jeng-Fong Chiou2, Mei Chuan Chu1, Lan-Hsin Fan1, Kuo-Feng Chang1, Ran Zhao3 1 National Taiwan Normal University, Taipei, Taiwan 2 Taipei Medical University Hospital, Taipei, Taiwan 3 National Taiwan University, Taipei, Taiwan This study aims to develop a tool to assess the core competencies of palliative care spiritual care (PCSC) providers in Taiwan. Two studies were conducted to develop the Palliative Care Spiritual Care Competency Scale (PCSCCS). In study 1, 18 PCSC providers with an average of 12.7 years of palliative care experience were recruited. Six focus groups were held to collect data for identifying indicators of core competencies. The content analysis method was applied to analyze the data. Three domains, namely spiritual care knowledge, spiritual care attitude and spiritual care professional skills, and 18 subcategories of core competencies emerged from the analysis. In study 2, 84 preliminary items were generated based on the findings of study 1. Response data to those items were collected from 134 trainees who had attended the PCSC training conducted by Schweitzer Christian and Missionary Alliance (SCMA) in the past two years. After reliability analysis and exploratory factor analysis on those data, 18 items were selected
e33
and constituted the PCSCCS. The result showed that three factors (knowledge and skills of spiritual care, self awareness and attitude of spiritual care, and spiritual care that meets the spiritual needs) corresponded with the finding of study 1. The Cronbach’s was from .80 to .92, providing empirical evidence that the psychometric properties were in an acceptable range. Furthermore, another set of data from 199 participants who received SCMA’s training, was used to conduct confirmatory factor analysis. The result showed that the response data fit reasonably well with the hypothetical structure of PCSCCS, which in turn provides positive evidence for its construct validity. It is proposed that the PCSCCS is an appropriate assessment tool for the competency of PCSC providers in Taiwan. Future studies are needed to assess the suitability of using PCSCCS in other cultures.
D07-C Foundations of Spiritual Care: Evaluation of a New Zealand Hospice Spiritual Care Programme Rod MacLeod1,2, Richard Egan3, Tess Moeke-Maxwell4, Rachael Crombie5 1 University of Sydney, Sydney, Australia 2 HammondCare, Sydney, Australia 3 University of Otago, Dunedin, New Zealand 4 University of Auckland, Auckland, New Zealand 5 Hospice New Zealand, Wellington, New Zealand
Objective: Hospice New Zealand (HNZ) identified a need to increase the capacity for spiritual care within the hospice. An evaluation examined whether subsequent national spiritual care training across all workforce domains (the Foundations of Spiritual Care Programme), had built spiritual health literacy and competency in the hospice workforce. Methods: The evaluation used a mixed methods approach and reflected the bicultural aspect/nature of the programme. It included cross-sectional surveys of programme participants and key informants (facilitators and senior management) within hospices and focus groups of programme participants. It also included information from participants’ post programme reflection forms. Results: The programme provided positive experiences and outcomes for staff and volunteers and organisations as a whole. Participants were positively influenced in two key areas; personal and professional. 100% of hospices involved (n¼21) reported benefits in undertaking the programme, but they also recognised that there were challenges involved (96%). Only one hospice that undertook the