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Evaluation of an Interdisciplinary Faculty Development Program at an Academic Hospice
Vol. 39 No. 2 February 2010
Schedule with Abstracts
IV. Results. The average distress level (0 to 10) reported by patients was M ¼ 5.5 (SD ¼ 3.22). Distress was significantly correlated with DSMIV-TR depression criteria (r ¼ .73, P < .001) and generalized anxiety criteria (r ¼ .64, P < .001). Sixty-one percent of the sample met criteria for depression and 57% of the sample met criteria for generalized anxiety. The most distressing problems included pain, sleep difficulty, fatigue, financial difficulties, muscle tension, and worry. Many patients expressed regret that the supportive care assessment was not completed earlier in their disease trajectory. The majority of patients were willing to have information from the assessment appear in their medical record, with a few exceptions. V. Conclusion. The OSU Center for Palliative Care Supportive Care Assessment is a comprehensive, feasible, valid assessment tool to identify the level and nature of patient distress and triage to appropriate team members and/or resources. VI. Implications for Research, Policy, or Practice. This presentation will inform clinicians and researchers about a measure for use in their practice to elicit the multidimensional nature of distress. Domain Structure and Processes of Care
Evaluation of an Interdisciplinary Faculty Development Program at an Academic Hospice Annette Vollrath, MD, The Institute for Palliative Medicine at San Diego Hospice, San Diego, CA. JJ Nadicksbernd, MSW, The Institute for Palliative Medicine at San Diego Hospice, San Diego, CA. Matthew Soskins, PhD Esq, The Institute for Palliative Medicine at San Diego Hospice, San Diego, CA. Charles von Gunten, and MD PhD, The Institute for Palliative Medicine at San Diego Hospice, San Diego, CA. (All speakers have disclosed no relevant financial relationships.) Objectives 1. Describe the Interdisciplinary Faculty Development Program (IFDP) as one example of a mentorship-model driven program to develop clinician-educators from all disciplines involved in the delivery of palliative care. 2. Discuss pre-, post-, and long-term outcome data of this program addressing its effects
383
on the participants’ academic activity, competency, and job satisfaction. 3. Discuss the role of mentorship in the academic palliative care setting. I. Background. Palliative care as a rapidly growing field in the world carries a significant educational mission. The Institute for Palliative Medicine (IPM) contributes to this mission with training programs for multiple disciplines. Hospice staff serves as faculty. Traditionally, faculty development for clinician-teachers focuses on physicians and nurses. Thus IPM created a new interdisciplinary faculty development program (IFDP) to develop clinician-educators from all disciplines involved in the delivery of care. II. Research Objectives 1. Create a mentorship-model program to develop clinician-educators from all disciplines involved in the delivery of palliative care. 2. Evaluate the program’s effects on participants’ academic activity, competency, and job satisfaction with pre-, post-, and long-term data. III. Methods. Following an application and selection process, 6e10 participants per year from multiple disciplines participated in a 9-month program. Each participant was paired with a mentor, completed an educational project, and participated in three peer mentorship sessions, monthly seminars and a 2-day retreat focusing on key topics in education. Participants presented their projects at the completion of the program, and completed self-evaluation inventories before, immediately after and one year after completion of the program. Mentors completed one questionnaire. IV. Results. Participation in IFDP increases the participants’ feelings of academic competence, actual involvement in educational activities and overall job satisfaction. This remains true one year after completion of the program. V. Conclusion. IFDP is one example of a program that addresses the need to develop clinicianteachers from all disciplines involved in the delivery of palliative care. Its most effective components are believed to be the participant selection process, the project focus, as well as the two mentorship components. VI. Implications for Research, Policy, or Practice. IFDP is effective, low cost, and easy to duplicate. We encourage other academic palliative care providers to explore and expand on IFDP in their pursuit to grow interdisciplinary palliative care faculty.
384
Schedule with Abstracts
Domain Structure and Processes of Care
Paper Session (413) Spiritual Care Needs and Expectations in Outpatient Palliative Care Elizabeth Kvale, MD, University of Alabama Birmingham, Birmingham, AL. (Kvale has disclosed no relevant financial relationships.) Objectives 1. Recognize the spiritual needs of palliative care outpatients. 2. Identify the expectation for spiritual care among palliative care outpatients. I. Background. Spiritual and existential concerns may have a significant impact on quality of life among community-dwelling persons living with advanced illness. The spiritual care needs of palliative care outpatients are not well-characterized in the literature, yet are widely recognized as important components in developing a patient centered palliative care plan. To better guide the development of services needed to provide spiritual care to palliative care outpatients we undertook a qualitative study of the spiritual needs and expectations of a representative population. II. Research Objectives. We sought to understand the spiritual care needs and preferences among palliative care outpatients in the Southeastern United States. III. Methods. All study activities received IRB approval through UAB. Twenty individuals were recruited from among palliative care outpatients seen at the UAB Supportive and Palliative Care Outpatient Clinic. Semi-structured telephone interviews were conducted with volunteers by research personnel who were not involved in the clinical care of patients. Descriptive analyses were undertaken to describe the population, and frequencies, proportions, and means were generated for responses. Qualitative responses are reported verbatim. IV. Results. Seventeen participants (85%) identified themselves with an organized religion or spiritual organization, 2 participants (10%) did not. The majority (16, 80%) of participants felt that their physician should be aware of their spiritual beliefs and needs, but 3 individuals (15%) did not. Similarly, 16 participants (80%) felt the physician should take their spiritual beliefs into account in the development of a care plan, and 3 participants (15%) did not. Ten participants
Vol. 39 No. 2 February 2010
(50%) indicated that they felt it would be helpful for their palliative care provider to pray for them. All respondents (n ¼ 19, 95%, 1 missing) indicated that their spiritual beliefs helped them cope with their illness. V. Conclusion. The majority of participants in this assessment both affiliated themselves with an organized religion, and felt that it was important that their palliative care provider be aware of their spiritual beliefs and incorporate them in the development of a care plan. A minority of participants did not have an interest in formal spiritual care through palliative care. VI. Implications for Research, Policy, or Practice. Routine screening for spiritual needs is indicated in palliative care, and measures for the incorporation of the patients’ spiritual beliefs in a palliative care plan should be developed. Domains Structure and Processes of Care; and Spiritual, Religious, and Existential Aspects of Care
Losing Hope: The Relationship between Hope and Pain, Depression, and Spiritual Well-Being among Ambulatory Cancer Patients Michael Rabow, MD, University of California San Francisco, San Francisco, CA. Blake Rawdin, MD MPH, University of California San Francisco, San Francisco, CA. (All speakers have disclosed no relevant financial relationships.) Objectives 1. Review the literature on the associations between hope, depression, and quality of life. 2. Identify the level of hope among ambulatory patients with cancer at an urban comprehensive cancer center. 3. Describe the relationships between hope and cancer-associated pain, as well as other clinical outcomes, including cancer stage, mood, and spiritual well-being. I. Background. Although hope has been associated with depression and quality of life, there is little research about hope and other important clinical outcomes. Limited research has suggested that hope is inversely correlated with pain, but the relationship between hope and pain among cancer patients in the United States has not been studied. II. Research Objectives. (i) Assess the levels of hope among outpatients with cancer receiving concurrent oncologic and palliative care; and (ii)
Schedule with Abstracts
IV. Results. The average distress level (0 to 10) reported by patients was M ¼ 5.5 (SD ¼ 3.22). Distress was significantly correlated with DSMIV-TR depression criteria (r ¼ .73, P < .001) and generalized anxiety criteria (r ¼ .64, P < .001). Sixty-one percent of the sample met criteria for depression and 57% of the sample met criteria for generalized anxiety. The most distressing problems included pain, sleep difficulty, fatigue, financial difficulties, muscle tension, and worry. Many patients expressed regret that the supportive care assessment was not completed earlier in their disease trajectory. The majority of patients were willing to have information from the assessment appear in their medical record, with a few exceptions. V. Conclusion. The OSU Center for Palliative Care Supportive Care Assessment is a comprehensive, feasible, valid assessment tool to identify the level and nature of patient distress and triage to appropriate team members and/or resources. VI. Implications for Research, Policy, or Practice. This presentation will inform clinicians and researchers about a measure for use in their practice to elicit the multidimensional nature of distress. Domain Structure and Processes of Care
Evaluation of an Interdisciplinary Faculty Development Program at an Academic Hospice Annette Vollrath, MD, The Institute for Palliative Medicine at San Diego Hospice, San Diego, CA. JJ Nadicksbernd, MSW, The Institute for Palliative Medicine at San Diego Hospice, San Diego, CA. Matthew Soskins, PhD Esq, The Institute for Palliative Medicine at San Diego Hospice, San Diego, CA. Charles von Gunten, and MD PhD, The Institute for Palliative Medicine at San Diego Hospice, San Diego, CA. (All speakers have disclosed no relevant financial relationships.) Objectives 1. Describe the Interdisciplinary Faculty Development Program (IFDP) as one example of a mentorship-model driven program to develop clinician-educators from all disciplines involved in the delivery of palliative care. 2. Discuss pre-, post-, and long-term outcome data of this program addressing its effects
383
on the participants’ academic activity, competency, and job satisfaction. 3. Discuss the role of mentorship in the academic palliative care setting. I. Background. Palliative care as a rapidly growing field in the world carries a significant educational mission. The Institute for Palliative Medicine (IPM) contributes to this mission with training programs for multiple disciplines. Hospice staff serves as faculty. Traditionally, faculty development for clinician-teachers focuses on physicians and nurses. Thus IPM created a new interdisciplinary faculty development program (IFDP) to develop clinician-educators from all disciplines involved in the delivery of care. II. Research Objectives 1. Create a mentorship-model program to develop clinician-educators from all disciplines involved in the delivery of palliative care. 2. Evaluate the program’s effects on participants’ academic activity, competency, and job satisfaction with pre-, post-, and long-term data. III. Methods. Following an application and selection process, 6e10 participants per year from multiple disciplines participated in a 9-month program. Each participant was paired with a mentor, completed an educational project, and participated in three peer mentorship sessions, monthly seminars and a 2-day retreat focusing on key topics in education. Participants presented their projects at the completion of the program, and completed self-evaluation inventories before, immediately after and one year after completion of the program. Mentors completed one questionnaire. IV. Results. Participation in IFDP increases the participants’ feelings of academic competence, actual involvement in educational activities and overall job satisfaction. This remains true one year after completion of the program. V. Conclusion. IFDP is one example of a program that addresses the need to develop clinicianteachers from all disciplines involved in the delivery of palliative care. Its most effective components are believed to be the participant selection process, the project focus, as well as the two mentorship components. VI. Implications for Research, Policy, or Practice. IFDP is effective, low cost, and easy to duplicate. We encourage other academic palliative care providers to explore and expand on IFDP in their pursuit to grow interdisciplinary palliative care faculty.
384
Schedule with Abstracts
Domain Structure and Processes of Care
Paper Session (413) Spiritual Care Needs and Expectations in Outpatient Palliative Care Elizabeth Kvale, MD, University of Alabama Birmingham, Birmingham, AL. (Kvale has disclosed no relevant financial relationships.) Objectives 1. Recognize the spiritual needs of palliative care outpatients. 2. Identify the expectation for spiritual care among palliative care outpatients. I. Background. Spiritual and existential concerns may have a significant impact on quality of life among community-dwelling persons living with advanced illness. The spiritual care needs of palliative care outpatients are not well-characterized in the literature, yet are widely recognized as important components in developing a patient centered palliative care plan. To better guide the development of services needed to provide spiritual care to palliative care outpatients we undertook a qualitative study of the spiritual needs and expectations of a representative population. II. Research Objectives. We sought to understand the spiritual care needs and preferences among palliative care outpatients in the Southeastern United States. III. Methods. All study activities received IRB approval through UAB. Twenty individuals were recruited from among palliative care outpatients seen at the UAB Supportive and Palliative Care Outpatient Clinic. Semi-structured telephone interviews were conducted with volunteers by research personnel who were not involved in the clinical care of patients. Descriptive analyses were undertaken to describe the population, and frequencies, proportions, and means were generated for responses. Qualitative responses are reported verbatim. IV. Results. Seventeen participants (85%) identified themselves with an organized religion or spiritual organization, 2 participants (10%) did not. The majority (16, 80%) of participants felt that their physician should be aware of their spiritual beliefs and needs, but 3 individuals (15%) did not. Similarly, 16 participants (80%) felt the physician should take their spiritual beliefs into account in the development of a care plan, and 3 participants (15%) did not. Ten participants
Vol. 39 No. 2 February 2010
(50%) indicated that they felt it would be helpful for their palliative care provider to pray for them. All respondents (n ¼ 19, 95%, 1 missing) indicated that their spiritual beliefs helped them cope with their illness. V. Conclusion. The majority of participants in this assessment both affiliated themselves with an organized religion, and felt that it was important that their palliative care provider be aware of their spiritual beliefs and incorporate them in the development of a care plan. A minority of participants did not have an interest in formal spiritual care through palliative care. VI. Implications for Research, Policy, or Practice. Routine screening for spiritual needs is indicated in palliative care, and measures for the incorporation of the patients’ spiritual beliefs in a palliative care plan should be developed. Domains Structure and Processes of Care; and Spiritual, Religious, and Existential Aspects of Care
Losing Hope: The Relationship between Hope and Pain, Depression, and Spiritual Well-Being among Ambulatory Cancer Patients Michael Rabow, MD, University of California San Francisco, San Francisco, CA. Blake Rawdin, MD MPH, University of California San Francisco, San Francisco, CA. (All speakers have disclosed no relevant financial relationships.) Objectives 1. Review the literature on the associations between hope, depression, and quality of life. 2. Identify the level of hope among ambulatory patients with cancer at an urban comprehensive cancer center. 3. Describe the relationships between hope and cancer-associated pain, as well as other clinical outcomes, including cancer stage, mood, and spiritual well-being. I. Background. Although hope has been associated with depression and quality of life, there is little research about hope and other important clinical outcomes. Limited research has suggested that hope is inversely correlated with pain, but the relationship between hope and pain among cancer patients in the United States has not been studied. II. Research Objectives. (i) Assess the levels of hope among outpatients with cancer receiving concurrent oncologic and palliative care; and (ii)