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Even Children Can Be Victims of Abuse and Neglect (TH330)
Vol. 47 No. 2 February 2014
Schedule With Abstracts
Palliative care leaders must be fluent in the current healthcare reform discussion to have a seat at the table. This session will provide a framework for sound palliative care innovation in health systems.
Principles of Writing a Watertight Manuscript for Publication (TH329) David Casarett, MD MA, University of Pennsylvania, Philadelphia, PA. Charles Von Gunten, MD PhD, Ohio Health Home Reach Hospice, Columbus, OH. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Craft a manuscript that piques the interest of editors and reviewers. 2. Revise manuscripts effectively to meet reviewers’ critiques. 3. Prepare manuscripts that have the best possible chance of publication in peer-reviewed journals. Publication in the medical literature is essential to the growth of palliative care as a field of research and clinical practice, and offers a valuable way to share research results, clinical insights, and innovations in education and healthcare delivery. Furthermore, publications are essential for all facultydclinicians, clinician educators, and researchersdworking in an academic setting. However, most clinicians, clinician educators, and even researchers do not receive formal training that will help them to prepare a manuscript that will have the best possible chance of acceptance. Submissions to journals are often rejected or delayed substantially because of problems with clarity and argument, because they miss their target audience, or because of other common errors and omissions. Many of these barriers to acceptance are easily overcome by careful consideration early in the writing process. This sessions’ presenters have prominent roles in the two main palliative care journals in the United States. Dr. Charles von Gunten is the editor-in-chief of the Journal of Palliative Medicine and Dr. David Casarett is the senior associate editor of the Journal of Pain and Symptom Management. Together, Drs. von Gunten and Casarett will bring that experience to this session, beginning with a brief didactic presentation that will recommend strategies for
405
writing a clear and compelling manuscript. Next, the presenters will use a case-based format to discuss how editors and reviewers consider manuscripts, with an emphasis on identifying features that significantly increase or decrease a manuscript’s chance of acceptance. These cases will illustrate key principles of effective writing, including effective communication tips, and advice about how to choose a journal, how to write for your audience and how to anticipate and defuse concerns and critiques.
Even Children Can Be Victims of Abuse and Neglect (TH330) David Korones, MD, University of Rochester, Rochester, NY. Philene Cromwell, MS RN PNP, Compassion Net/Lifetime Care, Rochester, NY. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Define the challenges in communication between palliative care teams and child protective services. 2. Explore the stresses experienced by families, palliative care teams, and child protective teams when assessing for abuse and neglect of a dying child. 3. Explore barriers of medical teams, palliative care teams, and child protective services to advocating for the potentially abused/neglected child. Healthcare practitioners are mandated reporters when there is suspicion of child abuse or neglect. However, following through on the obligation to report can be a daunting challenge when it occurs in the care a dying child. We report three cases of dying children whose families or pediatric palliative care team felt compelled to report for child abuse/neglect. One child had pneumonia and a neurodegenerative disorder and his parents would not allow nurses in the home to assess for comfort. A second child was dying of leukemia; his father called the police to the home because he felt the mother was intoxicated while administering opioids. The father of a third child dying of neuroblastoma was intoxicated and reportedly abused the child’s brother. In each instance, Child Protective Services (CPS) seemed uncomfortable with the tragic circumstances of the referral. The need for referral was seen very differently by CPS versus the palliative care
406
Schedule With Abstracts
team. The children were not removed from the home and no changes were mandated by CPS. The subsequent care of these children was likely compromised in all three cases. There are significant barriers to reporting the abuse or neglect of dying children. It is difficult for a palliative care team (who may be emotionally attached to a child and family) to assess objectively whether their suspicion of abuse/ neglect is warranted. It is just as difficult for CPS, which may have little experience investigating abuse or neglect of a terminally ill child. The challenge for both teams is to sort out when the line between overwhelming stress and actual neglect/abuse is crossed. As difficult as referral to CPS may be when a child is dying, these children need a voice, and the palliative care team can be that voice.
Teaching on the Run: How to Engage Learners from Different Disciplines and Levels of Training on a Busy Palliative Care Service (TH331) Maie El-Sourady, MD MS, Vanderbilt University Medical Center, Nashville, TN. Don Moore, PhD, Vanderbilt University School of Medicine, Nashville, TN. Jill Nelson, MSN ANP-BC ACHPN, Vanderbilt University Medical Center, Nashville, TN. Sumathi Misra, MD, Vanderbilt University Medical Center, Nashville, TN. Mohana Karlekar, MD, Vanderbilt University, Nashville, TN. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Describe an organizational approach to simultaneously educating multiple learners of different disciplines and levels of training on a busy palliative care service. 2. Describe an educational infrastructure that is reproducible and adaptable to multiple learners and levels of training. 3. Review measurement and feedback tools created for learners under the new infrastructure and curriculum. The need for palliative care (PC) will continue to grow as the population ages, technology and therapies evolve, and patients and providers continue to appreciate the contribution of PC. It is unlikely and unrealistic that there will be adequate PC providers to meet this demand. PC providers have the privilege and responsibility of educating future healthcare providers. We
Vol. 47 No. 2 February 2014
describe an approach that can support both provider and learner while providing patient care. Our consult service sees more than 1,600 new consultations per year from most specialties, including general surgery, trauma, neurosurgery, neurology, oncology, and medicine. The PC unit serves approximately 120 patients per month. Our providers include full- and parttime physicians and nurse practitioners, who have multiple clinical and administrative responsibilities throughout the week. We describe an approach to organizing a curriculum that aims to educate multiple learners at different levels of training within different disciplines on both the PC consult service and unit. Learners include palliative care, geriatric, and pain fellows, medical residents, medical students, nurse practitioner students, and first-year health professional students. We describe an organizational approach for preceptors and learners to provide a consistent yet flexible learning experience. Interventions include weekly emails to preceptors and learners that outline lesson plans and assignments and an online library with published articles, lectures, and Web-based resources. In addition, learners receive personalized goals and objectives based on their level of training, rotation duration, and career interests, and meet weekly with an assigned preceptor in order to reflect on cases and receive feedback. All learners take a pre-test and a post-test to gauge the learner’s experience and provide feedback for the rotation. We also describe educational interventions for PC preceptors to improve teaching techniques, including lectures, resources, and feedback from learners.
Regulatory Issues for Hospice Staff (TH332) Judi Lund Person, MPH, National Hospice and Palliative Care Organization, Alexandria, VA. Jennifer Kennedy National Hospice and Palliative Care Organization, Alexandria, VA. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. List at least three regulatory changes that will impact how hospice care is delivered in the future. 2. Identify the focus for hospice compliance issues for 2014 and beyond. 3. Describe the options for hospice payment reform and current activities and timeframes.
Schedule With Abstracts
Palliative care leaders must be fluent in the current healthcare reform discussion to have a seat at the table. This session will provide a framework for sound palliative care innovation in health systems.
Principles of Writing a Watertight Manuscript for Publication (TH329) David Casarett, MD MA, University of Pennsylvania, Philadelphia, PA. Charles Von Gunten, MD PhD, Ohio Health Home Reach Hospice, Columbus, OH. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Craft a manuscript that piques the interest of editors and reviewers. 2. Revise manuscripts effectively to meet reviewers’ critiques. 3. Prepare manuscripts that have the best possible chance of publication in peer-reviewed journals. Publication in the medical literature is essential to the growth of palliative care as a field of research and clinical practice, and offers a valuable way to share research results, clinical insights, and innovations in education and healthcare delivery. Furthermore, publications are essential for all facultydclinicians, clinician educators, and researchersdworking in an academic setting. However, most clinicians, clinician educators, and even researchers do not receive formal training that will help them to prepare a manuscript that will have the best possible chance of acceptance. Submissions to journals are often rejected or delayed substantially because of problems with clarity and argument, because they miss their target audience, or because of other common errors and omissions. Many of these barriers to acceptance are easily overcome by careful consideration early in the writing process. This sessions’ presenters have prominent roles in the two main palliative care journals in the United States. Dr. Charles von Gunten is the editor-in-chief of the Journal of Palliative Medicine and Dr. David Casarett is the senior associate editor of the Journal of Pain and Symptom Management. Together, Drs. von Gunten and Casarett will bring that experience to this session, beginning with a brief didactic presentation that will recommend strategies for
405
writing a clear and compelling manuscript. Next, the presenters will use a case-based format to discuss how editors and reviewers consider manuscripts, with an emphasis on identifying features that significantly increase or decrease a manuscript’s chance of acceptance. These cases will illustrate key principles of effective writing, including effective communication tips, and advice about how to choose a journal, how to write for your audience and how to anticipate and defuse concerns and critiques.
Even Children Can Be Victims of Abuse and Neglect (TH330) David Korones, MD, University of Rochester, Rochester, NY. Philene Cromwell, MS RN PNP, Compassion Net/Lifetime Care, Rochester, NY. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Define the challenges in communication between palliative care teams and child protective services. 2. Explore the stresses experienced by families, palliative care teams, and child protective teams when assessing for abuse and neglect of a dying child. 3. Explore barriers of medical teams, palliative care teams, and child protective services to advocating for the potentially abused/neglected child. Healthcare practitioners are mandated reporters when there is suspicion of child abuse or neglect. However, following through on the obligation to report can be a daunting challenge when it occurs in the care a dying child. We report three cases of dying children whose families or pediatric palliative care team felt compelled to report for child abuse/neglect. One child had pneumonia and a neurodegenerative disorder and his parents would not allow nurses in the home to assess for comfort. A second child was dying of leukemia; his father called the police to the home because he felt the mother was intoxicated while administering opioids. The father of a third child dying of neuroblastoma was intoxicated and reportedly abused the child’s brother. In each instance, Child Protective Services (CPS) seemed uncomfortable with the tragic circumstances of the referral. The need for referral was seen very differently by CPS versus the palliative care
406
Schedule With Abstracts
team. The children were not removed from the home and no changes were mandated by CPS. The subsequent care of these children was likely compromised in all three cases. There are significant barriers to reporting the abuse or neglect of dying children. It is difficult for a palliative care team (who may be emotionally attached to a child and family) to assess objectively whether their suspicion of abuse/ neglect is warranted. It is just as difficult for CPS, which may have little experience investigating abuse or neglect of a terminally ill child. The challenge for both teams is to sort out when the line between overwhelming stress and actual neglect/abuse is crossed. As difficult as referral to CPS may be when a child is dying, these children need a voice, and the palliative care team can be that voice.
Teaching on the Run: How to Engage Learners from Different Disciplines and Levels of Training on a Busy Palliative Care Service (TH331) Maie El-Sourady, MD MS, Vanderbilt University Medical Center, Nashville, TN. Don Moore, PhD, Vanderbilt University School of Medicine, Nashville, TN. Jill Nelson, MSN ANP-BC ACHPN, Vanderbilt University Medical Center, Nashville, TN. Sumathi Misra, MD, Vanderbilt University Medical Center, Nashville, TN. Mohana Karlekar, MD, Vanderbilt University, Nashville, TN. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Describe an organizational approach to simultaneously educating multiple learners of different disciplines and levels of training on a busy palliative care service. 2. Describe an educational infrastructure that is reproducible and adaptable to multiple learners and levels of training. 3. Review measurement and feedback tools created for learners under the new infrastructure and curriculum. The need for palliative care (PC) will continue to grow as the population ages, technology and therapies evolve, and patients and providers continue to appreciate the contribution of PC. It is unlikely and unrealistic that there will be adequate PC providers to meet this demand. PC providers have the privilege and responsibility of educating future healthcare providers. We
Vol. 47 No. 2 February 2014
describe an approach that can support both provider and learner while providing patient care. Our consult service sees more than 1,600 new consultations per year from most specialties, including general surgery, trauma, neurosurgery, neurology, oncology, and medicine. The PC unit serves approximately 120 patients per month. Our providers include full- and parttime physicians and nurse practitioners, who have multiple clinical and administrative responsibilities throughout the week. We describe an approach to organizing a curriculum that aims to educate multiple learners at different levels of training within different disciplines on both the PC consult service and unit. Learners include palliative care, geriatric, and pain fellows, medical residents, medical students, nurse practitioner students, and first-year health professional students. We describe an organizational approach for preceptors and learners to provide a consistent yet flexible learning experience. Interventions include weekly emails to preceptors and learners that outline lesson plans and assignments and an online library with published articles, lectures, and Web-based resources. In addition, learners receive personalized goals and objectives based on their level of training, rotation duration, and career interests, and meet weekly with an assigned preceptor in order to reflect on cases and receive feedback. All learners take a pre-test and a post-test to gauge the learner’s experience and provide feedback for the rotation. We also describe educational interventions for PC preceptors to improve teaching techniques, including lectures, resources, and feedback from learners.
Regulatory Issues for Hospice Staff (TH332) Judi Lund Person, MPH, National Hospice and Palliative Care Organization, Alexandria, VA. Jennifer Kennedy National Hospice and Palliative Care Organization, Alexandria, VA. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. List at least three regulatory changes that will impact how hospice care is delivered in the future. 2. Identify the focus for hospice compliance issues for 2014 and beyond. 3. Describe the options for hospice payment reform and current activities and timeframes.