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Implications of Interdisciplinary Palliative Care when Caring for Older Adults with Advanced Cancer
394
Schedule with Abstracts
palliative care in the home setting. Our geriatrics palliative home care program Palliative Access Through Care at Home (PATCH) was developed with an accompanying curriculum for medical students and residents. II. Research Objective. Our objective in this study was to analyze content themes from third year medical students reflections completed after their experience with PATCH. III. Method. As part of a month long rotation in geriatrics palliative home care, third year medical students were asked to complete a piece reflecting on their experience making visits. We reviewed and coded these pieces independently (LV, DCH) using a qualitative analysis of coding methods from Grounded Theory. IV. Results. All third year medical students (n ¼ 83) from academic year 2008e2009, completed the rotation and submitted reflective pieces. The products were 1 song, 4 drawings, 4 collages, 4 letters, 11 poems, and 59 journal entries. The three most common themes reported include appreciating patients’ perspectives, realizing the importance of caregivers, and understanding that patients are much more than a disease process. V. Conclusion. Students use an array of modalities to reflect on and express their strong emotional response to the home palliative care experience. The reflections allowed us to gauge the impact of this curriculum on a subjective, individual level, not permitted by traditional quantitative evaluations, such as pre- and post-knowledge tests. Overall, students wanted more opportunities to conduct geriatric palliative home visits and learn much from this experience that may help them in taking care of patients in other clinical settings such as the ambulatory clinic and hospital. VI. Implications for Research, Policy, or Practice. Refection seems to provide students a way to express the depth of their learning. Domain Structure and Processes of Care
Implications of Interdisciplinary Palliative Care when Caring for Older Adults with Advanced Cancer Tarik Hadid, MD, UTHSCSA, San Antonio, TX. Sandra Sanchez-Reilly, MD, The University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System, San Antonio, TX. (All speakers have disclosed no relevant financial relationships.)
Vol. 39 No. 2 February 2010
Objectives 1. Compare an interdisciplinary approach and standard of care approach when caring for older adults with advanced cancer and learn about effects of either one on patient care. 2. Discuss the importance of providing early palliative care within an interdisciplinary format. 3. Discuss the benefits of an interdisciplinary model when caring for frail elders. I. Background. Advanced Cancer is considered the second most common cause of death among older adults (OA) and accounts for the majority of diagnoses referred to hospice. Traditionally, oncologists have assumed the primary responsibility to care for these patients, and interdisciplinary team care (IDT) and early palliative care (EPC) seldom used. II. Research Objectives. To evaluate the impact of EPC/IDT approach for medical care on the quality of life of OA with advanced cancer as compared to routine oncologic follow-up. III. Methods. Retrospective case-control chart review study, n ¼ 50, matching by age, gender, type of cancer and co-morbidities. The intervention group (IG ¼ 25) received EPC/IDT from oncologists, EPC specialists, onco-psychologist, nurses, dieticians and social workers. The control group (CG ¼ 25) received usual care provided by oncologists. Assessments included functional assessments (ADL/ IADL) and performance (ECOG, Karnofsky), depression (Geriatric Depression Scale) and cognitive evaluations (Mini-mental). We also compared prevalence of advance directives. IV. Results. IG white 28%, Hispanic 60%, CG white 76%, Hispanic 16%. IG had more comorbidities (9.8 vs. 7.9, P ¼.03). IG showed 20% functional improvements (ADL/ IADL) as compared with CG (P ¼.02). Performance, depression, and cognitive evaluations improvements were not significant. 58% IG had advance directives versus 0% CG. V. Conclusion. EPC/IDT in OA with advanced cancer may improve functional status and completion of advance directives in these very frail subjects. VI. Implications for Research, Policy, or Practice. IDT and EPC might improve quality of life among frail elders with cancer. Further studies are needed to support our findings and investigate the cost effectiveness of this approach. Domain Structure and Processes of Care
Schedule with Abstracts
palliative care in the home setting. Our geriatrics palliative home care program Palliative Access Through Care at Home (PATCH) was developed with an accompanying curriculum for medical students and residents. II. Research Objective. Our objective in this study was to analyze content themes from third year medical students reflections completed after their experience with PATCH. III. Method. As part of a month long rotation in geriatrics palliative home care, third year medical students were asked to complete a piece reflecting on their experience making visits. We reviewed and coded these pieces independently (LV, DCH) using a qualitative analysis of coding methods from Grounded Theory. IV. Results. All third year medical students (n ¼ 83) from academic year 2008e2009, completed the rotation and submitted reflective pieces. The products were 1 song, 4 drawings, 4 collages, 4 letters, 11 poems, and 59 journal entries. The three most common themes reported include appreciating patients’ perspectives, realizing the importance of caregivers, and understanding that patients are much more than a disease process. V. Conclusion. Students use an array of modalities to reflect on and express their strong emotional response to the home palliative care experience. The reflections allowed us to gauge the impact of this curriculum on a subjective, individual level, not permitted by traditional quantitative evaluations, such as pre- and post-knowledge tests. Overall, students wanted more opportunities to conduct geriatric palliative home visits and learn much from this experience that may help them in taking care of patients in other clinical settings such as the ambulatory clinic and hospital. VI. Implications for Research, Policy, or Practice. Refection seems to provide students a way to express the depth of their learning. Domain Structure and Processes of Care
Implications of Interdisciplinary Palliative Care when Caring for Older Adults with Advanced Cancer Tarik Hadid, MD, UTHSCSA, San Antonio, TX. Sandra Sanchez-Reilly, MD, The University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System, San Antonio, TX. (All speakers have disclosed no relevant financial relationships.)
Vol. 39 No. 2 February 2010
Objectives 1. Compare an interdisciplinary approach and standard of care approach when caring for older adults with advanced cancer and learn about effects of either one on patient care. 2. Discuss the importance of providing early palliative care within an interdisciplinary format. 3. Discuss the benefits of an interdisciplinary model when caring for frail elders. I. Background. Advanced Cancer is considered the second most common cause of death among older adults (OA) and accounts for the majority of diagnoses referred to hospice. Traditionally, oncologists have assumed the primary responsibility to care for these patients, and interdisciplinary team care (IDT) and early palliative care (EPC) seldom used. II. Research Objectives. To evaluate the impact of EPC/IDT approach for medical care on the quality of life of OA with advanced cancer as compared to routine oncologic follow-up. III. Methods. Retrospective case-control chart review study, n ¼ 50, matching by age, gender, type of cancer and co-morbidities. The intervention group (IG ¼ 25) received EPC/IDT from oncologists, EPC specialists, onco-psychologist, nurses, dieticians and social workers. The control group (CG ¼ 25) received usual care provided by oncologists. Assessments included functional assessments (ADL/ IADL) and performance (ECOG, Karnofsky), depression (Geriatric Depression Scale) and cognitive evaluations (Mini-mental). We also compared prevalence of advance directives. IV. Results. IG white 28%, Hispanic 60%, CG white 76%, Hispanic 16%. IG had more comorbidities (9.8 vs. 7.9, P ¼.03). IG showed 20% functional improvements (ADL/ IADL) as compared with CG (P ¼.02). Performance, depression, and cognitive evaluations improvements were not significant. 58% IG had advance directives versus 0% CG. V. Conclusion. EPC/IDT in OA with advanced cancer may improve functional status and completion of advance directives in these very frail subjects. VI. Implications for Research, Policy, or Practice. IDT and EPC might improve quality of life among frail elders with cancer. Further studies are needed to support our findings and investigate the cost effectiveness of this approach. Domain Structure and Processes of Care