- Email: [email protected]
“It's About the Conversation”: A Multidisciplinary Intervention to Support Advance Care Planning (S808)
464
Poster Abstracts
Multivariate logistic and linear regression models were used to determine the impact of targeted therapy on the following endpoints in the last 3 months: emergency department (ED) visits, hospitalizations, and hospice utilization. Analyses were adjusted for differences in patient age, gender, race, comorbidity, socioeconomic status, and geography. Results. Among the whole study cohort 83% of patients received chemotherapy alone, 12% received chemotherapy with targeted therapy, and 5% received targeted therapy alone. The delivery of any targeted therapy in the last 3 months increased across the study period, from 1.5% in 2000 to 28% in 2009. Compared to patients treated with chemotherapy alone, those treated with targeted therapy alone had lower rates of ED visits (adjusted odds ratio [aOR]¼0.81, p¼0.01), lower rates of hospitalization (adjusted odds ratio [aOR]¼0.69, p<0.0001), no difference in overall hospice utilization rates, though had longer stays on hospice (5.1 days longer, p<0.0001). Compared to patients treated with chemotherapy alone, those treated with both chemotherapy and targeted therapy had no difference in ED visits or hospitalizations, though had decreased rates of hospice utilization (aOR ¼ 0.79, p<0.0001), and shorter stays on hospice (2.7 days shorter, p<0.0001). Conclusions. This study found that targeted therapy was associated with varying patterns of healthcare utilization at the end-of-life. Implications for Research, Policy, or Practice. Future research is needed to define the impact of targeted therapy on quality of life at the end-of-life.
‘‘It’s About the Conversation’’: A Multidisciplinary Intervention to Support Advance Care Planning (S808) Finly Zachariah, MD, Duarte, CA. Linda Klein, JD, Duarte, CA. Nancy Clifton-Hawkins, MPH MCHES, Duarte, CA. Maria (Becky) Andrews, AACOMM, Covina, CA. Dawn Gross, MD PhD, San Francisco, CA. Objectives Understand how the ‘‘Go Wish’’ card game is played. Describe how various forms of media can be used to advertise and effectively engage patients, caregivers, and staff. Original Research Background. A recent California Healthcare Foundation study found 60% of Californians highly valued ‘‘making sure their families are not burdened by tough decisions about their care.’’ However, less than 50% have communicated end-oflife (EOL) wishes to their surrogate decision maker. 82% say it is important to have EOL wishes in writing, but only 23% say they have done so. At City of Hope (COH), the advance directive (AD) completion rate is less than 15%.
Vol. 49 No. 2 February 2015
Research Objectives. The event should engage patients and staff in advance care planning (ACP) conversations and increase AD completion. Methods. A multi-disciplinary team designed a social media advertised 4-hour interactive event. Over 40 staff and volunteers facilitated individualized ACP conversations, private consultations with social workers, showed novel COH ACP videos, provided multilingual ACP literature and AD documents available for completion with complimentary notary support on-site. Results. Over 300 people attended. 47 ADs were completed (24 by patient/caregivers, 23 by COH staff). 29 Go Wish games were facilitated (2 in Spanish). Of 52 attendees who completed exit evaluations, 44% were patients, 31% staff, and 11% were caregivers. Respondents reported the event increased their comfort and likelihood of having ACP conversations with others. Importantly, 38 of the 52 surveyed did not have an AD prior to attending the event. Of those 38 attendees, 18 of them completed an AD at the event (or 47%). Conclusions. ACP is an all too often avoided conversation that results in increased distress of patients, families, and providers. By proactively designing opportunities for facilitated conversations in dynamic and public arenas, fear and stigmas are diffused and the true focus and intent of discovering what people wish so the medical team, surrogates, and family can ensure their values are honored and met. Implications for Research, Policy, or Practice. Further research is needed to effectively engage patients, caregivers, and staff in ACP.
Is There a Demand for Mobile Application Development in Palliative Care? The Palliative Care Fast Facts for iOS story (S809) Haipeng Zhang, DO, Harvard Palliative Care Fellowship, Boston, MA. Objectives Provide a broad overview of the development process of the fast facts mobile application. Create an example of a palliative care focused application that can inspire the creation of future applications by others. Original Research Background. In 2013, an ePocrates Mobile Trend Report predicted that in the coming year, nine out of ten healthcare providers will use smartphones. Of these, 88% will use their smartphones for search or reference in relation to their jobs. To date, a lack of native palliative care mobile applications can be seen on the most popular smartphone application stores. This lack of quality palliative care applications conflicts with the rising utilization of mobile devices in the clinical setting. We attempted to address
Poster Abstracts
Multivariate logistic and linear regression models were used to determine the impact of targeted therapy on the following endpoints in the last 3 months: emergency department (ED) visits, hospitalizations, and hospice utilization. Analyses were adjusted for differences in patient age, gender, race, comorbidity, socioeconomic status, and geography. Results. Among the whole study cohort 83% of patients received chemotherapy alone, 12% received chemotherapy with targeted therapy, and 5% received targeted therapy alone. The delivery of any targeted therapy in the last 3 months increased across the study period, from 1.5% in 2000 to 28% in 2009. Compared to patients treated with chemotherapy alone, those treated with targeted therapy alone had lower rates of ED visits (adjusted odds ratio [aOR]¼0.81, p¼0.01), lower rates of hospitalization (adjusted odds ratio [aOR]¼0.69, p<0.0001), no difference in overall hospice utilization rates, though had longer stays on hospice (5.1 days longer, p<0.0001). Compared to patients treated with chemotherapy alone, those treated with both chemotherapy and targeted therapy had no difference in ED visits or hospitalizations, though had decreased rates of hospice utilization (aOR ¼ 0.79, p<0.0001), and shorter stays on hospice (2.7 days shorter, p<0.0001). Conclusions. This study found that targeted therapy was associated with varying patterns of healthcare utilization at the end-of-life. Implications for Research, Policy, or Practice. Future research is needed to define the impact of targeted therapy on quality of life at the end-of-life.
‘‘It’s About the Conversation’’: A Multidisciplinary Intervention to Support Advance Care Planning (S808) Finly Zachariah, MD, Duarte, CA. Linda Klein, JD, Duarte, CA. Nancy Clifton-Hawkins, MPH MCHES, Duarte, CA. Maria (Becky) Andrews, AACOMM, Covina, CA. Dawn Gross, MD PhD, San Francisco, CA. Objectives Understand how the ‘‘Go Wish’’ card game is played. Describe how various forms of media can be used to advertise and effectively engage patients, caregivers, and staff. Original Research Background. A recent California Healthcare Foundation study found 60% of Californians highly valued ‘‘making sure their families are not burdened by tough decisions about their care.’’ However, less than 50% have communicated end-oflife (EOL) wishes to their surrogate decision maker. 82% say it is important to have EOL wishes in writing, but only 23% say they have done so. At City of Hope (COH), the advance directive (AD) completion rate is less than 15%.
Vol. 49 No. 2 February 2015
Research Objectives. The event should engage patients and staff in advance care planning (ACP) conversations and increase AD completion. Methods. A multi-disciplinary team designed a social media advertised 4-hour interactive event. Over 40 staff and volunteers facilitated individualized ACP conversations, private consultations with social workers, showed novel COH ACP videos, provided multilingual ACP literature and AD documents available for completion with complimentary notary support on-site. Results. Over 300 people attended. 47 ADs were completed (24 by patient/caregivers, 23 by COH staff). 29 Go Wish games were facilitated (2 in Spanish). Of 52 attendees who completed exit evaluations, 44% were patients, 31% staff, and 11% were caregivers. Respondents reported the event increased their comfort and likelihood of having ACP conversations with others. Importantly, 38 of the 52 surveyed did not have an AD prior to attending the event. Of those 38 attendees, 18 of them completed an AD at the event (or 47%). Conclusions. ACP is an all too often avoided conversation that results in increased distress of patients, families, and providers. By proactively designing opportunities for facilitated conversations in dynamic and public arenas, fear and stigmas are diffused and the true focus and intent of discovering what people wish so the medical team, surrogates, and family can ensure their values are honored and met. Implications for Research, Policy, or Practice. Further research is needed to effectively engage patients, caregivers, and staff in ACP.
Is There a Demand for Mobile Application Development in Palliative Care? The Palliative Care Fast Facts for iOS story (S809) Haipeng Zhang, DO, Harvard Palliative Care Fellowship, Boston, MA. Objectives Provide a broad overview of the development process of the fast facts mobile application. Create an example of a palliative care focused application that can inspire the creation of future applications by others. Original Research Background. In 2013, an ePocrates Mobile Trend Report predicted that in the coming year, nine out of ten healthcare providers will use smartphones. Of these, 88% will use their smartphones for search or reference in relation to their jobs. To date, a lack of native palliative care mobile applications can be seen on the most popular smartphone application stores. This lack of quality palliative care applications conflicts with the rising utilization of mobile devices in the clinical setting. We attempted to address