- Email: [email protected]
Oncology (P16)
310
Schedule With Abstracts
individual, team, and institutional efforts that promote resilience. No prior experience is necessary.
Now in 3D: Managing Geriatric Delirium, Dementia, and Dementia Related Behavioral Disturbances (P13) AAHPM Leadership Forum: IgnitedUtilizing DISC Behavioral Styles to Increase Leadership and Team Effectiveness in Palliative Care and Hospice Settings (P14) Lisa A. Bouchard, CPBA CPMA, Data Dome, Inc., Atlanta, GA. Objectives Understanding the DISC MethodologydRecognizing your strengths and limitations as a leader Understanding Your TeamdHow to best manage, motivate, and communicate with them Understanding Your Patients (and Family)dRaising awareness of their needs, concerns, and how to make better decisions together Palliative care and hospice settings can be filled with stress, change, and tension. What separates the best organizations from the struggling are strong leaders that focus on building highly productive teams. This halfday session will focus on utilizing the DISC Behavioral Styles methodology to take your leadership skills and team to the next level. Awareness of behavioral styles directly impacts trust, collaboration, and engagement. Participants will complete a personalized DISC profile which will help to determine how to best leverage their style to build the most effective team. They will also learn how to adapt their communication to the specific style needs of both team members and patients, leading to stronger relationships, better decisions, and unprecedented results.
1:15e5 pm How to Create Actor-Based Simulations that Provide Deliberate Practice with Feedback (P15) William Bond, MD MS, OSF Healthcare, Peoria, IL. Robert Sawicki, MD HMDC FAAFP FAAHPM, OSF Health Care, Peoria, IL. Linda Fehr, BSN RN CPHQ, OSF Healthcare System, Peoria, IL. Amy Funk, PhD, Illinois Wesleyan University, Bloomington, IL. Lynne Madori OSF Healthcare System, Peoria, IL. Objectives Learn how to build actor-based simulation scenarios, including actor scripting. Write and use debriefing questions that emphasize appreciative inquiry methods.
Vol. 53 No. 2 February 2017
Learn to maximize the use of resources through observing learner engagement. The session is a faculty development workshop designed to give learners insights and tools to build actor-based simulation at their institution and consider the resources required. Educational needs in palliative care are substantial, and there is often little or no opportunity for deliberate practice with feedback. Recent efforts to improve the education of Advanced Care Planning facilitators through the use of actor-based simulation will be demonstrated and shared. This will include: video vignette examples, templates for case development, actor scripting templates, debriefing scripting templates, methods and forms for observing learner engagement, and examples of assessments and evaluations. The workshop is hands-on with the goal of learners developing their own simulations that target their learners’ educational needs. Simulations may be designed to meet the entire spectrum of learners in palliative care and may easily be built to include interprofessional learning objectives.
Oncologist in My Pocket: What the Hospice & Palliative Provider Needs to Know About Hematology/Oncology (P16) Kristina Newport, MD FAAHPM, Hospice & Community Care, Lancaster, PA. Barton T. Bobb, MSN FNPBC ACHPN, VCU Health Massey’s Thomas Palliative Care Service, Richmond, VA. Thomas LeBlanc, MD MA, Duke University School of Medicine, Durham, NC. Shanthi Sivendran, MD, PENN Medicine at Lancaster General, Lancaster, PA. Objectives Verbalize the need for increased knowledge of topics in Hematology/Oncology. Define and describe the language and assessment tools utilized by Hematologist/Oncologists. Describe available treatment and prognosis for advanced solid tumor malignancies including chemotherapy, immunotherapy and targeted treatments. Hospice and palliative care (HPC) providers are increasingly called upon to care for patients receiving active treatment of hematologic or oncologic malignancies because of growing evidence that early palliative care improves survival, symptoms, mood, cost, and patient satisfaction. HPC providers may care for these patients on hospital consultation services, in outpatient clinics, and in home hospice or palliative care services. The need for upstream palliative care has resulted in the development of innovative models by private insurance companies and a demonstration project by the Center for Medicare and Medicaid Services. To ensure success of these models, and encourage upstream involvement, it is imperative that HPC providers can competently care for the patients
Vol. 53 No. 2 February 2017
Schedule With Abstracts
in question. Current hospice & palliative training and certification does not necessarily ensure competency in all essential areas. In fact, providers may not have had any direct exposure to hematology/oncology care before entering the field while at the same time, care of patients with hematologic or oncologic malignancies is increasingly complex. Novel therapies emerge rapidly with mechanisms and side effects that are different from traditional chemotherapy and allow for treatment of patients with more limited performance status. This has resulted in attendees of the AAHPM annual meeting repeatedly requesting sessions to keep up-todate on topics in hematology/oncology. This workshop will ensure providers are equipped with the essentials needed to approach the care of these patients, including: terminology, treatment options, unique aspects of targeted therapies, hematology/oncology emergencies, hospice coverage of cancer care, expected side effects of treatments and navigating relationships with hematologists/oncologists. Upon completion of this workshop, hospice and palliative providers will have the necessary tools to develop an approach to the care of patients with hematologic or oncologic malignancies at any point along their cancer trajectory.
Opioid Pharmacology: The Good, the Bad, and the Ugly (P17) Mellar Davis, MD FCCP FAAHPM, Geisinger Medical Center, Danville, PA. Paul A. Sloan, MD, University of Kentucky, Lexington, KY. Objectives Discuss the benefits of combining opioids, either bifunctional ligands or as opioid combinations. Discuss the evidence for opioid induced hyperalgesia and propose that early use of adjuvants such as gabapentinoids in minimizing opioid pronociception. Commercially available opioids have side effect limitations and a narrow therapeutic index. Much of the practice of double opioid prescribing is by default without evidence. Opioid agonist interactions may modify receptor signaling biasing downstream signaling which favors analgesia and reduces side effects. The presence of receptor dimers means that multi-targeted opioid ligands which are linked, fused or merged can target mu homodimers, opioid heterodimers, or opioid receptor-non-opioid receptor heterodimers. Peptide bi-functional ligands have proven effective in animal models. Combinations of oxycodone with morphine, sequential use of fentanylmorphine, combinations of morphine-methadone in animal models and in clinical studies have demonstrated improved pain responses at lower doses. Recent studies suggest that functional MRI studies can help in discovering and investigating opioid combinations. A recent study using nalbuphine found that the addition of low
311
dose naloxone significantly potentiated analgesia in humans which correlated with alterations in functional connectivity between CNS centers. On the other dark side is opioid induced hyperalgesia. Fourteen prospective human studies have a common finding which limits pain relief through analgesic tolerance or paradoxical pain. Quantitative sensory studies of prospectively treated patients have demonstrated increased cold pressor pain, increased temporal summation (wind-up), impaired conditioned pain modulation and clinically relevant increased procedure related pain in individuals who are opioid tolerant. Recent evidence suggests that all opioids cause neuroinflammation through Tool Like Receptors which leads to activation of glia and activation of NMDA receptors The common occurrence of opioid induced hyperalgesia suggests that early use of adjuvant analgesics such as (þ) naloxone and (þ) naltrexone which do not interact with opioid receptors gabapentin or tricyclic which limit hyperalgesia may facilitate analgesia. Future studies are needed to confirm this supposition.
‘‘The Doctor Is In: Part 2’’: Challenging Topics at the Intersection of Pediatric Palliative Care and Psychiatry (P18) Jennifer Hwang, MD MHS, Children’s Hospital of Philadelphia, Philadelphia, PA. Vanessa Battista, MS RN CPNP-BC, Children’s Hospital of Philadelphia, Philadelphia, PA. Natalie Jacobowski, MD, Massachusetts General Hospital, Boston, MA. Pamela Mosher, MD MDiv, Hospital for Sick Children, Toronto, ON. Anna Muriel, MD MPH, Dana-Farber Cancer Institute, Boston, MA. Carolyn Long, MSW, Children’s Hospital of Philadelphia, Philadelphia, PA. Objectives Give two examples of strategies your team can implement when providing palliative or hospice care for a child with a parent with major psychiatric illness. Describe a developmental approach to delirium assessment in young children. Create a medication and behavioral plan for a hospice patient with complex psychiatric symptoms including mania and psychosis. Unaddressed psychiatric issues can prevent us from providing the best care to children and their families and not all pediatric palliative care teams and pediatric hospice teams have access to experts in Child and Adolescent Psychiatry who are comfortable managing children at the end of life. In this session, we will address three challenging topics: (1) providing palliative care to a child when a parent has a major psychiatric illness; (2) assessment and treatment of delirium in children (including those who are preverbal); (3) treatment of children with complex psychiatric symptoms and life limiting illnesses in the outpatient and home setting. In addition, we will
Schedule With Abstracts
individual, team, and institutional efforts that promote resilience. No prior experience is necessary.
Now in 3D: Managing Geriatric Delirium, Dementia, and Dementia Related Behavioral Disturbances (P13) AAHPM Leadership Forum: IgnitedUtilizing DISC Behavioral Styles to Increase Leadership and Team Effectiveness in Palliative Care and Hospice Settings (P14) Lisa A. Bouchard, CPBA CPMA, Data Dome, Inc., Atlanta, GA. Objectives Understanding the DISC MethodologydRecognizing your strengths and limitations as a leader Understanding Your TeamdHow to best manage, motivate, and communicate with them Understanding Your Patients (and Family)dRaising awareness of their needs, concerns, and how to make better decisions together Palliative care and hospice settings can be filled with stress, change, and tension. What separates the best organizations from the struggling are strong leaders that focus on building highly productive teams. This halfday session will focus on utilizing the DISC Behavioral Styles methodology to take your leadership skills and team to the next level. Awareness of behavioral styles directly impacts trust, collaboration, and engagement. Participants will complete a personalized DISC profile which will help to determine how to best leverage their style to build the most effective team. They will also learn how to adapt their communication to the specific style needs of both team members and patients, leading to stronger relationships, better decisions, and unprecedented results.
1:15e5 pm How to Create Actor-Based Simulations that Provide Deliberate Practice with Feedback (P15) William Bond, MD MS, OSF Healthcare, Peoria, IL. Robert Sawicki, MD HMDC FAAFP FAAHPM, OSF Health Care, Peoria, IL. Linda Fehr, BSN RN CPHQ, OSF Healthcare System, Peoria, IL. Amy Funk, PhD, Illinois Wesleyan University, Bloomington, IL. Lynne Madori OSF Healthcare System, Peoria, IL. Objectives Learn how to build actor-based simulation scenarios, including actor scripting. Write and use debriefing questions that emphasize appreciative inquiry methods.
Vol. 53 No. 2 February 2017
Learn to maximize the use of resources through observing learner engagement. The session is a faculty development workshop designed to give learners insights and tools to build actor-based simulation at their institution and consider the resources required. Educational needs in palliative care are substantial, and there is often little or no opportunity for deliberate practice with feedback. Recent efforts to improve the education of Advanced Care Planning facilitators through the use of actor-based simulation will be demonstrated and shared. This will include: video vignette examples, templates for case development, actor scripting templates, debriefing scripting templates, methods and forms for observing learner engagement, and examples of assessments and evaluations. The workshop is hands-on with the goal of learners developing their own simulations that target their learners’ educational needs. Simulations may be designed to meet the entire spectrum of learners in palliative care and may easily be built to include interprofessional learning objectives.
Oncologist in My Pocket: What the Hospice & Palliative Provider Needs to Know About Hematology/Oncology (P16) Kristina Newport, MD FAAHPM, Hospice & Community Care, Lancaster, PA. Barton T. Bobb, MSN FNPBC ACHPN, VCU Health Massey’s Thomas Palliative Care Service, Richmond, VA. Thomas LeBlanc, MD MA, Duke University School of Medicine, Durham, NC. Shanthi Sivendran, MD, PENN Medicine at Lancaster General, Lancaster, PA. Objectives Verbalize the need for increased knowledge of topics in Hematology/Oncology. Define and describe the language and assessment tools utilized by Hematologist/Oncologists. Describe available treatment and prognosis for advanced solid tumor malignancies including chemotherapy, immunotherapy and targeted treatments. Hospice and palliative care (HPC) providers are increasingly called upon to care for patients receiving active treatment of hematologic or oncologic malignancies because of growing evidence that early palliative care improves survival, symptoms, mood, cost, and patient satisfaction. HPC providers may care for these patients on hospital consultation services, in outpatient clinics, and in home hospice or palliative care services. The need for upstream palliative care has resulted in the development of innovative models by private insurance companies and a demonstration project by the Center for Medicare and Medicaid Services. To ensure success of these models, and encourage upstream involvement, it is imperative that HPC providers can competently care for the patients
Vol. 53 No. 2 February 2017
Schedule With Abstracts
in question. Current hospice & palliative training and certification does not necessarily ensure competency in all essential areas. In fact, providers may not have had any direct exposure to hematology/oncology care before entering the field while at the same time, care of patients with hematologic or oncologic malignancies is increasingly complex. Novel therapies emerge rapidly with mechanisms and side effects that are different from traditional chemotherapy and allow for treatment of patients with more limited performance status. This has resulted in attendees of the AAHPM annual meeting repeatedly requesting sessions to keep up-todate on topics in hematology/oncology. This workshop will ensure providers are equipped with the essentials needed to approach the care of these patients, including: terminology, treatment options, unique aspects of targeted therapies, hematology/oncology emergencies, hospice coverage of cancer care, expected side effects of treatments and navigating relationships with hematologists/oncologists. Upon completion of this workshop, hospice and palliative providers will have the necessary tools to develop an approach to the care of patients with hematologic or oncologic malignancies at any point along their cancer trajectory.
Opioid Pharmacology: The Good, the Bad, and the Ugly (P17) Mellar Davis, MD FCCP FAAHPM, Geisinger Medical Center, Danville, PA. Paul A. Sloan, MD, University of Kentucky, Lexington, KY. Objectives Discuss the benefits of combining opioids, either bifunctional ligands or as opioid combinations. Discuss the evidence for opioid induced hyperalgesia and propose that early use of adjuvants such as gabapentinoids in minimizing opioid pronociception. Commercially available opioids have side effect limitations and a narrow therapeutic index. Much of the practice of double opioid prescribing is by default without evidence. Opioid agonist interactions may modify receptor signaling biasing downstream signaling which favors analgesia and reduces side effects. The presence of receptor dimers means that multi-targeted opioid ligands which are linked, fused or merged can target mu homodimers, opioid heterodimers, or opioid receptor-non-opioid receptor heterodimers. Peptide bi-functional ligands have proven effective in animal models. Combinations of oxycodone with morphine, sequential use of fentanylmorphine, combinations of morphine-methadone in animal models and in clinical studies have demonstrated improved pain responses at lower doses. Recent studies suggest that functional MRI studies can help in discovering and investigating opioid combinations. A recent study using nalbuphine found that the addition of low
311
dose naloxone significantly potentiated analgesia in humans which correlated with alterations in functional connectivity between CNS centers. On the other dark side is opioid induced hyperalgesia. Fourteen prospective human studies have a common finding which limits pain relief through analgesic tolerance or paradoxical pain. Quantitative sensory studies of prospectively treated patients have demonstrated increased cold pressor pain, increased temporal summation (wind-up), impaired conditioned pain modulation and clinically relevant increased procedure related pain in individuals who are opioid tolerant. Recent evidence suggests that all opioids cause neuroinflammation through Tool Like Receptors which leads to activation of glia and activation of NMDA receptors The common occurrence of opioid induced hyperalgesia suggests that early use of adjuvant analgesics such as (þ) naloxone and (þ) naltrexone which do not interact with opioid receptors gabapentin or tricyclic which limit hyperalgesia may facilitate analgesia. Future studies are needed to confirm this supposition.
‘‘The Doctor Is In: Part 2’’: Challenging Topics at the Intersection of Pediatric Palliative Care and Psychiatry (P18) Jennifer Hwang, MD MHS, Children’s Hospital of Philadelphia, Philadelphia, PA. Vanessa Battista, MS RN CPNP-BC, Children’s Hospital of Philadelphia, Philadelphia, PA. Natalie Jacobowski, MD, Massachusetts General Hospital, Boston, MA. Pamela Mosher, MD MDiv, Hospital for Sick Children, Toronto, ON. Anna Muriel, MD MPH, Dana-Farber Cancer Institute, Boston, MA. Carolyn Long, MSW, Children’s Hospital of Philadelphia, Philadelphia, PA. Objectives Give two examples of strategies your team can implement when providing palliative or hospice care for a child with a parent with major psychiatric illness. Describe a developmental approach to delirium assessment in young children. Create a medication and behavioral plan for a hospice patient with complex psychiatric symptoms including mania and psychosis. Unaddressed psychiatric issues can prevent us from providing the best care to children and their families and not all pediatric palliative care teams and pediatric hospice teams have access to experts in Child and Adolescent Psychiatry who are comfortable managing children at the end of life. In this session, we will address three challenging topics: (1) providing palliative care to a child when a parent has a major psychiatric illness; (2) assessment and treatment of delirium in children (including those who are preverbal); (3) treatment of children with complex psychiatric symptoms and life limiting illnesses in the outpatient and home setting. In addition, we will