- Email: [email protected]
P330 Current Practices at the End of Life in General Medicine Acute Care Settings in Canada
e150
Selected Abstracts
the general population. CS visit specialists during treatment, and 75% of them also see their primary care provider (PCP) during and after treatments. Despite their key role in survivorship care, PCP lack knowledge and have low confidence regarding CS care, supporting the imperative need to educate them about CS issues. Objective: To assess the educational benefit of a survivorship workshop (EW) targeting PCP in Montreal, Canada. Methods: A Mainpro-accredited EW based on common survivor issues was developed and delivered to 155 PCP at 5 sites. Brief matched pre and post surveys were designed (Likert scale and short-answer questions), and completed on a voluntary basis by PCP. Outcome measures were based on the first 3 levels of Kirkpatrick’s learning model: satisfaction, knowledge, and behaviour. Data analysis included an opencoding approach to identify major themes, and t-tests. Ethics approval was granted. Results: Response rate was 64%. Findings indicated high relevance and satisfaction of EW content (95%). Using t-tests to compare pre and post responses, results were statistically significant for both ‘‘list 2 standards of survivorship’’ and ‘‘name 2 late-effects of cancer treatment’’ survey items, indicating an increase in both standards and late effects identified post EW. When asked: ‘‘Did you learn anything today that you will put into practice?’’, 99% expressed intent to incorporate survivorship information into practice. Conclusions: Much research has focused on identifying PCP barriers to survivorship care delivery such as limited topic proficiency, yet further efforts are warranted to close that knowledge gap. Our EW intervention increased PCP survivorship knowledge. A second workshop targeting cardiovascular health promotion has been created: delivery is anticipated early 2016.
Vol. 52 No. 6 December 2016
Background: Many Canadians die in hospital, but there is limited information on the quality of end of life (EOL) care in Canadian hospitals. Aim: To study the quality and timing of EOL care and involvement of palliative care (PC) in a tertiary centre. Methods: We conducted a retrospective chart review of 150 patients who died on an inpatient internal medicine unit in 2012. Information was extracted on patient demographics; cause of death; diagnosis of dying; goals of care (GOC) discussion; involvement of PC, social work, spiritual care; and medications for symptom management. Results: Of the 150 deaths, the median age was 79.5 (range 22-101), 58% were male, 69% spoke English, and median length of stay (LS) was 8 days (1-206). A total of 41% deaths were from cancer, 50% were coded as anticipated, 37% occurred without social work or spiritual care involvement, and 66% occurred with prior PC team involvement. PC patients had a GOC discussion median 6 days prior to death (vs 2 days without PC, p LT 0.0001), during which the patient was present 49.5% of the time (vs 25%, p¼0.007). PC patients tended to have earlier discontinuation of: blood work (median 2 days before death vs 1, p LT 0.001); vital signs (1 vs 0, p¼0.007); and IV fluids (1 days vs 0, p¼0.002). PC deaths were more likely to have antiemetic (46.5% vs 27.5%, p¼0.03), analgesic (95% vs 71%, p LT 0.0001), anticholinergic agent (41% vs 18%, p¼0.003) and antipsychotic (65% vs 32%, p¼0.001) ordered. On multivariate analysis controlling for length of hospital admission and expected death, PC intervention was associated with earlier discontinuation of bloodwork and vital signs, and with earlier opioid and antipsychotic orders (all p LT 0.05). Conclusion: Quality of EOL care is inconsistent for hospital inpatients while palliative care involvement is associated with better care in this population.
Other P330 Current Practices at the End of Life in General Medicine Acute Care Settings in Canada 1
2
3
Philippe Toupin , Natalia Novosedlik , Lisa Le , Camilla Zimmermann1, Kirsten Wentlandt1, Ebru Kaya1 1 University Of Toronto, Toronto, ON, Canada 2 Scarborough Centre for Healthy Communities, Toronto, ON, Canada 3 Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
P331 Transition to Palliative Care for Patients with Metastatic Prostate Cancer: How Well Have We Integrated?
Anna Collins1,2, Jodie Burchell2, Vijaya Sundararajan2, Jeremy Millar3, Brian Le4, David Currow5, Peter Hudson1,2,6, Sue-Anne McLachlan7, Linda Mileshkin8, Meinir Krishnasamy9 1 Centre for Palliative Care, St Vincent’s Hospital, Melbourne, Victoria, Australia 2 Department of Medicine, University of Melbourne, Victoria, Australia
Selected Abstracts
the general population. CS visit specialists during treatment, and 75% of them also see their primary care provider (PCP) during and after treatments. Despite their key role in survivorship care, PCP lack knowledge and have low confidence regarding CS care, supporting the imperative need to educate them about CS issues. Objective: To assess the educational benefit of a survivorship workshop (EW) targeting PCP in Montreal, Canada. Methods: A Mainpro-accredited EW based on common survivor issues was developed and delivered to 155 PCP at 5 sites. Brief matched pre and post surveys were designed (Likert scale and short-answer questions), and completed on a voluntary basis by PCP. Outcome measures were based on the first 3 levels of Kirkpatrick’s learning model: satisfaction, knowledge, and behaviour. Data analysis included an opencoding approach to identify major themes, and t-tests. Ethics approval was granted. Results: Response rate was 64%. Findings indicated high relevance and satisfaction of EW content (95%). Using t-tests to compare pre and post responses, results were statistically significant for both ‘‘list 2 standards of survivorship’’ and ‘‘name 2 late-effects of cancer treatment’’ survey items, indicating an increase in both standards and late effects identified post EW. When asked: ‘‘Did you learn anything today that you will put into practice?’’, 99% expressed intent to incorporate survivorship information into practice. Conclusions: Much research has focused on identifying PCP barriers to survivorship care delivery such as limited topic proficiency, yet further efforts are warranted to close that knowledge gap. Our EW intervention increased PCP survivorship knowledge. A second workshop targeting cardiovascular health promotion has been created: delivery is anticipated early 2016.
Vol. 52 No. 6 December 2016
Background: Many Canadians die in hospital, but there is limited information on the quality of end of life (EOL) care in Canadian hospitals. Aim: To study the quality and timing of EOL care and involvement of palliative care (PC) in a tertiary centre. Methods: We conducted a retrospective chart review of 150 patients who died on an inpatient internal medicine unit in 2012. Information was extracted on patient demographics; cause of death; diagnosis of dying; goals of care (GOC) discussion; involvement of PC, social work, spiritual care; and medications for symptom management. Results: Of the 150 deaths, the median age was 79.5 (range 22-101), 58% were male, 69% spoke English, and median length of stay (LS) was 8 days (1-206). A total of 41% deaths were from cancer, 50% were coded as anticipated, 37% occurred without social work or spiritual care involvement, and 66% occurred with prior PC team involvement. PC patients had a GOC discussion median 6 days prior to death (vs 2 days without PC, p LT 0.0001), during which the patient was present 49.5% of the time (vs 25%, p¼0.007). PC patients tended to have earlier discontinuation of: blood work (median 2 days before death vs 1, p LT 0.001); vital signs (1 vs 0, p¼0.007); and IV fluids (1 days vs 0, p¼0.002). PC deaths were more likely to have antiemetic (46.5% vs 27.5%, p¼0.03), analgesic (95% vs 71%, p LT 0.0001), anticholinergic agent (41% vs 18%, p¼0.003) and antipsychotic (65% vs 32%, p¼0.001) ordered. On multivariate analysis controlling for length of hospital admission and expected death, PC intervention was associated with earlier discontinuation of bloodwork and vital signs, and with earlier opioid and antipsychotic orders (all p LT 0.05). Conclusion: Quality of EOL care is inconsistent for hospital inpatients while palliative care involvement is associated with better care in this population.
Other P330 Current Practices at the End of Life in General Medicine Acute Care Settings in Canada 1
2
3
Philippe Toupin , Natalia Novosedlik , Lisa Le , Camilla Zimmermann1, Kirsten Wentlandt1, Ebru Kaya1 1 University Of Toronto, Toronto, ON, Canada 2 Scarborough Centre for Healthy Communities, Toronto, ON, Canada 3 Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
P331 Transition to Palliative Care for Patients with Metastatic Prostate Cancer: How Well Have We Integrated?
Anna Collins1,2, Jodie Burchell2, Vijaya Sundararajan2, Jeremy Millar3, Brian Le4, David Currow5, Peter Hudson1,2,6, Sue-Anne McLachlan7, Linda Mileshkin8, Meinir Krishnasamy9 1 Centre for Palliative Care, St Vincent’s Hospital, Melbourne, Victoria, Australia 2 Department of Medicine, University of Melbourne, Victoria, Australia