- Email: [email protected]
P339 Equipoise: A Concept Analysis
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Selected Abstracts
patient fatigue and symptom burden. Therefore, we conducted a pilot study to explore the feasibility of measuring change in QOL for advanced cancer patients who are admitted to hospital. Methods: Inclusion criteria: age > 21 years old, stage 4 solid tumor, and hospital admission from 22 November 2015 to 29 February 2016. QOL was measured with the Functional Assessment of Cancer Therapy e General (FACT-G) questionnaire, which was administered at up to four time points: days 1-3, 4-6 and 7-9 of admission and day of discharge. Results: There were 460 patient admissions: 283 met the inclusion criteria, of which 142 (50.2%) were recruited and able to complete FACT-G at least once. Only 60 (21.2%) completed FACT-G at both day 1-3 and day 4-6 of admission. Only 16 (5.7%) completed FACT-G at day 1-3, day 4-6 and day 7-9 of admission. Only 4 (1.4%) completed all four time points of data collection. Reasons for low completion rate at subsequent time points include fatigue, unavailability (e.g. away for scan or procedure), and clinical deterioration. Some were also discharged before the subsequent time points and we did not administer FACTG after discharge. For all 460 admissions, the mean hospital length of stay was 6.26 days and median was 4 days. The 30-day and 7-day readmission rates were 26.5% and 6.5% respectively. Conclusions: Given the low recruitment rate and data completion rate of sequential FACT-G measurements, using change in QOL as the primary outcome may not be feasible. Mean hospital length of stay or hospital readmission rate are possible alternative primary outcomes to consider.
P338 Incidence of Venous Thromboembolism and Related Mortality among Cancer Patients in Tertiary Care Hospital in Saudi Arabia Ahmed Ali, Adel Hamody, Hamdi Saudi, Walid Selwi, King Fahad Specialist Hospital, Dammam, Saudi Arabia Correlation between thromboembolic events and malignancy is a renowned phenomenon. The incidence of such devastating events in vulnerable oncology patients dictates further studies in cancer centers. The effect of the disease stage, chemotherapy received, performance status, and other demographic data are observed as well.
Vol. 52 No. 6 December 2016
Methods: In a retrospective analysis, the incidence of deep vein thrombosis, and or pulmonary embolism have been studied in cancer patients admitted to the adult medical oncology department during the period of 2012 and 2013. The effect of the stage of the disease, chemotherapy or hormonal therapy received, ECOG performance status, and the use of prophylactic anticoagulants have been studied, along with the incidence of side effects with the use of anticoagulants and the consequences (mortality and morbidity) caused by these events. Results: 144 patients developed thromboembolic manifestations during this period (two years) constituting about 8% of the population.
P339 Equipoise: A Concept Analysis Kathleen Sheikh, Misericordia University, Dallas, PA, United States Background: Healthcare system reform in the United States presents the opportunity for innovation in healthcare. Moving from a paternalistic model of healthcare to the expectation that patients participate in their healthcare decisions has evolved as part of health policy, healthcare reform, and patient-centered care. Clarification of the concept equipoise, may elucidate contributory elements of patient healthcare decision-making and patient achievement of desired healthcare outcomes. Purpose: Through concept analysis, determine the antecedents, attributes, and consequences of the concept equipoise; derive an operational definition of the concept of equipoise; and relate the concept of equipoise to patient healthcare decision-making. Method: The Walker and Avant method of concept analysis was used to isolate antecedents, attributes, and consequences of equipoise, and derive a conceptual meaning of equipoise in the context of patient healthcare decision-making. Academic Search Premier, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Philosopher’s Index, POESIS, and PsyInfo using the keywords ‘*equipoise, nursing, and clinical research’ covering the period from 1974 to 2012. Conclusion and Implications: Equipoise is uniquely constructed by each individual, and takes into account all aspects of a healthcare decision-making. The analysis contributes to the advancement of knowledge of the concept of equipoise by proposing an operational
Vol. 52 No. 6 December 2016
Selected Abstracts
definition. Equipoise has relevance to patient’s healthcare decisions, sense of well-being, and desired healthcare outcomes. The concept of equipoise is significant to nursing science, research, practice and education. Keywords: equipoise, nursing, healthcare decisionmaking
P341 An Analysis of Palliative Content on Youtube
Sarah Cousins1, Michael Donnelly2 1 Marie Curie Hospice, Belfast, Northern Ireland, United Kingdom 2 Queen’s University, Belfast, Northern Ireland, United Kingdom Objectives: To understand how YouTube videos are being used as a platform for palliative issues, and how YouTube users respond to this. In addressing this aim, the ultimate goal would be to guide palliative care professionals in how to use YouTube to inform, educate and engage on palliative issues. Methods: YouTube was systematically searched for the search terms ‘death’, ‘terminal’, ‘dying’, ‘hospice’, ‘palliative’ and ‘end of life’ on 29th July 2015. User engagement data, measured by views, comments, likes and dislikes, was recorded. Results: 106 videos (29 hours of material) were identified. Overall views and engagement with palliative content was low. The search term ‘dying’ produced the smallest number of relevant videos but showed dramatically higher user engagement than videos under the search terms ‘hospice’, ‘palliative’ and ‘end of life’. Non-profit, non-caregiving organisations (33/106, 31%), healthcare providers (28/106, 26%), for-profit organisations (20/106, 19%) and individuals (17/106, 16%) formed the majority of video uploaders. Individuals and for-profit sources (mainly news/media/ broadcasting companies) showed the highest viewing figures and user-engagement. Healthcare providers and non-profit non-care giving organisations showed the lowest views per day and user engagement. Informative/educational (81/106, 76%) was by far the most prevalent type of video posted but prompted least user engagement. Videos classified as personal information received by far the greatest user engagement with a median of 673 views per day (IQR 838), median 775 comments (IQR 1067), median likes 1439 (IQR 4922) and dislikes 51 (IQR 145). The majority of videos (75/106, 71%) primarily targeted the general public. Videos did not feature racial diversity.
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Conclusion: Palliative professionals should use YouTube to understand information needs related to endof-life care in order to produce videos, which engage as well as inform. Without a social media or internet regulating body, promoting information about palliative care on YouTube is a collective responsibility.
P342 Identifying Screening Criteria for a Palliative Care Referral Gillian Phua, Tan Ying Peh, Shirlynn Ho, Grace Yang, National Cancer Centre Singapore, Singapore Background: The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology recommend that all cancer patients should be screened for palliative care needs at initial visit, at appropriate intervals, and as clinically indicated, and a consultation with a palliative care specialist should be sought if criteria are met. Objective: The aim of this study was to develop a brief screening tool to identify patients who may benefit from a palliative care review. Methods: Based on 28 NCCN criteria, 8 healthcare professionals comprising palliative care physicians and medical oncologists were asked to rank the top 5 most appropriate criteria to trigger a palliative care referral. A shortlist of 8 referral criteria was chosen based on their response. Doctors and nurses in the Lung Oncology team evaluated all the acute hospital inpatients under their care for any of the 8 criteria on 2 consecutive days. Results: A total of 37 patients were screened. The top 4 criteria were: limited anti-cancer treatment options (28 patients, 75.6%), rapid functional decline (24 patients, 64.9%), symptoms not controlled by standard approaches (23 patients, 62.1%), and moderate to severe distress in patient and/or family (23 patients, 62.1%). Eighteen (49%) patients were referred to palliative care, of whom all met at least 2 of the above 4 criteria. A further 11 (30%) patients met at least 2 of the criteria, but were not referred to palliative care. Among all the criteria, inter-rater reliability was highest for limited anti-cancer treatment options and rapid functional decline. Conclusion: It may be feasible to use the following 4 screening criteria for a referral to a palliative care specialist, with the presence of 2 or more criteria triggering a referral: Limited anti-cancer treatment options Rapid functional decline
Selected Abstracts
patient fatigue and symptom burden. Therefore, we conducted a pilot study to explore the feasibility of measuring change in QOL for advanced cancer patients who are admitted to hospital. Methods: Inclusion criteria: age > 21 years old, stage 4 solid tumor, and hospital admission from 22 November 2015 to 29 February 2016. QOL was measured with the Functional Assessment of Cancer Therapy e General (FACT-G) questionnaire, which was administered at up to four time points: days 1-3, 4-6 and 7-9 of admission and day of discharge. Results: There were 460 patient admissions: 283 met the inclusion criteria, of which 142 (50.2%) were recruited and able to complete FACT-G at least once. Only 60 (21.2%) completed FACT-G at both day 1-3 and day 4-6 of admission. Only 16 (5.7%) completed FACT-G at day 1-3, day 4-6 and day 7-9 of admission. Only 4 (1.4%) completed all four time points of data collection. Reasons for low completion rate at subsequent time points include fatigue, unavailability (e.g. away for scan or procedure), and clinical deterioration. Some were also discharged before the subsequent time points and we did not administer FACTG after discharge. For all 460 admissions, the mean hospital length of stay was 6.26 days and median was 4 days. The 30-day and 7-day readmission rates were 26.5% and 6.5% respectively. Conclusions: Given the low recruitment rate and data completion rate of sequential FACT-G measurements, using change in QOL as the primary outcome may not be feasible. Mean hospital length of stay or hospital readmission rate are possible alternative primary outcomes to consider.
P338 Incidence of Venous Thromboembolism and Related Mortality among Cancer Patients in Tertiary Care Hospital in Saudi Arabia Ahmed Ali, Adel Hamody, Hamdi Saudi, Walid Selwi, King Fahad Specialist Hospital, Dammam, Saudi Arabia Correlation between thromboembolic events and malignancy is a renowned phenomenon. The incidence of such devastating events in vulnerable oncology patients dictates further studies in cancer centers. The effect of the disease stage, chemotherapy received, performance status, and other demographic data are observed as well.
Vol. 52 No. 6 December 2016
Methods: In a retrospective analysis, the incidence of deep vein thrombosis, and or pulmonary embolism have been studied in cancer patients admitted to the adult medical oncology department during the period of 2012 and 2013. The effect of the stage of the disease, chemotherapy or hormonal therapy received, ECOG performance status, and the use of prophylactic anticoagulants have been studied, along with the incidence of side effects with the use of anticoagulants and the consequences (mortality and morbidity) caused by these events. Results: 144 patients developed thromboembolic manifestations during this period (two years) constituting about 8% of the population.
P339 Equipoise: A Concept Analysis Kathleen Sheikh, Misericordia University, Dallas, PA, United States Background: Healthcare system reform in the United States presents the opportunity for innovation in healthcare. Moving from a paternalistic model of healthcare to the expectation that patients participate in their healthcare decisions has evolved as part of health policy, healthcare reform, and patient-centered care. Clarification of the concept equipoise, may elucidate contributory elements of patient healthcare decision-making and patient achievement of desired healthcare outcomes. Purpose: Through concept analysis, determine the antecedents, attributes, and consequences of the concept equipoise; derive an operational definition of the concept of equipoise; and relate the concept of equipoise to patient healthcare decision-making. Method: The Walker and Avant method of concept analysis was used to isolate antecedents, attributes, and consequences of equipoise, and derive a conceptual meaning of equipoise in the context of patient healthcare decision-making. Academic Search Premier, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Philosopher’s Index, POESIS, and PsyInfo using the keywords ‘*equipoise, nursing, and clinical research’ covering the period from 1974 to 2012. Conclusion and Implications: Equipoise is uniquely constructed by each individual, and takes into account all aspects of a healthcare decision-making. The analysis contributes to the advancement of knowledge of the concept of equipoise by proposing an operational
Vol. 52 No. 6 December 2016
Selected Abstracts
definition. Equipoise has relevance to patient’s healthcare decisions, sense of well-being, and desired healthcare outcomes. The concept of equipoise is significant to nursing science, research, practice and education. Keywords: equipoise, nursing, healthcare decisionmaking
P341 An Analysis of Palliative Content on Youtube
Sarah Cousins1, Michael Donnelly2 1 Marie Curie Hospice, Belfast, Northern Ireland, United Kingdom 2 Queen’s University, Belfast, Northern Ireland, United Kingdom Objectives: To understand how YouTube videos are being used as a platform for palliative issues, and how YouTube users respond to this. In addressing this aim, the ultimate goal would be to guide palliative care professionals in how to use YouTube to inform, educate and engage on palliative issues. Methods: YouTube was systematically searched for the search terms ‘death’, ‘terminal’, ‘dying’, ‘hospice’, ‘palliative’ and ‘end of life’ on 29th July 2015. User engagement data, measured by views, comments, likes and dislikes, was recorded. Results: 106 videos (29 hours of material) were identified. Overall views and engagement with palliative content was low. The search term ‘dying’ produced the smallest number of relevant videos but showed dramatically higher user engagement than videos under the search terms ‘hospice’, ‘palliative’ and ‘end of life’. Non-profit, non-caregiving organisations (33/106, 31%), healthcare providers (28/106, 26%), for-profit organisations (20/106, 19%) and individuals (17/106, 16%) formed the majority of video uploaders. Individuals and for-profit sources (mainly news/media/ broadcasting companies) showed the highest viewing figures and user-engagement. Healthcare providers and non-profit non-care giving organisations showed the lowest views per day and user engagement. Informative/educational (81/106, 76%) was by far the most prevalent type of video posted but prompted least user engagement. Videos classified as personal information received by far the greatest user engagement with a median of 673 views per day (IQR 838), median 775 comments (IQR 1067), median likes 1439 (IQR 4922) and dislikes 51 (IQR 145). The majority of videos (75/106, 71%) primarily targeted the general public. Videos did not feature racial diversity.
e155
Conclusion: Palliative professionals should use YouTube to understand information needs related to endof-life care in order to produce videos, which engage as well as inform. Without a social media or internet regulating body, promoting information about palliative care on YouTube is a collective responsibility.
P342 Identifying Screening Criteria for a Palliative Care Referral Gillian Phua, Tan Ying Peh, Shirlynn Ho, Grace Yang, National Cancer Centre Singapore, Singapore Background: The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology recommend that all cancer patients should be screened for palliative care needs at initial visit, at appropriate intervals, and as clinically indicated, and a consultation with a palliative care specialist should be sought if criteria are met. Objective: The aim of this study was to develop a brief screening tool to identify patients who may benefit from a palliative care review. Methods: Based on 28 NCCN criteria, 8 healthcare professionals comprising palliative care physicians and medical oncologists were asked to rank the top 5 most appropriate criteria to trigger a palliative care referral. A shortlist of 8 referral criteria was chosen based on their response. Doctors and nurses in the Lung Oncology team evaluated all the acute hospital inpatients under their care for any of the 8 criteria on 2 consecutive days. Results: A total of 37 patients were screened. The top 4 criteria were: limited anti-cancer treatment options (28 patients, 75.6%), rapid functional decline (24 patients, 64.9%), symptoms not controlled by standard approaches (23 patients, 62.1%), and moderate to severe distress in patient and/or family (23 patients, 62.1%). Eighteen (49%) patients were referred to palliative care, of whom all met at least 2 of the above 4 criteria. A further 11 (30%) patients met at least 2 of the criteria, but were not referred to palliative care. Among all the criteria, inter-rater reliability was highest for limited anti-cancer treatment options and rapid functional decline. Conclusion: It may be feasible to use the following 4 screening criteria for a referral to a palliative care specialist, with the presence of 2 or more criteria triggering a referral: Limited anti-cancer treatment options Rapid functional decline