- Email: [email protected]
Palliative Care and Advanced Heart Failure Management: Meeting at the Crossroads? (317-C)
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Schedule with Abstracts
reported no or mild pain, 43% were not frail, 35.2% were pre-frail, and 21.8% were frail. Of participants who reported moderate or greater pain, 16.2% were not frail, 34.1% were pre-frail, and 49.8% were frail. Overall, frailty status was significantly associated with pain self-report, p < 0.01. The odds of being pre-frail was higher by a factor of 2.52 (2.13, 2.19), p < 0.05 for persons with moderate or greater pain compared to those who were not frail. The odds of being frail was higher by a factor of 5.52 (4.49, 6.64), p < 0.05 for persons with moderate or greater pain compared to those who were not frail. Conclusion. The concept of ‘‘pain homeostenosis’’ is supported by our findings. Implications for research, policy, or practice. Research is needed to evaluate pain management in mitigating the relationship between pain and frailty. Domain Physical Aspects of Care
Pain and Physical/Psychological Symptoms in Ambulatory Patients with HIV (317-B) Jessica Merlin, MD MBA, Mount Sinai School of Medicine, New York, NY. Liyi Cen. Amy Praestgaard. Michelle Turner, MS, MSKCC, New York, NY. Aura Obando, MD, MGH, Somerville, MA. Craig Alpert. Sophie Woolston. David Casarett, MD MA FAAHPM, University of Pennsylvania, Philadelphia, PA. Jay Kostman. Ian Frank. Robert Gross. (All speakers for this session have disclosed no relevant financial relationships with the exception of: Frank is on the advisory board and speakers bureau for Gilead Sciences, Tibotec, and BristolMyers Squibb. Frank also received a research grant from Merck.) Objectives 1. Describe the prevalence and of pain and physical/psychological symptoms in a population of ambulatory HIV patients. 2. Recognize HIV as a disease in which pain is associated with history of psychiatric illness and IV drug use, but not with markers of HIV disease such as CD4 and viral load. Background. HIV has become a manageable chronic disease. There are few studies of pain and symptoms in the current treatment era, when most patients are virologically suppressed. Research objectives. Determine the prevalence of and risk factors for pain and physical and
Vol. 41 No. 1 January 2011
psychological symptoms in a population of ambulatory HIV patients. Methods. Cross-sectional sectional study using the Brief Pain Inventory and Memorial Symptom Assessment Scale. Results. We evaluated 156 individuals with a median age of 53.5 years (range 21-71 years), median time since HIV diagnosis of 11 years (range < 1-25 years), and median CD4 count of 502 cells/mm3 (interquartile range 308683). The majority (125, 80.6%) had an undetectable viral load. Seventy-six (48.7%) reported pain, of whom 39 (51.3%) had moderate to severe pain, and 43 (57.3%) reported that the pain caused moderate to severe interference with their lives. The median number of symptoms was 8 (interquartile range 5-14.5) out of 32. The most common physical symptoms were lack of energy (89, 57.1%) and numbness/ tingling in the hands and feet (72, 46.2%). Sixty-one patients (39.1%) experienced high distress from three or more physical symptoms, and 74 (47%) experienced high distress from at least one psychological symptom. There was no relationship between pain severity and CD4 or viral load (p ¼ 0.16 and 0.31, respectively), or number of symptoms and CD4 or viral load (p ¼ 0.21, p ¼ 0.2, respectively). Patients with psychiatric illness were more likely to report pain than patients without [37/52 (71.2%) vs. 39/104 (37.9%), p < 0.001], and the presence of pain was correlated with more psychological symptoms (p ¼ 0.002). Conclusion. Pain and other physical and psychological symptoms are common among ambulatory HIV patients. Pain was not related to markers of HIV disease, but rather with intravenous drug use (IDU) and psychiatric history. Implications for research, policy, or practice. Future investigation should identify barriers to achieving pain and symptom control, and the impact of pain and symptoms on quality of life and adherence. Domain Physical Aspects of Care; Psychological and Psychiatric Aspects of Care
Palliative Care and Advanced Heart Failure Management: Meeting at the Crossroads? (317-C) Parag Bharadwaj, MD, Cedars-Sinai Medical Center, Los Angeles, CA. Helen Ansari, MD, Cedars-Sinai Medical Center, Los Angeles, CA.
Vol. 41 No. 1 January 2011
Schedule with Abstracts
Arvind Shinde, MD MBA MPH, San Diego Hospice and Institute of Palliative Medicine, San Diego, CA. Ernst Schwarz, MD PhD, Cedars Sinai Medical Center, Los Angeles, CA. (All speakers for this session have disclosed no relevant financial relationships.) Objectives 1. Identify the need for palliative care in patients with advanced stages of heart failure. 2. Describe the role of palliative care consultation service with heart failure service. 3. Discuss the outcomes of the experience. Background. Approximately 2,200 heart transplants are performed every year in the United States. In 2008e2009, 26 heart transplants were performed at Cedars-Sinai Medical Center (CSMC) while 76 patients were evaluated for advanced surgical therapies including heart transplantation. Research objectives. Study the outcomes, benefits, and impact of introducing a palliative care consultation service in the care of patients with advanced heart disease. Methods. A palliative care consultation was obtained by the heart failure team for one or more of the following: symptom management, advance care planning, clarification of goals, support to patients and families, and end-oflife care/hospice referral. Results. Data of the first 20 patients referred by the heart failure service at CSMC to the palliative care consultation service was analyzed. Two patients received a successful heart transplant. Three patients received an LVAD as destination therapy. BIVAD was placed in one patient as a bridge to transplant. Four patients had received a heart transplant in the past. Five patients were identified as not being a candidate for a heart transplant. Two patients were discharged home on hospice and two patients received end-of-life care in the hospital. Valuable feedback was reported by the heart failure service, patients, and their families. The heart failure service observed that the involvement of palliative care improved patient care and transition, a surprising decrease in the use of opioids and improved efficiency of their service. Patients and families reported better symptom control and improved planning of course of treatment. This experience has changed the perception of palliative care involvement not being limited solely to end-of-life care.
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Conclusion. Palliative care is an integral part of providing comprehensive care to patients with advanced heart failure. Its involvement should be independent of the prognosis or treatment goal. Implications for research, policy, or practice. Palliative care should be the standard of care in this patient population. Domain Physical Aspects of Care; Psychological and Psychiatric Aspects of Care
Educational Impact of Weekly E-mailed Fast Facts and Concepts (318-A) Rene Claxton, MD, University of Pittsburgh Medical Center, Pittsburgh, PA. Robert Arnold, MD, University of Pittsburgh, Pittsburgh, PA. (All speakers for this session have disclosed no relevant financial relationships.) Objectives 1. Describe the constraints facing current medical education which limit the addition of palliative care curricular innovations to residency training. 2. Describe the educational benefit of weekly e-mailed Fast Facts and Concepts to internal medicine residents in terms of resident medical knowledge, self-reported preparedness, and satisfaction. 3. Describe the advantages and limitations of weekly e-mails as an educational tool in residency training. Background. Educational interventions such as electives, case discussions, didactics, and webbased teaching have been shown to improve residents’ knowledge, attitudes, and skills. However, integrating curricular innovations into residency training is difficult due to limited time, faculty, and cost. Time- and cost-effective educational methods are increasingly desirable. Research objectives. Assess the educational impact of weekly Fast Fact and Concept (FFAC) e-mails on residents’ knowledge of palliative care topics, self-reported preparedness in palliative care skills, and satisfaction with palliative care education. Methods. Internal medicine interns at the University of Pittsburgh and Medical College of Wisconsin were randomized to control and intervention groups. Pre- and posttests assessed knowledge through 24 multiple choice questions, preparedness on 14 skills via a 4-point
Schedule with Abstracts
reported no or mild pain, 43% were not frail, 35.2% were pre-frail, and 21.8% were frail. Of participants who reported moderate or greater pain, 16.2% were not frail, 34.1% were pre-frail, and 49.8% were frail. Overall, frailty status was significantly associated with pain self-report, p < 0.01. The odds of being pre-frail was higher by a factor of 2.52 (2.13, 2.19), p < 0.05 for persons with moderate or greater pain compared to those who were not frail. The odds of being frail was higher by a factor of 5.52 (4.49, 6.64), p < 0.05 for persons with moderate or greater pain compared to those who were not frail. Conclusion. The concept of ‘‘pain homeostenosis’’ is supported by our findings. Implications for research, policy, or practice. Research is needed to evaluate pain management in mitigating the relationship between pain and frailty. Domain Physical Aspects of Care
Pain and Physical/Psychological Symptoms in Ambulatory Patients with HIV (317-B) Jessica Merlin, MD MBA, Mount Sinai School of Medicine, New York, NY. Liyi Cen. Amy Praestgaard. Michelle Turner, MS, MSKCC, New York, NY. Aura Obando, MD, MGH, Somerville, MA. Craig Alpert. Sophie Woolston. David Casarett, MD MA FAAHPM, University of Pennsylvania, Philadelphia, PA. Jay Kostman. Ian Frank. Robert Gross. (All speakers for this session have disclosed no relevant financial relationships with the exception of: Frank is on the advisory board and speakers bureau for Gilead Sciences, Tibotec, and BristolMyers Squibb. Frank also received a research grant from Merck.) Objectives 1. Describe the prevalence and of pain and physical/psychological symptoms in a population of ambulatory HIV patients. 2. Recognize HIV as a disease in which pain is associated with history of psychiatric illness and IV drug use, but not with markers of HIV disease such as CD4 and viral load. Background. HIV has become a manageable chronic disease. There are few studies of pain and symptoms in the current treatment era, when most patients are virologically suppressed. Research objectives. Determine the prevalence of and risk factors for pain and physical and
Vol. 41 No. 1 January 2011
psychological symptoms in a population of ambulatory HIV patients. Methods. Cross-sectional sectional study using the Brief Pain Inventory and Memorial Symptom Assessment Scale. Results. We evaluated 156 individuals with a median age of 53.5 years (range 21-71 years), median time since HIV diagnosis of 11 years (range < 1-25 years), and median CD4 count of 502 cells/mm3 (interquartile range 308683). The majority (125, 80.6%) had an undetectable viral load. Seventy-six (48.7%) reported pain, of whom 39 (51.3%) had moderate to severe pain, and 43 (57.3%) reported that the pain caused moderate to severe interference with their lives. The median number of symptoms was 8 (interquartile range 5-14.5) out of 32. The most common physical symptoms were lack of energy (89, 57.1%) and numbness/ tingling in the hands and feet (72, 46.2%). Sixty-one patients (39.1%) experienced high distress from three or more physical symptoms, and 74 (47%) experienced high distress from at least one psychological symptom. There was no relationship between pain severity and CD4 or viral load (p ¼ 0.16 and 0.31, respectively), or number of symptoms and CD4 or viral load (p ¼ 0.21, p ¼ 0.2, respectively). Patients with psychiatric illness were more likely to report pain than patients without [37/52 (71.2%) vs. 39/104 (37.9%), p < 0.001], and the presence of pain was correlated with more psychological symptoms (p ¼ 0.002). Conclusion. Pain and other physical and psychological symptoms are common among ambulatory HIV patients. Pain was not related to markers of HIV disease, but rather with intravenous drug use (IDU) and psychiatric history. Implications for research, policy, or practice. Future investigation should identify barriers to achieving pain and symptom control, and the impact of pain and symptoms on quality of life and adherence. Domain Physical Aspects of Care; Psychological and Psychiatric Aspects of Care
Palliative Care and Advanced Heart Failure Management: Meeting at the Crossroads? (317-C) Parag Bharadwaj, MD, Cedars-Sinai Medical Center, Los Angeles, CA. Helen Ansari, MD, Cedars-Sinai Medical Center, Los Angeles, CA.
Vol. 41 No. 1 January 2011
Schedule with Abstracts
Arvind Shinde, MD MBA MPH, San Diego Hospice and Institute of Palliative Medicine, San Diego, CA. Ernst Schwarz, MD PhD, Cedars Sinai Medical Center, Los Angeles, CA. (All speakers for this session have disclosed no relevant financial relationships.) Objectives 1. Identify the need for palliative care in patients with advanced stages of heart failure. 2. Describe the role of palliative care consultation service with heart failure service. 3. Discuss the outcomes of the experience. Background. Approximately 2,200 heart transplants are performed every year in the United States. In 2008e2009, 26 heart transplants were performed at Cedars-Sinai Medical Center (CSMC) while 76 patients were evaluated for advanced surgical therapies including heart transplantation. Research objectives. Study the outcomes, benefits, and impact of introducing a palliative care consultation service in the care of patients with advanced heart disease. Methods. A palliative care consultation was obtained by the heart failure team for one or more of the following: symptom management, advance care planning, clarification of goals, support to patients and families, and end-oflife care/hospice referral. Results. Data of the first 20 patients referred by the heart failure service at CSMC to the palliative care consultation service was analyzed. Two patients received a successful heart transplant. Three patients received an LVAD as destination therapy. BIVAD was placed in one patient as a bridge to transplant. Four patients had received a heart transplant in the past. Five patients were identified as not being a candidate for a heart transplant. Two patients were discharged home on hospice and two patients received end-of-life care in the hospital. Valuable feedback was reported by the heart failure service, patients, and their families. The heart failure service observed that the involvement of palliative care improved patient care and transition, a surprising decrease in the use of opioids and improved efficiency of their service. Patients and families reported better symptom control and improved planning of course of treatment. This experience has changed the perception of palliative care involvement not being limited solely to end-of-life care.
201
Conclusion. Palliative care is an integral part of providing comprehensive care to patients with advanced heart failure. Its involvement should be independent of the prognosis or treatment goal. Implications for research, policy, or practice. Palliative care should be the standard of care in this patient population. Domain Physical Aspects of Care; Psychological and Psychiatric Aspects of Care
Educational Impact of Weekly E-mailed Fast Facts and Concepts (318-A) Rene Claxton, MD, University of Pittsburgh Medical Center, Pittsburgh, PA. Robert Arnold, MD, University of Pittsburgh, Pittsburgh, PA. (All speakers for this session have disclosed no relevant financial relationships.) Objectives 1. Describe the constraints facing current medical education which limit the addition of palliative care curricular innovations to residency training. 2. Describe the educational benefit of weekly e-mailed Fast Facts and Concepts to internal medicine residents in terms of resident medical knowledge, self-reported preparedness, and satisfaction. 3. Describe the advantages and limitations of weekly e-mails as an educational tool in residency training. Background. Educational interventions such as electives, case discussions, didactics, and webbased teaching have been shown to improve residents’ knowledge, attitudes, and skills. However, integrating curricular innovations into residency training is difficult due to limited time, faculty, and cost. Time- and cost-effective educational methods are increasingly desirable. Research objectives. Assess the educational impact of weekly Fast Fact and Concept (FFAC) e-mails on residents’ knowledge of palliative care topics, self-reported preparedness in palliative care skills, and satisfaction with palliative care education. Methods. Internal medicine interns at the University of Pittsburgh and Medical College of Wisconsin were randomized to control and intervention groups. Pre- and posttests assessed knowledge through 24 multiple choice questions, preparedness on 14 skills via a 4-point