- Email: [email protected]
Patient Navigation Interventions to Improve Palliative Care for the Underserved: Integrating the Voice of the Community and Scientific Rigor (335)
Vol. 43 No. 2 February 2012
Schedule With Abstracts
for healing, authentic collaboration, and creation of healthier work environments. Navigating moral distress with integrity requires the cultivation of capacities for focused attention, emotional stability, curiosity and inquiry, and authentic presence. This experiential and interactive session will explore the dimensions of moral distress in palliative care through the application of current research findings, theoretical constructs, clinical experience, and contemplative practices. Participants will engage in mindfulness and reflective practices to examine their responses to situations involving moral distress and explore ways to stabilize their minds and emotions when activated. Strategies for supporting themselves and each otherdand thereby enhancing professionalism, integrity, and a healthy work environmentdwill be discussed.
Palliative Care for COPD (334) John Morris, MD, Four Seasons Hospice, Flat Rock, NC. (Morris has disclosed no relevant financial relationships.) Objectives 1. Identify GOLD criteria for COPD staging and guidelines for COPD treatment at each stage of COPD. 2. Identify and manage the special palliative care needs of COPD patients. 3. Discuss a model program to improve care for COPD patients at end-of-life. COPD is the 4th leading cause of death worldwide and expected to continue to increase. COPD patients experience more symptoms than other patients and have less access to palliative care and hospice. Four Seasons has a large community-based palliative care program with 6 FTE physicians and 10 FTE NPs and PAs. Four Seasons won a Circle of Life award in 2009 for innovative end of life programs including the COPD program discussed in this concurrent session. My expertise as a pulmonary physician and palliative medicine physician led me to develop a special program to improve care for COPD patients. I will discuss the epidemiology and burdens of COPD care, as well as review the current GOLD guidelines for staging COPD and treating COPD. As COPD patients progress, there are special symptoms and needs that can be best addressed by interdisciplinary palliative care teams. Pharmacologic and non-pharmacologic symptom management in COPD will be
361
reviewed. American Thoracic Society and American College of Chest Physicians guidelines for palliative care in COPD will be reviewed with a discussion of how to engage pulmonary colleagues on the benefits of palliative care and hospice care for COPD. Prognostication will be reviewed with special emphasis on determining hospice eligibility using evidenced based guidelines from recently published pulmonary literature. Finally I will discuss a Four Seasons Pulmonary Program developed to meet the special needs of COPD patients in hospice care and reduce readmission rates to hospitals. The components of this special hospice program to be discussed include (a) Four Seasons staff education program, (b) patient and family education modules on COPD (comprised of six teaching units), and (c) protocols for home management of COPD. Participants will develop an understanding of the elements included in evidenced based palliative care and hospice programs for COPD patients.
Patient Navigation Interventions to Improve Palliative Care for the Underserved: Integrating the Voice of the Community and Scientific Rigor (335) Stacy Fischer, MD, University of Colorado School of Medicine, Aurora, CO. Joshua Hauser, MD, Northwestern University, Evanston, IL. (All authors listed above for this session have disclosed no relevant financial relationships with the following exceptions: Hauser is on the advisory board and received an honorarium from CVS.) Objectives 1. Discuss how patient navigators delivering a culturally tailored intervention can address and improve palliative care outcomes for underserved populations. 2. Recognize how to design, implement, and manualize a palliative care training curriculum for a patient navigator. 3. Recognize basic process measures and techniques to ensure scientific rigor in palliative care patient navigator interventions. Palliative care recognizes that cultural values can have a major impact on care preferences at the end of life for many patients. Therefore, a onesize-fits-all approach will not be sufficient and may widen the gap of cultural differences and health disparities in palliative care. Community-based culturally tailored interventions,
362
Schedule With Abstracts
often utilizing community health workers or patient navigators, have been shown to reduce health disparities in preventive health, cancer screening, diagnosis, and treatment. In this session we will describe the use of patient navigators to deliver culturally tailored interventions and show how a novel patient navigator intervention can improve palliative care outcomes for underserved populations. We will discuss the history of patient navigation, how the principles and strategies of patient navigation integrate with palliative care, and demonstrate how to develop and manualize a training curriculum that can be tailored to specific populations and designed to target specific symptoms or aspects of palliative care. We will also demonstrate the need for process and outcome measures for patient navigator interventions. Participants will learn the basic principles and importance of measuring processes such as fidelity to the intervention, tracking cost of the interventions and health care utilization, and approaches to measuring actual processes of the intervention. The patient navigator model offers a unique and important opportunity to improve palliative care outcomes, build trust, and improve communication with underserved communities. However, the challenge for these interventions is to maintain methodological rigor so that successful interventions can be replicated and measured in a way that moves the field forward and elevates the state of science for palliative care.
Models and Approaches to Developing Integrated Palliative Care Systems (336) Kathleen Bickel, MD MPhil, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI. Phillip Rodgers, MD FAAHPM, University of Michigan, Ann Arbor, MI. Diane Meier, MD FACP FAAHPM, Mount Sinai School of Medicine, Center to Advance Palliative Care, and Lilian and Benjamin Hertzberg Palliative Care Institute, New York, NY. Robert Arnold, MD FAAHPM, University of Pittsburgh, Pittsburgh, PA. Anna Loengard, MD, St. Francis Healthcare System, Honolulu, HI. Vicki Jackson, MD MPH, Massachusetts General Hospital, Boston, MA. (All authors listed above for this session have disclosed no relevant financial relationships.) Objectives 1. Describe the key characteristics of effective healthcare collaborations that include hospice and palliative medicine providers.
Vol. 43 No. 2 February 2012
2. Describe ongoing changes in the U.S. healthcare payor system and recent initiatives. 3. Identify potential opportunities for increased collaboration/integration with local institutions and care providers. Changes within the U.S. healthcare system are placing increasing emphasis on collaboration and cooperation through models such as the Patient-Centered Medical Home (PCMH) and Accountable Care Organizations (ACOs). PCMHs and ACOs hold the promise of higher quality and streamlined care but require a change from the traditional fee-for-service mentality. Hospice and palliative medicine (HPM) providers can play an important role in these new models of care. However, the challenge is determining the most effective and most useful strategies to integrate existing HPM providers/teams into various local heathcare infrastructures. This session will highlight the organizational structure of several evolving collaborative models, including both community-based and academic groups. We will describe the known issues and successes of these models, along with an update of the current payor landscape. Using this information, we will then discuss initial strategies that HPM groups may find useful to enhance their local collaborative efforts with hospitals, nursing facilities, and outpatient care providers.
Visitor in a Foreign Land: Consultation Etiquette in the Emergency Department (337) Tammie Quest, MD, Emory University, Atlanta, GA. David Weissman, MD, Palliative Care Education, LLC, Shorewood, WI. (All authors listed above for this session have disclosed no relevant financial relationships.) Objectives 1. Describe key elements of ED practice/ culture that PC consultants need to be aware of. 2. Review 10 steps of effective palliative care consultations in the ED. 3. List three methods for improving Palliative Care-ED relationships. Palliative care and emergency department partnerships can be key in the growth of a palliative care program. Palliative care consultants can assist the ED in (a) attempting to rapidly achieve consensus about goals of care, (b) assisting with challenging symptom management problems,
Schedule With Abstracts
for healing, authentic collaboration, and creation of healthier work environments. Navigating moral distress with integrity requires the cultivation of capacities for focused attention, emotional stability, curiosity and inquiry, and authentic presence. This experiential and interactive session will explore the dimensions of moral distress in palliative care through the application of current research findings, theoretical constructs, clinical experience, and contemplative practices. Participants will engage in mindfulness and reflective practices to examine their responses to situations involving moral distress and explore ways to stabilize their minds and emotions when activated. Strategies for supporting themselves and each otherdand thereby enhancing professionalism, integrity, and a healthy work environmentdwill be discussed.
Palliative Care for COPD (334) John Morris, MD, Four Seasons Hospice, Flat Rock, NC. (Morris has disclosed no relevant financial relationships.) Objectives 1. Identify GOLD criteria for COPD staging and guidelines for COPD treatment at each stage of COPD. 2. Identify and manage the special palliative care needs of COPD patients. 3. Discuss a model program to improve care for COPD patients at end-of-life. COPD is the 4th leading cause of death worldwide and expected to continue to increase. COPD patients experience more symptoms than other patients and have less access to palliative care and hospice. Four Seasons has a large community-based palliative care program with 6 FTE physicians and 10 FTE NPs and PAs. Four Seasons won a Circle of Life award in 2009 for innovative end of life programs including the COPD program discussed in this concurrent session. My expertise as a pulmonary physician and palliative medicine physician led me to develop a special program to improve care for COPD patients. I will discuss the epidemiology and burdens of COPD care, as well as review the current GOLD guidelines for staging COPD and treating COPD. As COPD patients progress, there are special symptoms and needs that can be best addressed by interdisciplinary palliative care teams. Pharmacologic and non-pharmacologic symptom management in COPD will be
361
reviewed. American Thoracic Society and American College of Chest Physicians guidelines for palliative care in COPD will be reviewed with a discussion of how to engage pulmonary colleagues on the benefits of palliative care and hospice care for COPD. Prognostication will be reviewed with special emphasis on determining hospice eligibility using evidenced based guidelines from recently published pulmonary literature. Finally I will discuss a Four Seasons Pulmonary Program developed to meet the special needs of COPD patients in hospice care and reduce readmission rates to hospitals. The components of this special hospice program to be discussed include (a) Four Seasons staff education program, (b) patient and family education modules on COPD (comprised of six teaching units), and (c) protocols for home management of COPD. Participants will develop an understanding of the elements included in evidenced based palliative care and hospice programs for COPD patients.
Patient Navigation Interventions to Improve Palliative Care for the Underserved: Integrating the Voice of the Community and Scientific Rigor (335) Stacy Fischer, MD, University of Colorado School of Medicine, Aurora, CO. Joshua Hauser, MD, Northwestern University, Evanston, IL. (All authors listed above for this session have disclosed no relevant financial relationships with the following exceptions: Hauser is on the advisory board and received an honorarium from CVS.) Objectives 1. Discuss how patient navigators delivering a culturally tailored intervention can address and improve palliative care outcomes for underserved populations. 2. Recognize how to design, implement, and manualize a palliative care training curriculum for a patient navigator. 3. Recognize basic process measures and techniques to ensure scientific rigor in palliative care patient navigator interventions. Palliative care recognizes that cultural values can have a major impact on care preferences at the end of life for many patients. Therefore, a onesize-fits-all approach will not be sufficient and may widen the gap of cultural differences and health disparities in palliative care. Community-based culturally tailored interventions,
362
Schedule With Abstracts
often utilizing community health workers or patient navigators, have been shown to reduce health disparities in preventive health, cancer screening, diagnosis, and treatment. In this session we will describe the use of patient navigators to deliver culturally tailored interventions and show how a novel patient navigator intervention can improve palliative care outcomes for underserved populations. We will discuss the history of patient navigation, how the principles and strategies of patient navigation integrate with palliative care, and demonstrate how to develop and manualize a training curriculum that can be tailored to specific populations and designed to target specific symptoms or aspects of palliative care. We will also demonstrate the need for process and outcome measures for patient navigator interventions. Participants will learn the basic principles and importance of measuring processes such as fidelity to the intervention, tracking cost of the interventions and health care utilization, and approaches to measuring actual processes of the intervention. The patient navigator model offers a unique and important opportunity to improve palliative care outcomes, build trust, and improve communication with underserved communities. However, the challenge for these interventions is to maintain methodological rigor so that successful interventions can be replicated and measured in a way that moves the field forward and elevates the state of science for palliative care.
Models and Approaches to Developing Integrated Palliative Care Systems (336) Kathleen Bickel, MD MPhil, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI. Phillip Rodgers, MD FAAHPM, University of Michigan, Ann Arbor, MI. Diane Meier, MD FACP FAAHPM, Mount Sinai School of Medicine, Center to Advance Palliative Care, and Lilian and Benjamin Hertzberg Palliative Care Institute, New York, NY. Robert Arnold, MD FAAHPM, University of Pittsburgh, Pittsburgh, PA. Anna Loengard, MD, St. Francis Healthcare System, Honolulu, HI. Vicki Jackson, MD MPH, Massachusetts General Hospital, Boston, MA. (All authors listed above for this session have disclosed no relevant financial relationships.) Objectives 1. Describe the key characteristics of effective healthcare collaborations that include hospice and palliative medicine providers.
Vol. 43 No. 2 February 2012
2. Describe ongoing changes in the U.S. healthcare payor system and recent initiatives. 3. Identify potential opportunities for increased collaboration/integration with local institutions and care providers. Changes within the U.S. healthcare system are placing increasing emphasis on collaboration and cooperation through models such as the Patient-Centered Medical Home (PCMH) and Accountable Care Organizations (ACOs). PCMHs and ACOs hold the promise of higher quality and streamlined care but require a change from the traditional fee-for-service mentality. Hospice and palliative medicine (HPM) providers can play an important role in these new models of care. However, the challenge is determining the most effective and most useful strategies to integrate existing HPM providers/teams into various local heathcare infrastructures. This session will highlight the organizational structure of several evolving collaborative models, including both community-based and academic groups. We will describe the known issues and successes of these models, along with an update of the current payor landscape. Using this information, we will then discuss initial strategies that HPM groups may find useful to enhance their local collaborative efforts with hospitals, nursing facilities, and outpatient care providers.
Visitor in a Foreign Land: Consultation Etiquette in the Emergency Department (337) Tammie Quest, MD, Emory University, Atlanta, GA. David Weissman, MD, Palliative Care Education, LLC, Shorewood, WI. (All authors listed above for this session have disclosed no relevant financial relationships.) Objectives 1. Describe key elements of ED practice/ culture that PC consultants need to be aware of. 2. Review 10 steps of effective palliative care consultations in the ED. 3. List three methods for improving Palliative Care-ED relationships. Palliative care and emergency department partnerships can be key in the growth of a palliative care program. Palliative care consultants can assist the ED in (a) attempting to rapidly achieve consensus about goals of care, (b) assisting with challenging symptom management problems,