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Predicting Prognosis and Palliative Care Potential for Congestive Heart Patients Using the Seattle Heart Failure Model (721)
Vol. 37 No.3 March 2009
Schedule with Abstracts
to provide optimal comfort, and unless death is imminent; invasive treatment should be considered. Resection, bypass, or ostomy can be done surgically or laparoscopically. Surgical approach is preferable due to commonly encountered adhesions and metastases. These options often carry considerable morbidity and mortality, and the rate of recurrence of obstruction is often high. Different observational studies showed improvement on patient’s quality of life after surgery. Endoscopic stent or PEG tube placement is an alternative approach. II. Case Description. An 87-year-old man presented with worsening bowel obstruction. The patient was receiving palliative care since he was found to have a large pelvic mass secondary to recurrent metastatic prostate adenocarcinoma. Although his symptoms were treated effectively with antiemetics, anticholinergics, and nasogastric suctioning; he continued to have a compromised quality of life by inability to eat, and nasogastric tube-related discomfort. He had no other significant complaints. Imaging studies revealed terminal ileum obstruction. Because of prior high-dose radiation treatment, palliative radiation therapy was deemed inappropriate. Laparoscopic ileostomy was performed. The patient had a remarkable improvement. Within 3 days the nasogastric tube was removed, and he was able to eat without complications. He was discharged home with hospice. He had no reported gastrointestinal complaints before he died at home 3 weeks after discharge. III. Conclusion. Invasive management of malignant bowel obstruction should be considered when it is expected to improve the quality of life in terminally ill patients with a manageable perioperative risk.
Palliative Care Physician, Nursing, Social Work, and Chaplain Fellowships that Educate, Increase Referrals, and Recruit Staff (720) Gillian Hamilton, MD PhD, Hospice of the Valley, Phoenix, AZ; Vicki Hochstetler, BA, Hospice of the Valley, Phoenix, AZ; Lee Ann Black, MSW, Hospice of the Valley, Phoenix, AZ; Betheny Rodden, RN, Hospice of the Valley, Phoenix, AZ Objectives 1. Describe how to design and implement a 1-week resident physician rotation in palliative
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care. 2. Know how to develop a Palliative Care Nursing, Social Work, and Chaplain Fellowship. 3. Recognize the factors involved in fellowship design that maximize subsequent referral. I. Background. Hospice of the Valley (HOV) in 2006 developed a model program for teaching palliative care to resident physicians. Subsequently, palliative care fellowships for nurses, social workers, and chaplains were developed and evaluated. II. Aims. The aim of the poster session is to describe how to develop each program, and to show evaluations for each program and research data comparing disciplines. III. Methods/Session Descriptions. HOV in 2006 developed a model program for teaching palliative care to resident physicians. Local internal medicine, family practice, pediatric, psychiatry, and surgery residents are required to spend 1 week with HOV completing online, interactive teaching modules, being mentored by physicians, social workers, and chaplains, and viewing a model dementia unit. Over 120 physicians complete the program each year, with final reports tied to ACGME competencies (a sample report card will be displayed). In 2007 a Palliative Care Nursing Fellowship was developed. Ten community-based nurses complete the 2-day fellowship each month, spending one half-day learning about hospice, advance directives/ethics, and dementia care; one day doing home and palliative care unit visits with hospice nurses; and one half day of journaling, discussion, and online evaluation. The program has been phenomenally successful, with changes in practice and attitude clearly documented in immediate and 6-month evaluations. Due to the success of the nursing fellowship, the program was expanded to include social workers and chaplains. They became equally enthusiastic about palliative care and hospice referrals. Evaluation was a major component. Each program was independently evaluated by the Columbia Institute of Learning Technologies after each session and again 6 months later; results and comparative data from all disciplines will be shared. The poster materials will include schedules; interactive online teaching modules including video clips; evaluation forms; journals; and research evaluation data.
Schedule with Abstracts
to provide optimal comfort, and unless death is imminent; invasive treatment should be considered. Resection, bypass, or ostomy can be done surgically or laparoscopically. Surgical approach is preferable due to commonly encountered adhesions and metastases. These options often carry considerable morbidity and mortality, and the rate of recurrence of obstruction is often high. Different observational studies showed improvement on patient’s quality of life after surgery. Endoscopic stent or PEG tube placement is an alternative approach. II. Case Description. An 87-year-old man presented with worsening bowel obstruction. The patient was receiving palliative care since he was found to have a large pelvic mass secondary to recurrent metastatic prostate adenocarcinoma. Although his symptoms were treated effectively with antiemetics, anticholinergics, and nasogastric suctioning; he continued to have a compromised quality of life by inability to eat, and nasogastric tube-related discomfort. He had no other significant complaints. Imaging studies revealed terminal ileum obstruction. Because of prior high-dose radiation treatment, palliative radiation therapy was deemed inappropriate. Laparoscopic ileostomy was performed. The patient had a remarkable improvement. Within 3 days the nasogastric tube was removed, and he was able to eat without complications. He was discharged home with hospice. He had no reported gastrointestinal complaints before he died at home 3 weeks after discharge. III. Conclusion. Invasive management of malignant bowel obstruction should be considered when it is expected to improve the quality of life in terminally ill patients with a manageable perioperative risk.
Palliative Care Physician, Nursing, Social Work, and Chaplain Fellowships that Educate, Increase Referrals, and Recruit Staff (720) Gillian Hamilton, MD PhD, Hospice of the Valley, Phoenix, AZ; Vicki Hochstetler, BA, Hospice of the Valley, Phoenix, AZ; Lee Ann Black, MSW, Hospice of the Valley, Phoenix, AZ; Betheny Rodden, RN, Hospice of the Valley, Phoenix, AZ Objectives 1. Describe how to design and implement a 1-week resident physician rotation in palliative
541
care. 2. Know how to develop a Palliative Care Nursing, Social Work, and Chaplain Fellowship. 3. Recognize the factors involved in fellowship design that maximize subsequent referral. I. Background. Hospice of the Valley (HOV) in 2006 developed a model program for teaching palliative care to resident physicians. Subsequently, palliative care fellowships for nurses, social workers, and chaplains were developed and evaluated. II. Aims. The aim of the poster session is to describe how to develop each program, and to show evaluations for each program and research data comparing disciplines. III. Methods/Session Descriptions. HOV in 2006 developed a model program for teaching palliative care to resident physicians. Local internal medicine, family practice, pediatric, psychiatry, and surgery residents are required to spend 1 week with HOV completing online, interactive teaching modules, being mentored by physicians, social workers, and chaplains, and viewing a model dementia unit. Over 120 physicians complete the program each year, with final reports tied to ACGME competencies (a sample report card will be displayed). In 2007 a Palliative Care Nursing Fellowship was developed. Ten community-based nurses complete the 2-day fellowship each month, spending one half-day learning about hospice, advance directives/ethics, and dementia care; one day doing home and palliative care unit visits with hospice nurses; and one half day of journaling, discussion, and online evaluation. The program has been phenomenally successful, with changes in practice and attitude clearly documented in immediate and 6-month evaluations. Due to the success of the nursing fellowship, the program was expanded to include social workers and chaplains. They became equally enthusiastic about palliative care and hospice referrals. Evaluation was a major component. Each program was independently evaluated by the Columbia Institute of Learning Technologies after each session and again 6 months later; results and comparative data from all disciplines will be shared. The poster materials will include schedules; interactive online teaching modules including video clips; evaluation forms; journals; and research evaluation data.