- Email: [email protected]
The Intersection of Research and Clinical Practice: The Art and Science of Reading a Paper (FR458)
376
Schedule With Abstracts
for community-based palliative care. Audience participation will include discussion of instances where such arguments for community-based palliative care have worked, and where they have not.
The Intersection of Research and Clinical Practice: The Art and Science of Reading a Paper (FR458) Donna Zhukovsky, MD FACP FAAHPM, MD Anderson Cancer Center, Houston, TX. David Hui, MD MS MSC, MD Anderson Cancer Center, Houston, TX. Ronit Elk, PhD, University of South Carolina, Columbia, SC. Objectives Review the process of searching for relevant articles to the clinical question of interest. Demonstrate an overview of a systematic process for critically evaluating quality of quantitative manuscripts reporting clinical research. Provide a paradigm to evaluate applicability of research results to hospice and palliative care clinical practice. With the recent explosion of technology and social media platforms, busy clinicians are continuously bombarded with data. Not all data are worthy of the same attention or have implications for the practice of hospice and palliative medicine. Using a journal club format, the presenters, a palliative care tenured physician scientist, an academic palliative care clinician and a PhD researcher and former American Cancer Society study section program director, will discuss the art of scientific reading. We will start by discussing how to identify relevant studies by formulating the appropriate clinical question. As busy clinicians and researchers often do not have time to read beyond the abstract, we will then illustrate the importance of reading beyond the abstract, as a thorough review of the manuscript often provides important insights, and may sometimes lead the reader to reach a different conclusion, highlighting the need to ‘‘dig deeper.’’ Next, we will demonstrate an efficient way to screen published research in order to decide if the work is of sufficient quality to merit further review and to determine if study results are valid and clinically significant. Moving on we will apply the evidence-based medicine framework to critically appraise some recently published research articles, answering 3 key questions: ‘‘Are the results valid?’’ ‘‘What are the results?’’ ‘‘Are the results applicable to my practice?’’ Emphasis will be placed on the process of assessing the methods (e.g. sample size, study dates, eligibility criteria, nature of control group, outcome measures). Finally, the panelists will discuss the process of knowledge translation and how to make sense of the rapidly evolving literature to inform clinical
Vol. 53 No. 2 February 2017
decision making. By the conclusion of the session, it is anticipated that participants will be better able to efficiently incorporate evidence-based medicine into their clinical practice.
Caring for Patients Whose Decision-Makers Have Questionable Capacity: Ethical and Clinical Concerns (FR459) Jeffrey Berger, MD FACP, Winthrop Hospital, Mineola, NY. Joel Frader, MD FAAP, Lurie Children’s Hospital, Chicago, IL. Bridget Sumser, LMSW ACHP-SW, University of California San Francisco Medical Center, San Francisco, CA. Objectives Describe the phenomenon of decision makers with questionable capacity and its ethical implications in adult care. Explore the ethical implications and obligations associated with care of pediatric patients whose decision makers may lack adequate capacity to make needed decisions. Discuss strategies for managing situations involving decision makers suspected of being impaired. Palliative care clinicians commonly face high complexity and stressful decision making. Decisions by surrogates occur for 25%-30% of hospitalized adults, and in pediatrics parents usually serve as legal surrogates. The ethical and legal authority for such decisions is well established. However, not well described are problems with decisionmakers suspected of impaired decisional capacity. These individuals may have well-recognized or undiagnosed psychiatric disorders, impairment from substance abuse, or cognitive disorders such as dementias. Unfortunately, clinicians caring for the index patient have no standing to formally assess surrogates, to substantiate suspicions that the decision maker are impaired, or to direct them to health care services. In some circumstances, e.g., suspected abuse or neglect of minors or elders, clinicians may have options for reporting surrogates to public authorities. In all cases, clinicians may have ethical obligations to intervene on behalf of dependent, vulnerable patients. Clinicians may also have ethical duties to the impaired decision maker, even without a clinician-patient relationship. How ought clinicians manage these circumstances? In this presentation we discuss these challenges from the perspectives of a pediatric palliative care physician, an adult palliative care physician, and a palliative care social worker.
Neither Hastening nor Prolonging Death: Hospice in a State with Legalized PhysicianAssisted Death (FR460) Krista Harrison, PhD, University of California San Francisco, San Francisco, CA. Margaret Bourne, MD
Schedule With Abstracts
for community-based palliative care. Audience participation will include discussion of instances where such arguments for community-based palliative care have worked, and where they have not.
The Intersection of Research and Clinical Practice: The Art and Science of Reading a Paper (FR458) Donna Zhukovsky, MD FACP FAAHPM, MD Anderson Cancer Center, Houston, TX. David Hui, MD MS MSC, MD Anderson Cancer Center, Houston, TX. Ronit Elk, PhD, University of South Carolina, Columbia, SC. Objectives Review the process of searching for relevant articles to the clinical question of interest. Demonstrate an overview of a systematic process for critically evaluating quality of quantitative manuscripts reporting clinical research. Provide a paradigm to evaluate applicability of research results to hospice and palliative care clinical practice. With the recent explosion of technology and social media platforms, busy clinicians are continuously bombarded with data. Not all data are worthy of the same attention or have implications for the practice of hospice and palliative medicine. Using a journal club format, the presenters, a palliative care tenured physician scientist, an academic palliative care clinician and a PhD researcher and former American Cancer Society study section program director, will discuss the art of scientific reading. We will start by discussing how to identify relevant studies by formulating the appropriate clinical question. As busy clinicians and researchers often do not have time to read beyond the abstract, we will then illustrate the importance of reading beyond the abstract, as a thorough review of the manuscript often provides important insights, and may sometimes lead the reader to reach a different conclusion, highlighting the need to ‘‘dig deeper.’’ Next, we will demonstrate an efficient way to screen published research in order to decide if the work is of sufficient quality to merit further review and to determine if study results are valid and clinically significant. Moving on we will apply the evidence-based medicine framework to critically appraise some recently published research articles, answering 3 key questions: ‘‘Are the results valid?’’ ‘‘What are the results?’’ ‘‘Are the results applicable to my practice?’’ Emphasis will be placed on the process of assessing the methods (e.g. sample size, study dates, eligibility criteria, nature of control group, outcome measures). Finally, the panelists will discuss the process of knowledge translation and how to make sense of the rapidly evolving literature to inform clinical
Vol. 53 No. 2 February 2017
decision making. By the conclusion of the session, it is anticipated that participants will be better able to efficiently incorporate evidence-based medicine into their clinical practice.
Caring for Patients Whose Decision-Makers Have Questionable Capacity: Ethical and Clinical Concerns (FR459) Jeffrey Berger, MD FACP, Winthrop Hospital, Mineola, NY. Joel Frader, MD FAAP, Lurie Children’s Hospital, Chicago, IL. Bridget Sumser, LMSW ACHP-SW, University of California San Francisco Medical Center, San Francisco, CA. Objectives Describe the phenomenon of decision makers with questionable capacity and its ethical implications in adult care. Explore the ethical implications and obligations associated with care of pediatric patients whose decision makers may lack adequate capacity to make needed decisions. Discuss strategies for managing situations involving decision makers suspected of being impaired. Palliative care clinicians commonly face high complexity and stressful decision making. Decisions by surrogates occur for 25%-30% of hospitalized adults, and in pediatrics parents usually serve as legal surrogates. The ethical and legal authority for such decisions is well established. However, not well described are problems with decisionmakers suspected of impaired decisional capacity. These individuals may have well-recognized or undiagnosed psychiatric disorders, impairment from substance abuse, or cognitive disorders such as dementias. Unfortunately, clinicians caring for the index patient have no standing to formally assess surrogates, to substantiate suspicions that the decision maker are impaired, or to direct them to health care services. In some circumstances, e.g., suspected abuse or neglect of minors or elders, clinicians may have options for reporting surrogates to public authorities. In all cases, clinicians may have ethical obligations to intervene on behalf of dependent, vulnerable patients. Clinicians may also have ethical duties to the impaired decision maker, even without a clinician-patient relationship. How ought clinicians manage these circumstances? In this presentation we discuss these challenges from the perspectives of a pediatric palliative care physician, an adult palliative care physician, and a palliative care social worker.
Neither Hastening nor Prolonging Death: Hospice in a State with Legalized PhysicianAssisted Death (FR460) Krista Harrison, PhD, University of California San Francisco, San Francisco, CA. Margaret Bourne, MD