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Validation of a Chinese Version of the Spiritual Needs Assessment for Patients (SNAP) (410-C)
Vol. 43 No. 2 February 2012
Schedule With Abstracts
MS, MD Anderson Cancer Center, Houston, TX. Takamaru Ashikaga, PhD, University of Vermont, Burlington, VT. Steven Grunberg, FACP, University of Vermont, Burlington, VT. Mitsunori Miyashita, PhD, Tohoku University Graduate School of Medicine, Sendai, Miyagi. (All authors listed above for this session have disclosed no relevant financial relationships with the following exception: Grunberg is on the speaker advisory board and receives an honoraria, consulting fees and is a stockholder; is a consultant and receives consulting fees from Helsinn; is on the advisory board and receives consulting fees from Archimedes Pharma.) Objectives 1. Describe how acculturation influences the preferences for place of end-of-life cancer care among individuals of Japanese ancestry living in America. 2. Describe how acculturation influences the preferences for place of death among individuals of Japanese ancestry living in America. 3. Describe how acculturation influences the preferences of prognosis disclosure among individuals of Japanese ancestry living in America. Background. Although more than 1.2 million Japanese Americans, with a wide range of generations, live in America, little is known about the impact of acculturation on their preferences about EOL cancer care. Research objective. To demonstrate differences in the preferences about EOL cancer care among Japanese Americans (JA/A), Japanese in America (J/A), and Japanese in Japan (J/J). Method. Self-administered questionnaires were distributed to JA/A and J/A who participated in two social events in New York and West Virginia and members of two Japanese American organizations. Respondents were asked to state their preferences for place of EOL care and death as well as prognostic disclosure. The questionnaires were previously used in a Japanese nationwide study and its results were used as J/J data. Chi-square tests were used to compare outcomes among the three groups. Result. 140 JA/A, 301 J/A, and 2,548 J/J responded to the survey. JA/A and J/A were more likely than J/J to be older (40%, 31%, 17%, respectively, were more than 70 years old; p < 0.0001).
373
Conclusion. Preferences about EOL cancer care differ significantly among JA/A, J/A, and J/J, reflecting prevailing attitudes in American/ Japanese societies. Implications for research, policy, or practice. Appreciation of different acculturation levels among individuals of Japanese ancestry may improve EOL communication.
Validation of a Chinese Version of the Spiritual Needs Assessment for Patients (SNAP) (410-C) Rashmi Sharma, MD MHS, Northwestern University, Chicago, IL. Alan Astrow, MD, Maimonides Cancer Center, New York, NY. Daniel Sulmasy, MD PhD, University of Chicago, Chicago, IL. (All authors listed above for this session have disclosed no relevant financial relationships.) Objectives 1. Describe the development process for the Chinese version of the Spiritual Needs Assessment for Patients. 2. Describe the study sample. 3. Identify the results of the validation process. Background. Unmet spiritual needs have been associated with decreased patient ratings of quality of care, satisfaction, and quality of life. Few instruments exist to measure spiritual needs particularly among non-English speaking patients in the U.S. Research objective. To validate a Chinese version of the Spiritual Needs Assessment for Patients (SNAP). Method. The SNAP consists of 23 total items in 3 domains: psychosocial (n ¼ 5), spiritual (n ¼ 13), and religious (n ¼ 5). The Chinese SNAP was developed through a translation-back translation process and cognitive pretesting in 8 Chinese patients. The Chinese SNAP was administered to a convenience sample of 30 ambulatory Chinese cancer patients in New York. Internal reliability was assessed by the Cronbach’s a, test-retest reliability by Spearman’s correlation coefficients, and construct validity by comparing instrument scores to a previously used single item spiritual needs question. Result. Mean participant age was 65 years, 53% were male, 70% had less than a high school education, and 77% had Medicaid. Twenty three percent were Buddhist, 63% identified
374
Schedule With Abstracts
no religious affiliation, 83% described themselves as spiritual but not religious, 33% reported unmet spiritual needs, and 60% wanted help meeting their spiritual needs. The Cronbach’s a for the total SNAP was 0.89 and for the subscales was: psychosocial ¼ 0.58, spiritual ¼ 0.83, and religious needs ¼ 0.90. Test-retest correlation coefficients were: total SNAP ¼ 0.72, psychosocial needs ¼ 0.43, spiritual needs ¼ 0.73, and religious needs ¼ 0.72. Unmet spiritual needs, as assessed through a single-item question were not associated with higher SNAP scores in contrast to results of the English SNAP. Conclusion. The Chinese SNAP is a reliable instrument for measuring spiritual needs. Implications for research, policy, or practice. Lack of correlation between the SNAP and the single-item question on unmet spiritual needs suggests that the SNAP may capture patient needs that Chinese patients would not readily describe as spiritual whether due to cultural differences or educational level.
Benzodiazepines and the Management of Dyspnea in Palliative Care Patients (411-A) Patama Gomutbutra, MD, University of California San Francisco, San Francisco, CA. Davod O’Riordan, PhD, University of California San Francisco, San Francisco, CA. Kathleen Kerr, BA, University of California San Francisco, San Francisco, CA. Stevem Pantilat, MD, University of California San Francisco, San Francisco, CA. (All authors listed above for this session have disclosed no relevant financial relationships.) Objectives 1. Describe of the impact of BZD in improving dyspnea of chronically ill patients. 2. Describe dyspnea management in palliative care setting. Background. Benzodiazepines (BZD) are commonly prescribed for relief of dyspnea, yet there is little evidence describing the efficacy of the treatment of dyspnea in chronically ill patients. Research objective. To describe the impact of BZD in improving dyspnea of chronically ill patients. Method. A retrospective chart review was undertaken of adults with dyspnea seen by the UCSF Palliative Care Service (PCS) during 2005-2010. Dyspnea was assessed using a four-point
Vol. 43 No. 2 February 2012
categorical scale (0 ¼ none, 1 ¼ mild, 3 ¼ moderate, 4 ¼ severe). Result. We reviewed charts for 93.6% (308/330) of eligible cases. Patients were 66 years old, male (52%), white (52%), and diagnosed with lung cancer (40%), heart failure ([HF]¼24%), or COPD (19%). At baseline, most patients had either mild (53%), moderate (28%), or severe (19%) dyspnea. BZD were prescribed to 37% (n ¼ 113) of patients, with 66% (n ¼ 75) receiving BZD in the first 24 hours of being referred to the PCS. In multivariate logistic regression, variables associated with receiving BDZ included concurrent opioid use (OR ¼ 4.8, 95% CI ¼ 2.2, 10.3), gender (female: OR ¼ 1.7, 95% CI ¼ 1.1, 3.3), and age (OR ¼ 0.9, 95% CI ¼ 0.96, 0.99). Overall 56% (n ¼ 172) had a clinically meaningful improvement (1-point) in dyspnea at 24 hours, 38% (n ¼ 117) had no improvement, and 7% (n ¼ 20) got worse. A multivariate logistic regression indentified that the strongest predictors of a clinically meaningful improvement in dyspnea were age (OR ¼ 1.02, 95% CI ¼ 1.0, 1.03), and being prescribed BDZ (2.3, 95% CI ¼ 1.2, 4.2). Conclusion. BZD were associated with improvements in dyspnea among patients seen in a PCS. Implications for research, policy, or practice. BZD maybe an appropriate adjuvant treatment for dyspnea.
Rapid Treatments for Depression and Anxiety (411-B) Scott Irwin, MD PhD, The Institute for Palliative Medicine at San Diego Hospice, San Diego, CA. (Irwin has disclosed no relevant financial relationships.) Objectives 1. Recognize the significance of depression near the end of life. 2. Recognize new data suggesting ketamine and methylphenidate may rapidly ameliorate depression in patients receiving hospice care. 3. Discuss further investigation of ketamine and methylphenidate for the rapid treatment of depression in medically ill patients. Background. Depression is prevalent and undertreated in patients receiving hospice care. Standard antidepressants do not work rapidly or often enough to benefit most of these patients. Ketamine and methylphenidate may provide viable alternatives in this population.
Schedule With Abstracts
MS, MD Anderson Cancer Center, Houston, TX. Takamaru Ashikaga, PhD, University of Vermont, Burlington, VT. Steven Grunberg, FACP, University of Vermont, Burlington, VT. Mitsunori Miyashita, PhD, Tohoku University Graduate School of Medicine, Sendai, Miyagi. (All authors listed above for this session have disclosed no relevant financial relationships with the following exception: Grunberg is on the speaker advisory board and receives an honoraria, consulting fees and is a stockholder; is a consultant and receives consulting fees from Helsinn; is on the advisory board and receives consulting fees from Archimedes Pharma.) Objectives 1. Describe how acculturation influences the preferences for place of end-of-life cancer care among individuals of Japanese ancestry living in America. 2. Describe how acculturation influences the preferences for place of death among individuals of Japanese ancestry living in America. 3. Describe how acculturation influences the preferences of prognosis disclosure among individuals of Japanese ancestry living in America. Background. Although more than 1.2 million Japanese Americans, with a wide range of generations, live in America, little is known about the impact of acculturation on their preferences about EOL cancer care. Research objective. To demonstrate differences in the preferences about EOL cancer care among Japanese Americans (JA/A), Japanese in America (J/A), and Japanese in Japan (J/J). Method. Self-administered questionnaires were distributed to JA/A and J/A who participated in two social events in New York and West Virginia and members of two Japanese American organizations. Respondents were asked to state their preferences for place of EOL care and death as well as prognostic disclosure. The questionnaires were previously used in a Japanese nationwide study and its results were used as J/J data. Chi-square tests were used to compare outcomes among the three groups. Result. 140 JA/A, 301 J/A, and 2,548 J/J responded to the survey. JA/A and J/A were more likely than J/J to be older (40%, 31%, 17%, respectively, were more than 70 years old; p < 0.0001).
373
Conclusion. Preferences about EOL cancer care differ significantly among JA/A, J/A, and J/J, reflecting prevailing attitudes in American/ Japanese societies. Implications for research, policy, or practice. Appreciation of different acculturation levels among individuals of Japanese ancestry may improve EOL communication.
Validation of a Chinese Version of the Spiritual Needs Assessment for Patients (SNAP) (410-C) Rashmi Sharma, MD MHS, Northwestern University, Chicago, IL. Alan Astrow, MD, Maimonides Cancer Center, New York, NY. Daniel Sulmasy, MD PhD, University of Chicago, Chicago, IL. (All authors listed above for this session have disclosed no relevant financial relationships.) Objectives 1. Describe the development process for the Chinese version of the Spiritual Needs Assessment for Patients. 2. Describe the study sample. 3. Identify the results of the validation process. Background. Unmet spiritual needs have been associated with decreased patient ratings of quality of care, satisfaction, and quality of life. Few instruments exist to measure spiritual needs particularly among non-English speaking patients in the U.S. Research objective. To validate a Chinese version of the Spiritual Needs Assessment for Patients (SNAP). Method. The SNAP consists of 23 total items in 3 domains: psychosocial (n ¼ 5), spiritual (n ¼ 13), and religious (n ¼ 5). The Chinese SNAP was developed through a translation-back translation process and cognitive pretesting in 8 Chinese patients. The Chinese SNAP was administered to a convenience sample of 30 ambulatory Chinese cancer patients in New York. Internal reliability was assessed by the Cronbach’s a, test-retest reliability by Spearman’s correlation coefficients, and construct validity by comparing instrument scores to a previously used single item spiritual needs question. Result. Mean participant age was 65 years, 53% were male, 70% had less than a high school education, and 77% had Medicaid. Twenty three percent were Buddhist, 63% identified
374
Schedule With Abstracts
no religious affiliation, 83% described themselves as spiritual but not religious, 33% reported unmet spiritual needs, and 60% wanted help meeting their spiritual needs. The Cronbach’s a for the total SNAP was 0.89 and for the subscales was: psychosocial ¼ 0.58, spiritual ¼ 0.83, and religious needs ¼ 0.90. Test-retest correlation coefficients were: total SNAP ¼ 0.72, psychosocial needs ¼ 0.43, spiritual needs ¼ 0.73, and religious needs ¼ 0.72. Unmet spiritual needs, as assessed through a single-item question were not associated with higher SNAP scores in contrast to results of the English SNAP. Conclusion. The Chinese SNAP is a reliable instrument for measuring spiritual needs. Implications for research, policy, or practice. Lack of correlation between the SNAP and the single-item question on unmet spiritual needs suggests that the SNAP may capture patient needs that Chinese patients would not readily describe as spiritual whether due to cultural differences or educational level.
Benzodiazepines and the Management of Dyspnea in Palliative Care Patients (411-A) Patama Gomutbutra, MD, University of California San Francisco, San Francisco, CA. Davod O’Riordan, PhD, University of California San Francisco, San Francisco, CA. Kathleen Kerr, BA, University of California San Francisco, San Francisco, CA. Stevem Pantilat, MD, University of California San Francisco, San Francisco, CA. (All authors listed above for this session have disclosed no relevant financial relationships.) Objectives 1. Describe of the impact of BZD in improving dyspnea of chronically ill patients. 2. Describe dyspnea management in palliative care setting. Background. Benzodiazepines (BZD) are commonly prescribed for relief of dyspnea, yet there is little evidence describing the efficacy of the treatment of dyspnea in chronically ill patients. Research objective. To describe the impact of BZD in improving dyspnea of chronically ill patients. Method. A retrospective chart review was undertaken of adults with dyspnea seen by the UCSF Palliative Care Service (PCS) during 2005-2010. Dyspnea was assessed using a four-point
Vol. 43 No. 2 February 2012
categorical scale (0 ¼ none, 1 ¼ mild, 3 ¼ moderate, 4 ¼ severe). Result. We reviewed charts for 93.6% (308/330) of eligible cases. Patients were 66 years old, male (52%), white (52%), and diagnosed with lung cancer (40%), heart failure ([HF]¼24%), or COPD (19%). At baseline, most patients had either mild (53%), moderate (28%), or severe (19%) dyspnea. BZD were prescribed to 37% (n ¼ 113) of patients, with 66% (n ¼ 75) receiving BZD in the first 24 hours of being referred to the PCS. In multivariate logistic regression, variables associated with receiving BDZ included concurrent opioid use (OR ¼ 4.8, 95% CI ¼ 2.2, 10.3), gender (female: OR ¼ 1.7, 95% CI ¼ 1.1, 3.3), and age (OR ¼ 0.9, 95% CI ¼ 0.96, 0.99). Overall 56% (n ¼ 172) had a clinically meaningful improvement (1-point) in dyspnea at 24 hours, 38% (n ¼ 117) had no improvement, and 7% (n ¼ 20) got worse. A multivariate logistic regression indentified that the strongest predictors of a clinically meaningful improvement in dyspnea were age (OR ¼ 1.02, 95% CI ¼ 1.0, 1.03), and being prescribed BDZ (2.3, 95% CI ¼ 1.2, 4.2). Conclusion. BZD were associated with improvements in dyspnea among patients seen in a PCS. Implications for research, policy, or practice. BZD maybe an appropriate adjuvant treatment for dyspnea.
Rapid Treatments for Depression and Anxiety (411-B) Scott Irwin, MD PhD, The Institute for Palliative Medicine at San Diego Hospice, San Diego, CA. (Irwin has disclosed no relevant financial relationships.) Objectives 1. Recognize the significance of depression near the end of life. 2. Recognize new data suggesting ketamine and methylphenidate may rapidly ameliorate depression in patients receiving hospice care. 3. Discuss further investigation of ketamine and methylphenidate for the rapid treatment of depression in medically ill patients. Background. Depression is prevalent and undertreated in patients receiving hospice care. Standard antidepressants do not work rapidly or often enough to benefit most of these patients. Ketamine and methylphenidate may provide viable alternatives in this population.