GENERALIST PALLIATIVE CARE: MOVING FROM KNOWLEDGE TO CULTURE CHANGE AND PATIENT OUTCOMES

Wednesday, April 30, 2014

Eytan Szmuilowicz, MD
Director, Section of Palliative Medicine, Northwestern Medicine

Martha L. Twaddle, MD, FACP, FAAHPM
Chief Medical Officer, Midwest Palliative & Hospice Care Center

Generalist palliative care refers to the basic skills all clinicians should achieve in caring for patients with serious illness. Those skills include basic symptom assessment and management, psychosocial support and matching appropriate care provided to patient goals and values. Translating generalist palliative care skills to goal-consistent care requires cultural and systematic change.
The presenters will describe an initiative that focuses on communication skills development for clinicians of various backgrounds from hospitals across Illinois. Started in the fall of 2011 as part of a larger initiative to address high readmission rates, the program has grown to include participants from 29 hospitals across the state. In addition to describing the project and preliminary results, the presenters will discuss lessons learned, and describe next steps from simply teaching generalist palliative care skills to influencing patient outcomes.
Join Us!

What You'll Learn

• You will be able to define general palliative care and describe its importance in the continuum of care for seriously ill patients
• You will understand the link between goal-centered communication skills and high-quality medical care
• You will understand and be able to describe some of the steps necessary to move from general palliative care exposure to culture change
• You will be able to describe collateral benefits to your institution or system created by engaging in general palliative care development

Who Should Attend?

• Physician, nurse, social work, or chaplain palliative care educators
• Hospital and hospital system administrators
• Hospital and hospital system-quality improvement specialists
• Insurance company administrators and quality specialists

Call Details

• $99 per registered participant, which includes post event recording download
• Web conference event which requires live internet access. Audio portion may be accessed through toll line or through VOIP (computer speakers and/or headset/microphone).
• Payment is online by credit card only
• PowerPoint presentations accompany each event
• You will have the opportunity to participate in a Q&A session with the presenters
• Continue the discussion following the event at CAPCconnect™, the CAPC forum.

Any questions? Contact Margaret Schutz at (212) 201-2670 or margaret.schutz@mssm.edu

Symptom burden in palliative care patients: perspectives of patients, their family caregivers, and their attending physicians.

Oechsle K¹, Goerth K, Bokemeyer C, Mehnert A.

Author information

Abstract

RATIONALE:

The purpose of this study was to prospectively evaluate the perspectives of palliative care patients, their family caregivers, and their attending palliative care specialists on frequency, intensity, distress, and treatment requirement of the patient's physical and psychological symptoms.

PATIENTS AND METHODS:

Forty advanced cancer patients and their family caregivers were recruited through a palliative care inpatient ward within 24 h after admission. Patients, caregivers, and physicians completed a modified version of the Memorial Symptom Assessment Scale (including perceived treatment requirement).

RESULTS:

Thirty-nine patients (98 %) suffered from at least one symptom frequently or almost constantly (median number 5; range, 0-9). Most frequent symptoms were lack of energy (95 %), tiredness (88 %), and pain (80 %), which were scored correspondingly by patients, caregivers, and physicians to be the most intensive, distressing, and treatment requiring. Treatment requirement was determined by symptom intensity or distress in patients and physicians, but by distress in caregivers. Significant differences in symptom burden between patients, caregivers, and physicians were found with regard to pain (p = .007), tiredness (p = .037), lack of energy (p < .05), anxiety (p < .05), and sadness (p < .05). Physicians underestimated 60 % of symptom dimensions, while the caregivers overestimated 77 %; however, overall median scoring differences were limited with -.10 (range, -.55 to +.25) between patients and physicians and +.33 (range, -.78 to +.61) between patients and family caregivers.

CONCLUSIONS:

While physicians tended to underestimate, family caregivers tended to overestimate the patient's symptoms. 
Therefore, adequate symptom treatment can only be successful in a close dialog between patients, their caregivers, and a multidisciplinary team.

Antinociceptive Effects of Pomegranate
(Punica granatum L.) Juice and Seed Extracts
on Acute Corneal Pain in Mice
Zahra Malek1, Shirin Mansoori Dara1, Mahsa Hadipour Jahromy2*
1Medical Sciences Research Center, Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad
University, Tehran, Iran

 

Abstract

In the present study, the antinociceptive effects of acute (2, 4 and 6 ml/kg) and chronic (1, 2 and 3 ml/kg for 14 days) oral administration of pomegranate (Punica granatum L.) juice and seed extract with or without morphine and naloxane were investigated on hypertonic saline-induced acute corneal pain perception in mice. 
The number of eye wipes with a forelimb was counted for a period of 30 seconds as the criterion for pain assessment. Acute oral administration of the extract
(at 6 ml/kg dose, once) and chronic oral administration (at 2 and 3 ml/kg for 14 days each) significantly decreased the number of eye wipes after subcutaneous injection of morphine (2 mg/kg, sc), naloxone (2 mg/kg, sc) and normal saline (2 mg/kg, sc) compared with control (p < 0.05). The
morphine-induced antinociception was significantly improved by both acute and chronic oral administrations of pomegranate extract (p < 0.05). Naloxone (2 mg/kg, sc) did not reverse the antinociceptive effects of acute (at 6 ml/kg dose, once, oral) and chronic (at 2 and 3 ml/kg for 14 days
each) treatments. 

These findings demonstrate that acute high-dose and long-term lower-dose of pomegranate juice and seed extract can decrease acute corneal pain and improve morphine-induced antinociception in mice.
Keywords
Punica granatum, Morphine, Naloxone, Acute Corneal Pain, Mice

Exercise despite pain – breast cancer patient experiences of muscle and joint pain during adjuvant chemotherapy and concurrent participation in an exercise intervention

1. C. Andersen MPH Oncology Nurse, PhD^1,*,
2. M. Rørth MD professor, dr med²,
3. B. Ejlertsen PhD, MD professor² and
4. L. Adamsen PhD, MScSoc, RN professor^3,4

European Journal of Cancer Care

Keywords:

• breast cancer;
• adjuvant chemotherapy;
• multimodal exercise intervention;
• treatment related muscle and joint pain;
• qualitative research;
• phenomenological analysis methodology

Chemotherapy-related pain is a well-known side effect in cancer patient receiving chemotherapy. However, limited knowledge exists describing whether exercise exacerbates existing pain. Aim of the research was to explore muscle and joint pain experienced by women with breast cancer receiving adjuvant chemotherapy with epirubicin and cyclophosphamide followed by docetaxel and factor support and concurrently participating in an exercise intervention. The study used individual semi-structured interviews (pre- and post-intervention). Fifteen women were interviewed. The multimodal group intervention comprised supervised training: high-intensity cardiovascular, heavy resistance and relaxation, massage and body-awareness (9 h weekly, 6 weeks). The analysis revealed five categories: Abrupt pain – a predominant side effect, cogitated pain management, the adapted training, non-immediate exacerbation of pain and summarised into the essence of chemotherapy related muscle and joint pain in exercise breast cancer patients; exercise despite pain. 
Findings indicate that the patients' perception of sudden onset of chemotherapy-related muscle and joint pain was not aggravated by training. 
Pain intensity peaked between 2 and 9 days after chemotherapy and is described to be stabbing pain with a feeling of restlessness in the body. 
The patients demonstrated a high adherence rate to the exercise intervention caused by their own willpower and camaraderie of the group.