Anne Kinderman

The Cambia Sojourns Scholars Leadership Program: Project Summaries from the Inaugural Scholar Cohort.

BACKGROUND As palliative care grows and evolves, robust programs to train and develop the next generation of leaders are needed. Continued integration of palliative care into the fabric of usual health care requires leaders who are prepared to develop novel programs, think creatively about integration into the current health care environment, and focus on sustainability of efforts. Such leadership development initiatives must prepare leaders in clinical, research, and education realms to ensure that palliative care matures and evolves in diverse ways. METHODS The Cambia Health Foundation designed the Sojourns Scholar Leadership Program to facilitate leadership development among budding palliative care leaders. RESULTS The background, aims, and results to date of each of the projects from the scholars of the inaugural cohort are presented.

Palliative Oncologic Care Curricula for Providers in Resource-Limited and Underserved Communities: a Systematic Review

Familiarity with principles of palliative care, supportive care, and palliative oncological treatment is essential for providers caring for cancer patients, though this may be challenging in global communities where resources are limited. Herein, we describe the scope of literature on palliative oncological care curricula for providers in resource-limited settings. A systematic literature review was conducted using PubMed, Embase, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Med Ed Portal databases, and gray literature. All available prospective cohort studies, case reports, and narratives published up to July 2017 were eligible for review. Fourteen articles were identified and referenced palliative care education programs in Argentina, Uganda, Kenya, Australia, Germany, the USA, or multiple countries. The most common teaching strategy was lecture-based, followed by mentorship and experiential learning involving role play and simulation. Education topics included core principles of palliative care, pain and symptom management, and communication skills. Two programs included additional topics specific to the underserved or American Indian/Alaskan Native community. Only one program discussed supportive cancer care, and no program reported educational content on resource-stratified decision-making for palliative oncological treatment. Five programs reported positive participant satisfaction, and three programs described objective metrics of increased educational or research activity. There is scant literature on effective curricula for providers treating cancer patients in resource-limited settings. Emphasizing supportive cancer care and palliative oncologic treatments may help address gaps in education; increased outcome reporting may help define the impact of palliative care curriculum within resource-limited communities.

Psychosocial distress screening in the health care safety net.

91 Background: Recognizing that psychosocial distress (PSD) is underestimated in patients with cancer, the Commission on Cancer mandated screening using a validated tool. Studies of PSD screening exist, but none to date in a diverse, multicultural safety net setting where patients face challenges such as homelessness, mental illness, and substance abuse, which may augment PSD. METHODS We performed a retrospective cohort study of patients with cancer offered PSD screening during 2015. Overall distress scores and problems in each domain were analyzed. Chart review identified potential predictors of distress including age, gender, race, language, housing, psychiatric illness, substance abuse, and cancer stage. RESULTS Of 177 eligible patients, 113 (64%) completed screening. The most common reasons patients were not screened were refusal, too symptomatic (physically or emotionally), or language barriers. Of screened patients, 40.7% were female, 57.5% male, and 1.7% transgender. 31% were Caucasian, 27% Asian/Pacific Islander, 25% Hispanic, and 17% African American. 35% were non-English speaking. 29% had history of mental illness and 34% of substance abuse. 23% were marginally housed or homeless. 63% reported moderate to severe levels of PSD as defined by the NCCN as ≥ 4. Patients with mental illness were nearly twice as likely to report PSD ≥ 4 (p = 0.012) and had higher mean PSD scores (5.78 vs. 4.03, p = 0.002). English speaking patients had a mean PSD score of 5.01 compared to 3.6 and 3.2 for Spanish and Chinese speaking patients, respectively (p = 0.02 for English v. Chinese) and more domains causing PSD (p = 0.028 for English v. Chinese). Lack of stable housing also correlated with more domains causing PSD (p = 0.05). CONCLUSIONS This proved to be an ethnically diverse cohort with high rates of mental illness, substance abuse, and homelessness, with the majority reporting moderate to severe distress. Even with a small cohort, English language and mental illness were significant predictors of PSD, and housing status correlated with more domains contributing to PSD. Several other variables trended toward significance, suggesting a larger cohort may be needed to determine if additional characteristics predict higher levels of PSD.

Making the Case: Is Outpatient Palliative Care for Oncology Patients Feasible Within the Safety Net? (S745)

identified student’s need to; 1) Ask more about the degree of knowledge family members want; 2) Ask religious beliefs; 3) Assess family member’s level of education (p<0.001). Conclusions. FM-OSCE provided students with a valuable learning experience providing direct feedback and identifying specific areas where MS require further communication expertise. Implications forResearch,Policy, orPractice. Future research is needed on how standardized communication teaching interventions with real time feedback such as FM-OSCEs could improve patient care, patient’s quality of life, and, subsequently, health systems.