Gregory P. Gramelspacher

What and How Psychiatry Residents at Ten Training Programs Wish to Learn About Ethics

The study’s objective was to survey what and how psychiatry residents want to learn about ethics during residency. A 4-page questionnaire developed for this study was sent to 305 residents at 10 adult psychiatry programs in the United States. One-hundred and eighty-one (59%) of those surveyed responded. Seventy-six percent reported facing an ethical dilemma in residency for which they felt unprepared. Forty-six percent reported having received no ethics training during residency. More than 50% of the respondents requested that “more” curricular attention be paid to 19 specific ethics topics and more than 40% for 25 topics. Preferences with respect to learning methods are presented. This survey may provide guidance in structuring the content and process of ethics education for psychiatry residents. These findings should stimulate the efforts of faculty to commit time and attention to this important curricular area.

Financial Impact of Palliative Care Consultation in a Public Hospital

BACKGROUND Palliative care programs assist with prognostication, symptom control, and communication with patient and family. Hospitals often require financial justification for new programs Objective: Study the financial impact of the palliative care consultation (PCc) service in a public hospital. SETTING/SUBJECTS From January to December 2005, 258 deaths occurred on the medicine service. Of those deceased patients, 116 were studied. DESIGN Inclusion criteria were 50 or more years of age, length of stay (LOS) 3 days or more, admission to an internal medicine service, and death during that hospitalization. MEASUREMENTS Charges, diagnosis-related groups (DRGs), DRG weights, and demographic variables were examined. RESULTS Of the 116 deceased patients studied, 61 patients received a PCc, while 55 did not. Most patients had Medicare or Medicaid (82.8%). Both groups were similar in terms of demographic characteristics. Average LOS was 14.4 days for patients with a PCc versus 12.2 days for those without (p = 0.57). Median charges for the group without a PCc were

Assessment of the face validity of two pain scales in Kenya: a validation study using cognitive interviewing

42,731, versus a median of

Acceptance of external funds by physician organizations - Issues and policy options

35,824 for those with a PCc. There was no significant variation of DRG weights within the same DRG. DRG weight was significantly positively correlated with charges. Both PCc and DRG weight were significant predictors of charges, with 36% of charges variability explained by PCc and DRG weight. CONCLUSIONS PCc significantly reduced charges in adult patients who died during their last hospitalization, even though the average LOS was higher for those who received a PCc versus those who did not.

Palliative care content on cancer center websites

BackgroundPatients in sub-Saharan Africa commonly experience pain, which often is un-assessed and undertreated. One hindrance to routine pain assessment in these settings is the lack of a single-item pain rating scale validated for the particular context. The goal of this study was to examine the face validity and cultural acceptability of two single-item pain scales, the Numerical Rating Scale (NRS) and the Faces Pain Scale-Revised (FPS-R), in a population of patients on the medical, surgical, and pediatric wards of Moi Teaching and Referral Hospital in Kenya.MethodsSwahili versions of the NRS and FPS-R were developed by standard translation and back-translation. Cognitive interviews were performed with 15 patients at Moi Teaching and Referral Hospital in Eldoret, Kenya. Interview transcripts were analyzed on a question-by-question basis to identify major themes revealed through the cognitive interviewing process and to uncover any significant problems participants encountered with understanding and using the pain scales.ResultsCognitive interview analysis demonstrated that participants had good comprehension of both the NRS and the FPS-R and showed rational decision-making processes in choosing their responses. Participants felt that both scales were easy to use. The FPS-R was preferred almost unanimously to the NRS.ConclusionsThe face validity and acceptability of the Swahili versions of the NRS and FPS-R has been demonstrated for use in Kenyan patients. The broader application of these scales should be evaluated and may benefit patients who currently suffer from pain.

The effect of discussions about advance directives on patients’ satisfaction with primary care

S everal years ago, the Society of General In te rna l Medicine (SGIM) held a precourse on AIDS at its a n n u a l meeting. After the precourse had been designed, speakers chosen, and topics defined, a pha rmaceu t i ca l company that made a drug used in the t r e a tme n t for AIDS gave an educa t iona l g r a n t to the Society to suppor t , among other th ings , the cost of the precourse. In ensu ing years, this a r r a n g e m e n t created some controversy among the people p l a n n i n g a n n u a l meet ings . Should they ar range ano the r precourse on AIDS in the realistic hope that the company would come th rough aga in with a generous gift? Was it too soon to have ano the r precourse on AIDS? Could mee t ing p l a n n e r s even be expected to objectively decide on the mer i t s of a precourse on AIDS when they knew the a m o u n t of money tha t would be tied to their dec i s ion? Should precourses be

Preferences of Physicians and Their Patients for End-of-Life Care

PurposeProfessional guidelines recommend that palliative care begin early in advanced cancer management, yet integration of palliative and cancer care remains suboptimal. Cancer centers may miss opportunities to provide palliative care information online. In this study, we described the palliative care content on cancer center websites.MethodsWe conducted a systematic content analysis of 62 National Cancer Institute- (NCI) designated cancer center websites. We assessed the content of center homepages and analyzed search results using the terms palliative care, supportive care, and hospice. For palliative and supportive care webpages, we assessed services offered and language used to describe care. Two researchers analyzed all websites using a standardized coding manual. Kappa values ranged from 0.78 to 1.ResultsNCI-designated cancer center homepages presented information about cancer-directed therapy (61%) more frequently than palliative care (5%). Ten percent of cancer centers had no webpage with palliative care information for patients. Among centers with information for patients, the majority (96%) defined palliative or supportive care, but 30% did not discuss delivery of palliative care alongside curative treatment, and 14% did not mention provision of care early in the disease process.ConclusionsCancer center homepages rarely mention palliative care services. While the majority of centers have webpages with palliative care content, they sometimes omit information about early use of care. Improving accessibility of palliative care information and increasing emphasis on early provision of services may improve integration of palliative and cancer care.