Jeanette Ross

Quality of life in low-income menopausal women attending primary care clinics

OBJECTIVE To examine the quality of life and health status of a population of menopausal age primary care attendees that demographically has not been well represented in previous studies, and to describe the relationships between population characteristics and outcomes. DESIGN Cross-sectional. SETTING Community primary care clinics. PATIENT(S) Women 45-60 years of age within 5 years of their last period. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Participants provided demographic information and completed a series of questionnaires, including the Menopause Quality of Life Instrument (MENQOL) and the Short Form-36 health survey (SF-36). RESULT(S) Women who were employed, had higher levels of education, or higher levels of income reported better overall health and fewer menopausal symptoms. The study population scored significantly lower than the national norms on a summary survey of mental and physical health. There were no significant differences between ethnic groups with respect to either menopausal quality of life or health status. CONCLUSION(S) In a generally low income, poorly educated menopausal population, ethnicity did not significantly affect quality of life. Socioeconomic characteristics (less education and lower income) were associated with increased menopausal symptoms.

Hospice and Palliative Medicine: Curriculum Evaluation and Learner Assessment in Medical Education

Major efforts have been pursued to improve palliative care education for physicians at all levels of their training. Such changes include the incorporation of palliative care curriculum and guidelines, an established process for competency-based evaluation and certification, faculty development, innovative educational experiences, the improvement of textbooks, and the establishment of accredited palliative medicine fellowships. Hospice and palliative medicine (HPM) has been clearly defined as a subspecialty and a crucial area of medical education. As innovative curricular approaches have become available to educate medical and other interprofessional trainees, this article aims to describe different models and methods applied in curriculum evaluation, tailoring such approaches to the field of palliative medicine. A stepwise process of curriculum development and evaluation is described, focusing on available curriculum evaluation competency-based tools for each level of learners. As HPM evolves and its educational programs grow, curriculum evaluation will provides invaluable feedback to institutions and programs in many ways.

Sleeping in the arms of cancer: A review of sleeping disorders among patients with cancer

AbstractIt is well known that cancer patients experience lack of sleep, which affects their symptoms and decrease their much needed energy, particularly while undergoing treatment. Insomnia, which is defined as a predominant complaint of dissatisfaction with sleep quantity or quality during different phases of the sleep cycle, could easily affect patients’ quality of life and even cancer treatment outcomes. In this article, we review the current research on and treatments for insomnia, as well as explore cancer-related fatigue and its connections to sleep disorders.

Reaching the heart of the caregiver

Abstract Rapidly increasing numbers of Spanish-speaking Hispanic elders portend similar increases in dementing disorders among this group; this, in turn, points to increasing numbers and challenges among the family caregivers (Janevic & Connell, 2001; U.S. Department of Commerce, 1996). Successful programs have been developed to equip non-Hispanic family members to effectively assume the caregiving role. This article reports on preliminary efforts to transform one such psychoeducation program into the “Cuidando con Respeto” program, a culturally appropriate, Spanish language program for Hispanic family caregivers. Principles of development, results from the prototype program, and future evaluation developments are presented.

Effectiveness of a Geriatrics and Palliative Care Consultation on Symptom Management and Geriatric Syndromes

With the increase in geriatric patientsand the wide spectrum of their illnesses, geriatricians and palliative care physicians would benefit from combining their expertise in treating chronically and terminally ill elder patients in a hospital setting. The objective of our pilot study was to determine if a Geriatric Palliative Care consult could improve pain management and prevent geriatric syndromes in elder patients. Our data was collected from a retrospective chart review of subjects older than 65 years-old who received combined Geriatrics and Palliative Care consult from a combined Geriatrics Palliative Care team. Previously validated instruments identified pain score and level of comorbidity. A total of 60 charts were reviewed. Results showed a Geriatric Palliative Care consultation lowered pain score from pre-consult to post-consult (2.63 vs. 1.17; p=0.012) and effectively improved pain in 20% of subjects (41.7% vs. 21.7%; p=0.002). The Geriatric Palliative Care consult team effectively lowered the in-hospital complication of restraints (11.7% vs. 3.3%; p=0.025) and also had a positive effect on delirium and advance directives (p=0.5). In conclusion, Geriatric Palliative Care consults have shown to improve the quality of care for older adults by effectively managing pain symptoms and improving pain scores among 20% of the subjects.

Tough Conversations Development of a Curriculum for Medical Students to Lead Family Meetings

Background: Few educational interventions have been developed to teach Family Meeting (FM) communication skills at the undergraduate level. We developed an innovative curriculum to address this gap. Methods: Fourth year medical students during 2011-2013 (n = 674) completed training for conducting a FM. To assess the effectiveness of this training, students completed a FM Objective Structured Clinical Exam (OSCE) that included 15 domains rated on a 1-5 point Likert scale. Tasks included discussing prognosis, establishing goals of care and demonstrating conflict resolution skills. Students received one-to-one feedback from standardized family members and faculty observers. Group debriefings with faculty were held after the OSCE. Results: Analysis of faculty feedback narratives revealed four themes in which students required improvement: 1) Discussing prognosis, 2) Explaining palliative care/hospice, 3) Avoiding medical jargon, and 4) Discussing cultural/religious preferences. Evaluation total mean score was 28.2 (Min 15, Max 63; SD 7.57), and identified student’s need to; 1) Ask more about the degree of knowledge family members want, 2) Ask religious beliefs, and 3) Assess family members’ level of education (p < 0.001). Qualitative analysis of group debriefings suggested that student perception of the OSCE experience was positive overall. Students found the case to be realistic and immediate feedback to be helpful. Conclusions: Conducting a FM is an advanced skill. This study shows that it is possible to train fourth year students to lead FMs and identify their strengths, needs using a FM OSCE.

The Double Parallel Curriculum in Palliative Care: Teaching Learners to Teach End-of-Life Care at the Bedside:

Context: Dying is a natural process, yet physicians are often uncomfortable caring for dying patients. Learners have limited exposure to curriculum on caring for dying patients and often navigate these encounters without appropriate skills and confidence. We developed and implemented the Double Parallel Curriculum in Palliative Care (DP-PC): End-of-Life (EOL) module. The DP-PC focuses on teaching third-year medical students (MS3) to not only take care of patients in their last hours of life but give learners the confidence to teach patient’s families what to expect as they hold vigil at their loved one’s bedside. Objectives: To develop and implement an educational intervention that improves learners’ knowledge and confidence in EOL patient and family care. To expand learner confidence to a dual level (learners become teachers) with a simplified and culturally sensitive electronic bedside teaching tool designed to guide learners and patients/families conversations. Methods: Curriculum was completed during MS3 ambulatory rotation and included pre-/posttests, an online case-based module, faculty demonstration, and learner role-play using the bedside teaching tool. Results: A total of 247 participants took the pretest, 222 participants took the posttest, and 222 participants matched the pre-/posttest surveys. Students’ knowledge of EOL care and the confidence to teach other learners and families about EOL care significantly improved after completing the curriculum. Conclusion: The DP-PC is a technology-savvy educational intervention that improves learner confidence and knowledge toward caring for dying patients and their families. Easy access, technology-based teaching tools may enhance bedside teaching of health-care learners and improve the care of patients and their families at the end of life.

The Double Parallel Curriculum in Palliative Care(DP-PC): Using a Double Parallel Education Strategy with Multimedia to Enhance Learners Knowledge and Skills in End of Life Palliative Care (EOL-PC) (TH325-C)

The Double Parallel Curriculum in Palliative Care(DP-PC): Using a Double Parallel Education Strategy with Multimedia to Enhance Learners Knowledge and Skills in End of Life Palliative Care (EOL-PC) (TH325-C) Jennifer Healy, DO, University of Texas Health Science Center, San Antonio, TX. Shuko Lee, MS, South Texas Veterans Health Care System, San Antonio, TX. Jeanette Ross, MD, University of Texas Health Science Center at San Antonio and South Texas Veterans Healthcare System, San Antonio, TX. Sandra Sanchez-Reilly, MD FAAHPM, University of Texas Health Science Center and South Texas Veterans Healthcare System, San Antonio, TX. Phylliss Chappell, MD, University of Texas Health Science Center at San Antonio, San Antonio, TX. Deborah Villarreal, MD, University of Texas Health Science Center at San Antonio, San Antonio, TX. (All authors listed above had no relevant financial relationships to disclose.)

Do Older Adults with Completed Advance Directives Really Understand Them? (704)

Cross-tabulations compared patient discharge outcomes based on transfer status to the APCU. PCCS patient unit costs for ICU, medical-surgical units, and the APCU were also compared. IV. Results. The PCCS has documented appropriateness for transfer to the APCU for 5,985 patients. Thirty percent transferred to the APCU from an inpatient unit or the ER, and 18% were not appropriate for the APCU. The other 52% appropriate for care on the APCU were not transferred due primarily to lack of bed availability. Although patients who expired or were discharged to hospice care were more likely to transfer to the APCU, only 40% of those who expired and 29% of patients discharged to hospice were transferred to the APCU. APCU unit costs average

A model for increasing palliative care in the intensive care unit: Enhancing interprofessional consultation rates and communication

136 less than other medical-surgical units and