Stacie Levine

Using Assessing Care of Vulnerable Elders Quality Indicators to Measure Quality of Hospital Care for Vulnerable Elders

OBJECTIVES: To assess the quality of care for hospitalized vulnerable elders using measures based on Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs).

Perceptions, attitudes, and experiences of hematology/oncology fellows toward incorporating geriatrics in their training

The aging of the U.S. population continues to highlight emerging issues in providing care generally for older adults and specifically for older adults with cancer. The majority of patients with cancer in the U.S. are currently 65 years of age or older; therefore, training and research in geriatrics and geriatric oncology are viewed to be integral in meeting the needs of this vulnerable population. Yet, the ways to develop and integrate best geriatrics training within the context of hematology/oncology fellowship remain unclear. Toward this end, the current study seeks to evaluate the prior and current geriatric experiences and perspectives of hematology/oncology fellows. To gain insight into these experiences, focus groups of hematology/oncology fellows were conducted. Emergent themes included: 1) perceived lack of formal geriatric oncology didactics among fellows; 2) a considerable amount of variability exists in pre-fellowship geriatric experiences; 3) shared desire to participate in a geriatric oncology-based clinic; 4) differences across training levels in confidence in managing older adults with cancer; and 5) identification of specific criteria on how best to approach older adults with cancer in a particular clinical scenario. The present findings will help guide future studies in evaluating geriatrics among hematology/oncology fellows across institutions. They will also have implications in the development of geriatrics curricula and competencies specific to hematology/oncology training.

Using Chaplains to Facilitate Advance Care Planning in Medical Practice

fore were considered to have dropped out of the study. Depression negatively correlated (P = .05) and baseline marijuana use positively correlated (P = .04) with study completion. The Table provides characteristics and results for the sample; we found no sex association with study completion or opioid reduction. Among study completers (n = 51) baseline median MEDD (interquartile range [IQR]) was 288 (153-587) mg, with a median 6-year duration (IQR, 3-9) duration of opioid use. Median pain intensity was moderate (5 out of 10 on a numeric pain rating). After 4 months, the median MEDD was reduced to 150 (IQR, 54-248) mg (P = .002). The likelihood of a greater than 50% opioid dose reduction was not predicted by starting dose, baseline pain intensity, years prescribed opioids, or any psychosocial variable. Neither pain intensity (P = .29) nor pain interference (P = .44) increased with opioid reduction. The Figure shows the relationship between percentage change in MEDD and pain intensity in study completers.

Compassion Fatigue Among Palliative Care Clinicians: Findings on Personality Factors and Years of Service:

Objectives: Palliative medicine is a rewarding field, but providers encounter patient trauma on a routine basis. Compassion fatigue, marked by burnout, secondary traumatic stress, and low satisfaction may result. However, professionals differ markedly in how they respond to patient trauma. The objective of the current study was to determine whether personality traits of neuroticism and agreeableness relate to aspects of compassion fatigue, after accounting for time spent working in the field. Methods: Sixty-six palliative medicine physicians, nurses, social workers, and chaplains completed validated measures of personality traits, compassion fatigue, and work background. Results: Providers who had worked longer reported higher levels of satisfaction and lower levels of burnout. Neuroticism demonstrated strong significant associations with secondary traumatic stress and burnout (Ps < .001). Agreeableness was significantly and strongly associated with compassion satisfaction (P < .001). These associations held after accounting for years spent working in the field. Significance of Results: Personality traits of neuroticism and agreeableness may convey risk and resilience, respectively, for palliative care professionals. More research is needed to determine if assessing personality traits can help identify providers at risk for adverse reactions to patient trauma.

Palliative Workforce Development and a Regional Training Program

Aims: Our primary aims were to assess growth in the local hospital based workforce, changes in the composition of the workforce and use of an interdisciplinary team, and sources of support for palliative medicine teams in hospitals participating in a regional palliative training program in Chicago. Methods: PC program directors and administrators at 16 sites were sent an electronic survey on institutional and PC program characteristics such as: hospital type, number of beds, PC staffing composition, PC programs offered, start-up years, PC service utilization and sources of financial support for fiscal years 2012 and 2014. Results: The median number of consultations reported for existing programs in 2012 was 345 (IQR 109 – 2168) compared with 840 (IQR 320 – 4268) in 2014. At the same time there were small increases in the overall team size from a median of 3.2 full time equivalent positions (FTE) in 2012 to 3.3 FTE in 2013, with a median increase of 0.4 (IQR 0-1.0). Discharge to hospice was more common than deaths in the acute care setting in hospitals with palliative medicine teams that included both social workers and advanced practice nurses (p < .0001). Conclusions: Given the shortage of palliative medicine specialist providers more emphasis should be placed on training other clinicians to provide primary level palliative care while addressing the need to hire sufficient workforce to care for seriously ill patients.

Improving medical and pharmacy student confidence in medication management and attitudes about interprofessional collaboration by utilizing an interprofessional module

ABSTRACT Adverse drug events are common and often preventable. Educating the interprofessional workforce to appropriately manage medications as part of a team is a priority. An interprofessional medication management module for graduating medical and pharmacy students was developed. The module was case-based and co-led by physicians and pharmacists. Students completed pre- and post-module surveys regarding their attitudes about interprofessional collaboration, confidence in managing medications, and self-reported ability to perform the tasks laid out in the minimum geriatrics competencies as a result of the module. Eighteen medical and 13 pharmacy students participated over a two-year period. There was statistically significant improvement in students’ attitudes about interprofessional collaboration with regards to understanding their role and the role of others on the interprofessional team, and about teamwork between medical and pharmacy students. There was also statistically significant improvement in confidence with regards to the 3 medication management competencies after completion of the module. The vast majority of students agreed that the module improved their self-reported ability to manage medications. An interprofessional medication management module is an effective way to improve medical and pharmacy students’ attitudes about interprofessional collaboration and confidence in medication management.

Medication management in older adults and interprofessional education: a needs assessment

ABSTRACT Elderly, multi-morbid patients are at high risk for suffering adverse drug events. Safe medication management is a key process in preventing these adverse events, and requires interprofessional teamwork. We performed a needs assessment survey of graduating medical students and faculty to evaluate student training in medication management, in particular students’ preparedness in the three minimum geriatrics competencies pertaining to medication management, interprofessional educational opportunities, and optimal learning methods. Response rates were 45/105 (43%) for students and 38/93 (41%) for faculty. The majority of students felt that they did not receive sufficient training in medication management in older adults. Faculty either agreed with students or were unsure whether students received sufficient training. Neither students nor faculty felt that students were extremely prepared to carry out the three minimum geriatrics competencies at the time of medical school graduation. Students and faculty identified direct patient care experiences as the optimal learning method, and inappropriate medications as the highest priority topic. Students and faculty felt that students do not receive sufficient interprofessional educational opportunities. The results of this study are currently being used to create customized interprofessional educational experiences for medical students related to medication management in older adults.

What Do Chaplains Do: The Views of Palliative Care Physicians, Nurses, and Social Workers

It is well accepted that attention to spiritual concerns is a core dimension of palliative care. It is similarly well accepted that chaplains are the spiritual care specialists who should address such concerns. However, what chaplains do when they provide care for patients and families is often poorly understood by their palliative care colleagues. Having a clear understanding of what chaplains do is important because it contributes to improved utilization of the spiritual care and other resources of the palliative care team and thereby to better care for patients and families. The aim of this study was to describe what palliative care physicians, nurses, and social workers understand about what chaplains do. Brief surveys were distributed to participants at 2 workshops for palliative care professionals in 2016. The survey was completed by 110 participants. The majority reported that they understood what chaplains do moderately well or very well. Thirty-three percent of the written comments about what chaplains do were very general; 25% were more specific. Only a small proportion of the participants were aware that chaplains provide care for the team, are involved in facilitating treatment decision-making, perform spiritual assessments, and bridge communication between the patient/family/team/community. Based on our survey, palliative care colleagues appear to have a broad understanding of what chaplains do but many may be unfamiliar with important contributions of chaplains to care for patients, families, and teams. These findings point to the need for ongoing education of palliative teams about what chaplains do in palliative care.

Fellowship Directors’ Program—What Keeps us Awake at Night: Addressing the Challenges of Palliative Medicine Fellowship Programs as the Next Accreditation System and the Match Become Reality (P04)

Ignite your leadership potential. Financial DecisionMaking Approaches is designed to equip hospice and palliative medicine physicians with foundational principles in financial management to increase their understanding of institutional or organizational financial reports. This course will provide an introduction to financial concepts and terminology followed by an exploration of cost analysis and resource allocation using sample financial tools and documents, case studies, and scenarios to provide practical relevance for HPM physicians. This preconference program is offered in partnership with the American Association for Physician Leadership (Association) and presented by Association faculty. This session applies to all physician leaders and practice settings looking to enhance their financial management understanding and decision-making for their organization. Primary leadership competencies addressed in this program include financial acumen and resource management. AAHPM Ignite is one of three sessions included in the AAHPM Leadership Forum. AAHPM and the American Association for Physician Leadership have designed a comprehensive leadership training program that offers a variety of learning opportunities and varied environments, including face-to-face didactic instruction and Web-based self-study. You can create your own customized and flexible learning pathway and select content based on your unique leadership development goals and career pathway. Learn more at aahpm.org/career/leadership.

Add Your Voice: Vetting the Entrustable Professional Activities for HPM Physicians (TH335)

1994 to 2003, the PDIA created funding initiatives in professional and public education, the arts, research, clinical care, and public policy that transformed care for patients living with serious illnesses in the United States. Four PDIA Awards will be presented: the AAHPM PDIA Palliative Medicine National Leadership Award, the AAHPM PDIA Palliative Medicine Community Leadership Award, the HPNF PDIA Nursing Leadership Award in Palliative Care, and the SWPHN PDIA Career Achievement Award. Award recipients will participate in panel presentations on topics such as career trajectory, lessons learned, and take-away ‘‘pearls’’ for the attendees.