Suzana Makowski

A systematic review and meta-analysis of meditative interventions for informal caregivers and health professionals

Background Burnout, stress and anxiety have been identified as areas of concern for informal caregivers and health professionals, particularly in the palliative setting. Meditative interventions are gaining acceptance as tools to improve well-being in a variety of clinical contexts, however, their effectiveness as an intervention for caregivers remains unknown. Aim To explore the effect of meditative interventions on physical and emotional markers of well-being as well as job satisfaction and burnout among informal caregivers and health professionals. Design Systematic review of randomised clinical trials and pre–post intervention studies with meditative interventions for caregivers. Data sources PubMed, EMBASE, CINAHL and PsycINFO were searched up to November 2013. Of 1561 abstracts returned, 68 studies were examined in full text with 27 eligible for systematic review. Results Controlled trials of informal caregivers showed statistically significant improvement in depression (effect size 0.49 (95% CI 0.24 to 0.75)), anxiety (effect size 0.53 (95% CI 0.06 to 0.99)), stress (effect size 0.49 (95% CI 0.21 to 0.77)) and self-efficacy (effect size 0.86 (95% CI 0.5 to 1.23)), at an average of 8 weeks following intervention initiation. Controlled trials of health professionals showed improved emotional exhaustion (effect size 0.37 (95% CI 0.04 to 0.70)), personal accomplishment (effect size 1.18 (95% CI 0.10 to 2.25)) and life satisfaction (effect size 0.48 (95% CI 0.15 to 0.81)) at an average of 8 weeks following intervention initiation. Conclusions Meditation provides a small to moderate benefit for informal caregivers and health professionals for stress reduction, but more research is required to establish effects on burnout and caregiver burden.

Assessing local market and organizational readiness for the integration of complementary and alternative medicine into ambulatory care centers.

Abstract:Complementary and alternative medicine (CAM) is one of the fastest growing segments of the health care industry today, with studies suggesting that between 30% and 50% of the adult population in the United States uses some form of CAM. Many ambulatory care centers are considering integrating CAM into their clinical services. This article will review some of the national trends and present a framework for assessing local market demand for CAM in order to help prioritize an organizations CAM integration strategy.

Health System Advance Care Planning Culture Change for High-Risk Patients: The Promise and Challenges of Engaging Providers, Patients, and Families in Systematic Advance Care Planning

BACKGROUND The success of a facilitator-based model for advance care planning (ACP) in LaCrosse, Wisconsin, has inspired health systems to aim for widespread documentation of advance directives, but limited resources impair efforts to replicate this model. One promising strategy is the development of interactive, Internet-based tools that might increase access to individualized ACP at minimal cost. However, widespread adoption and implementation of Internet-based ACP efforts has yet to be described. OBJECTIVE We describe our early experiences in building a systematic, population-based ACP initiative focused on health system-wide deployment of an Internet-based tool as an adjunct to a facilitator-based model. METHODS With the sponsorship of our healthcare systems population health leadership, we engaged a diverse group of clinical stakeholders as champions to design an Internet-based ACP tool and facilitate local practice change. We describe how we simultaneously began to train clinicians in ACP conversations, engage patients and health system employees in thinking about ACP, redesign clinic workflows to accommodate ACP discussions, and integrate the Internet-based tool into the electronic medical record (EMR). RESULTS Over 18 months, our project engaged two subspecialty clinics in a systematic ACP process and began work with a large primary care practice with a large Medicare Accountable Care Organization at-risk population. Overall, 807 people registered at the Internet site and 85% completed ACPs. CONCLUSION We learned that changing culture and systems to promote ACP requires a comprehensive vision with simultaneous, interconnected strategies targeting patient education, clinician training, EMR documentation, and community awareness.

Spiritual Dimensions of Pain and Suffering

Pain is a multi-dimensional, complex experience. It is a struggle to adequately identify and meet the needs of patients experiencing pain in a bio-psycho-social–spiritual context. In this chapter we explore the relationship between the spiritual dimensions of suffering and the experience of physical pain. By intertwining research with clinical case studies, the chapter reviews definitions, the relationship between spiritual anguish and physical pain, and finally interdisciplinary and evidence-based approaches to alleviating suffering.

A Comprehensive Approach to the Patient at End of Life: Assessment of Multidimensional Suffering.

Abstract Pain is a multidimensional, complex experience. There are many challenges in identifying and meeting the needs of patients experiencing pain. Evaluation of pain from a bio-psycho-social-spiritual framework is particularly germane for patients approaching the end of life. This review explores the relation between the psychospiritual dimensions of suffering and the experience of physical pain, and how to assess and treat pain in a multidimensional framework. A review of empirical data on the relation between pain and suffering as well as interdisciplinary evidence-based approaches to alleviate suffering are provided.

Impact of Creating Legacy Teaching Videos on Well-Being of Advanced Cancer Patients (S787)

Impact of Creating Legacy Teaching Videos on Well-Being of Advanced Cancer Patients (S787) Christina Fitch, DO MPH, University of Massachusetts Medical Center, Worcester, MA. Jennifer Tjia, MD, University of Massachusetts Memorial Medical Center, Worcester, MA. Alex Doering, BA, University of Massachusetts Medical School, Worcester, MA. Suzana Makowski, MD, University of Massachusetts Memorial Medical Center, Worcester, MA. Amy Wachholtz, MDiv PhD MS, University of Massachusetts Medical School, Worcester, MA.

Rediscovering the Voice of Our Calling: The Power of Our Stories (P11)

Discuss the effects of centuries of healthcare disparities and the implications for end-of-life decision-making in African-American communities. Understand cultural mainstays of importance that become barriers to care if they are not observed. It is a well-established tenet of hospice and palliative care that care must be culturally sensitive and appropriate. Yet research shows that providers are often uncomfortable with patients and families not of their own culture, and this is a barrier to effective communication and palliative healthcare delivery. Cultural and worldview differences pose significant communication barriers, certainly when religious beliefs are brought into secular-oriented health care. Particular examples may be when there is a reluctance to ‘‘concede’’ or ‘‘claim’’ that a terminal diagnosis exists or when prayer and appeals for miracles are used as strategies for ‘‘managing’’ terminal illness. As African-American culture is often opaque to the majority population, three aspects of cultural competence will be discussed. Centuries of healthcare disparities have led to distrust of ‘‘the system’’ and of majority providers; there will be a discussion of the consequences of these disparities and methods to overcome them. Second, there are ‘‘cultural pearls’’ that are often unknown to majority providers; transgression of them develops an immediate barrier, while observance engenders a sense of respect for the patient and family. Finally, while the influence of religion is fading in the public square, the church remains a bedrock of African-American culture. Engaging pastors in the conversation early, knowing that patients and families rely on their counsel as much as, or more than, physician opinion, increases communication and leads to culturally appropriate care. Methods for operationalizing this information will be presented.

Hablandocon Latinos: Goals of Care Conversations with Latino Patients and Families (TH316)

patient after years of hopeful and significant treatment, the hospice chaplain expected to care for her family in their grief after the death of her sibling, and the rural family doctor dealing with multiple smalltown dual relationships who is caregiving for a dying patient/friend. 2. Demonstrate three responses to the grief described in the cases that can care for the caregiver: the use of counsel and deep listening with our palliative teammates and peers; the practice of meditation; and the consideration of personal writing of brief narratives as a means of living with, and growing through, grief. 3. Practice the use of counsel and deep listening in small groups, writing brief narratives of our loss, and guided meditation, thereby learning how these practices are tools that we can bring back to our professional worlds and our lives. As hospice and palliative medicine practitioners, we see more than our share of grief in our work, and we recognize how unacknowledged, unexpressed grief can be toxic to the physical and emotional health of patients and their families. But what about us? What challenges and expectations dowe face as physicians, nurses, and spiritual caretakers when a patient we have become close to dies, or whenwe stepout of ourprofessional arena and a dear friend or family member dies? Three cases will be presented: the family doctor and palliative care specialist in a rural setting, where dual relationships are common, who is asked by a friend and spiritual mentor to be her palliative care provider at the end of life; the chaplain who loses two family members in one year and is asked by the family to manage the memorial service and support family members in their grief; and the oncologist facing the death of a patient after years of hopeful and significant treatment who finds few supports for expressing and managing personal grief in the professional setting. The unacknowledged grief of oncologists has been shown to influence their subsequent practice behavior, including lengthening courses of chemotherapy in the patients encountered after a loss (L. Granek, 2012). We deserve acknowledgement and response to our grief across all palliative care provider roles and kinds of losses so that we can face our next end-of-life patient with objectivity and an open heart. We need the ‘‘spiritual toolbox’’ that meditation, peer support and deep listening in small groups, and the humanities can provide to support us through our grief, inside and outside of our professional work setting.

AAHPM Measuring What Matters Project: Why It Matters What You Measure (TH303)

Palliative Care in the Era of Hypothermia Protocols (TH302) Robert Smeltz, MA RN NP ACHPN, NYU School of Medicine/Bellevue Hospital, New York, NY. Lisa Zelnick, MD, Bellevue Hospital Center, New York, NY. Susan Cohen, MD, Bellevue Hospital Center, New York, NY. Rebecca Freeman, LMSW, Bellevue Hospital Center, New York, NY. (All authors listed above had no relevant financial relationships to disclose.)

Eating the Carrot While Dodging the Stick: How to Put Quality Back into Your Quality Improvement Efforts (P18)

Eating the Carrot While Dodging the Stick: How to Put Quality Back into Your Quality Improvement Efforts (P18) Dale Lupu, PhD MPH, AAHPM, Silver Spring, MD. Joe Rotella, MD MBA FAAHPM, Hosparus, Louisville, KY. Arif Kamal, MD, Duke University, Durham, NC. Susan Kristiniak, DHA MSN RN-BC IAC, Abington Memorial Hospital, Abington, PA. Suzana Makowski, MD MMM FACP, University of Massachusetts Medical School, Worcester, MA. (All authors listed above had no relevant financial relationships to disclose with the following exception: Lupu served as a paid consultant for Daleview Associates, AAHPM, and the National Coalition for Hospice and Palliative Care.)