Eva Chittenden, MD, Mas- sachusetts General Hospital, Boston, MA. Juliet. Jacobsen, MD, Massachusetts General Hospital,. Boston, MA. Darshan Mehta, MD ...
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importance of spiritual care in palliative care. Recommendations for implementing these guidelines in palliative care, including a model for assessing and integrating spirituality into patients’ treatment plans, were developed at a national consensus conference, ‘‘Improving the Quality of Spiritual Care in Palliative Care,’’ led by the City of Hope and The George Washington Institute for Spirituality and Health (GWish). This work was published in JPM in 2009 and in a book, Making Healthcare Whole, in 2010. We have presented this material in two precourses at the AAHPM annual meetings in 2010 and 2011. In 2012 and 2013, we presented well-received advanced spiritual care precourses based on participant feedback. We have been strongly encouraged to propose this again with the addition of more case based discussions in the introduction and a section on how to take what was learned back to the participants’ settings. This workshop describes how to identify spiritual issues, do a spiritual history, and develop an interdisciplinary treatment plan that includes patients in the development of their treatment plan. Standardized patients from UCSD School of Medicine will be used for this session. There will be an online password protected learning community on the GWish website for participants to review basic background material prior to coming to the advanced course. This will include the FICA spiritual assessment DVD training. The standardized patients and the online community will be paid for by GWish. Participants will learn how to address patients’ spirituality in a systematic way, how to identify spiritual issues, and how to develop a treatment plan with an interdisciplinary team. They will develop plans to integrate what they learn into their clinical settings.
Building a Sustainable Practice-Resiliency Training for You and Your Team (P22) Vicki Jackson, MD MPH, Massachusetts General Hospital, Boston, MA. Eva Chittenden, MD, Massachusetts General Hospital, Boston, MA. Juliet Jacobsen, MD, Massachusetts General Hospital, Boston, MA. Darshan Mehta, MD, Massachusetts General Hospital, Boston, MA. (All authors listed above had no relevant financial relationships to disclose.)
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Objectives 1. Identify three threats to sustainability on an individual and team level. 2. Appreciate the evidence base related to burnout and resiliency in medical professionals and teams. 3. Gain skill in techniques to promote individual and team sustainability related to limit setting, cognitive reframing, appreciative inquiry, and mindfulness practices. Palliative care is rapidly expanding and teams often struggle to meet the demands. As a field, we need to innovate with new strategies to build a sustainable, resilient workforce. In this workshop, we will review the literature related to risk factors for burnout and compassion fatigue as well as describe one mature palliative care service’s qualitative and quantitative assessment of its own sustainability. Through an interactive reflective process, participants will identify threats to sustainability for them personally and the teams they are a part of. Participants will have the opportunity to gain skills that promote sustainability in the areas of limit setting, appreciative inquiry, cognitive reframing, and mindfulness.
Pain, Suffering, and Healing (P23) Janet Abrahm, MD, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA. Laurie Rosenblatt, MD, Beth Israel Deaconess Medical Center, Boston, MA. Adrianne Vincent, BA, Harvard Divinity School, Cambridge, MA. Eric Cassell, MD, Weill Medical College Cornell University, Delaware, PA. (All authors listed above had no relevant financial relationships to disclose with the following exceptions: Abrahm is an author and received royalties from Johns Hopkins University Press.) Objectives 1. Discover how to use narrative as a teaching and learning tool that promotes coherent professional identity and compassionate engagements with patients and families whose suffering cannot be ‘‘fixed’’; participants will make a concrete plan to use the technique in their own work setting. 2. Gain practical experience in Mindfulness Meditative exercises that can be used for healing of patients and caregivers, and through exposure to a variety of types of Mindfulness Meditation (eating, sitting, walking) and focus (body scan, breathing,
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impermanence, compassion), identify one or more they plan to use in the home or work setting. 3. Expand the concept of pain and suffering beyond the physical, social, psychological, and existential/spiritual to incorporate the meaning and functional consequences of the pain and how it can trigger suffering; recognize the pitfalls of reductionism, positivism, and the need to rescue, and help suffering patients heal through a renewed focus on function, purpose and meaning. The complex problems we face in the care of the patients who are our responsibility are daunting and can lead caregivers to burnout and compassion fatigue. We haven’t been taught to recognize when reductionism, positivism, and instrumental definitions of pain and treatment lead to frustration and misalignment of therapeutic expectations among staff, patients, and families. This workshop opens up better ways of seeing and managing the intellectual and emotional challenges presented by sick and diseased patients. We will introduce a different definition of sickness, tying together suffering, well-being, and healing. Starting there and based on clinical experience, we will show the utility of a narrative understanding of sickness and sick persons. We’ll introduce the discipline of narrative medicine, which uses the characteristics of stories to teach clinicians at any stage of training to see that what is happening to the patient is one storydone processdprogressing from the molecular to the spiritual. We’ll review what a story is, and how reflexive writing captures aspects of the story to which we were blinded by habit. Participants will write, reflect on the process, and identify a place for it in their usual work. Mindfulness Meditation is another powerful tool to help ourselves; it supports presence, compassion, and connection; decreases anxiety and stress; and helps people cope with impermanence. Workshop participants will experience Mindfulness Meditation to become aware of its benefits in clinical situations for our colleagues, our patients, and ourselves. Finally, the facilitators, using pain as an example, will help participants understand the effect of meaning and impaired function on the patient’s experience of symptoms,
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expanding them beyond their physical, social, psychological, and existential/spiritual aspects. Expect this workshop to be a door opener, introducing new ways of understanding sickness and dealing with our patients’ problems and our own dilemmas.
Quality Improvement: Getting Started, Making Changes, Getting Results (P24) Joy R. Goebel, MN RN PhD, School of Nursing, California State University, Long Beach, CA. Marie Bakitas, RN NP-C ACHPN AOCN FAAN, School of Nursing, University of Alabama, Birmingham, AL. Karen Kehl, PhD MSN RN, School of Nursing, University of Wisconsin, Madison, WI. Karl Lorenz, MSHS MD, University of California, Los Angeles and VA Palliative Care Quality Improvement Center, Los Angeles, CA. (All authors listed above had no relevant financial relationships to disclose with the following exception: Lorenz is a DMC member and receives consulting fees from Otsuka Pharmaceuticals’ phase II trial of Sativex.) Objectives 1. Discuss quality improvement (QI) conceptual frameworks for translating evidencebased practices into quality bedside care. 2. Identify actionable palliative care targets for QI in your setting. 3. Design a QI project appropriate for your setting. Increasing emphasis in performance based payment, public reporting, and quality improvement (QI) has led to widespread interest on measuring and improving the quality of care. With high level political interest and additional funding streams opening for QI projects, clinicians can anticipate widespread support for initiatives to benefit patients and institutions. The aim of this preconference is to enable attendees to plan, implement, and evaluate a QI project at their clinical setting. During this seminar the participants will: 1) identify a project to improve the knowledge, skills, or attitudes of palliative care providers in their practice setting; 2) name approaches for maximizing buy-in by bedside clinicians and program managers for QI implementation; and 3) develop skills for designing, implementing, and evaluating a QI project. In the
