Archive for April, 2014

Self Care Activities in Summa’s Palliative Care and Hospice Services

By Rod Myerscough, PhD

We have developed a number of initiatives that we believe are creating the conditions that support good self-care. Fundamental to these efforts is the clarification of our core values so that, in the words of Parker Palmer, our “soul and role” are congruent. That is, when we know our personal, core values and our jobs conform to them, we believe that we will be effective and able to sustain a long and satisfying career.

For example, we have offered a two year training course in “The Sacred Art of Living and Dying”. This training involved four two-day retreats over two years accompanied by monthly meetings in small, four-to-six person study support groups to advance the work and learning identified in the retreats. It was designed to help the participants clarify their core values, become attentive to patients’ interpersonal and spiritual needs at the end of life, and to integrate these into their actual day to day work.

We also provided several courses of mindfulness training, a modified version of the popular eight week program, Mindfulness Based Stress Reduction (MBSR) described in Jon Kabat-Zinn’s book, Full Catastrophe Living. In it we placed special emphasis on meditation training and MBSR’s Seven Foundational Attitudes of Mindfulness (Non-Judging, Patience, Beginners Mind, Trust, Non-Striving, Acceptance, and Letting Go). We believe that when we practice these attitudes it is highly unlikely (if not outright impossible) for compassion fatigue to develop. The practice of mindfulness is uniquely situated to advance and support the goal of congruent “soul and role”.

We have also utilized poetry to advance the goals of self-care. W.H. Auden observed that “What the poet says has never been said before, but, once he has said it, his readers recognize its validity for themselves.” We partnered with Kent State University’s Wick Poetry Center to have poetry workshops in which members of the Palliative Care Team discuss a selected poem and then write one of their own. These discussions and the poetry that has emerged have been remarkably powerful experiences for the way they move the practitioners away from their usual clinical way of observing the world to one more informed by the heart’s vision. Additionally, a poem is read at the start or the end of team meetings. The poems selected are chosen because of their capacity to stimulate reflection and to help the team members see the world and themselves in a way that they would not otherwise do and, in Auden’s words, “…recognize its validity for themselves.”

The intention behind all of these efforts is the maintenance and, if necessary, the restoration of the practitioner’s sense of competency and wholeness. Our self-care strategy assumes that we already have all that we need, although it is certainly possible to forget this and to become lost and burned out. Our hope is that these and other initiatives will prevent compassion fatigue, promote good patient care, and allow practitioners to have long-lasting and meaningful careers in Palliative Care.

For more on Summa’s Palliative Care and Hospice Services, visit AAHPM’s Profiles in Innovation.

HMDC PREP – Assess your knowledge of hospice medicine

AAHPM launched a comprehensive study tool, the HMDC PREP, for those preparing for the Hospice Medical Director Certification Exam coming up in May. The tool includes 75 case-based questions, rationales and active links to references. According to Dr. Porter Storey, executive vice president of AAHPM and a reviewer of HMDC PREP, “This new online tool is a valuable study aid and review of a number of important aspects of our field. Clinical care, administrative issues, and team dynamics are all represented in these carefully crafted vignettes and discussions. It not only teaches you a lot, but helps you focus your studies on where they will help you the most. Highly recommended!”

Whether you are studying for the exam, are new to hospice, or want to assess your knowledge after years of experience, you’ll enjoy using this online tool. To learn more about HMDC PREP or purchase your copy, visit aahpm.org.

Submitted by Julie Bruno, AAHPM Director of Education and Training.

Findings of first empirical data on contributions of chaplain interventions in palliative care

By Eric J. Hall, president & CEO, HealthCare Chaplaincy Network

When the latest Clinical Practice Guidelines for Quality Palliative Care guidelines were announced at last year’s AAHPM annual conference, project co-chair Betty Ferrell, PhD, RN, FAAN, FPCN, research scientist at City of Hope, said, “Quality palliative care includes all eight domains. If you are not providing excellent spiritual care, you are not providing palliative care.”

Nonetheless hospital administrators who are skeptical about the value of professional chaplaincy care need data about what chaplains do and their contributions to better patient care.

The first large-scale attempt at forming an evidence base for chaplaincy care effectiveness in health care has culminated in six studies funded by the John Templeton Foundation under a grant managed by HealthCare Chaplaincy Network. The findings were released the inaugural conference of HealthCare Chaplaincy Network’s first annual conference Caring for the Human Spirit: Driving the Research Agenda in Spiritual Care in Health Care March 31 – April 3, 2014, at the New York Academy of Medicine:

Spiritual Assessment and Intervention Model (AIM) in Outpatient Palliative Care for Patients with Advanced Cancer. University of California, San Francisco; Project Director, Laura Dunn, MD, Project Chaplain, Allison Kestenbaum, BCC
This is one of very few studies to provide an in-depth picture of spiritual care work with patients. No validated spiritual assessment tools have existed prior to this study. Even three sessions with a professional chaplain had important, positive effects for patients. The research raises the possibility that spiritual care should be studied as a potentially powerful intervention for patients with various serious illnesses, not just cancer.

Impact of Hospital-Based Chaplain Support on Decision-Making During Serious Illness in a Diverse Urban Palliative Care Population. Emory University (Atlanta); Project Director, Tammie Quest, MD, Project Chaplain, George Grant, ACPE
A diary study of 1140 chaplain-patient encounters demonstrated the value of chaplain-patient communication and revealed that more than half of chaplain visits focused on issues other than spiritual. The study also showed that conversations with patients were more likely to be about “practical matters” (family care, life review, medical care, work) than about “ultimate concerns” (expressed emotions, existential matters, spiritual/religious matters, physical symptoms).

Hospital Chaplaincy and Medical Outcomes at the End of Life. Dana Farber Cancer Institute (Boston):
Project Director, Tracy Balboni, MD, Project Chaplain, Angelika Zollfrank, BCC

The data from this study is a first step in furthering the understanding of how chaplaincy care influences patient well-being and medical decision making at the end of life.

Understanding Pediatric Chaplaincy in Crisis Situations, Children’s Mercy Hospital (Kansas City)
Project Director, John Lantos, MD, Project Chaplain, Dane Sommer, BCC

Researchers analyzed seven in-depth case studies that reveal how medical professionals utilize chaplains in the care of seriously ill children. They learned that most health professionals have little or no understanding of what chaplains do and that this has implications for patient and family care. Key findings showed that: tangible objects are very important (e.g., prayer shawls and teddy bears); physical interaction builds trust (e.g., eye contact).

Caregiver Outlook: An Evidence-Based Intervention for the Chaplain Toolkit. Duke University Medical Center (Durham, NC):Project Director, Karen Steinhauser. PhD, Project Chaplain, Annette Olsen, BCC
For the first time, researchers established that it is feasible for chaplains to use a standardized, low-cost phone-delivered intervention. This has important implications because the intervention is measurable, controllable and transferrable. Both religious and non-religious participants found conversations with the chaplain meaningful and without an agenda.

“What do I do” – Developing a Taxonomy of Chaplaincy Activities and Interventions for Spiritual Care in ICU Palliative Care. Advocate Charitable Foundation & Advocate Health Care (Chicago):
Project Director, Kevin Massey, BCC, Co-Principal Investigator, William Summerfelt, PhD

This study begins to explain how spiritual care is helpful by revealing a common language, list of activities, effects and outcomes for chaplains. The research showed that professional chaplains play a major role in helping patients express their wishes about end of life and advance care planning. The study generated 348 taxonomy items.

If you wish more detail about any of this research, please contact jsiegel@healthcarechaplaincy.org

Highlights of the April Issue of the Journal of Pain and Symptom Management

Listed below are a few articles from the most recent issue of the journal:

Differences in the Symptom Experience of Older Oncology Outpatients
Christine Ritchie, Laura B. Dunn, Steven M. Paul, Bruce A. Cooper, Helen Skerman, John D. Merriman, Bradley Aouizerat, Kimberly Alexander, Patsy Yates, Janine Cataldo, and Christine Miaskowski

A Novel Website to Prepare Diverse Older Adults for Decision Making and Advance Care Planning: A Pilot Study
Rebecca L. Sudore, Sara J. Knight, Ryan D. McMahan, Mariko Feuz, David Farrell, Yinghui Miao, and Deborah E. Barnes

Dying With Dementia: Symptoms, Treatment, and Quality of Life in the Last Week of Life
Simone A. Hendriks, Martin Smalbrugge, Cees M.P.M. Hertogh, and Jenny T. van der Steen

To access the articles, you must subscribe to JPSM or be a member of the American Academy of Hospice and Palliative Medicine (AAHPM). For further information on the Academy, call 847.375.4712 or visit aahpm.org.

Submitted by: David J. Casarett, MD, MA, Senior Associate Editor, JPSM

Reflections of the AAHPM Research Scholars Program and the NPCRC Foley Retreat

Last October, I was fortunate enough to attend the National Palliative Care Research Center’s “Kathleen M. Foley Research Retreat” as one of AAHPM’s Research Scholars. The annual Foley Retreat brings together the country’s leading experts in palliative and hospice care research to discuss the state of the science, set priorities for future research, and allow for the creation of new friendships and collaborations among colleagues. It is a remarkable experience.

As a non-clinician health services researcher whose work is clinically-focused, it can sometimes be a little bit daunting to find where you belong. Does a non-clinician fit in at a clinical society meeting (like AAHPM’s Annual Assembly)? Sure. But often, the annual meetings of clinical societies predominately cater their offerings towards practitioners – and rightly so. Well, what about more methods-focused organizations? Sure, those are phenomenal meetings, too, but let’s be honest – sometimes those meetings tend to “geek out” over the minutiae of research methods at the expense of real-life applicability. The sweet spot for someone like me can be hard to find.

But enough with my Goldilocks-meets-Little Orphan Annie soliloquy. I can confidently say that after last fall’s NPCRC Foley Retreat, I have found a community where I believe that I belong. The Foley Retreat is one of the most inspiring meetings I’ve attended, and the passion of its attendees is readily apparent. These individuals are the true leaders and innovators in palliative care research. They are the ones actively working to build the evidence base for the care of those with serious illness, the ones who have paved the way for junior palliative care researchers, and the ones who we ultimately aspire to emulate in our careers. Aside from seeing exciting research presented by both junior and senior colleagues funded by NPCRC and ACS, there is another aspect of this retreat worth highlighting. The relaxed atmosphere of the retreat allows for friendly and supportive interactions amongst attendees. Indeed, I have never felt so welcomed during another professional meeting – mid-level and senior researchers were genuinely interested in my work, freely providing their suggestions, perspectives, and general career mentorship. The Foley Retreat makes the nurturing of junior attendees a priority – something that as an early stage investigator myself, I truly appreciate.

I can’t adequately thank AAHPM for its ongoing commitment to my career development. The Research Scholars Program is but one example of how AAHPM is dedicated to supporting and advancing the careers of junior palliative care researchers. Thank you for affording me the opportunity to participate in such a phenomenal experience. I’m already excitedly looking forward to next year’s retreat!

Dio Kavalieratos, PhD
Postdoctoral Fellow, University of Pittsburgh School of Medicine
Adjunct Assistant Professor of Health Policy and Management, University of North Carolina at Chapel Hill