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A Vital Layer of Support: One Safety Net Hospital's Palliative Care Response to the Pandemic

Xu, Yijie; Zhang, Luyi K; Smeltz, Robert L; Cohen, Susan E
PMID: 33555977
ISSN: 1557-7740
CID: 4780802

Working Upstream in Advance Care Planning in Pandemic Palliative Care

Zaurova, Milana; Krouss, Mona; Israilov, Sigal; Hart, Louis; Jalon, Hillary; Conley, Georgia; Luong, Khoi; Wei, Eric K; Smeltz, Robert; Frankenthaler, Michael; Nichols, Jeffrey; Cohen, Susan; Suleman, Natasha; Ivanyuk, Marina; Shulman, Pavel; Tala, Osbely; Parker, Lauren; Castor, Tita; Pearlstein, Nicole; Kavanagh, Elizabeth; Cho, Hyung J
PMID: 32706629
ISSN: 2326-5108
CID: 4534282

SIMplifying Palliative Extubations: A Two-Part OSCE in a Simulation Center to Assess Entrustable Professional Activities (EPAs) in Hospice and Palliative Medicine (TH315) [Meeting Abstract]

Rau, M E; Cohen, S E
Objectives: * Identify the critical steps of a palliative extubation procedure. * Assess how the Palliative Extubation objective structured clinical exam (OSCE) applies to the clinical competencies of EPAs in Hospice and Palliative Medicine. * Demonstrate the innovative Palliative Extubation OSCE simulation. * Construct an educational toolkit in order to adapt and implement the Palliative Extubation OSCE simulation to your own institution. Healthcare professionals require education and practice to master their communication and procedure skills, especially in potentially distressing circumstances such as palliative extubations. Palliative extubation refers to removal of mechanical ventilator support when, based on an individual's goal of care, it is thought to be prolonging the dying process rather than helping to support through a reversible illness. Removing the endotracheal tube will allow a natural death to occur. In order to provide competent and compassionate care for patients and family members before, during, and after a palliative extubation, healthcare providers must provide a clear explanation of this complex procedure, show proficiency in performing the procedure, and demonstrate leadership skills. One method of evaluating a healthcare provider's competency in the domains of performing a palliative extubation and communication, is through use of an objective structured clinical exam (OSCE). An OSCE in a simulation center is an effective method to teach theoretical knowledge, improve hands-on skills, and assess clinical competencies while also reducing the risk of harm to patients and providers, especially for scenarios that do not occur on a daily basis. A simulation provides the advantage of providing a controlled, standardized situation, allowing for multiple interventions to be applied. This concurrent session describes an innovative Palliative Extubation OSCE in a simulation center using a mannequin as the patient and a standardized patient (SP) actor as a family member. The OSCE is divided into two parts-part 1: the family meeting and part 2: the extubation procedure. This session describes how the OSCE is structured to teach and assess the clinical competencies of the 17 EPAs in Hospice and Palliative Medicine. The session will conclude with a demonstration of the Palliative Extubation OSCE followed by small group discussions on how to implement the OSCE at participants' own institutions.
Copyright
EMBASE:2004708297
ISSN: 1873-6513
CID: 4295792

Development of an Outpatient Palliative Care Protocol to Monitor Fidelity in the Emergency Medicine Palliative Care Access Trial

Grudzen, Corita R; Schmucker, Abigail M; Shim, Deborah J; Ibikunle, Aminat; Cho, Jeanne; Chung, Frank R; Cohen, Susan E
PMID: 31486726
ISSN: 1557-7740
CID: 4067522

Playing Together in the Sandbox: An Interprofessional Simulation to Teach Collaborative Communication Skills in a Family Meeting [Meeting Abstract]

Wholihan, Dorothy; Cohen, Susan; Smeltz, Robert
ISI:000348478200109
ISSN: 1873-6513
CID: 1477272

Hidden in Plain Sight: Palliative Care for Undocumented Immigrants [Meeting Abstract]

Kinderman, Anne; Bien, Melanie; Cohen, Susan; Smeltz, Robert
ISI:000348478200055
ISSN: 1873-6513
CID: 1480902

Palliative Care in the Era of Hypothermia Protocols [Meeting Abstract]

Smeltz, Robert; Zelnick, Lisa; Cohen, Susan; Freeman, Rebecca
ISI:000331150000047
ISSN: 0885-3924
CID: 852772

Goals of Care Discussion and Withdrawal of Life-Sustaining Treatment Using High Fidelity Simulation [Meeting Abstract]

Zelnick, Lisa; Cohen, Susan; Gang, Maureen; Smeltz, Robert
ISI:000331150000117
ISSN: 0885-3924
CID: 852812

Medical repatriation at end of life: Barriers, facilitation, and fulfillment-A case-series study at a New York public hospital

Seetharamu, Nagashree; Ma, Hilary Y; Smeltz, Robert; Schindewolf, Jessica; Empalmado, Mariam; Cohen, Susan E
141 Background: Foreign-born cancer patients frequently desire to return to their home country at the end of life. However, many barriers can make this process challenging. We herein present our recent experience with such patients. METHODS: We reviewed charts of terminal cancer patients (pts) who traveled to their homeland at the end of life. Pts' age, diagnoses, co-morbidities, prior cancer-directed treatment, predicted survival, symptoms, code status, admissions within 4 weeks of travel, oxygen need were noted. Interval between decision to travel and travel date, events during travel, and feedback from families, if available were collected. RESULTS: 17 charts (11 female, 6 male) were analyzed. Mean age was 60 years and the most common diagnosis was thoracic malignancy (70%, 12 pts). All pts had disseminated cancer and had received an average of 2 lines of cancer-directed therapy. All had progressive cancers with expected survival <6 months. All were under the care of medical oncologists, palliative care and social work. The mean interval between decision to travel and travel date was 9 days. 8 were hospitalized at least once in the 4 weeks prior to the day of travel and 6 were cared for as inpatients immediately prior to travel. 11 pts were receiving opioids for pain and 3 were oxygen-dependent. 10 had documented discussions regarding resuscitation and 9 were discharged with New York State out-of -hospital DNR forms. All were discharged with medical records, medication supply and provider contact information. Mean travel distance was 4,099 miles. Provider concerns for decompensation during travel included brain herniation (2), spinal cord compression (3), bleeding (1), and sepsis (2). 16 pts successfully completed their journey. 1 pt died en-route prior to boarding the aircraft. 12 pts/families provided positive feedback about the experience. CONCLUSIONS: Return to homeland is an important goal for many terminally ill cancer pts and should be a routine part of end-of-life discussions. Medical repatriation can be accomplished when conducted in a planned, well-coordinated manner. Insights from this review can help us create guidelines that can be readily applied to specific scenarios.
ORIGINAL:0013187
ISSN: 1527-7755
CID: 3590052

Moving upstream: a review of the evidence of the impact of outpatient palliative care

Rabow, Michael; Kvale, Elizabeth; Barbour, Lisa; Cassel, J Brian; Cohen, Susan; Jackson, Vicki; Luhrs, Carol; Nguyen, Vincent; Rinaldi, Simone; Stevens, Donna; Spragens, Lynn; Weissman, David
Abstract Background: There is good evidence for the efficacy of inpatient palliative care in improving clinical care, patient and provider satisfaction, quality of life, and health care utilization. However, the evidence for the efficacy of nonhospice outpatient palliative care is less well known and has not been comprehensively reviewed. Objective: To review and assess the evidence of the impact of outpatient palliative care. Methods: Our study was a review of published, peer-reviewed outcomes research, including both observational studies and controlled trials of nonhospice outpatient palliative care services. We assessed patient, family caregiver, and clinician satisfaction; clinical outcomes including symptom management, quality of life, and mortality; and heath care utilization outcomes including readmission rates, hospice use, and cost. Results: Four well-designed randomized interventions as well as a growing body of nonrandomized studies indicate that outpatient palliative care services can: 1) improve patient satisfaction, 2) improve symptom control and quality of life, 3) reduce health care utilization, and 4) lengthen survival in a population of lung cancer patients. Conclusions: The available evidence supports the ongoing expansion of innovative outpatient palliative care service models throughout the care continuum to all patients with serious illness.
PMID: 24225013
ISSN: 1557-7740
CID: 712592