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A total of 21% MS (9/43) with neutral or posi-tive prior experiences employed comforting orempowering strategies.V. Conclusion. MS with prior negative EOL expe-riences are less likely to communicate a terminalprognosis with a higher-level strategy; howeverthe influence of prior positive EOL experiencesdid not reach statistical significance. Innovativeteaching strategies are needed in order to trans-late communication knowledge into an actualchange in attitude towards EOL-CS.VI. Implications for Research, Policy, or Practice.Activation of prior knowledge and structuringa well-prepared first experience may serve as in-novative teaching strategies for EOL-CS.

Theory into Practice: Withdrawal ofArtificial Life Support in the ICU (733)Karen Lukacs, ANP, VAMC, Charleston, SC.Steve Cagle, VAMC, Charleston, SC. VinceBacarri, VAMC, Charleston, SC. Jane Senseney,VAMC, Charleston, SC. James Vail, VAMC,Charleston, SC.(All speakers have disclosed no relevant finan-cial relationships.)

Objectives1. Review concise medication order set for physi-

cians to guide withdrawal of life support inICU.

2. Review ICU nurse’s intervention and docu-mentation form for withdrawal of life supportin the ICU.

3. Discuss the process of instituting a formalizedprogram for withdrawal of life support in ICU.

I. Background. This presentation portrays a threestep process in providing quality end-of-life carein the ICU and summarizes the following inter-ventions; integration into the ICU physicianand nursing culture; construction and finaliza-tion of a physician medication order set and cre-ation of a nursing intervention/documentationform. Theory was put into practice by an inter-disciplinary team comprised of the PalliativeCare Consult Team’s (PCCT) nurse practitionerand physician, ICU nurse specialist and clinicalapplication’s pharmacist and nurse coordinator.We elected a minimalist approach in order toformalize a previously informal practice regard-ing withdrawal of life support in the ICU. Thereare many excellent clinical resources in the liter-ature regarding withdrawal of life support in theICU. We used them to form the foundation ofthe order set and nursing intervention/

documentation form. However, forms alone arenot sufficient to support a quality program.The PCCT immersed themselves within the med-ical and nursing culture of the ICU over a 2-yearperiod using one on one interaction and rolemodeling. We view this period as the most influ-ential aspect of this venture.II. Aims. Present medication order set and nurs-ing intervention/documentation form to guidewithdrawal of life support in the ICU. Discusspathways the PCCT traveled in order to ensureviability of the medication order set and nursingintervention/documentation form.III. Method/Session Description. Poster/Presentation.IV. Conclusion. Formalization of a medicationorder set and nursing intervention/documenta-tion form will enable all care providers to facili-tate a peaceful death for patients who undergowithdrawal of life support. The forms also fostermedical and nursing staff to include social work,chaplains, and the patient’s family in all aspectsof the withdrawal of care process.

Culturally Competent Care: An Imperativefor Effective Outcomes in Palliative Care(734)Sara Martin, MD, Vanderbilt University MedicalCenter, Nashville, TN. Sumathi Misra, MDMPH, Vanderbilt University, Nashville, TN.Mohana Karlekar, MD, Vanderbilt University,Nashville, TN.(All speakers have disclosed no relevant finan-cial relationships.)

Objectives1. Recognize and acknowledge cultural

differences.2. Creatively construct a patient-centered care

plan focused on the patient’s cultural beliefs.I. Background. Cultural beliefs and value systemsare an integral and unique part of every humanbeing. Patient’s interpretation and approach toan illness is thus unique. Recognition and opti-mal incorporation of these distinct needs is crit-ical to the process of effective and individualizedcare planning.II. Case Description. A 19-year-old Tanzanian malepresented with leg pain and was diagnosed withhigh grade non-resectable osteosarcoma refrac-tory to chemotherapy. His prognosis was collec-tively determined as poor by multidisciplinarytreatment teams. His disease course was compli-cated by significant pain, a deep vein thrombo-sis, and bacteremia. Communication was

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challenging and complicated as patient and fam-ily only spoke Swahili. Palliative care was con-sulted for assistance with pain management, toaddress the goals of care, and disposition plan-ning. It quickly became apparent through multi-ple interpreter-based family meetings thatneither the patient nor family understood his di-agnosis of cancer, the concept of palliation, hos-pice care, advance directives, or code status.Striking cultural- and value-based differencescreated unique challenges in developing opti-mal end-of-life care as in the Tanzanian tribalculture people typically did not die of knowncancer. Most deaths were perceived as secondaryto AIDS, poisons, and malnutrition. The prog-nosis and dying experience were difficult to dis-cuss and not culturally appropriate as expressedby family. Ultimately, a plan of care was devel-oped based on the patient’s cultural values andoptimally utilizing the numerous Tanzaniansthat lived in close proximity. Through hospiceinvolvement this community was recruited toprovide continuous care in the home setting.The patient died peacefully surrounded by hisfamily, community, and culture.III. Conclusion. The palliative care team’s recog-nition of the significant role of culture was criti-cal and central to the delivery of effective andcompassionate care. The team’s interdisciplin-ary, creative, and innovative approach facilitatedrespectful, culturally competent patient-cen-tered care.

A Journey to Remember (735)Polly Mazanec, PhD ACNP AOCN, Case WesternReserve University, Cleveland, OH. ElizabethPitorak, MSN CNS, Hospice of the Western Re-serve, Cleveland, OH. Maureen Klinc, RNOCN, University Hospitals Case Medical Center,Cleveland, OH.(All speakers have disclosed no relevant finan-cial relationships.)

Objectives1. Describe the triumphs and challenges along

the cancer disease trajectory as narrated bya patient who died from lung cancer.

2. Utilize the narrative to enhance one’s under-standing of the cancer experience.

I. Background. A diagnosis of cancer is devastatingfor patients and their families. The treatment sideeffects, the anxiety of pending CTscan results, thesadness of recurrence become a way of life forthose living with advanced disease. Often patients

are reluctant to share their true feelings andsymptoms with the team, fearing that they willnot get treated if they appear ill. Healthcare pro-fessionals may not know what some patients andfamilies are really going through.II. Case Description. Narrative analysis allows us theopportunity to look into the personal reflectionsof an individual or group of individuals and gaintremendous insight into the lived experience. Inthis case study discussion, the authors use a the-matic approach to analyze the diary of a womanwho described her lung cancer experience inher daily journal, from diagnosis until end-of-life. Powerful journal entries describe the physi-cal, psychological, and spiritual impact of her can-cer journey from treatment, to stable disease,recurrences, and hospice. Throughout the 48months of her life, she recorded the details ofher triumphs and challenges. Her husbandshared this diary with the palliative care cancerteam that cared for her from diagnosis until deathso that healthcare professionals might better un-derstand the lived cancer experience.III. Conclusion. One woman’s story allows us togain insight into the cancer experience andstrengthens our understanding and compassionas we care for others living with advanced cancer.

Impact of Opening an Inpatient HospiceCenter On Site of Death for ElderlyResidents in Cheyenne, Wyoming (736)Robert Monger, MD, University of Wyoming,Cheyenne, WY. Kristina Stefka, MD, Universityof Wyoming, Cheyenne, WY.(All speakers have disclosed no relevant finan-cial relationships.)

Objectives1. Describe the impact of opening an inpatient

hospice center on site of death for elderly res-idents in Cheyenne, WY.

2. Describe trends in hospital mortality rates be-fore and after an inpatient hospice center wasopened in Cheyenne, WY.

I. Background. Few studies have examined the im-pact of opening an inpatient hospice facility onthe site of death for community residents. Aredeaths that occur in the inpatient hospice centerbeing shifted from the hospital, nursing homes,or other places in the community? Our study ex-amines changes in place of death for elderly res-idents in Cheyenne, Wyoming after an inpatienthospice facility was opened.