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University of California, San Francisco, SanFrancisco, CA. Lee-May Chen, MD, University ofCalifornia, San Francisco Helen Diller Fa-mily Comprehensive Cancer Center, San Fran-cisco, CA.(All authors listed above had no relevant finan-cial relationships to disclose.)

Objectives1. Name the symptoms domains that may be

improved by an outpatient palliative careconsultation.

2. Quantify the magnitude of change in symp-toms that might be expected after onefollow-up visit.

Background. Several studies have demon-strated that palliative care is associated with animprovement in quality of life and, in the caseof non-small cell lung cancer (Temel, NEJM,2010), an increase in survival. As a result of thesestudies, the American Society of ClinicalOncology issued a provisional clinical opinionin 2012 recommending the combination of stan-dard oncologic care and early palliative care forpatients with metastatic cancer and furtherresearch into strategies to optimize this integra-tion. Few studies have looked at the efficacy ofpalliative care in gynecologic cancer patients.Research Objectives. The purpose of thisstudy is to determine the impact of an outpa-tient palliative care consultation on symptomburden in gynecologic cancer patients.Methods. We studied gynecologic cancer pa-tients seen at an outpatient symptom manage-ment clinic at a single academic center fromJune 2007 through January 2013 who attendeda follow-up visit within 90 days of their initialconsultation. At each visit, patients completeda questionnaire that included the EdmontonSymptom Assessment System (ESAS). Demo-graphic, clinico-pathologic, and treatment datawere obtained through chart review. Analysis ofvariance and chi-squared statistics were used toassess changes in symptom scores and compari-sons of patient sub-groups.Results. Of the 160 patients who had initialvisits during the study period, 79 returned fora follow-up visit within 90 days and wereincluded in the analysis. Of these, 58% hadovarian, fallopian tube, or peritoneal cancer;20% had uterine cancer; and 15% had cervicalcancer. Eighty-one percent of women had stageIII, IV, or recurrent cancer. The mean age was57 years. At study entry, 85% of patients had

disease present, and 62% were undergoing treat-ment. Sixty-two percent were Caucasian, and85% spoke English. Eighty-eight percent of pa-tients had previously undergone surgery. Eight-seven percent had received chemotherapy, and30% had received radiation. Twenty-fourpercent had been hospitalized during themonth prior to their initial palliative care visit.There were no statistically significant differencesbetween women who did and did not havefollow-up visits with respect to disease site, stage,presence of disease, and whether or not theywere undergoing treatment. Between the initialand follow-up visit, there was a statistically signif-icant improvement in almost all symptom scores(P<0.05). Specifically, there was a decrease inpain (mean change ¼ -0.80), fatigue (-0.78),anxiety (-1.18), depression (-1.36), nausea(-0.79), drowsiness (-0.75), and shortness ofbreath (-1.00). There were no statistically signif-icant changes in scores for appetite, sexual prob-lems, or relationship problems. There was alsoan improvement in scores for well-being (0.40)and quality of life (0.10). In the multivariatemodel, significant improvements in symptomburden remained after adjusting for age, diseasesite, stage, presence of disease, and whether ornot they were undergoing treatment.Conclusions. An outpatient palliative careconsultation is associated with a decrease insymptom burden for women with gynecologicmalignancies.Implications for research, policy, orpractice. Gynecologic cancer patients with ahigh symptom burden should be referred forpalliative care services regardless of whetherthey are undergoing concurrent treatment.

SIG Symposium

How We Grieve: Practitioners EncounteringPersonal Loss (TH311)Jonna Goulding, MD, Gifford Medical Center,Randolph, VT. Jan Jahner, BC-RN CHPN PMO,Christus St. Vincent Hospital, Santa Fe, NM.Alexi Wright, MD MPH, Dana-Farber CancerInstitute, Boston, MA.(All authors listed above had no relevant finan-cial relationships to disclose.)

Objectives1. Describe three case studies of practitioner

grief: the oncologist facing the death of a

396 Vol. 47 No. 2 February 2014Schedule With Abstracts

patient after years of hopeful and signifi-cant treatment, the hospice chaplain ex-pected to care for her family in their griefafter the death of her sibling, and the ruralfamily doctor dealing with multiple small-town dual relationships who is caregivingfor a dying patient/friend.

2. Demonstrate three responses to the griefdescribed in the cases that can care forthe caregiver: the use of counsel and deeplistening with our palliative teammatesand peers; the practice of meditation; andthe consideration of personal writing ofbrief narratives as a means of living with,and growing through, grief.

3. Practice the use of counsel and deeplistening in small groups, writing brief nar-ratives of our loss, and guided meditation,thereby learning how these practices aretools that we can bring back to our profes-sional 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, unex-pressed grief can be toxic to the physical andemotional health of patients and their families.But what about us? What challenges and expecta-tions dowe face as physicians, nurses, and spiritualcaretakers when a patient we have become close todies, or whenwe stepout of ourprofessional arenaand a dear friend or family member dies?

Three cases will be presented: the family doc-tor and palliative care specialist in a rural setting,where dual relationships are common, who isasked by a friend and spiritual mentor to beher palliative care provider at the end of life;the chaplain who loses two family members inone year and is asked by the family to managethe memorial service and support family mem-bers in their grief; and the oncologist facingthe death of a patient after years of hopefuland significant treatment who finds few supportsfor expressing and managing personal grief inthe professional setting.

The unacknowledged grief of oncologists hasbeen shown to influence their subsequent prac-tice behavior, including lengthening courses ofchemotherapy in the patients encountered aftera loss (L. Granek, 2012). We deserve acknowl-edgement and response to our grief across allpalliative care provider roles and kinds of lossesso that we can face our next end-of-life patientwith objectivity and an open heart. We need

the ‘‘spiritual toolbox’’ that meditation, peersupport and deep listening in small groups,and the humanities can provide to support usthrough our grief, inside and outside of our pro-fessional work setting.

3:15e4:15 pm

Concurrent Sessions

Hablandocon Latinos: Goals of CareConversations with Latino Patients andFamilies (TH316)Ankur Bharija, MD, East Boston NeighborhoodHealth Center, East Boston, MA. Suzana Makow-ski, MD MMM FACP FAAHPM, UMass MemorialMedical Center and UMass Medical School,Worcester, MA. Madeleine Toland, BSN RNPHN, Spring Valley, CA. Henry RodriguezScripp’s Horizon Hospice, Poway, CA.(All authors listed above had no relevant financialrelationships to disclose with the following excep-tions:Makowski is an advisor and receives 0.1%ofH-STAR company profits if and when sold.)

Objectives1. Identify barriers to meaningful goals of care

conversations in the Latino population.2. Understand how Latino patients and fam-

ilies may approach decision makingregarding end-of-life preferences.

3. Learn and apply culturally sensitive and lit-eracy-appropriate tools for adding valueand meaning to goals of care conversations.

Even though studies show that the majority ofolder Latinos prefer less aggressive, comfort-focused end-of-life care, this patient populationas a whole tends to choose to die in the hospitaland to avoid medications that could betterpalliate symptoms for fear that they may shortentheir lifespan. Furthermore, the majority havenot documented or communicated their prefer-ences, hence remaining at a higher risk of beingsubjected to aggressive interventions close to theend of life. Within the Latino population, prefer-ences may also vary based on widely diversecultural values, literacy levels, demographic char-acteristics, levels of acculturation, and knowl-edge of end-of-life treatment options.Although it is impossible to have adequate

bicultural and bilingual Spanish speaking pro-viders for this ever-increasing ethnic minorityin the United States, it remains clear that