Vol. 41 No. 1 January 2011 181Schedule with Abstracts

services by those with lung cancer. From thesetwo pilot studies, the most common symptomswere pain, cough, dyspnea, and fatigue withonly 64 referrals in 57 of the 100 patients. Thepatient and family interventions were deliveredby an advanced practice nurse based on inputfrom an interdisciplinary team. The projectincluded distinct education interventions forearly- and late-stage lung cancer and for familycaregivers. Project 1 focuses on early-stage lungcancer (N ¼ 207) provides a model of integrat-ing palliative care throughout the trajectory ofdisease. Project 2 focuses on late-stage lung can-cer (N ¼ 326) a population who has decreasedsurvival and high QOL and symptom concerns.Project 3 focuses on family caregivers (N ¼533) of patients with lung cancer.Evaluation. Outcomes evaluation of the projectinclude assessment of the impact of the educa-tion on patient symptoms QOL and supportiveresource use as well as family caregiver QOLself-care and skills preparedness for caregiving.

DomainStructure and Processes of Care; Physical Aspectsof Care; Psychological and Psychiatric Aspects ofCare; Spiritual, Religious, and Existential Aspectsof Care

Dancing with Broken Bones: Race, Class,and Spirit-Filled Dying in the InnerCity (303)David Moller, PhD, University of Medicine andBiosciences, Kansas City, MO.(Moller has disclosed no relevant financialrelationships.)

Objectives1. Discuss how class and race intersect with the

experience of dying in the inner city.2. Discuss the specific characteristics that shape

end-of-life experiences for patients and lovedones, including challenges that surround com-munication, mistrust, and inadequate cultur-ally based understanding of patient needs.

3. Discuss how a home-based learning curriculumcan increase cultural proficiency and empathicskill in caring for patients who aremarginalizedby racial and economical barriers.

Those challenged by economical and racial bar-riers in urban poverty are especially marginal-ized near the end of life. There is a divide thatseparates providers from patients because ofteneach come from very different backgrounds.

Mistrust, suspicion, and poor communicationfrequently define the relationship between phy-sicians and their impoverished patients. Yetthere also are remarkable faith and stoic sourcesof support that patients and families draw uponto endure circumstances that few in this countrycan imagine. Although many inner-city poor arefractured by the injuries imposed by class injus-tice and racism they embody a resilience that en-ables them to dance. Hence the title of thepresentationdDancing with Broken Bones.This presentation will describe the dismal realityof health care for people with terminal condi-tions in the urban environment. Drawing onoriginal community-based participatory re-search, real-life narratives will illustrate how in-ept healthcare arrangements lead to indignityand inequity in care for this vulnerable popula-tion. It will also present narratives of exemplaryend-of-life care that establish a paradigm for ex-cellence in caring for vulnerable populations.A portrait of the ‘‘invisible world’’ of the dyingpoor will be crafted and describe the following:� indignities of living in poverty� the roles of race and prejudice� indignities of dying in poverty� relationship between patients and providersdanger, suspicion, mistrust

� relationshipbetweenpatients andprovidersdgratitude, culturally competent care

� sources of social support� presence and power of faith� mindful presence as clinically necessary skillin caring for the those challenged by eco-nomic and racial barriers.

An innovative home-visit learning curriculumdesigned to enhance skill and compassionamong student physicians in caring for diversepopulations will be presented.

DomainSocial Aspects of Care; Spiritual, Religious, andExistential Aspects of Care; Cultural Aspects ofCare; Care of the Imminently Dying Patient

Rage Against the Dying of the Light:Geriatrics, Palliative Care, andDementia (304)Elizabeth Clark, MD, James J. Peters VA MedicalCenter, Bronx, NY.(Clark has disclosed no relevant financialrelationships.)

182 Vol. 41 No. 1 January 2011Schedule with Abstracts

Objectives1. List three principles underlying the geriatrics

approach to dementia care.2. List three principles underlying the palliative

care approach to dementia care.3. List two ways in which a combined geriatrics

and palliative care approach to dementiacare can enhance overall care and qualityof life for dementia patients and theircaregivers.

Dementia, the quintessential geriatric syndrome,is also both a primary palliative care diagnosisand a complicating comorbidity of many otherpalliative care diagnoses in the elderly. The twodisciplines of geriatrics and palliative care, how-ever, offer different approaches to dementiacare. Geriatrics focuses on function. ‘‘Use it orlose it’’ is themantra of primary dementia preven-tion and informs efforts at secondary preventionof further cognitive decline. Geriatrics stressesearly detection of dementia to facilitate imple-mentation of pharmacologic and nonpharmaco-logic measures to mitigate symptoms and helpmaintain functional independence as long as pos-sible. Geriatrics attempts to balance the compet-ing goals of patient autonomy and safety.Geriatrics recognizes the frequent occurrenceof atypical presentations of common illnesses inpatients with dementia thus improving care fordistressing and life threatening conditions. Evenin dementia’s final stages geriatrics often fails toconsider dementia a terminal illness. Palliativecare views dementia as a terminal illness. Pallia-tive care’s emphasis on ‘‘hope for the best but pre-pare for the worst’’ encourages frank discussionsof prognosis early in the disease trajectory. Thesediscussions in turn help patients and families es-tablish goals of care while patients retain deci-sional capacity, thus supporting patientautonomy and improving patient and family satis-faction. Palliative care’s attention to expert man-agement of distressing symptoms increasesquality of life for patients and their caregivers.However, patients with dementia at the end oflife present special challenges as atypical diseaseand symptom presentations may delay or compli-cate care. This presentation will review the cur-rent literature on the geriatrics and palliativecare approaches to dementia care then seek todemonstrate through a case discussion how de-mentia care that incorporates geriatrics and palli-ative care principles enhances functionalindependence, symptom management, patient

autonomy, and quality of life for dementia pa-tients and their caregivers.

DomainStructure and Processes of Care; Physical Aspectsof Care; Psychological and Psychiatric Aspects ofCare; Social Aspects of Care

Community-Based Opportunitiesfor Extending the Palliative CareContinuum (305)Lynn Spragens, MBA, Spragens & Associates,Durham, NC. Amber Jones, MEd, Center toAdvance Palliative Care, Loudonville, NY.(All speakers for this session have disclosed norelevant financial relationships.)

Objectives1. Identify barriers to smooth transitions of care;

list specific research references citing patientpreferences for care; and identify health pol-icy initiatives designed to improve or extendcommunity-based services and avoid unneces-sary rehospitalizations.

2. Identify community-based palliative care prac-tice opportunities based on case study exam-ples addressing: (a) recent experiences ofhealth system-based providers who offer com-munity services outreach and (b) recent expe-riences of community-based providers whoare working to align services more closelywith hospital partners to create a continuumof care.

3. Describe which aspects of the models outlinedwould best fit with local circumstances and listconcrete action steps that will position theirorganizations to initiate or support partner-ships designed to improve community-basedpalliative care access.

Although hospital-based palliative care serviceshave proliferated patient access to non-hospicepalliative care, expertise outside the hospital set-ting is often limited or nonexistent. Yet for careto be patient centered it must be able to perme-ate boundaries and be available where patientsneed it whether at home in hospitals or in outpa-tient settings. Palliative care providers are recog-nizing that community-based settings are thenew frontierdthe point-of-care that needs tobe developed to achieve a true continuum ofcare. This practical interactive session will ad-dress how community-based palliative care ser-vices can respond to patient preferences forcare at home and will discuss policy initiatives