Dec 6, 2016 - we developed a dedicated triage center to streamline the assessment of PC ... cancer center that provide PC and supportive services. Examples include ... tient subtypes, and hosting interdisciplinary tumor boards for complex ...
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empathy and compassion stemming from a larger grounded theory study focused on compassion. An overview of how these constructs have been employed in the healthcare literature will be provided to orientate audience members to the topic. Methods: After completing a literature review of these constructs within the healthcare literature, we conducted semi-structured, face-to-face interviews with 53 palliative care patients to elicit their experiences and understandings of sympathy, empathy and compassion using grounded theory. Patients were recruited from a large acute teaching hospital in Western Canada over a 9 month period, with the research team independently and collectively analyzing data in accordance with the three stages of Straussian grounded theory. Results: Each of the three categories contained several distinct themes. Patients identified sympathy as a pitybased response rooted in a lack of understanding, intended to primarily serve the needs of the observer. Empathy was a more personalized response based in an understanding of the person’s needs and an affective response on the part of the respondent. Compassion was described as a virtuous response that seeks to address the suffering and needs of a person through relational understanding and action. Conclusions: Patients perspectives and preferences related to sympathy, empathy, and compassion are important to a patient-centred approach to palliative care. Delineating between these constructs is also foundational to clinical training and research, where these terms are typically conflated and lack specificity.
P321 PathWell: The Development of a Triage Center and Access Hub for Comprehensive Palliative Care in Oncology
Erika Tribett1, Marcy Winget1, LaTisha Webster2, Dorothy Valmayor2, Jenna Lunger2, Patricia Falconer2, Sandy Chan2 1 Stanford University School of Medicine, Stanford, CA, USA 2 Stanford Health Care, Stanford, CA, USA Background: Routine screening to identify palliative care (PC) needs, followed by assessment and management of needs is critical for high-quality cancer care. In our current healthcare system there is poor screening for PC needs, low referral rates to PC services, and unmet needs. In response to these gaps, we developed a dedicated triage center to streamline
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the assessment of PC needs and connect patients with appropriate supportive care services. Methods: We identified 24 services at our academic cancer center that provide PC and supportive services. Examples include PC, psycho-oncology, survivorship, nutrition, and social work. Representatives from these groups convened to map service overlap and develop referral structures based on patient need and acuity. A triage hub (PathWell) was established to complete uniform assessments of patient needs and determine appropriate referrals. The hub utilized a centralized scheduling platform, new patient coordinators, and an oncology nurse for assessment and triage. Referrals to the hub were made via EHR, direct patient contact, or prompted by routine distress screening. Results: PathWell launched on February 1, 2016. Referral volume to the hub was 54 in February, 91 in March and 74 in April. Referrals from PathWell were distributed amongst the 24 services, the majority of referrals going to PC, psycho-oncology and nutrition. All programs that were part of the triage center experienced growth in volume; PC 41%, psycho-oncology 14%, nutrition 16%. Conclusions: Partnerships between specialist services and dedicated triage staff can improve early access to resources for PC needs. Early data from PathWell reveals improved assessment and management of patient needs via referrals to appropriate services. The hub has also unveiled important resource gaps (e.g. physical therapy, integrative medicine). These gaps were not previously quantified, and thus not prioritized by leadership. Future state includes reporting operational and health-related outcomes, optimizing distress screening, establishing care pathways for patient subtypes, and hosting interdisciplinary tumor boards for complex distress management.
P322 The Hope Seeking Narrative Structure in Applying the Intervention Derived from ‘The Narrative Communication Model of Hope Seeking Intervention’ in a Young Female Advanced Cancer Patient
Dal-Sook Kim (DS Kim)1, Hesook Suzie Kim2, Sally Thorne3 1 Chungnam National University, Daejeon, South Korea 2 University of Rhode Island, Kingston, RI, United States 3 University of British Columbia, Vancouver, BC, Canada Purpose: The purpose of this study was to identify the thematic narrative structure revealed in the hopeseeking stories told by a young female advanced
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Selected Abstracts
cancer patient during a narrative intervention to help the patient to seek her own hope experiences. Method: A narrative intervention derived from the ‘the narrative communication model of hope seeking intervention’ developed by the authors (2013) involves an interview process with a patient with a terminal illness involving cue-oriented questioning, attentive listening, and confirmation responses in order for the patient to arrive at one’s own hope-seeking narrative. We obtained the hope-seeking-narrative from a young woman with advanced head and neck cancer as we carried out this narrative intervention with the patient. The intervention session was terminated when the interventionist considered the patient constructed her own hope-seeking narrative fully which was also confirmed by the patient. The intervention session lasted 56 minutes, which was audio-recorded then transcribed later. The transcription from the whole intervention session was analyzed applying Riessman’s narrative analysis (1993) in three steps: (a) separating stories having different themes, (b) analyzing the internal structure of each story using Labov’s 6 elements, and (c) connecting themes in an external structure of hope-seeking applying logic. Results: We found 4 stories to have different internal structures with themes, which then were reconstructed into the external thematic structure of the narrative: (a) story #1 - ‘a cross-point of conflicts between ‘enduring’ and ‘giving up’ the severe distressing treatment-related situations’; (b) story #2- ‘anxiety for ‘giving-up’ leading her to feel oppressed in thinking about dying against living’ ; (c) story #3 - ‘acknowledging the internal-external interactional sources from the past experiences to endure the situation’: and (d) story #4 - ‘feeling of her as the self, transcending beyond this-like-situations and this-like-oppressed-consciousness in the future’.
P325 Feasibility and Acceptability of a Dignity Therapy/Life Plan Intervention for Individuals with Advanced Cancer Undergoing Treatment Ann Marie Dose, Jeff Sloan, Joleen Hubbard, Aaron Mansfield, Catherine Krecke, Pamela McCabe, Mayo Clinic, Rochester, MN, United States Objectives: For individuals with advanced cancer, quality of life (QOL) worsens due to disease and psychosocial factors, as well as cancer treatment itself. Palliative care, recommended to occur simultaneously with cancer treatment, improves outcomes, but we know little about the logistics of providing interventions and their influence on aspects of psychosocial QOL. Dignity
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Therapy (DT), a brief focused life review/values clarification intervention, improves outcomes at end of life. There are limited data about its feasibility during treatment and its pairing with a Life Plan (LP) intervention. This study’s purpose was to determine feasibility, acceptability and psychosocial outcomes of the DT/LP intervention for persons with advanced pancreatic cancer (PC) or non-small cell lung cancer (NSCLC) receiving treatment. Methods: DT was delivered during three outpatient cancer treatment visits. Audiotaped interviews were transcribed and edited to produce a document, which the participant kept. Life Plan is a type of ‘bucket list’ of future hopes/dreams. Participant acceptability was evaluated, distress measured with the Distress Thermometer, and QOL measured with the Linear Analogue Self-Assessment (LASA) and Functional Assessment of Cancer Therapy (FACT) instruments. Baseline distress and QOL scores were compared with those after intervention completion, about 6 weeks later. Results: Of 25 PC or NSCLC participants enrolled, seven withdrew, due to worsening disease or other life changes; 18 completed the intervention/measures. Seventy-eight percent felt it was worthwhile to participate in the study; 88% felt the timing of the DT/LG intervention was ‘just right.’ Data trended toward improved emotional QOL, and lessened emotional distress and anxiety. Conclusions: These findings demonstrated our ability to recruit advanced cancer patients, retain them to complete the DT/LG intervention, validated that we were targeting a relevant population for DT/LG and allowed us to determine next steps in examining important outcomes and appropriate instruments to measure QOL and other important psychosocial outcomes.
Survivorship P327 Delivery of a Cancer Survivorship Workshop to Primary Care Providers
Genevieve Chaput1, Kristin Hendricks1, Micheal Shulha2, Manuel Borod1, Laura Naismith3 1 McGill University, Montre al, QC, Canada 2 Jewish General Hospital, Montre al, QC, Canada 3 University of Toronto, Toronto, ON, Canada Background: By 2020, it is estimated there will be 2 million cancer survivors (CS) in Canada. Nearly 1 in 2 CS is afflicted with treatment-related effects. CS are burdened with more medical conditions than
