This multi-year study analyzed end-of-life discussions at a cancer center over four years. On average, 113 patients expired each year, with 60 expiring seven or more days after admission. Lung cancer was the most common cause of death. While palliative care consultations occurred for only 25.5% of patients on average, the study found no correlations between variables like timing of discussions, location, attendance, and palliative care involvement. Without interventions between years, the study could not measure performance improvement directly. Future research would require implementing interventions to gauge their impact over multiple years.
2014 Cancer Survivorship Conference at Jefferson University Hospitalsjeffersonhospital
Jefferson's Cancer Survivorship Program will help you understand what it means to be a cancer survivor and what to expect from your cancer diagnosis, treatment and follow-up care. This Program is for current patients, cancer survivors and loved ones who have lived with a cancer diagnosis or have undergone cancer treatment at Jefferson.
How We Do Harm: A Webinar by SHARE with Dr. Otis Brawleybkling
Dr. Otis Brawley, author of How We Do Harm, pulls back the curtain on how health care is really practiced in American. Hosted by SHARE: Self-help for Women with Breast or Ovarian Cancer.. www.sharecancersupport.org. If you would like to watch the full webinar, visit www.sharecancersupport.org/brawley.
2014 Cancer Survivorship Conference at Jefferson University Hospitalsjeffersonhospital
Jefferson's Cancer Survivorship Program will help you understand what it means to be a cancer survivor and what to expect from your cancer diagnosis, treatment and follow-up care. This Program is for current patients, cancer survivors and loved ones who have lived with a cancer diagnosis or have undergone cancer treatment at Jefferson.
How We Do Harm: A Webinar by SHARE with Dr. Otis Brawleybkling
Dr. Otis Brawley, author of How We Do Harm, pulls back the curtain on how health care is really practiced in American. Hosted by SHARE: Self-help for Women with Breast or Ovarian Cancer.. www.sharecancersupport.org. If you would like to watch the full webinar, visit www.sharecancersupport.org/brawley.
Jefferson University Hospitals' April 2013 Cancer Survivorship Conference Pre...jeffersonhospital
At Jefferson University Hospitals' Cancer Survivorship Conference on April 12, 2013, Mary McCabe of Memorial Sloan-Kettering Cancer Center gave the keynote address. Jefferson's new Survivorship platform includes biannual conferences featuring keynote speakers and several breakout sessions to give cancer patients, survivors and caregivers a better understanding of survivorship and what comes next after a cancer diagnosis. This is a free event open to all cancer patients and survivors. Learn more: http://www.jeffersonhospital.org/departments-and-services/kimmel-cancer-center/cancer-survivorship-program
Communicating hope and truth: A presentation for health care professionalsbkling
Dr. Don S. Dizon, gynecologic oncologist at Massachusetts General Hospital Cancer Center, discusses the lessons he's learned while trying to communicate in an honest and hopeful way with patients facing a difficult diagnosis. This was presented as a webinar hosted by SHARE. If you'd like to view the complete webinar, go to www.sharecancersupport.org/dizon
Cancer Survivorship: longer term issues and the role of primary care - Prof E...Irish Cancer Society
A presentation given at the Irish Cancer Society's Survivorship Research Day at the Aviva Stadium, Dublin on Thursday, September 20th, 2013.
Cancer Survivorship: longer term issues and the role of primary care - Prof Eila Watson (Oxford Brookes University).
Evaluating the Quality of Life and Social Support in Patients with Cervical C...CrimsonpublishersTTEH
Aims: Purposes of this descriptive correlational research were to 1) describe quality of life and social support and 2) look at the correlation of certain factors and quality of life in women with cervical cancer after treatment. Methods: Fifty-three women diagnosed with cervical cancer who were followed up after finished the treatments at the Gynecological outpatient department of a university hospital in 2016.They were asked to fill 3 questionnaires; 1) the general information; 2) Social support; and 3) Functional Assessment of Chronic Illness Therapy (FACT-Cervix). Alpha Cronbach’s coefficients for the social support was .73 and for the FACT-Cervix was .91. Data were analyzed by descriptive statistic and Spearman Rank Test.Result: Results showed that participants’ age was ranged from 30 to 86, mean=55.15 (SD=10.05). Social support was about 29 to 59, mean=48.23 (SD=6.76). Symptom distress was from 0 to 9, mean=3.36 (SD=2.83). For quality of life was diverted from 75 to159, mean=126.02 (SD=21.09). The results discovered that there was no correlation between age and social support with the quality of life, however, there was negative correlation between symptom distress and quality of life with r=-.40 at p=0.003.Conclusion: This study disclosed that social support for this women’s group could not help to improve their quality of life. Their symptom distress seems to have a direct effect on their QOL. Thus, the healthcare team needs to alleviate patients’ distress in order to improve the quality of life in cervical cancer survivors.
Geriatric Oncology
1. Relationship between aging and cancer
2. Constructs of frailty and multimorbidity
3. Evidence for geriatric assessment in older adults living with cancer
cancer in the young, cancer in AYA, cancer in TYA, yeenage and adolescent cancer, adolescent and young adult cancer
Presentation date : 03-03-2012
CME - Head and Neck Oncology
2013 Cancer Survivorship Conference at Jefferson University Hospitalsjeffersonhospital
Jefferson's Cancer Survivorship Program will help you understand what it means to be a cancer survivor and what to expect from your cancer diagnosis, treatment and follow-up care. This Program is for current patients, cancer survivors and loved ones who have lived with a cancer diagnosis or have undergone cancer treatment at Jefferson.
2006 presentation at The European Health Psychology Conference in Bath: Can We Bury the Idea That Psychotherapy Extends the survival of Cancer Patients?
Strategies for Long-term Management of Recurrent Ovarian Cancerbkling
A panel of doctors and patients will discuss decision-making in the recurrent setting of ovarian cancer, including how to understand and consider options like chemotherapy, surgery, and clinical trials. Panelists include Dr. Jason Wright and Dr. June Hou from Columbia University College of Physicians and Surgeons, survivor/research advocate Annie Ellis, and others living with recurrence.
Jefferson University Hospitals' April 2013 Cancer Survivorship Conference Pre...jeffersonhospital
At Jefferson University Hospitals' Cancer Survivorship Conference on April 12, 2013, Mary McCabe of Memorial Sloan-Kettering Cancer Center gave the keynote address. Jefferson's new Survivorship platform includes biannual conferences featuring keynote speakers and several breakout sessions to give cancer patients, survivors and caregivers a better understanding of survivorship and what comes next after a cancer diagnosis. This is a free event open to all cancer patients and survivors. Learn more: http://www.jeffersonhospital.org/departments-and-services/kimmel-cancer-center/cancer-survivorship-program
Communicating hope and truth: A presentation for health care professionalsbkling
Dr. Don S. Dizon, gynecologic oncologist at Massachusetts General Hospital Cancer Center, discusses the lessons he's learned while trying to communicate in an honest and hopeful way with patients facing a difficult diagnosis. This was presented as a webinar hosted by SHARE. If you'd like to view the complete webinar, go to www.sharecancersupport.org/dizon
Cancer Survivorship: longer term issues and the role of primary care - Prof E...Irish Cancer Society
A presentation given at the Irish Cancer Society's Survivorship Research Day at the Aviva Stadium, Dublin on Thursday, September 20th, 2013.
Cancer Survivorship: longer term issues and the role of primary care - Prof Eila Watson (Oxford Brookes University).
Evaluating the Quality of Life and Social Support in Patients with Cervical C...CrimsonpublishersTTEH
Aims: Purposes of this descriptive correlational research were to 1) describe quality of life and social support and 2) look at the correlation of certain factors and quality of life in women with cervical cancer after treatment. Methods: Fifty-three women diagnosed with cervical cancer who were followed up after finished the treatments at the Gynecological outpatient department of a university hospital in 2016.They were asked to fill 3 questionnaires; 1) the general information; 2) Social support; and 3) Functional Assessment of Chronic Illness Therapy (FACT-Cervix). Alpha Cronbach’s coefficients for the social support was .73 and for the FACT-Cervix was .91. Data were analyzed by descriptive statistic and Spearman Rank Test.Result: Results showed that participants’ age was ranged from 30 to 86, mean=55.15 (SD=10.05). Social support was about 29 to 59, mean=48.23 (SD=6.76). Symptom distress was from 0 to 9, mean=3.36 (SD=2.83). For quality of life was diverted from 75 to159, mean=126.02 (SD=21.09). The results discovered that there was no correlation between age and social support with the quality of life, however, there was negative correlation between symptom distress and quality of life with r=-.40 at p=0.003.Conclusion: This study disclosed that social support for this women’s group could not help to improve their quality of life. Their symptom distress seems to have a direct effect on their QOL. Thus, the healthcare team needs to alleviate patients’ distress in order to improve the quality of life in cervical cancer survivors.
Geriatric Oncology
1. Relationship between aging and cancer
2. Constructs of frailty and multimorbidity
3. Evidence for geriatric assessment in older adults living with cancer
cancer in the young, cancer in AYA, cancer in TYA, yeenage and adolescent cancer, adolescent and young adult cancer
Presentation date : 03-03-2012
CME - Head and Neck Oncology
2013 Cancer Survivorship Conference at Jefferson University Hospitalsjeffersonhospital
Jefferson's Cancer Survivorship Program will help you understand what it means to be a cancer survivor and what to expect from your cancer diagnosis, treatment and follow-up care. This Program is for current patients, cancer survivors and loved ones who have lived with a cancer diagnosis or have undergone cancer treatment at Jefferson.
2006 presentation at The European Health Psychology Conference in Bath: Can We Bury the Idea That Psychotherapy Extends the survival of Cancer Patients?
Strategies for Long-term Management of Recurrent Ovarian Cancerbkling
A panel of doctors and patients will discuss decision-making in the recurrent setting of ovarian cancer, including how to understand and consider options like chemotherapy, surgery, and clinical trials. Panelists include Dr. Jason Wright and Dr. June Hou from Columbia University College of Physicians and Surgeons, survivor/research advocate Annie Ellis, and others living with recurrence.
Developing a cancer survivorship research agenda - Prof Patricia GanzIrish Cancer Society
A presentation given at the Irish Cancer Society's Survivorship Research Day at the Aviva Stadium, Dublin on Thursday, September 20th, 2013.
Developing a cancer survivorship research agenda: challenges & opportunities - Prof Patricia Ganz, UCLA Fielding School of Public Health
Evidence TableEvidence TablePICOT Question
[Insert here]APA Source Reference
(Include the DOI or URL. Use the source URL, not the library link.) Indicate: Peer Reviewed,
Clinical Guideline, or
Best Practice GuidelineAim, Hypothesis,
or Research QuestionConceptual or
Theoretical FrameworkResearch Design/MethodologyMeasurement
MethodSample Population
or SettingResearch Variables Data AnalysisFindingsGaps in ResearchSignificant Findings from a Critical Appraisal of the Evidence
(level, quality of the evidence)Good QuotesAdditional NotesEnd of Worksheet
Role of Clinical Trial Participation in Cancer Research: Barriers,
Evidence, and Strategies
Joseph M. Unger, Ph.D.1, Elise Cook, M.D.2, Eric Tai, M.D.3, and Archie Bleyer, M.D.4
1Fred Hutchinson Cancer Research Center, Seattle, Washington
2The University of Texas MD Anderson Cancer Center, Houston, Texas
3Centers for Disease Control and Prevention, Atlanta, Georgia
4St Charles Health System, Quality Department, Bend, Oregon
OVERVIEW
Fewer than 1 in 20 adult cancer patients enroll in cancer clinical trials. But although barriers to
trial participation have been the subject of frequent study, the rate of trial participation has not
changed substantially over time. Barriers to trial participation are structural, clinical, and
attitudinal, and differ according to demographic and socioeconomic factors. In this paper, we
characterize the nature of cancer clinical trial barriers, and we consider global and local strategies
for reducing barriers. We also consider the specific case of adolescents with cancer, and show that
the low rate of trial enrollment in this age group strongly correlates with limited improvements in
cancer population outcomes compared to other age groups. Our analysis suggests that a clinical
trial system that enrolls patients at higher rates produces treatment advances at a faster rate and
corresponding improvements in cancer population outcomes. Viewed in this light, the issue of
clinical trial enrollment is foundational, lying at the heart of the cancer clinical trial endeavor.
Fewer barriers to trial participation would allow trials to be completed more quickly and would
improve the generalizability of trial results. Moreover, increased accrual to trials is important to
patients, since trials provide patients the opportunity to receive the newest treatments. In an era of
increasing emphasis on a treatment decision-making process that incorporates the patient
perspective, the opportunity for patients to choose trial participation for their care is vital.
INTRODUCTION
The path from initial development of a new cancer drug to diffusion of the new therapy into
the cancer treatment community relies, crucially, on clinical trials, which represent the final
step in evaluating the efficacy of new therapeutic approaches for malignancy. It has been
repeatedly estimated that <5% of adult cancer patients enroll in cancer clinical trials.1,2
...
VOLUME 21, NUMBER 1 CLINICAL JOURNAL OF ONCOLOGY NURSING 79CJO.docxjessiehampson
VOLUME 21, NUMBER 1 CLINICAL JOURNAL OF ONCOLOGY NURSING 79CJON.ONS.ORG
A
Detecting Distress
Introducing routine screening in a gynecologic cancer setting
Moira O’Connor, BA(Hons), MSc, PhD, Pauline B. Tanner, RN, RM, CertOnc, SBCN, Lisa Miller, MBBS, DCH, FRACGP, FAChPm, FRANZCP,
Kaaren J. Watts, BA(Hons), PhD, and Toni Musiello, BA(Hons), MA, PhD
ALONGSIDE PHYSICAL SYMPTOMS AND SIDE EFFECTS of treatment, cancer results
in psychological, social, and practical challenges, which can contribute to
patient distress (Carlson, Waller, Groff, Giese-Davis, & Bultz, 2013). The
International Psycho-Oncology Society highlights distress as a critical factor
affecting patients’ well-being and recommends that distress be named the
sixth vital sign in oncology (Holland, Watson, & Dunn, 2011). The report-
ed prevalence rates of psychological distress in patients with cancer range
from 35%–49% (Carlson, Groff, Maciejewski, & Bultz, 2010). However, the
actual rates of distress are thought to be much higher because of underdetec-
tion. Clinician assessments have been shown to be inferior to gold-standard
methods, such as validated screening tools and clinical interviews (Werner,
Stenner, & Schüz, 2012), and distress is often missed by clinicians (Mitchell,
Vahabzadeh, & Magruder, 2011).
Distress encompasses a range of issues, including psychological, spiritual,
and existential distress, as well as juggling roles and having financial concerns
and practical problems, such as needing help with accommodation or travel.
Distress is associated with poorer physical and psychological quality of life
(Carlson et al., 2010). Detecting distress in patients with cancer can result in
early intervention, which helps avoid patients struggling with unmet or com-
plex needs (Faller et al., 2013). Identifying distress early could also reduce the
financial burden on health services (Han et al., 2015). Healthcare profession-
als (HCPs) must recognize distress so it can be adequately managed (Werner
et al., 2012); to do this, HCPs need to screen all patients systematically.
Several organizations and professional bodies state in their standards
for quality cancer care that psychosocial support should include routine
screening for distress, followed by appropriate referrals targeted to the needs
identified by patients (Holland et al., 2011; Werner et al., 2012). Despite this,
uptake of routine distress screening in clinical oncology settings has been
suboptimal (Mitchell, Lord, Slattery, Grainger, & Symonds, 2012). Many
barriers exist to the successful implementation of routine distress screen-
ing in clinical settings, including a lack of training, clinicians’ perception of
limited skills and confidence in identifying distress, and inadequate referral
resources (Absolom et al., 2011). A shortage of private space has also been
identified (Ristevski et al., 2013). Many HCPs believe that addressing distress
will take too much time. However, appropri ...
This keynote speech was delivered by Janet Freeman-Daily to the IASLC 2017 Chicago Multidisciplinary Symposium in Thoracic Oncology on September 14, 2017.
Existing value frameworks for cancer care omit a key component: patient-defined value. This presentation looks at some patient perspectives on value found in patient-driven research, discusses the importance of shared decision making and goals of care discussions, and shares resources to help clinicians incorporate patient-defined value in cancer care.
Multidisciplinary Approach to Prostate Cancer and Changes in Treatment Decisi...CrimsonpublishersCancer
In order to demonstrate the impact of multi-disciplinary care in the community oncology setting, we evaluated treatment decisions following the initiation of a dedicated genitourinary multi-disciplinary clinic (GUMDC).
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
The Impact of Patients’ Disease-Labels on Disease Experience Living Longer ...semualkaira
Advances in oncology have resulted in prolonged disease trajectories, also for patients with incurable cancer. This has induced discussions about the ‘right’ medical terminology. The impact of choosing a specific disease-label on well-being can be high.
Information and support for patients on MKI treatmentMarika Porrey
Information and support for patients on MKI treatment - guidance for physicians and patient organizations by Dr Fabian Pitoia
Encargado de la Sección Tiroides
División Endocrinología - Hospital de Clínicas
Universidad de Buenos Aires
Cancer Survivorship Care: Global Perspectives and Opportunities for Nurse-Le...Carevive
The 18th CNSA Annual Winter Congress, held Perth, Australia will featured On Q Health’s co-founder Dr. Carrie Stricker as a keynote speaker. The theme for this year’s edition is “Cancer Nursing: Expanding the Possibilities” and will focus on exploring the opportunities that exist in cancer nursing in 2015 and beyond.
1. -" Cancer is the second most common cause of death in the United States;
In 2014, about 585,720 Americans were expected to die of cancer,
estimating at almost an alarming 1600 people per day (CDC,2015).
-People in our country deny death, believing that medical science can
cure any patient.; Death often is seen as a failure of the health care
system rather than a natural aspect of life (NCI, 2007).
-The importance of why the first end of life discussion should not be last
topic discussed in the diagnoses of serious illness; in addition to the
appropriate time for when this conversations should take place
(American Cancer Society, 2014).
Oncologists admitted that they go along with or nourish patients’ overly
optimistic views of the therapeutic options because they are afraid to
destroy their patients’ hope in alternate treatment and curative options .
(Pfeil, T., Laryionava, K., Reiter-Theil…2014).
INTRODUCTION TO THE PROBLEM
LITERATURE REVIEW
Completed a data clean up followed by a data analysis using data
collected from medical records, previously recorded by graduate
students
Filled in gaps in data where necessary
Created an SPSS file which included a complete data set of
demographics for all patients who expired at Fox Chase Cancer
Center from the years 2009-2012
Created an SPSS data set of a number of variables to test for
statistical differences and/ or correlations
Determined at what point in time the end of discussion was given
(timing)
Determined if any correlations could be made using any of the
variables tested
Determined which areas need improvement to prevent delays in future
end of life discussions at Fox Chase Cancer Center.
METHODS
During the multi-year End of life study period at the Fox Chase Cancer
on average 113 patients expired in the hospital a year from 2009-2012, 60
of which expired 7 days or greater. The mean age of patients who expired
was 63. During the study it was identified that in the year 2009 Lung
Cancer was the leading cause of death accounting for (22.0%) of the
population, Gastrointestinal Cancer (15.3%), Hematology Cancer
accounted for (11.9%), Head & Neck (11.9%), Genitourinary (10.2%),
Gynecology (8.5%), Breast Cancer (6.8%), Pancreas (3.4%), Liver &
Biliary Tract Cancer (1.7%), Other (8.5%). In the year 2010, Lung
Cancer 11(25.9%), Hematology Cancer (12.1%), Gastrointestinal Cancer
(15.5%), Gynecology Cancer 5 (1.7%), Head & Neck Cancer 5 (8.6%),
Breast Cancer 4 (8.6%), Liver and Biliary Tract Cancer (3.4%), Pancreas
Cancer 2 (6.9%), Genitourinary Cancer (8.6%), Other (1.6%). In the
year 2011, the Primary Cancer Diagnosis: Lung Cancer 11(27.9%),
Hematology Cancer (16.4%), Gastrointestinal Cancer (21.3%),
Gynecology Cancer 5 (8.2%), Head & Neck Cancer (4.9%), Breast
Cancer (8.2%), Liver and Biliary Tract Cancer (4.9%), Pancreas Cancer
2 (3.3%), Genitourinary Cancer (3.3%), Other (1.6%). In the year 2012,
the Primary Cancer Diagnosis 2012: Lung Cancer 11(19.0%),
Hematology Cancer (10.3%), Gastrointestinal Cancer (17.2%),
Gynecology Cancer (6.9%), Head & Neck Cancer (5.2%), Breast Cancer
(15.5%), Liver and Biliary Tract Cancer (6.9%), Pancreas Cancer (6.9%),
Genitourinary Cancer (1.7%), Other (10.3%).
RESULTS
CONCLUSION
As presented, there were no correlations or statistical differences found
between variables presented, as hypothesized at the start of the study.
The biggest drawback of the study was lack of intervention, because no
intervention was set at the end of each year there wasn’t really a way to
measure performance improvement, so instead we searched for
correlations between variables. In order for future research to be
conducted there will need be some type of intervention put into place to
measure improvement over a multi-year period.
REFERENCES
Balaban, R. (2000). A physician’s guide to talking about end-of-life care. J
Gen Intern Med, 15(3), 195-200. doi:10.1046/j.1525-1497.2000.07228.x
Butcher, L. (2010). Health Reform May Push End-of-Life Discussion
Forward; ‘End-of-Life Planning Shouldn't Happen at the End of Life’.
Oncology Times, 32(3), 12. doi:10.1097/01.cot.0000368445.05669.38
Cdc.gov,. (2015). CDC - Cancer - Statistics by Cancer Type. Retrieved 1
April 2015, from http://www.cdc.gov/cancer/dcpc/data/types.htm
Centers for Disease Control and Prevention.(2011). United States Cancer
Statistics. National
Program of Cancer Disease Registries.Retrieved from
http://apps.nccd.cdc.gov/USCS/state.aspx?state=Pennsylvania
Pfeil, T., Laryionava, K., Reiter-Theil, S., Hiddemann, W., & Winkler, E.
(2014). What Keeps Oncologists From Addressing Palliative Care Early
on With Incurable Cancer Patients? An Active Stance Seems Key. The
Oncologist, 20(1), 56-61. doi:10.1634/theoncologist.2014-0031
ACKNOWLEDGMENTS
I would like to thank West Chester University, specifically Dr. Stacie
Metz, PhD and Dr. Gopal Sankaran, MD, DrPH. I would also like to
express my boundless gratitude to my site supervisor, Delinda Pendleton,
BSN, MSN, CPHQ who has become a great mentor in my life, all your
acts of encouragement and words of wisdom served a great purpose. My
dedication and all my hard work thus far is dedicated, In Loving
Memory to the Loves Of My Life, my Grandparents, Dan Mcintosh &
Ruth Ella Stone, my loving angels who take account for my passion for
Medicine and Research; my phenomenal Parents John & LaiVitia Stone,
my Aunt Mary, my lifeline & sisters: Lajon & Tia, Cayana, my little
princess Jim, my brothers: John, Rick, Dywren and Vernon, Thank you
all for believing in me and being the reason I am who I am today. Lastly,
but certainly not least, I want to acknowledge my wonderful best friend
Shaniqua M. Rudd, BS,MS who has accomplished every milestone with
me hand in hand; I thank you for being such a great role model and
always encouraging me to put my best foot forward and conquer the
world!
Debra Bill, PhD, MCHES, Faculty Advisor, College of Health Sciences, West Chester University
Delinda Pendleton, RN, MSN, CPHQ Director Clinical Strategic Initiatives, Site Supervisor, Fox Chase Cancer Center
LaKesha Stone, BS., MPH Candidate
Multi-Year Analysis of End of Life Discussions at an
Oncology Facility:
PROGRAM BACKGROUND
As a medical professional, no matter how many talks you have given to
patients and their families, End of life discussions never seem to get
easier, one has to face the fact no one wants to hear or live with the reality
that they are dying; despite all the pain and suffering one might be
enduring, they still look for a better outcome. According to The National
Cancer Institute Cancer Control Continuum (2007), a patient’s cancer
experience is broken into six phases. The first two phases, prevention and
screening, involve the entire population. The diagnosis, treatment, and
survivorship phases eventually will involve all patients with a diagnosis of
cancer. The end-of-life phase is relevant for patients who have cancers
that cannot be cured but clearly is also relevant to individuals who die of
other causes. (pg 67). During The end of life phase the most critical
components are desirable outcomes and communication. The
communication component is essential when it comes down to doctors
and clinicians being aware of level of pain a patient may be experiencing
and/or any other symptoms, sending and receiving vital information,
keeping the emotions of both patients and clinicians under control,
making life threatening decisions such as: treatment options, palliative or
hospice care options, life sustaining treatments etc. Information exchange
can also be as problematic on both the patient and the clinician side.
Communication with patients with incurable cancer about the transition
from specific anticancer treatment to best supportive care often triggers
ethical challenges around whether or how to address death explicitly and
implies talking about valuable goals for the last weeks or months of life.
It also means dealing with patients’ feelings of hopelessness and
disappointment (Pfeil, T., Laryionava, K., Reiter-Theil, S., Hiddemann,
W., & Winkler, E. 2014). Communicating prognosis has three major
challenges. First, prognoses apply to groups, but the illness trajectory will
be unique for each individual. Second, patients and their families vary in
their wish to know what will happen next. Patients who might tolerate
knowing that they have cancer may not want to know that they are dying.
Third, patients are often discomfited by physician expressions of
uncertainty; consequently, the clinician may feel that he or she has to
assume a posture of expressing more than can be known (Epstein, R., &
Street, R., 2007). The dialogue on hope has similar challenges. Patients
generally want to know the truth. However, when asked, patients with
terminal illnesses often still express hope for a cure (National Cancer
Institute Cancer Control Continuum, 2007). Patients in continuous denial
refuse to accept the truth, and they go to cancer centers with hope in the
‘“name” of the Institution, something will be done, a wonder drug will be
available; they make it difficult for cancer specialized centers because
they still maintain their expectations despite all evidence to the contrary.
Oncologists admitted that they go along with or nourish patients’ overly
optimistic views of the therapeutic options because they are afraid to
destroy their patients’ hope. (Pfeil, T., Laryionava, K., Reiter-Theil, S.,
Hiddemann, W., & Winkler, E. 2014).
Palliative Care Consultation services address the physical, emotional and
spiritual suffering of patients living with chronic and complex illnesses.
Palliative Care is provided by physicians and nurse practitioners to
enhance quality of life, optimize function, relieve symptoms, and support
decision-making. Of those patients who expired, it was found that on
average only (25.5%) of those patients had Palliative Care consultations.
PROGRAM GOALS & OBJECTIVES
Averaging about 115 deaths per year at Fox Chase Cancer Center,
Clinical Strategic Initiatives Director Delinda Pendleton and The Vice
chair of Oncology, Michael Levy, MD decided to begin a study looking
at End of Life Discussions. Each year they would mentor a graduate
student who would collect the data from the previous year from the
medical charts of expired patients. The student would collect a variety
of information regarding expired patient’s end of life of life discussion
i.e. who was in attendance, where the discussion happened, the time
period between the last time treatment was received and the first
discussion etc. This process occurred for about four consecutive years;
however each student only analyzed the data for the year which they
collected.
DISCUSSION
Using the variables presented in the study I began to look for
correlations between variables in a Multi-Year study of end of life
discussions at an Oncology facility. In each of the statistical test I ran I
used a specific variable as the baseline, assuming that another variable
would be influenced by it. The first test I ran with hopes of finding
some type of correlations and/or statically different results was a
correlation Bivariate test in SPSS. Because there was no intervention
between each year the data was collected, the Principal Investigator,
Dr. Levy, predicted that there would be no correlation or statistical
differences found in any of the variables tested, the test proved his
hypothesis to be true. As a result, of this finding no further research
was discussed, nor were there any programs implemented; the
information presented will serve as a baseline to identify opportunities
for improvement.
Because the study was looking at multiple patients and their cases of a
particular disease initially it was thought that it was best for to choose
a case series study. Reason is, in all cases the patients were affected by
cancer and in each case end of life discussions were being examined.
As a result, there was not any pre/post testing, nor were there any
control or experimental groups. Using SPSS software descriptive
analysis tool, I analyzed standard deviation, mean, frequency, and/ or
percent of total for each of the years (2009-2012) the study was
conducted. I then used various charts and graphs to illustrate the
findings specifically the frequencies and percents, in addition to
showing the comparisons and differences in the results of each year
(2009-2012). The data was analyzed by looking at some key points
which included: (1) DNR status during End of life discussion (2)
Attendance during End of Life Discussion (3) Location during End of
Life Discussion (4) timing between Last chemotherapy treatment and
discussion (5) Palliative Care Consultations
PROCEDURES
The goal of this study was to: analyze end-of-life data collected over
a multi-year period to identify trends and opportunities for
improvement, so that future research and programs could be created
to improve timing and End of Life discussion protocols at Fox Chase
Cancer Center