1
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Amonoo HL, Daskalakis E, Deary EC, Bodd MH, Reynolds MJ, Nelson AM, Newcomb R, Dhawale TM, Yang D, Luger SM, Gustin JL, Brunner A, Fathi AT, LeBlanc TW, El-Jawahri A. Relationship Between Longitudinal Coping Strategies and Outcomes in Patients With Acute Myeloid Leukemia. J Natl Compr Canc Netw 2022; 20:1116-1123. [DOI: 10.6004/jnccn.2022.7045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/15/2022] [Indexed: 11/06/2022]
Abstract
Background: Patients with acute myeloid leukemia (AML) face an abrupt life-threatening illness and experience immense physical and psychological symptoms. However, no data describe how patients with AML cope longitudinally with their illness or the relationship between longitudinal coping and outcomes. Methods: We conducted a secondary analysis of longitudinal data from 160 patients with high-risk AML enrolled in a supportive care intervention trial to describe coping strategies longitudinally across the illness course. We used the Brief COPE questionnaire, the Hospital Anxiety and Depression Scale, the Post-Traumatic Stress Disorder (PTSD) Checklist-Civilian Version, and the Functional Assessment of Cancer Therapy-Leukemia to measure coping strategies, psychological distress, and quality of life (QoL) at baseline and at weeks 2, 4, 12, and 24 after diagnosis. Electronic health records were used to assess healthcare utilization and end-of-life (EoL) outcomes, and multivariate analyses were used to assess the relationship between coping and outcomes. Results: Longitudinal utilization of approach-oriented coping strategies was significantly associated with less distress (anxiety: β, –0.18; P<.001; depression symptoms: β, –0.42; P<.001; PTSD symptoms: β, –0.60; P<.001) and better QoL (β, 2.00; P<.001). Longitudinal utilization of avoidant coping strategies was significantly associated with greater distress (anxiety: β, 0.64; depression symptoms: β, 0.54; PTSD symptoms: β, 2.13; P<.001 for all) and worse QoL (β, –4.27; P<.001). Although the use of approach-oriented and avoidant coping strategies was not significantly associated with hospitalization, chemotherapy administration, or hospice use in the last 30 days of life, approach-oriented coping was associated with lower odds of ICU admissions (odds ratio, 0.92; P=.049). Conclusions: Longitudinal use of approach-oriented coping strategies was associated with less psychological distress, better QoL, and a lower likelihood of ICU admission, suggesting a possible target for supportive oncology interventions. Coping strategies did not impact EoL outcomes, and further research is needed to elucidate which patient factors impact EoL decision-making.
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Affiliation(s)
- Hermioni L. Amonoo
- 1Department of Psychiatry, Brigham and Women’s Hospital,
- 2Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, and
- 3Harvard Medical School, Boston, Massachusetts
| | | | - Emma C. Deary
- 1Department of Psychiatry, Brigham and Women’s Hospital,
| | - Monica H. Bodd
- 4Duke University School of Medicine, Durham, North Carolina
| | | | - Ashley M. Nelson
- 3Harvard Medical School, Boston, Massachusetts
- 6Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard Newcomb
- 5Division of Hematology and Oncology, Department of Medicine, and
| | | | - Daniel Yang
- 5Division of Hematology and Oncology, Department of Medicine, and
| | - Selina M. Luger
- 7Division of Hematology Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jillian L. Gustin
- 8Division of Palliative Medicine, The James Cancer Hospital, Ohio State University, Columbus, Ohio; and
| | - Andrew Brunner
- 3Harvard Medical School, Boston, Massachusetts
- 5Division of Hematology and Oncology, Department of Medicine, and
| | - Amir T. Fathi
- 3Harvard Medical School, Boston, Massachusetts
- 5Division of Hematology and Oncology, Department of Medicine, and
| | - Thomas W. LeBlanc
- 9Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Areej El-Jawahri
- 3Harvard Medical School, Boston, Massachusetts
- 5Division of Hematology and Oncology, Department of Medicine, and
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2
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Moyer KM, Verbeck N, Barnett MD, Denney-Koelsch EM, Ajayi T, Humphrey LM, Malhotra S, Ragsdale L, Waldman ED, Gustin JL. A National Survey to Guide Pediatric Curricula for Hospice and Palliative Medicine Fellows. J Pain Symptom Manage 2022; 64:e165-e171. [PMID: 35523388 DOI: 10.1016/j.jpainsymman.2022.04.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/08/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Kristen M Moyer
- Hospice and Community Care (K.M.M.), Lancaster, Pennsylvania, USA.
| | - Nicole Verbeck
- The Ohio State University College of Medicine (N.V.), Columbus, Ohio, USA
| | - Michael D Barnett
- University of Alabama at Birmingham (M.D.B.), Birmingham, Alabama, USA
| | | | - Toluwalase Ajayi
- Scripps Health and Rady Children's Hospital (T.A.), San Diego, California, USA
| | - Lisa M Humphrey
- Nationwide Children's Hospital (L.M.H.), Columbus, Ohio, USA
| | - Sonia Malhotra
- Tulane University School of Medicine and Louisiana State University School of Medicine (S.M.), New Orleans, Los Angeles, USA
| | - Lindsay Ragsdale
- University of Kentucky College of Medicine (L.R.), Lexington, Kentucky, USA
| | - Elisha D Waldman
- Northwestern University School of Medicine / Ann & Robert H. Lurie Children's Hospital of Chicago (E.D.W.), Chicago, Illinois, USA
| | - Jillian L Gustin
- The Ohio State University Wexner Medical Center (J.L.G.), Columbus, Ohio, USA
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3
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Case AA, Epstein AS, Gustin JL. Advance care planning imperative: High-quality patient-centred goals of care. BMJ Support Palliat Care 2022; 12:407-409. [PMID: 35477675 DOI: 10.1136/bmjspcare-2022-003677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/12/2022] [Indexed: 11/03/2022]
Abstract
Advance care planning (ACP) discussions aim to ensure goal-concordant care for patients with serious illness, throughout treatment and especially at the end of life. But recent literature has forced the field of palliative care to wrestle with the definition and impact of ACP. Are ACP discussions worthwhile? Is there a difference between ACP discussions early in a patient's illness versus discussions occurring later when a concrete medical care decision must be made? Here, we identify elements needed to answer these questions and describe how a multisite initiative will elucidate the value of discussing and documenting what matters most to patients.
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Affiliation(s)
- Amy Allen Case
- Supportive and Palliative Care, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | | | - Jillian L Gustin
- Division of Palliative Medicine, Arthur G James Cancer Hospital and Richard J Solove Research Institute, The Ohio State University College of Medicine, Columbus, Ohio, USA
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4
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Amonoo HL, LeBlanc TW, Kavanaugh AR, Webb JA, Traeger LN, Jagielo AD, Vaughn DM, Elyze M, Longley RM, Fathi AT, Hobbs GS, Brunner AM, O'Connor NR, Luger SM, Gustin JL, Bhatnagar B, Horick NK, El-Jawahri A. Posttraumatic stress disorder symptoms in patients with acute myeloid leukemia. Cancer 2021; 127:2500-2506. [PMID: 33764526 DOI: 10.1002/cncr.33524] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients with acute myeloid leukemia (AML) receiving intensive chemotherapy face a life-threatening illness, isolating hospitalization, and substantial physical and psychological symptoms. However, data are limited regarding risk factors of posttraumatic stress disorder (PTSD) symptoms in this population. METHODS The authors conducted a secondary analysis of data from 160 patients with high-risk AML who were enrolled in a supportive care trial. The PTSD Checklist-Civilian Version was used to assess PTSD symptoms at 1 month after AML diagnosis. The Brief COPE and the Functional Assessment of Cancer Therapy-Leukemia were to assess coping and quality of life (QOL), respectively. In addition, multivariate regression models were constructed to assess the relation between PTSD symptoms and baseline sociodemographic factors, coping, and QOL. RESULTS Twenty-eight percent of patients reported PTSD symptoms, describing high rates of intrusion, avoidance, and hypervigiliance. Baseline sociodemographic factors significantly associated with PTSD symptoms were age (B = -0.26; P = .002), race (B = -8.78; P = .004), and postgraduate education (B = -6.30; P = .029). Higher baseline QOL (B = -0.37; P ≤ .001) and less decline in QOL during hospitalization (B = -0.05; P = .224) were associated with fewer PTSD symptoms. Approach-oriented coping (B = -0.92; P = .001) was associated with fewer PTSD symptoms, whereas avoidant coping (B = 2.42; P ≤ .001) was associated with higher PTSD symptoms. CONCLUSIONS A substantial proportion of patients with AML report clinically significant PTSD symptoms 1 month after initiating intensive chemotherapy. Patients' baseline QOL, coping strategies, and extent of QOL decline during hospitalization emerge as important risk factors for PTSD, underscoring the need for supportive oncology interventions to reduce the risk of PTSD in this population.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Alison R Kavanaugh
- Harvard Medical School, Boston, Massachusetts.,Division of Palliative Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Jason A Webb
- Division of Hematology/Medical Oncology, Oregon Health and Science University, Portland, Oregon
| | - Lara N Traeger
- Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Annemarie D Jagielo
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Dagny M Vaughn
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts.,The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
| | - Madeleine Elyze
- Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Regina M Longley
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Amir T Fathi
- Harvard Medical School, Boston, Massachusetts.,Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Gabriela S Hobbs
- Harvard Medical School, Boston, Massachusetts.,Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew M Brunner
- Harvard Medical School, Boston, Massachusetts.,Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nina R O'Connor
- Department of Palliative Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Selina M Luger
- Department of Hematology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jillian L Gustin
- Division of Palliative Medicine, The Ohio State University, Columbus, Ohio
| | | | - Nora K Horick
- Harvard Medical School, Boston, Massachusetts.,Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts.,Department of Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts
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5
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Gustin JL, Yang HB, Radwany SM, Okon TR, Morrison LJ, Levine SK, Hwang JM, Buckholz GT, Barnett MD, Verbeck N, Landzaat LH. Development of Curricular Milestones for Hospice and Palliative Medicine Fellowship Training in the U.S. J Pain Symptom Manage 2019; 57:1009-1017.e6. [PMID: 30790721 DOI: 10.1016/j.jpainsymman.2019.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 01/31/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
CONTEXT A physician workgroup of the American Academy of Hospice and Palliative Medicine sought to define curricular milestones (CMs) for hospice and palliative medicine (HPM) Fellowship Programs. The developed list of CMs would serve as components upon which to organize curriculum and standardize what to teach during training. These would complement entrustable professional activities previously developed by this group and new specialty-specific reporting milestones (RMs) for HPM developed through the Accreditation Council for Graduate Medical Education. OBJECTIVES The objective of this study was to develop and vet CMs for HPM fellowships in the U.S. METHODS A draft of CMs was developed through an iterative consensus group process with repeated cycles of drafting, analyzing, and revising by a broadly representative expert workgroup who then gained input from HPM educators at a national meeting workshop. The CM draft was subsequently revised and then vetted through a national survey to 203 fellowship educators. Respondents were asked to "keep," "revise," or "exclude" each proposed CM with space for comments. An agreement of 75% among respondents was set as the criteria a priori for keeping a CM. Eighty-four of the 203 potential respondents participated in the survey. All items met the minimum agreement level of 75% or greater recommending keeping the CM. Greater than 85% of the respondents agreed to keep 19 of the 22 CMs with no revisions. Comments for revisions on other CMs were primarily related to changes in language and formatting, not conceptual underpinnings. CONCLUSION A group consensus method strengthened by inclusion of a national survey to HPM fellowship educators resulted in a CM document that is both carefully developed and broadly vetted. Along with entrustable professional activities and new specialty-specific RMs, these CMs offer educators and trainees tools to create more comprehensive curricula and behaviorally based assessment tools for HPM fellowships and their stakeholders.
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Affiliation(s)
- Jillian L Gustin
- Division of Palliative Medicine, Department of Internal Medicine, Hospice and Palliative Medicine Fellowship Program, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Holly B Yang
- University of California San Diego/Scripps Health Hospice and Palliative Medicine Fellowship Program, Scripps Health, San Diego, California, USA
| | - Steven M Radwany
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tomasz R Okon
- Marshfield Clinic Palliative Medicine Fellowship, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - Laura J Morrison
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Stacie K Levine
- Palliative Medicine Programs, University of Chicago, Chicago, Illinois, USA
| | - Jennifer M Hwang
- Pediatric Advanced Care Team and Hospice and Palliative Medicine Fellowship, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Clinical Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gary T Buckholz
- University of California San Diego/Scripps Health Hospice and Palliative Medicine Fellowship, University of California San Diego, La Jolla, California, USA
| | | | - Nicole Verbeck
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Lindy H Landzaat
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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6
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Patel PM, Goodman LF, Knepel SA, Miller CC, Azimi A, Phillips G, Gustin JL, Hartman A. Evaluation of Emergency Department Management of Opioid-Tolerant Cancer Patients With Acute Pain. J Pain Symptom Manage 2017; 54:501-507. [PMID: 28729010 DOI: 10.1016/j.jpainsymman.2017.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/29/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT There are no previously published studies examining opioid doses administered to opioid-tolerant cancer patients during emergency department (ED) encounters. OBJECTIVES To determine if opioid-tolerant cancer patients presenting with acute pain exacerbations receive adequate initial doses of as needed (PRN) opioids during ED encounters based on home oral morphine equivalent (OME) use. METHODS We performed a retrospective cohort study of opioid-tolerant cancer patients who received opioids in our ED over a two-year period. The percentage of patients who received an adequate initial dose of PRN opioid (defined as ≥10% of total 24-hour ambulatory OME) was evaluated. Logistic regression was used to establish the relationship between 24-hour ambulatory OME and initial ED OME to assess whether higher home usage was associated with higher likelihood of being undertreated. RESULTS Out of 216 patients, 61.1% of patients received an adequate initial PRN dose of opioids in the ED. Of patients taking <200 OMEs per day at home, 77.4% received an adequate initial dose; however, only 3.2% of patients taking >400 OMEs per day at home received an adequate dose. Patients with ambulatory 24-hour OME greater than 400 had 99% lower odds of receiving an adequate initial dose of PRN opioid in the ED compared to patients with ambulatory 24-hour OME less than 100 (OR <0.01, CI 0.00-0.02, P < 0.001). CONCLUSIONS Patients with daily home use less than 200 OMEs generally received adequate initial PRN opioid doses during their ED visit. However, patients with higher home opioid usage were at increased likelihood of being undertreated.
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Affiliation(s)
- Pina M Patel
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Lauren F Goodman
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States; Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States.
| | - Sheri A Knepel
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Charles C Miller
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Asma Azimi
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Gary Phillips
- The Ohio State University Center for Biostatistics, Columbus, Ohio, United States
| | - Jillian L Gustin
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Amber Hartman
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States; Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
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7
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Landzaat LH, Barnett MD, Buckholz GT, Gustin JL, Hwang JM, Levine SK, Okon TR, Radwany SM, Yang HB, Encandela J, Morrison LJ. Development of Entrustable Professional Activities for Hospice and Palliative Medicine Fellowship Training in the United States. J Pain Symptom Manage 2017; 54:609-616.e1. [PMID: 28729009 DOI: 10.1016/j.jpainsymman.2017.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/06/2017] [Accepted: 07/06/2017] [Indexed: 11/22/2022]
Abstract
CONTEXT Entrustable Professional Activities (EPAs) represent the key physician tasks of a specialty. Once a trainee demonstrates competence in an activity, they can then be "entrusted" to practice without supervision. A physician workgroup of the American Academy of Hospice and Palliative Medicine sought to define Hospice and Palliative Medicine (HPM) EPAs. OBJECTIVE The objective of this study was to describe the development of a set of consensus EPAs for HPM fellowship training in the United States. METHODS A set of HPM EPAs was developed through an iterative consensus process involving an expert workgroup, vetting at a national meeting with HPM educators, and an electronic survey from a national registry of 3550 HPM physicians. Vetting feedback was reviewed, and survey data were statistically analyzed. Final EPA revisions followed from the multisource feedback. RESULTS Through the iterative consensus process, a set of 17 HPM EPAs was created, detailed, and revised. In the national survey, 362 HPM specialists responded (10%), including 58 of 126 fellowship program directors (46%). Respondents indicated that the set of 17 EPAs well represented the core activities of HPM physician practice (mean 4.72 on a five-point Likert scale) and considered all EPAs to either be "essential" or "important" with none of the EPAs ranking "neither essential, nor important." CONCLUSIONS A set of 17 EPAs was developed using national input of practicing physicians and program directors and an iterative expert workgroup consensus process. The workgroup anticipates that EPAs can assist fellowship directors with strengthening competency-based training curricula.
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Affiliation(s)
- Lindy H Landzaat
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.
| | | | - Gary T Buckholz
- University of California San Diego/Scripps Health Hospice and Palliative Medicine Fellowship, University of California San Diego, La Jolla, California, USA
| | - Jillian L Gustin
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jennifer M Hwang
- The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Steven M Radwany
- Summa Health and Northeast Ohio Medical University, Akron, Ohio, USA
| | - Holly B Yang
- University of California San Diego/Scripps Health, Scripps Health San Diego, California, USA
| | - John Encandela
- Teaching and Learning Center Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Laura J Morrison
- Yale Palliative Care Program, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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8
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Probst DR, Gustin JL, Goodman LF, Lorenz A, Wells-Di Gregorio SM. ICU versus Non-ICU Hospital Death: Family Member Complicated Grief, Posttraumatic Stress, and Depressive Symptoms. J Palliat Med 2016; 19:387-93. [PMID: 26828564 DOI: 10.1089/jpm.2015.0120] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Family members of patients who die in an ICU are at increased risk of psychological sequelae compared to those who experience a death in hospice. OBJECTIVE This study explored differences in rates and levels of complicated grief (CG), posttraumatic stress disorder (PTSD), and depression between family members of patients who died in an ICU versus a non-ICU hospital setting. Differences in family members' most distressing experiences at the patient's end of life were also explored. METHODS The study was an observational cohort. Subjects were next of kin of 121 patients who died at a large, Midwestern academic hospital; 77 died in the ICU. Family members completed measures of CG, PTSD, depression, and end-of-life experiences. RESULTS Participants were primarily Caucasian (93%, N = 111), female (81%, N = 98), spouses (60%, N = 73) of the decedent, and were an average of nine months post-bereavement. Forty percent of family members met the Inventory of Complicated Grief CG cut-off, 31% met the Impact of Events Scale-Revised PTSD cut-off, and 51% met the Center for Epidemiologic Studies Depression Scale depression cut-off. There were no significant differences in rates or levels of CG, PTSD, or depressive symptoms reported by family members between hospital settings. Several distressing experiences were ranked highly by both groups, but each setting presented unique distressing experiences for family members. CONCLUSIONS Psychological distress of family members did not differ by hospital setting, but the most distressing experiences encountered at end of life in each setting highlight potentially unique interventions to reduce distress post-bereavement for family members.
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Affiliation(s)
- Danielle R Probst
- 1 Department of Psychiatry, Division of Palliative Medicine, Wexner Medical Center, The Ohio State University , Columbus, Ohio.,2 Department of Internal Medicine, Division of Palliative Medicine, Wexner Medical Center, The Ohio State University , Columbus, Ohio
| | - Jillian L Gustin
- 2 Department of Internal Medicine, Division of Palliative Medicine, Wexner Medical Center, The Ohio State University , Columbus, Ohio
| | - Lauren F Goodman
- 2 Department of Internal Medicine, Division of Palliative Medicine, Wexner Medical Center, The Ohio State University , Columbus, Ohio
| | - Amanda Lorenz
- 2 Department of Internal Medicine, Division of Palliative Medicine, Wexner Medical Center, The Ohio State University , Columbus, Ohio
| | - Sharla M Wells-Di Gregorio
- 1 Department of Psychiatry, Division of Palliative Medicine, Wexner Medical Center, The Ohio State University , Columbus, Ohio.,2 Department of Internal Medicine, Division of Palliative Medicine, Wexner Medical Center, The Ohio State University , Columbus, Ohio
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9
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Taylor RM, Gustin JL, Wells-DiGregorio SM. Improving do-not-resuscitate discussions: a framework for physicians. J Support Oncol 2010; 8:42-44. [PMID: 20235423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Robert M Taylor
- Center for Palliative Care, The Ohio State University, 453 West 10th Avenue, Atwell Hall, Room 246, Columbus, OH 43210, USA.
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