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

the RCPSC for a 2-year subspecialty programin HPM.

DomainStructure and Processes of Care

Discontinuing Treatment in Patients withEnd-Stage Illness: The Art and Science ofReconfiguring Therapy (406)Robert Kaiser, MD MHSc, Washington DC VAMedical Center and George Washington Univer-sity, Washington, DC. Stephanie BrimleyWashington DC VA Medical Center, Washington,DC. Beverly Lundsford, PhD RN, George Wash-ington University, Washington, DC.(All speakers for this session have disclosed norelevant financial relationships.)

Objectives1. Identify a practical clinical framework for re-

configuring medical treatments for patientswith life-limiting illnesses.

2. Utilize the framework as a tool for analyzingthree clinical scenarios of patients with ad-vanced chronic obstructive pulmonary dis-ease, dementia, and cancer.

Therapeutic requirements may change as an ill-ness progresses to its final stages and, therefore,a patient’s goals of care may change as a result.Decreasing the number of medications may beappropriate under the circumstances but thiscan be a challenging and complex task. Reconfi-guring treatment must take into account the pa-tient’s and the caregiver’s priorities as well as therisks and benefits of specific medications for co-morbid conditions in the context of limited lifeexpectancy; the patient may therefore expressdifferent preferences than previously held forpreventive or disease-modifying therapies. Thenumber of studies dealing with discontinuingmedications has been relatively small but thesestudies can nonetheless be helpful in establish-ing a framework for shared decision making byclinicians and patients. The purpose of thisworkshop is for participants to learn and to em-ploy an interdisciplinary approach to discontinu-ing medications. With the assistance andguidance of three faculty facilitatorsda physi-cian-pharmacist and nursedparticipants willhave the opportunity to consider and analyzethree clinical scenarios of patients with advancedchronic obstructive pulmonary disease, demen-tia, and cancer.

DomainStructure and Processes of Care; Care of theImminently Dying Patient; Ethical and LegalAspects of Care

Pain Theater: How to Talk to YourPatients When Their Pills Are‘‘Stolen’’dAgain (407)Julie Childers, MC, University of Pittsburgh,Pittsburgh, PA. Gordon Wood, MD, Universityof Pittsburgh Medical Center, Pittsburgh, PAMichael Barnett, MD, University of Alabama atBirmingham, Birmingham, AL.(All speakers for this session have disclosed norelevant financial relationships.)

Objectives1. Identify common red flags for opioid misuse.2. Discuss how to respond to signs of opioid mis-

use with empathy and appropriate limit-setting.

3. Interpret positive and negative urine drugscreens.

Many practitioners dread confronting a patientabout behaviors such as repeatedly ‘‘losing’’ pills,getting opioid prescriptions from multiple pro-viders, or using street drugs concurrently withopioids. While many of these patients may sim-ply need better pain management, some maybe abusing the medications, struggling withaddiction, or diverting medications. Palliativecare centers are seeing a growing number ofsuch difficult-to-manage patients in consulta-tion, and hospices struggle with the barriersthat active substance use disorders create to pro-viding quality end-of-life care. Most hospice andpalliative care clinicians do not receive educa-tion in how to communicate with patients withlife-limiting illnesses who also exhibit aberrantdrug-taking behavior. This session uses a tech-nique called ‘‘Pain Theater’’ to teach communi-cation skills around opioid misuse andaddiction disorders in the hospice and palliativecare population. Pain Theater is an educationalinnovation that was introduced at the 2010AAHPM Educational Exchange to overwhelm-ingly positive audience response. The center-piece of this year’s session is the opportunity tosee how an expert clinician communicates ina difficult encounter with a patient with newly di-agnosed metastatic cancer and a history ofchronic pain opioid misuse and a recent positiveurine drug screen. The case will be acted out in

Vol. 41 No. 1 January 2011 223Schedule with Abstracts

front of the audience by two of the presenters. Athird presenter facilitates the session, solicitingaudience feedback to identify the specific com-munication skills that were used and ‘‘pausing’’the encounter to ask for suggestions on how toproceed in a way that sets limits, but maintainsthe rapport necessary to develop a treatmentplan that addresses, both, opioid misuse andpain. Through this exercise the audience seesthe real-time consequences of skillful communi-cation and envisions how they could adopt thesestrategies with their own patients.

DomainStructure and processes of Care; Psychologicaland Psychiatric Aspects of Care; Social Aspectsof Care; Spiritual, Religious, and Existential As-pects of Care; Cultural Aspects of Care; Ethicaland Legal Aspects of Care

SIG Symposium

Phase I and Palliative Care:The Unnecessary Dilemma(408) (Advanced)CancerDavid Hui, MD MSc, MD Anderson CancerCenter, Houston, TX. Mary Buss, MD MPH,Beth Israel Deaconess Medical Center, Boston,MA. Biren Saraiya, MD, The Cancer Instituteof New Jersey, New Brunswick, NJ.(All speakers for this session have disclosed norelevant financial relationships.)

Objectives1. Recognize the risks and benefits associated

with Phase I clinical trials and what motivatespatients with advanced cancer to participatein these studies.

2. Examine the symptom burden and palliativecare needs among Phase I participants.

3. Discuss models for integrating Phase I clinicaltrials and palliative care.

Phase I clinical trials offer patients with ad-vanced cancer the opportunity to pursue life-prolonging cancer treatments while palliativecare focuses on improving their quality of life.Although these two teams have different objec-tives, they are both actively involved in the careof patients with advanced cancer. This sessionaims to review the complex decision-making pro-cess that affects how patients decide betweenPhase I and palliative care, and how the twoteams can collaborate together to enhance

patient care. Reasons to enroll in Phase I trialsinclude hope for disease control, improved sur-vival, contribution to scientific knowledge, andstrong support from the clinical research team.At the same time, Phase I trials are associatedwith potential adverse effects and significanttime, energy, emotional, and financial commit-ment. The literature has shown that patientswho participate in Phase I trials generally havelimited understanding regarding the objectivesof Phase I trials and have heightened expecta-tions regarding their prognosis and treatmentbenefit. Other factors such as risk-taking ten-dency, faith, attitudes of their oncologists, andfamily members may also play a role. Despitea better performance status, patients on PhaseI trials have similar symptom burden as theircounterparts based on matched cohort studies.Interestingly patients on a Phase I study areless likely to consider palliative care, homehealth aide counselors, and chaplains for them-selves. In this session, we will provide a compre-hensive literature review on the risks andbenefits associated with Phase I therapies, pa-tients’ decision-making processes, symptom bur-den, perceived need for, and referral topalliative care. We will highlight the perspectivesof both oncologists and Phase I patients. Finally,we will discuss the existing models and proposenew models for integrating Phase I and palliativecare to optimize both the quantity and quality oflife for patients with advanced cancer.

DomainStructure and Processes of Care; Ethical andLegal Aspects of Care

Case Conference I (409)

AAHPM Business MeetingHPNA Membership Meeting

1e2 pm

Advocacy Session

2:15e3:15 pm

Paper Sessions

The Use of Dermafill CelluloseWound-Care Dressing for Management