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

transitioning them to a more appropriate loca-tion for end-of-life care.Implications for research, policy, or practice. (1)PCUs can be non-monitored and staffed to ac-commodate dying ICU patients receiving me-chanical ventilation, dialysis, hemodynamicsupport, and other life-sustaining treatments.(2) PCUs are well suited to align treatmentswith patient preferences through the use oftime-limited trials of life-sustaining measures.

Barriers to Conducting Advanced CareDiscussions for Children withLife-Threatening Conditions (720)Amy Durall, MD, Children’s Hospital, Boston,MA.(Durall has disclosed no relevant financialrelationships.)

Objectives1. Identify barriers to conducting advanced care

discussions for children with life-threateningconditions.

2. Identify issues that are less likely to be barriersto advanced care discussions for children withlife-threatening conditions.

Background. Although some data exist regard-ing barriers to advanced care discussions amongthe care of adult patients, very little pediatricdata exist.Research objectives. Identify barriers to con-ducting advanced care discussions for childrenwith life-threatening conditions.Methods. Physicians and nurses from practicesettings where advanced care planning typicallytakes place were surveyed to collect data regard-ing their attitudes and behaviors about advancedcare discussions.Results. The survey had 266 respondents (54%response rate). Of the respondents, 53% per-cent were medical/surgical critical care clini-cians, 20% were cardiac critical care providers,and 27% specialized in oncology. Nurses com-prised 60% of respondents and 40% were physi-cians. Regarding work experience, 43% ofclinicians had practiced fewer than 10 years,30% had practiced 10-19 years, and 27% hadpracticed 20 years or more. The top-three bar-riers to conducting advanced care discussionswere: unrealistic parent expectations, differ-ences between clinician and patient/parent un-derstanding of prognosis, and lack of parentreadiness to have the discussion. On the other

hand, more than 50% of clinicians believedthat the following were never or rarely a barrier:clinician concern about losing the trust of thepatient, lack of importance to clinician(s), lawsand regulations, ethical considerations, conflictbetween the patient and parent, and concernabout the patient receiving less attention fromthe health-careteam once advanced care discus-sions began.Conclusion. Significant barriers to conductingadvanced care discussions for pediatric patientsexist.Implications for research, policy, or practice. Fu-ture studies should focus on strategies to over-come these challenges.

PAL-A-ROUNDS: An Innovative TeachingMethod for Nurses (721)Chad Farmer, MD MA, Axis Palliative Health-care, LLC, Tampa, FL. Linda Stennett. MaryLePiere. Lisa Frappier, RN, LifePath Hospice,Tampa, FL.(All speakers have disclosed no relevant finan-cial relationships.)

Objectives1. Describe the basic format of PAL-A-ROUNDS

educational sessions.2. Identify at least one benefit for the adult

learner with sessions presented in the PAL-A-ROUNDS format.

Background. Research shows that attention spanand ability to retain information decreases after15 minutes among adult learners. In addition,most nurses report that they do not have timeduring their typical workday to attend educa-tional sessions of 30 minutes or longer. This sug-gests a need to identify an innovative way todeliver palliative care education.Research objectives. (1) Present palliative caretopics effectively and efficiently to acute inpatientcare nurses. (2) Increase participation in palliativecare educational sessions. (3) Evaluate participantsatisfaction with the PAL-A-ROUNDS teachingformat.Methods. PAL-A-ROUNDS were created in a 300-bed community hospital as 10-15 minute, multi-media, interactive presentations covering diversepalliative care topics, such as, pain assessment;breaking bad news; and palliative care versus hos-pice. PAL-A-ROUNDS were presented at each ofthe seven nursing stations by the traveling PAL-A-ROUNDS team (physician presenter, nursing

Vol. 41 No. 1 January 2011 285Schedule with Abstracts

education specialist, nurse manager) using a tab-let PC with PowerPoint slides and a portable dryerase board. Satisfaction surveys were conductedat the conclusion of PAL-A-ROUNDS sessions.Results. From the seven nursing stations, 55nurses participated in a single PAL-A-ROUNDStopic. Seventy-one percent (39) felt the overallquality of the activity was excellent and 27%(16) felt the quality was good. Ninety-five per-cent either strongly agreed (30) or agreed (23)that the short format/audiovisuals/locationwere beneficial and helped achieve the desiredactivity objectives. Ninety-seven percent eitherstrongly agreed (29) or agreed (25) that as a re-sult of the activity, they would use the informa-tion in the care of their patients.Conclusion. Participants found that a shorter for-mat at the location where they are performingtheir duties was beneficial and that they woulduse the information to care for their patients.Implications for research, policy, or practice.Of-fering shorter, focused educational sessionswhere patient care is delivered may increasesatisfaction, increase participation in learningseminars, and translate into incorporation ofpalliative care principles at the bedside.

Palliative Care Online: A Pilot Study ona Pancreatic Cancer Website (722)Marian Grant, DNP CRNP RN, University ofMaryland School of Nursing, Reisterstown, MD.(Grant has disclosed no relevant financialrelationships.)

Objectives1. Discuss how the Internet is being used increas-

ingly for health information and support.2. Discuss the methodology and findings from

a pilot study of having a palliative care nursepractitioner available to answer questions ona leading pancreatic cancer website.

3. Discuss the opportunity for further study onproviding aspects of palliative care online.

Background. Patients with pancreatic cancerand their families could benefit from palliativecare services but may not have access to them.An emerging option is the Internet, which is be-coming an important source of health informa-tion and a link between patients, families, andhealthcare providers.Research objectives. (1) Determine if patientsand their families would use a webpage where

they could access a palliative care nurse practi-tioner (PCNP). (2) Identify the palliative careneeds of patients and families who accessedthat Webpage. (3) Determine the helpfulnessof the webpage/PCNP.Methods.Descriptive quantitative and qualitativeResults. The PCNP webpage was visited 650times by 395 unique individuals over an 8-weekstudy period. Forty-eight participants posted a to-tal of 55 questions or sent e-mails to the PCNP.The majority of questions (66%) fell into oneof the eight domains of palliative care. Of these,most of the questions, 42%, asked about physicalaspects of pancreatic cancer with the next larg-est domain, 11%, being psychological concernsabout the illness. The other third of questionshad to do with non-palliative aspects of pancre-atic cancer or its treatment. Twenty participants(5% of total visitors) completed an online sur-vey. Although statistical significance was notachieved, most survey respondents found thePCNP website helpful. It was considered easyto use and participants found information andsupport there and recommended that thePCNP page be an on-going resource.Conclusion. The Internet can be used to offeraspects of palliative care such as information,support and advice to patients and families deal-ing with a life-threatening illness.Implications for research, policy, or practice.Further research is needed in this evolvingarea.

‘‘I Want to Be Taking My Own LastBreath’’: Patients’ Reflections on IllnessWhen Presenting to an EmergencyDepartment at the End of Life (723)Corita Grudzen, MD MSHS, Mount Sinai Schoolof Medicine, New York, NY. Susan Stone, MDMPH, Cedars Sinai & UCLA, Venice, CA. SaritaMohanty, MD MPH, University of Southern Cal-ifornia. Karl A. Lorenz, MD MSHS, VA GreaterLos Angeles Healthcare System, Los Angeles,CA. Jacqueline Torres. Joanna Ortiz, BA, MountSinai School of Medicine, New York, NY. StefanTimmermans, PhD, UCLA, Los Angeles, CA.(All speakers have disclosed no relevant finan-cial relationships.)

Objectives1. Discuss what motivates patients to visit emer-

gency departments (ED) at the end of life.