Vol. 39 No. 2 February 2010 Schedule with Abstracts 337

V. Conclusion. Phase angle is determined by qual-itative cell membrane function and is a betterpredictor of survival than SMM.VI. Implications for Research, Policy, or Practice. BIA-determined phase angle predicts survival inde-pendent of skeletal muscle mass. PA should becompared to standard palliative prognostic indi-ces to see if it is an independent prognosticvariable.

DomainPhysical Aspects of Care

Predictors of Improvement of SymptomDistress in Patients with Advanced CancerSriram Yennu, MD, M. D. Anderson Cancer Cen-ter, Houston, TX. Diana Urbauer, MS, Universityof Texas M. D. Anderson Cancer Center, Hous-ton, TX. Eduardo Bruera, MD, University ofTexas M. D. Anderson Cancer Center, Houston,TX.(All speakers have disclosed no relevant finan-cial relationships.)

Objectives1. Discuss the frequency of physical and psycho-

logical symptoms in patients with advancedcancer.

2. Describe the results of a study to assess thepredictors of improvement of symptom dis-tress among advanced cancer patients seenat an outpatient supportive care clinic(OPC) in a tertiary cancer center.

I. Background. Advanced cancer patients developsevere physical and psychosocial symptoms.There is limited data on predictors of improve-ment of symptom distress on consultation byspecialized interdisciplinary palliative care teamin patients with advanced cancer.II. Research Objectives. In this study, we will also as-sess the response rates and predictors of improve-ment of symptom distress among advancedcancer patients.III. Methods. Four hundred six consecutive pa-tients with advanced cancer referred to a sup-portive care outpatient center (OPC) fromJanuary 2006 to June 2007 who had a completeEdmonton Symptom Assessment Scale (0e10scale) at the initial and follow-up visit were re-viewed. Response rate following initial interdis-ciplinary team management were analyzed.Using logistic regression models, we also as-sessed the predictors of improvement of symp-tom distress.

IV. Results. Median age was 59 years; 53% were fe-male. The median interval between initial andsubsequent visits is 15 days. Mean (SD) baselineand follow-up visit scores were: symptom com-posite score (SDS) 43 (16) and 35 (17).V. Conclusion. This study provides a preliminarydata on response rates to standardized IDT man-agement and independent predictors for im-provement of common symptoms includingpain, fatigue, and depression. Lower intensityof fatigue is associated with better improvementof other distressing cancer related symptomssuch anxiety, depression, nausea, and appetitedisturbances. Further prospective studies areneeded.VI. Implications for Research, Policy, or Practice. Thisstudy provides a preliminary data on responserates to standardized IDT management and in-dependent predictors for improvement of com-mon symptoms including pain.

DomainsPhysical Aspects of Care; Psychological Aspectsof Care; Social Aspects of Care; and Spiritual As-pects of Care

Paper Session (303)

Evaluation of Housestaff Knowledge andPerception of Competence in PalliativeMedicinePaula Lester, MD, Winthrop University Hospital,Mineola, NY.(Lester has disclosed no relevant financialrelationships.)

Objectives1. Demonstrate the need for palliative education

and training for housestaff in internal medi-cine (IM) residency and fellowship in hematol-ogy/oncology, pulmonary/critical care, andgeriatrics through review of the results of re-cent study to assess the effectiveness of currentteaching methods for residents and fellows atfour university-affiliated training sites.

2. Demonstrate results of self-assessment byhousestaff of their knowledge of palliativecare concepts as well as their self-perceivedcompetence in this field.

3. Describe trainees’ current educational experi-ences in palliative care and their preferencesfor learning opportunities in the future.

I. Background. The Accreditation Council forGraduate Medical Education (ACGME) requires

338 Schedule with Abstracts Vol. 39 No. 2 February 2010

that IM core curricula include end-of-life careand pain management concepts. Additionally,fellows in hematology/oncology, pulmonary/critical care, and geriatrics should receive formalinstruction and clinical experience in palliativeand end-of-life care.II. Research Objectives. We aimed to assess the ef-fectiveness of current teaching methods for resi-dents and fellows at four university-affiliatedtraining sites.III. Methods. We conducted online surveys of IMresidents and fellows in geriatrics, hematology/oncology, and pulmonary/critical care on sevendomains of knowledge of palliative care andpain management and self assessment of compe-tence in these areas. We also assessed trainees’current exposure and types of palliative care ed-ucation, as well as their preferred method oflearning. Surveys were conducted in the begin-ning and end of the academic year (the ‘‘end’’of year study is underway).IV. Results. On the initial survey, we received 180(55%) of 326 email surveys: 143 by residents and37 by fellows. All sites were represented in the re-sponses. Less than 50% of IM residents under-stood proper opioid dosing and non-painsymptom evaluation. A total of 70% or less offellows correctly answered questions on opioiddosing, delirium, and non-pain symptom evalua-tion. This was true even among those who felttheir competence was high. The majority oftrainees reported ‘‘no’’ or ‘‘too little’’ educa-tional training in the prior academic year. Over70% felt lectures would be useful or very useful.Only 3.1% felt a dedicated palliative medicinerotation would not be useful.V. Conclusion. This data reveals that self assess-ment of knowledge did not always match ac-tual knowledge base. Fellows did not alwayshave better knowledge than residents. Majorareas such as pain management and otherend-of-life symptoms are poorly understoodby most trainees.VI. Implications for Research, Policy, or Practice. Amore focused curriculum in palliative and end-of-life care is needed for residents and fellows.

DomainStructure and Processes of Care

Reality Bytes: Teaching Evidence-BasedMedicine on a Palliative Medicine ServiceNadia Marsh, MD, George Washington Univer-sity, Washington, DC. Elizabeth Cobbs, MD,

VAMC and George Washington University,Washington, DC.(All speakers have disclosed no relevant finan-cial relationships.)

Objectives1. Use the Patient Intervention Comparison

Outcomes (PICO) method to identify answer-able clinical questions.

2. Identify potential challenges in teaching thePICO method to residents and fellows andways to overcome them.

3. Demonstrate a learner-centered approach toteaching evidence-based medicine.

I. Background. Most evidence-based medicine(EBM) is taught formally in the context of jour-nal clubs or didactic sessions. This format doesnot necessarily result in improved care for pa-tients. Our palliative medicine fellowship pro-gram developed an EBM patient-centeredconsult service. Fellows learn to integrate EBMat the bedside while incorporating patient’sgoals and values, using a framework calledPICO, a method that facilitates an evidence-based literature search.II. Research Objectives. (i) To qualitatively identifythe kinds of clinical questions trainees identi-fied; (ii) to measure the quantity and quality offaculty input needed to facilitate trainees tocomplete the PICO conference; and (iii) to eval-uate learners’ satisfaction with utilizing thePICO method for teaching and providing pa-tient care.III. Methods. The intervention was a weekly PICOconference presentation by the palliative fellow,mentored by the palliative attending.Outcomes included (i) number of conferencesand identification of topics, (ii) qualitative as-sessment by palliative care consult attendingabout the quantity of assistance and mentoringneeding by the fellow, and (iii) learnersatisfaction.IV. Results. Ten PICO conferences were held over 6months. Most fellows initially required at least1 hour of direct assistance in identifying an an-swerable clinical question, searching the literaturefor reference, and interpreting the literature. Forthose who gave more than two conferences, the re-quirement for attending assistance decreased butwas never less than 30 minutes. Fellows un-animously rated this as a superior learningexperience.V. Conclusion. The PICO conference was rated asa superior learning experience by trainees, but