Addressing spirituality within serious illness is a core dimension of palliative care delivery. However, spiritual care frequently lacks integration within the care of patients and families facing serious illness. This chapter discusses the integration of spiritual care into palliative care delivery. Requisite to this integration is a clear understanding of definitions and palliative care guidelines informing spiritual care provision. Furthermore, integration is informed and motivated by a large body of evidence showing how spiritual and religious factors frequently play salient roles in serious illness and influence palliative care outcomes. The integration of spiritual care into palliative care practice relies on a generalist–specialist model, within which all members of the interdisciplinary palliative care team are responsible for spiritual care provision. Non-spiritual care specialist members of the palliative care team are responsible for generalist spiritual care delivery, including taking spiritual histories and screening for spiritual needs. The care team also includes spiritual care specialists, typically board-certified chaplains, who provide in-depth spiritual care delivery to patients and families and aid the care team in understanding the spiritual and religious dimensions of care. Additionally, data regarding tested spiritual care interventions are discussed as potential tools palliative care teams can employ to improve patient care and outcomes. Finally, the integration of spiritual care into palliative care teams presents both opportunities and challenges that must be considered as efforts needed to foster more seamless spiritual care delivery within palliative care.
123 Background: Radiation is often used to palliate symptoms in patients with advanced cancer and the number of fractions used can vary significantly from as short as a single fraction (SF) to up to a multiple week course. No data currently exists regarding demographic factors and their influence on survival and fractionation decisions. The aim of this project is to investigate the association of demographic factors with survival, likelihood of SF use in patients (pts) receiving RT for bone metastases, and likelihood of hypofractionation (HF) (≤ 5 fx) in pts being treated for any palliative reason, excluding those receiving partial brain RT (PBRT) which includes stereotactic radiosurgery, and stereotactic radiation therapy. Methods: We retrospectively reviewed charts of pts treated with palliative RT between 1/2015 – 5/2017 at 2 tertiary centers and 4 community satellite practices. Demographic factors analyzed are included in table 1. Logistic regression was used to evaluate the associations between the factors and outcomes. Results: A total of 928 pts were included in the survival analysis. In the two subset analyses, 373 pts were included in the bone metastasis analysis and 745 were included in the analysis of all patients excluding pts receiving PBRT. In pts treated for bone metastases, consult type (inpatient vs. outpatient) was the only significant factor on multivariate analysis, with inpatient consults being more likely to get SF (HR = 2.169, =.025). In the pts receiving palliative RT (excluding PBRT), race and consult location (tertiary vs. community) were significant. Non-white pts (HR=0.527, p=.012) and pts treated in the community (HR=.778, p<.001) were less likely to get HF. Gender (male vs. female), consult location (tertiary vs. community), and consult type (inpatient vs. outpatient) were significant on multivariate analysis for survival (HR=1.243, p=.028; HR=1.602, p<.001; HR=2.301, p<.001, respectively). Conclusions: This analysis suggests that demographic factors may affect both survival and decision making regarding fractionation in patients receiving palliative radiation. Further investigation into the reasons for these differences is needed.
128 Background: The TEACHH model was previously developed to predict life expectancy in patients with metastatic cancer receiving palliative radiation. However, the model was developed prior to the immunotherapy era and limited in its clinical utility due to broad ranges of survival in each prognostic group. The aim of this project is to refine the TEACHH model to improve its clinical utility in a modern cohort. Methods: We retrospectively reviewed the charts of patients seen in consultation for palliative radiation at two tertiary centers and 4 community satellite practices from 7/1/2015 – 12/31/2016. Cox proportional hazards regression was used to construct a prediction model for overall survival (OS), with a goal of predicting the probability of surviving to the clinically relevant timepoints of 2 months, 6 months, and 1 year. The model was stratified by consult location (tertiary vs. community). Results: A total of 744 patients were included in this analysis. The final model included: 1) Gender (Male HR 1.35, 95% CI 1.11 – 1.64) 2) ECOG PS (ECOG 1 HR 1.63, 95% CI 1.20 – 2.22, ECOG 2 HR 2.59, 95% CI 1.86 – 3.60, ECOG 3/4 HR 4.12, 95% CI 2.84 – 5.98) 3) Consultation type (Inpatient HR 1.87, 95% CI 1.40 – 2.49) 4) Primary histology 5) Number of metastases 6) Number of prior palliative chemotherapy courses. Due to interactions between primary histology and number of metastases as well as primary histology and number of prior palliative chemotherapy courses, hazard ratios for these variables are shown in Table 1. Conclusions: Our final refined TEACHH model includes 6 variables to predict OS. We hypothesize that its increased complexity will increase its sensitivity and we will validate the model in a separate patient cohort. A web-based calculator will then be created to facilitate easy use of the model. Hazard ratios of variables with significant interactions. [Table: see text]
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