e21506 Background: Palliative care (PC) has an important role in the care of cancer patients at the end of life. Unfortunately, referral occurs very late in the illness trajectory, often within days of patient death. We examined palliative care referral among advanced cancer patients and associated outcomes during their final 2 weeks of life at our academic medical center. Methods: We reviewed the medical records of 269 cancer inpatients with solid malignancies that died in the past three years at our institution. We retrospectively compared patients who accessed palliative care services with those who did not. A multivariate logistic regression model including age, gender, type of cancer and metastatic status was conducted. Results: 74/269 patients (28%) had a palliative care consult prior to death. The most common cancer types were respiratory (26%) and gastrointestinal (21%). Patients with breast and gynecologic malignancies had significantly greater referral to palliative care services. The overall aggressiveness of care for the last year was significantly less (p = 0.003) for patients who were referred to palliative care. Patients referred to PC received less chemotherapy in the last 2 weeks of life (8% versus 21%, p < 0.001). We found that patients who were not referred to palliative care services experienced death more frequently in the ICU (16% versus 2%, p < 0.001), and in the emergency room (12% versus 1%), p < 0.001). Conclusions: Despite increased awareness of the importance of palliative care, and their overall improvement in survival among cancer patients, there are still disparities regarding access to palliative care and location of death. Patients receiving palliative services receive less aggressive interventions during their 2 last weeks of life and are less likely to die in the intensive care unit or emergency room. Quality improvement projects are underway addressing our shortcomings to palliative care services for our patients with advanced malignancies.
There has long been recognition for improved education and training in aging and geriatrics. As the number of older individuals in the United States increases, with 20% being older than 65 years by 2030, it will become increasingly important for internists and medical subspecialty trainees to have proper training in the care of older adults. A survey was developed and administered to Internal Medicine Program Directors, to perform an educational needs assessment. The survey was administered during the beginning of the 2015 academic year via email. The survey assessed general program characteristics, details regarding required geriatric and palliative medicine teaching, opportunities for electives, barriers encountered at each training site, and future recommendations for improving the structure of resident education. Analysis of survey responses indicated that geriatric and palliative care education is lacking. Although all training programs provided some aspect of geriatric and palliative medicine training to internal medicine residents, only 27% of training programs had a formal curriculum in geriatric and palliative medicine. The majority had an informal curriculum. Very few programs reported using a multimodality approach; most used isolated experiences in either an inpatient or an outpatient setting. Although all residency directors believed curricular developments in geriatric and palliative medicine were important, very few have available faculty needed to facilitate curricular improvements. Almost all identified that they would use a restructured curriculum if it were readily available. Investment in developing content and a standardized curriculum in geriatric and palliative medicine would be very valuable and well received in New Jersey.
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