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Objectives Compare palliative care interventions used in randomized clinical trials for cancer versus non-cancer patients by content and structure. Discuss opportunities for future research regarding models of palliative care, particularly in non-malignant illnesses. Original Research Background. The majority of palliative care (PC) interventions are cancer-specific; fewer trials target individuals with non-malignant illnesses. Research Objectives. Compare the content and structure of PC interventions tested in cancer versus non-cancer populations. Methods. Secondary analysis of a systematic review Research Objectives. Describe the (1) frequency and severity of symptoms reported by patients with advanced cancer and (2) content of associated shared care plans.

Objectives Describe the general process used to develop and implement an EHR-based mortality risk stratification model. Assess the impact and implications of implementation an EHR-based mortality risk stratification model on clinical, quality, and financial metrics. Background. The frequency and timing of palliative care consultation is highly variable among inpatients with life-limiting illnesses despite evidence of its benefits. Objectives. To develop an EHR-based risk stratification model and evaluate its impact as a trigger for inpatient palliative care consultation. Methods. We performed a retrospective cohort study at three urban hospitals among 65,045 admissions in 2016. Using a randomly split sample and a machine learning approach, we developed and validated an EHR-based model (Palliative Connect) to predict risk of death within six months of admission. We then determined a risk threshold of $30% based on expert chart review and prospectively piloted Palliative Connect in a 4month pre-post study of triggered palliative care consultation on a general medicine service at a large academic hospital. Primary clinicians could decline the consult. We performed an intention-to-treat analysis to evaluate impact on care delivery, quality metrics, and costs. Original Research Background. While outpatient palliative care (PC) began primarily in cancer centers, outpatient PC increasingly serves patients with a wide range of diagnoses. Research Objectives. Compare characteristics of patients with cancer and non-cancer diagnoses referred to clinic-based PC, and the care they receive. Methods. Data were extracted from the Palliative Care Quality Network database regarding 3,569 patients seen by 27 clinic-based PC teams between 01/ 15/2016 and 07/17/2018. Results. Overall 79.3% (n¼2,766) of all patients referred to outpatient PC had cancer. Compared to patients with non-cancer diagnoses, patients with

Objectives: The 2013 International Society for Heart and Lung Transplantation (ISHLT) guidelines recommend, and the Centers for Medicare and Medicaid Services (CMS) conditions of participation mandate, inclusion of a palliative care (PC) specialist in care of patient who have received mechanical circulatory support devices (MCSD) as destination therapy. It is unclear to what extent MCSD care is consistent with these recommendations, or how that care is operationalized. Methods: We surveyed PC and MCSD coordinators/clinicians at Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) centers using Qualtrics™ web-based software, or via phone, to identify institutional PC and MCSD program characteristics and clinician attitudes about role and utilization of PC in this patient population. Using literature review, expert panel, and current MCSD guidelines, we developed 3 surveys: MCSD center institutional characteristics (15 items), PC program characteristics at those sites (23 items), and both MCSD and PC clinicians’ perceptions of the role of specialist and generalist PC (31 items). Cardiology clinicians answered an additional 7 items about their level of confidence performing PC tasks for patients with advanced cardiac disease. Results: Thirty-nine percent (55 of 140) of INTERMACS centers responded. More than half of MCSD programs were established by 2003; however, most PC programs were not established until 2007. MCSD programs (n=45) reported referring a mean of 78% of patients with MCSD to PC; more than 88% (39 of 44) had a formal protocol for referral, and virtually all reported positive working relationships between MCSD and PC clinicians. All respondents agreed with 2013 ISHLT guidelines for PC involvement during pre-implantation evaluation. Regarding end-of-life, nearly 32% (14 of 44) of institutions did not have a specific MCSD deactivation protocol; however 48% (21 of 44) of respondents “always” consulted with PC when a decision to deactivate was made. Cardiology respondents reported the lowest confidence levels in managing delirium, anxiety, and depression; however, 88% (14 of 16) reported discussing end-of-life preferences during MCSD evaluation. Conclusion: Although selection/respondent bias is an important limitation of these results, these respondents agreed with and reported enacting ISHLT and CMS recommendations for including PC in MCSD evaluation. Nevertheless, there was less consensus on clinicians’ roles and confidence levels with providing PC following MCSD implantation and at end-of-life versus during the pre-implantation period. Clinical Implications: Findings from this survey can enable cardiovascular clinicians to evaluate how PC involvement impacts care for patients with MCSD; however, metrics to evaluate patient and system outcomes are yet to be systematically developed and measured.

caregivers experienced increased meaning in life (F[1,25] ¼ 6.20, p ¼ .02; partial eta-squared ¼ .24). Volunteer interventionists also reported satisfaction with their involvement in the project. Conclusion.This intervention showed preliminary evidence of positive outcomes for patients and family caregivers supporting its successful translation to the community setting. Conclusion.Women Veterans received comparable, and on some metrics better, quality EOL than that received by male Veterans.

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