Data demonstrate that the majority of patients with serious or chronic illness would like their clinicians to address their spirituality but that the majority of clinicians do not provide such care. Reasons cited include lack of training. Palliative Medicine, built on the biopsychosocial-spiritual model of care, has long recognized the critical role of spirituality in the care of patients with complex, serious, and chronic illness. There is mounting evidence that spiritual care is a fundamental component of all high-quality compassionate health care, and it is most effective when it is recognized and reflected in the attitudes and actions of both patients and health care providers. We conducted focus groups as a first step in the process to arrive at a consensus definition of “spiritual care.” A second step involved collecting and comparing frameworks and models that recognize that providers cannot be made compassionate simply through the imposition of rules; methods were needed to achieve behavior change. The study group developed and piloted curriculum to train health care providers. The created curricula covered the definitions of a spiritual care, self-awareness, cultural sensitivity, assessment, and skills. As part of ongoing curriculum development processes, training included evaluation tools to accompany skill development . Our work demonstrated the need for compassionate presence during encounters, for applying the spirituality in professional life; and for identifying ethical issues in inter-professional spiritual care. We concluded that it is feasible to train clinicians to address spirituality and provide holistic and patient-centered care in an effort to minimize suffering.
13 Background: Use of medical cannabis (MC) for cancer-related symptoms is growing, yet many prior studies used formulations not available in the United States (US). Clinical data on formulation, dosing and efficacy for formulations available in the US is limited. Furthermore, though interest is growing in the use of MC for elderly patients, data on safety and efficacy in this population is limited. We aimed to assess the clinical characteristics of elderly people using MC, formulations prescribed, and efficacy for cancer-related pain, insomnia and anxiety. Methods: We conducted a retrospective chart review of patients age 65 and older prescribed MC in the year 2018 in an outpatient palliative care clinic at a tertiary comprehensive cancer center. Pain intensity and anxiety were measured by numerical rating (0-10), and insomnia was assessed by self-reported hours of sleep per night, with data collected at consecutive clinic visits before and after MC use. Results: Eighty-three patients aged 65 and over were included in our analysis. Half of patients were age 65-70, while 12% were age 76 or older. Slightly more than half were male (58%), while the majority were Caucasian (92%). For patients with pain, two thirds were already prescribed opioids; 28% were using gabapentin/pregabalin, 22% duloxetine, and 7% nortriptyline/amitriptyline. Two-thirds (65%) reported never using cannabis previously. The most common MC product used was oil (35%), followed by vape (13%), pill (6%) and powder (3%). The most common initial concentrations were equal THC/CBD (41%) and high THC (43%); 8% of patients used high CBD, and 8% used a combination. The median delta pain score did not change with use of MC (delta pain = 0.0, p = 0.72), nor did anxiety (delta anxiety = -0.2, p = 1.00) nor insomnia (delta hours sleep = -0.1, p = 1.000). Conclusions: In this study of elderly patients prescribed MC, the majority of whom were cannabis naïve and already prescribed opioids, most were initially prescribed high THC or 1:1 THC/CBD, with oil and vape the most common formulations used. Use of MC was not associated with changes in pain, anxiety nor insomnia scores.
124 Background: The use of medical cannabis (MC) in cancer symptom treatment has been increasing. Since its legalization is limited to select states, there are few clinical trials that have studied the effectiveness and safety of MC, and even fewer studies in the elderly patient population. Given this, we aimed to evaluate the effects of MC on nausea, appetite, and body mass index (BMI) of elderly cancer patients. Methods: We conducted a retrospective chart review of patients age 65 and older prescribed MC in the year 2018 in an outpatient palliative care clinic at a comprehensive cancer center. Nausea and appetite were measured by numerical rating (0-10) and BMI was recorded with data collected at consecutive clinic visits before and after MC use. Results: Eight-three patients aged 65 and over were included in our analysis. Half of patients were age 65-70, while 12% were age 76 or older. More than half were male (58%) and Caucasian (92%). For patients with anorexia or nausea, 58% had previously used cannabis. For nausea, 58% were prescribed ondansetron, 53% were prescribed prochlorperazine or metoclopramide, and 20% were prescribed olanzapine. For anorexia, 24% were prescribed mirtazapine, 6% were prescribed dronabinol, and 1% were prescribed megestrol. The majority of patients used oil (64%), with one-third using vape (33%) and fewer using pill (17%) and powder (5%). Patients primarily used high THC (50%) or equal THC:CBD (45%) formulations initially, with only 7% using high CBD products. The median nausea and anorexia trended towards improvement, though neither was significant (delta nausea = 0.1, p = 0.81) nor anorexia score (delta anorexia = 0.7, p = 0.69). BMI worsened despite MC use (delta BMI 1.9, p < 0.001). Conclusions: In this study of elderly patients with cancer prescribed MC, more than half had previously used cannabis. Two-thirds of patients with anorexia were using MC first-line for appetite stimulation. The majority of patients used oil, with vape next most commonly used, and the vast majority of patients using high THC or equal THC:CBD initially. Use of MC was not associated with a significant improvement in nausea nor anorexia, and BMI significantly decreased despite MC use.
In 2016, a total of 4,117 state and federal prisoners died in publicly or privately operated prisons. Each year from 2001 to 2016, an average of 88% of deaths in state prisons were due to natural causes, with more than half of those due to cancer, heart disease or liver disease, conditions for which non-incarcerated citizens often benefit from palliative care and hospice. Prisoners age 55 and older are the fastest-growing segment of the population residing in prisons, as well as those with the highest mortality rate. Compassionate release of seriously ill prisoners became a matter of federal statute in 1984 and has currently been adopted by the majority of U.S. prison jurisdictions. The spirit of the mandate is based on the idea that catastrophic health conditions ie terminal illness affect the four principles of incarceration: retribution, rehabilitation, deterrence, and incapacitation. Concerned about an aging prison population, overcrowded facilities, and soaring costs, many policy makers are calling for a wider use of compassionate release for persons with terminal illness as well as broader prison reform. The prognosticating criteria of compassionate release guidelines are clinically flawed, and the application and procedural barriers are prohibitive. In this paper we review cases of patients who qualified for compassionate release but had their applications denied. We will discuss the urgent need for access to quality palliative medicine for incarcerated persons with advanced illness and call healthcare providers to action with the aim of reducing suffering and promoting social justice for those in need.
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