Vol. 47 No. 2 February 2014 377Schedule With Abstracts

with drug abuse, and targeted treatment ofbreakthrough pain.

2. Improve the ability to use adjuvant analge-sics to manage bone pain, visceral pain,and neuropathic pain syndromes.

3. Use NSAIDs more effectively based on animproved understanding of potential risksand benefits.

Given the prevalence of pain in the medically ill,specialists in palliative medicine need a strongskill set in pain management. Pharmacotherapyis the mainstay approach and clinical guidelinesfor the use of three categories of drugs opioids,nonopioids, and so-called adjuvant analgesicsare evolving with new research and experience.Opioid guidelines now confirm that morphineis not the drug of choice but one among many,and differences in risk profiles, particularly asthis pertains to methadone, influence drug selec-tion. The importance of breakthrough pain isnow clear and treatment decisions have beencomplicated by the appearance of multiple fenta-nyl preparations, which have the benefit of morerapid onset but uncertain cost-utility relative toconventional drugs. Opioid side effect manage-ment is becoming more sophisticated, particu-larly with the recognition of side effects such ashypogonadism and sleep-disorder breathing,which may not be perceived by clinicians as beingopioid-related. The management of risks associ-ated with the abuse potential of opioid drugs isnow viewed as a key responsibility, given the in-crease of prescription drug abuse in the UnitedStates. All of these advances in the safe and effec-tive use of opioids are mirrored in changes thathave occurred in the use of other analgesic cate-gories. Slow progress toward mechanism-basedtreatment has highlighted the non-opioid op-tions for pains of varied mechanisms, such asbone pain, visceral pain and neuropathic pain.Drug combination therapy may offer the optimalbalance between analgesia and side effects. Thissession offers an update on the pharmacotherapyof pain in those with serious illness.

Overcoming Access Barriers to Home-BasedPediatric Palliative Care: A PerspectiveFrom California (P10)Kimberly Bower, MD, Horizon Hospice, San Die-go, CA. Robert Dimand, MD, California Chil-dren’s Services, Sacramento, CA. DavidSteinhorn, MD, University of California DavisMedical Center, Sacramento, CA. Terri Warren,

MSW, Providence TrinityCare Hospice and Palli-ative Services, Torrance, CA. Sandee Wishon,MSN RN, Hospice by the Bay, Larkspur, CA.Devon Dabbs, BBA, Children’s Hospice andPalliative Care Coalition, Watsonville, CA. JillAbramson, MD MPH, California Departmentof Healthcare Services, Sacramento, CA. Daph-na Gans, PhD, University of California, Los An-geles, Los Angeles, CA.(All authors listed above have disclosed no rele-vant financial relationships)

Objectives1. Develop strategies for collaborations be-

tween providers, payors, advocates, and par-ents that support the development ofinnovative, viable, home-based pediatricpalliative care programs.

2. Be able to present data that supports costsavings and improved family satisfaction af-ter the implementation of home-based pe-diatric palliative care in order to supportthe development and implementation ofnew programs.

3. Formulate a list of actionable items to sup-port the continued development of home-based pediatric palliative care in the settingin which the participant practices.

There are significant challenges in implementinghome-based pediatric palliative care programsdespite data suggesting that this type of care savesmoney and improves family satisfaction. Californiahas developed, implemented, and collected dataon several innovative programs to improve accessto pediatric palliative care. This workshop pre-sentedbyproviders, payors, advocates, andparentswill describe how these groups have collaboratedto provide cost effective, patient centered care.Participants will leave with strategies for devel-oping and implementing their own home basedpediatric palliative care programs.

The workshop will include information on 1)concurrent care from both the provider andpayor perspective, 2) Partners for Children, aMediCal funded program that provides in-home palliative care to children with advancedlife-threatening medical conditions withoutrequiring a specific prognosis or restricting ac-cess to aggressive interventions, 3) a telehealthpilot program to enhance care and efficiency,and 4) consideration of the most effective waysto allocate resources, including discussionsaround the funding and benefits of spiritualcare and activity therapies.

378 Vol. 47 No. 2 February 2014Schedule With Abstracts

For each program that is described, data willbe presented along with case material that dem-onstrates the function and efficacy of the pro-gram. There will be an interactive session onthe implementation of concurrent care as wellas two panel discussions. One panel made upof providers, advocates, and payors, includingrepresentatives from MediCal, will address cur-rent challenges and effective approaches to over-come these challenges. A second parent panelwill provide perspectives on what parents iden-tify as their most significant challenges withinthe healthcare system and what services pro-vided the most value to their families.

Care of Older Adults with Multimorbidity:Geriatric Training for Hospice andPalliative Medicine Providers (P11)Rachelle Bernacki, MD MS, Dana-Farber CancerInstitute, Boston, MA. Ankur Bharija, MD, BostonUniversity School of Medicine, Boston, MA. MonaGupta, MD, Cleveland Clinic, Cleveland, OH.Aurelio J. Muyot, MD AGSF FACP, Infinity Hos-pice Care, Las Vegas, NV. Jeanette Ross, MD, Uni-versity of Texas Health Science Center at SanAntonio, San Antonio, TX. Ruchir Shah, MD,Richmond VA Medical Center, Richmond, VA.Shaida Talebreza, MD, University of Utah Schoolof Medicine, Salt Lake City, UT. Paul Tatum, MDMSPH CMD FAAHPM, University of Missouri,Columbia, MO. Eric Widera, MD, University ofCalifornia, San Francisco, San Francisco, CA.(All authors listed above had no relevant finan-cial relationships to disclose.)

Objectives1. Conduct an effective evaluation and create

an evidence-based treatment plan for com-mon geriatric conditions applicable acrossdiverse healthcare settings (inpatient pallia-tive care, long-term care, and hospice).

2. Describe principles of appropriate prescrib-ing for geriatric patients, including appro-priate medication dosing.

3. Apply principles of the American GeriatricsSociety Expert Panel on the Care of OlderAdults with Multimorbidity to clinicalpractice.

According to the ElderCare Workforce, ‘‘The cur-rent healthcare system is already overwhelmed bydemands for geriatric care. Those specializing inthe care of older adults cannotmeet the current de-mand let alone the projected needs for eldercare.’’

Providers in the field of hospice and palliativemed-icine are increasinglymanaging the complex needsof geriatric patients with multiple comorbidities,oftentimes withminimal preparation. Those caringfor frail older adults withmultimorbidities near theend of life often must confront challenging situa-tions: decisions regarding treatments that improveone condition but make another worse; assessingpain and other symptoms in patients that are cogni-tively impaired; prescribing medications while tak-ing into account changes in pharmacokineticsdue to age, anddrug-disease anddrug-drug interac-tions. It is imperative for healthcare professionalsto meet the needs of this growing vulnerablepopulation.This workshop aims to provide education, re-

sources, and tools to hospice and palliative med-icine providers in the principles of care of olderadults with complex multimorbities. The work-shop will provide an interactive overview of theAmerican Geriatrics Society Expert Panel on theCare of Older Adults with Multimorbidity. Partic-ipants will engage in a PowerPoint game on thetopic of pain assessment and treatment in olderadults with multimorbidities. Facilitated smallgroups will discuss the American Geriatrics Soci-ety Geriatrics Evaluation and Management Tools(GEM Tools). Workshop facilitators will demon-strate an evolving case highlighting clinical inter-actions between a provider and an older adultwith complex multimorbidities; small groupswill then discuss the case demonstrationcompared with the evidenced-based material out-lined in the GEM Tools. The evolving case willcover evidence-based assessment and manage-ment of pain, delirium, dementia, behavioral dis-turbances, falls, and frailty across diversehealthcare settings (inpatient palliative care,long-term care, and hospice).

A Good ICU Death: Not an Oxymoron (P13)Michael Wesley, MD FACP FCCP, Virginia MasonMedical Center, Seattle, WA. David Kregenow,MD, Virginia Mason Medical Center, Seattle,WA. Shirley Sherman, MN RN CCRN, VirginiaMason Medical Center, Seattle, WA. WendyWank, MSN RN ACHPN-BC ARNP, Virginia Ma-son Medical Center, Seattle, WA. JonathanJahns, MA RRT, Virginia Mason Medical Center,Seattle, WA.(All authors listed above had no relevant finan-cial relationships to disclose.)