Hospital care for dying patients.
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Attitude to Death↗
Biomedical subjects
D E Weissman
Publications and source records attributed to D E Weissman.
Teaching cancer pain management: durability of educational effects of a role model program.
BACKGROUND: Inadequate management of cancer related pain has resulted primarily from attitudinal barriers and a lack of knowledge about clinical assessment, the administration of analgesics, and therapeutic interventions. METHODS: Fifty health-care providers (13 physicians, 21 nurses, and 16 pharmacists), working as a team, participated in a Role Model Program that presented principles of cancer pain management. A questionnaire that evaluated the fund of knowledge and attitudes regarding cancer pain management was administered prior to the 1-day workshop, at the end of the workshop, and at 4 and 12 months follow-up. The workshop consisted of lectures and discussion groups; in the discussion groups, concepts were clarified, cases presented, and barriers to optimal cancer pain management identified. RESULTS: Significant improvements in attitudes (P < 0.01), knowledge (P < 0.01), and total scores (P < 0.002) were observed when the preworkshop responses were compared with those obtained immediately after instruction. Scores on the questionnaire were the same or slightly better at both 4 and 12 months in follow-up, demonstrating no loss in acquired knowledge or attitude. Comparison of the postworkshop scores with those at 12 months follow-up were significantly better in attitude (P < 0.03), and in total score (P < 0.01); improvements in knowledge also approached significance (p < 0.06). These represented continuing improvements because significant differences in the attitude scores (P < 0.05) and the total score (P < 0.05) were observed when the 4-month and 12-month follow-up responses were evaluated. The effectiveness of the program in the transference of knowledge was also measured; in the first year of the program, more than 4500 health-care professionals were subsequently informed about cancer pain management from the Role Model Participants. CONCLUSIONS: Significant improvements were observed immediately in both attitude and knowledge of cancer pain management principles after the 1-day Role Model Workshop. These improvements continued, as determined at 4 and 12 months follow-up. The Role Model Participants were highly motivated to share the learned principles of cancer pain management with other health-care professionals. These results are consistent with other Role Model Programs that both instruct and involve the participants. The Role Model Program is an efficient and effective means of educating health-care professionals in the concepts of cancer pain management.
Analgesia↗
Palliative medicine nurse preceptorship at the Medical College of Wisconsin.
This article describes a 3-day nurse preceptorship education program in cancer pain and palliative medicine at the Medical College of Wisconsin (MCW). The program includes experiential and didactic information skills development, and assistance with planning for institutional change in the delivery of health care services. The education program is centered around five teaching modules: pain, nonpain symptoms, hospice, nursing professional issues, and palliative care. Evaluation data from a recent cohort of 23 nurses demonstrate that learning and personal objectives were met to a high degree of satisfaction.
Education, Nursing, Continuing↗
Cancer pain education for physicians in practice: establishing a new paradigm.
Traditional education methods for physicians have failed to impact positively upon cancer pain clinical practice. This article presents a new paradigm for physician cancer pain education based on principles of adult learning and physician behavior theory. Three key issues that weave together education and institutionalization issues are reviewed: (a) how to make physicians aware that their current practice behavior is less than optimal; (b) how to match education objectives with appropriate education formats; and (c) how to change pain management practices without imposing new burdens on physician practice.
Adult↗
Update on the cancer pain role model education program.
Application of traditional educational methods has done little to improve cancer pain management in the United States. This report details the results of the first year of the expanded Wisconsin Cancer Pain Initiative Role Model Program, a novel approach to cancer pain education. One hundred and ninety-six physicians and nurse educators together with their clinical partners attended one of three role model conferences in 1992-1993 and developed Action Plans detailing their proposed educational goals. Results indicate that participants demonstrated significant improvement in cancer pain knowledge as a result of the 1-day conference. Within 12 months of the conference, 64% of Role Model teams completely or partially met their Action Plan goals. In total, 227 educational or clinical practice projects were completed. The Cancer Pain Role Model Program represents an excellent educational program for disseminating cancer pain information and instituting positive changes in clinical practice.
Education, Medical, Continuing↗
Palliative medicine education at the Medical College of Wisconsin.
Palliative medicine is an emerging worldwide discipline. This article describes efforts at the Medical College of Wisconsin to develop programs to enhance palliative care education and clinical care. New courses, seminars, and clinical programs have been developed with assistance from various medical school departments and affiliated hospitals. Education and clinical care activities since 1990 have included a new 6-week course for 2nd-year medical students; a hospice volunteer experience for preclinical students; clinical electives for 3rd- and 4th-year medical students; a clinical palliative care consultation service; a palliative care seminar series designed for housestaff; a nurse preceptorship program; and an allied health observership program. Palliative care activities include both the academic medical center and community health agencies. The MCW has integrated palliative care into its academic environment so that trainees at all education levels now have opportunities for didactic and clinical palliative care education.
Education, Medical, Undergraduate↗
Fear and greed: the commercialization of palliative medicine.
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Advertising↗
The Palliative Care Consultation Service of the Medical College of Wisconsin.
Palliative care has not become a routine aspect of US academic medicine due to lack of reimbursement for clinical services, little research funding, and the perception that care for the terminally ill is not important in academic medical centers. This article describes the clinical activities of a new Palliative Care Consultation Service (PCS) for inpatients and outpatients, which was started at the Medical College of Wisconsin in April 1993. The goals of the PCS are to provide symptom control, assist with end-of-life decision making, and serve as a resource for appropriate discharge planning for all dying patients, not only those with cancer. Since its inception, an average of five consultations per week have been seen. Pain and end-of-life decisions were the most frequent reasons for consultation. Thirteen different clinical services consulted the PCS, most commonly internal medicine and oncology. Cancer and acquired immunodeficiency syndrome (AIDS) were the most frequent diagnoses. The PCS has also been used as a resource for assessment of inpatients with chronic nonmalignant pain who were believed to be drug addicts. The PCS has received widespread acceptance by the medical, nursing, and support staffs. The clinical and educational role of a dedicated palliative care service in academic medicine is discussed.
Humans↗
Re: "Treatment of advanced colorectal cancer with recombinant interferon alpha and fluorouracil: activity in liver metastasis".
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Colorectal Neoplasms↗
The Cancer Pain Role Model Program of the Wisconsin Cancer Pain Initiative.
The Cancer Pain Role Model Program was established in 1990 by the Wisconsin Cancer Pain Initiative to train physicians to be role models for appropriate pain management. Community and academic physicians along with their "clinical partners," a nurse or pharmacist, were recruited to attend a 1-day education conference that included lectures, small group workshops, and development of an action plan. A total of 44 physicians and 55 clinical partners have attended two conferences (1990 and 1991). Participants listed 199 activities on their action plans; postconference surveys have documented initiation of 212 projects aimed at educating others, improving clinical care, resource development, educating self, or research. The Cancer Pain Role Model Program appears to be a promising means of transferring cancer pain information, legitimizing cancer pain as an important treatment issue, and institutionalizing cancer pain management.
Education, Medical, Continuing↗
Pre-clinical palliative medicine education at the Medical College of Wisconsin.
A newly designed six-week course, Palliative Medicine, for second-year medical students at the Medical College of Wisconsin is described. A previous course on death and dying received unfavorable student reviews related to an emphasis on philosophical and theoretical concepts concerning death. The new course presented the concepts of palliative medicine in the context of practical clinical care issues and physician-patient-family communication issues. Student evaluations were very favorable. Implications for legitimizing palliative care in the United States are discussed.
Curriculum↗
The style of early clinical research reporting: what are we saying and how do we say it?
Phase II studies involving novel chemotherapy treatment are often first reported to the scientific community as a published abstract. This study was designed to determine how authors report their phase II abstract data and what types of conclusions are made. All 1992 phase II colorectal cancer abstracts from the 1992 Proceedings of the American Society of Clinical Oncology were reviewed and analyzed for descriptive and quantitative data and conclusions. The response rate was the most commonly reported response statistic (28/29), with few studies reporting confidence intervals (4/29), median duration of response (5/29), or median survival (9/29). Toxicity data was quantitative in 21 trials and qualitative or absent in 8 trials. Conclusions about the toxicity data were ambiguous or absent in five trials. Conclusions about the response data included inappropriate use of terms, indirect or ambiguous language, or no conclusion. These results indicate that the reporting of phase II trials in abstract form is highly variable and plagued by problems that make data interpretation difficult. Recommendations for change are suggested.
Abstracting and Indexing↗
A cry from the fringe.
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Attitude of Health Personnel↗
Doctors, opioids, and the law: the effect of controlled substances regulations on cancer pain management.
Opioids are underused by physicians for the treatment of cancer pain. Reasons for this include excessive concern about opioid-induced respiratory depression, tolerance, and addiction, as well as the impact of controlled substances regulations. The negative impact of controlled substances regulations on patient care is not well understood. This paper reviews the historical basis and current structure of the regulatory system. Four potential ways in which controlled substances regulations and policies can affect medical care are discussed: (1) by placing restrictions on physician practice, (2) by affecting patient access to opioids, (3) by stigmatizing patients, and (4) indirectly through physicians' perceptions of regulations, resulting in modified medical practices. Physicians are urged to work with state regulatory agencies to identify regulatory impediments to appropriate patient care.
Analgesics, Opioid↗
Intraosseous meningioma: appearance on bone scintigraphy over five years.
While meningiomas are common intradural tumors, such lesions only rarely arise outside of the meninges. All meningiomas, however, may slowly enlarge causing concern for malignancy. We report the appearance of an intraosseous meningioma in the patient with a history of breast carcinoma where the lesion progressively enlarged over a period of 5 yr to reach approximately three times the original size.
Adult↗
Bone marrow necrosis in lymphoma studied by magnetic resonance imaging.
We used magnetic resonance imaging (MRI) to examine the extent of necrosis in the marrow space in three patients with lymphoma who had necrosis in bone marrow biopsies taken from the posterior iliac crest. Two of the patients had multiple focal lesions observed in the spine, pelvis, and femurs. These lesions had MRI characteristics of fluid-filled necrosis within marrow or lymphoma. The third patient exhibited a unique pattern of anatomically extensive marginated lesions otherwise typical of avascular necrosis of bone. These cases provide evidence that MRI can document the extent of necrosis within the marrow space and can differentiate two distinct patterns of necrosis.
Adult↗
Treatment of recurrent metastatic medulloblastoma with intensive chemotherapy and allogeneic bone marrow transplantation.
We report here the first known case of a patient with recurrent metastatic medulloblastoma to achieve long-term disease-free survival following treatment with allogeneic bone marrow transplantation. A 27 year old white male with recurrent metastatic medulloblastoma involving lymph nodes, bone and bone marrow was treated with multi-agent chemotherapy followed by allogeneic bone marrow transplantation from an HLA-identical sibling donor. Morbidity was acceptable with moderate to severe mucositis in the immediate post transplant period and clinical grade I graft versus host disease of the skin controlled with modest doses of corticosteroids. The patient continues in unmaintained complete remission in excess of 28 months with a performance status of 100%. Allogeneic marrow transplantation following cytoreductive salvage chemotherapy is an aggressive strategy that may offer an improved likelihood of disease eradication and ultimate cure for poor prognosis patients with recurrent metastatic medulloblastoma.
Adult↗