EAPC - ipac

412 EAPC Abstracts
Background: Malignant wounds, caused by direct invasion of cancer into
the skin, occur in cancer patients with primary skin tumors, and as
cutaneous metastasis in about 10% of patients with metastatic internal
malignancies. Malignant wounds can have a profound impact on patients,
family members and clinicians. Assessment of the patient with a malignant
wound is complex, and until now, there has been no widely accepted, consistent
approach. Valid, descriptive survey research methods were used to
develop the Malignant Wound Assessment Tool (MWAT). Methods: We
developed two versions of the MWAT: a brief clinical version (MWAT-C)
and a more detailed research version (MWAT-R). Domains include clinical
wound features (size, location, classification), physical effects (pain, odor,
exudate, bleeding, edema and functional impairment), and emotional and
social impacts. The two tools then underwent content and construct validity
testing using a Delphi process, involving professionals with significant
clinical or research expertise related to malignant wounds. An international
expert panel was formed (n=32 members from Canada, US, UK, Denmark,
and New Zealand). Panelists were given the option to review one or both
tools. Results: Panelists participated in two rounds of review for each tool.
Response rates were acceptable for each round. For both tools, there was a
positive shift between rounds of review resulting in substantial consensus
on individual tool items. Conclusions: Validity testing of the MWAT-C and
MWAT-R tools through the Delphi process has resulted in tools, which we
will share at the conference, that can support clinical and research activities
designed to improve care for patients. Next steps will include dissemination
of the tools for routine use, and further validation and reliability studies
involving patients in various practice and research settings. Funding provided
by: Canadian Institutes of Health Research Grant PET69772.
43 Oral Presentation
Assessment and measurement tools
Palliative Care Staff Satisfaction: The Survey of Team Attitudes
and Responses (STAR)
Authors: Stephen Connor Research and International Development
National Hospice and Palliative Care Organization U. STATES
David Casarett, MD The Center for Health Equity Research and
Promotion, University of Pennsylvania, VAMC Philadelphia, Pennsylvania
U. STATES
Brye Quaseem, PhD, MPH The Center for Health Equity Research and
Promotion, University of Pennsylvania, VAMC Philadelphia, Pennsylvania
U. STATES
Judy Shea, PhD The Center for Health Equity Research and Promotion,
University of Pennsylvania, VAMC Philadelphia, Pennsylvania U. STATES
Background: Despite the emotional and interpersonal challenges that hospice
and palliative care workers face in providing care to patients near the
end of life, no systematic effort has been made to evaluate the work environment
that hospice and palliative care providers provide to their staff. The
aim of this project was to develop a job satisfaction survey that could be
used to evaluate the hospice work environment and, ultimately, to guide
interventions to improve the work experience for hospice staff. Methods:
The Survey of Team Attitudes and Relationships (STAR) was developed
through semistructured interviews with an interdisciplinary sample of staff
from nine hospices, and then refined with input from additional interviews
and from an expert panel. The draft was tested on larger samples of staff
(n 1 /4 160) from six hospices and revised with input from the expert panel.
The final survey was tested with 599 staff from 10 hospices. Results: The
final survey contains 45 items in six domains: individual work rewards,
teamwork, management support,organizational support, workload issues,
and global assessment of job satisfaction. Items had excellent psychometric
characteristics, with acceptable floor and ceiling effects. The overall STAR
had a Cronbach’s alpha of 0.93, indicating good homogeneity, and each
domain had alpha values that are appropriate for between-group comparisons
(range 0.74e0.84). Conclusions: These results suggest that the STAR
offers a unique instrument to measure the work environment hospices and
palliative care programs provide to their staff. Workforce excellence is a
significant factor in the provision of quality palliative care and poses unique
challenges for palliative care providers. This survey has now been introduced
to all hospice and palliative care providers in the United States by the
National Hospice and Palliative Care Organization and will be used to
benchmark staff satisfaction throughout the over 4,000 US hospice
providers and may be useful in other countries.
44 Oral Presentation
Assessment and measurement tools
Detecting psychological distress in palliative care: validating
screening tools against psychiatric interview
Presenting author: Mike Bennet
Authors: Parvez Thekkumpurath School of Molecular & Clinical Medicine
University of Edinburgh UNITED KINGDOM
Chitra Venkateswaran St.Gemma’s Hospice Leeds UNITED KINGDOM
Manoj Kumar Leeds Mental Health Trust Leeds UNITED KINGDOM
Mike Bennett International Observatory on End of Life Care, Lancaster
University Lancaster UNITED KINGDOM
Background: Psychological distress is common but not routinely picked
up in palliative care. Systematic and routine screening is now recommended
in most cancer settings. Examining validity of screening questionnaires
is an essential step prior to their use in this population. This study
examined the validity of Distress Thermometer (DT) along with two other
screening questionnaires (BSI-18, GHQ-12 ) in detecting psychological
distress in the terminally ill by comparing against a semi structured psychiatric
interview: Schedules for Clinical Assessment in Neuropsychiatry
(SCAN). Methods: Consecutive and eligible patients were recruited from
inpatient and day hospice attendees at St. Gemma’s and Wheatfield’s
Hospices, Leeds. Patients completed the three questionnaires, adapted on
to a on a touch screen format. Within 72 hours, the gold standard psychiatric
interview, SCAN, was conducted by one of the two trained psychiatrists
with established inter-rater reliability. The questionnaires were
compared against the SCAN interview using Receiver operator curve
(ROC) analysis. Results: A total of 226 patients were approached,52 opted
out and 24 dropped out. 150 patients completed all interviews. The mean
age was 70 years (SD 12). More than half of the sample died within
six weeks of the interview (median survival time: 44 days. We found 34%
of our sample had psychiatric morbidity; the commonest form of distress
is Adjustment disorder (22%), and not Depressive disorders (7%). A past
history of psychological problems/treatments was significantly associated
with the presence of distress. The three questionnaires perform reasonably
well in correctly identifying distress in this population. All show an area
under the curve of >0.725. Distress Thermometer at a cut off of 5,shows a
sensitivity of 0.77 and sensitivity of 0.59 with a positive predictive value
of 50%. Conclusions: Given the similar performance of the three screening
questionnaires, we recommend using Distress Thermometer, which is
the briefest and easiest to complete.
45 Oral Presentation
Assessment and measurement tools
Measuring hopelessness at the end of life
Authors: Barry Rosenfeld Psychology Fordham University U. STATES
William Breitbart Memorial Sloan-Kettering Cancer Center New York
U. STATES
Hayley Pessin Memorial Sloan-Kettering Cancer Center New York, NY
U. STATES
Background: Hopelessness has been increasingly recognized as a critical
factor in end-of-life decision making (e.g. terminating life-sustaining treatments,
suicidal attempts). Yet hopelessness is poorly understood, particularly
in the context of a terminal illness. Current measures are often too long
and contain inappropriate items for palliative care patients. This paper