EAPC - ipac

418 EAPC Abstracts
troubled by uncertainty about the adequacy of their caregiving. However,
patients gave examples both of carer behaviours that promoted selfmanagement
and conversely of those that were experienced as disabling.
This paper critiques the patient focus of most intervention that aims to support
self-management. Drawing on the example of people with advanced
cancer managing eating difficulties, it argues that self-management might
best be facilitated using a family focused approach to supportive cancer care.
Conclusions: Further work is needed to establish the ways in which carers
can be helped to support patient self-management. Reference 1.Hopkinson
J.B. (2007) How people with advanced cancer manage change in eating
habits. Journal of Advanced Nursing. 59(5) 454–462. Acknowledgement
The author would like to thank Macmillan Cancer Support UK for funding
this study.
63 Oral Presentation
Education and Epidemiology
Predictors of palliative care program enrollment in Nova Scotia,
Canada using new analytic methods for improved application
and understanding
Authors: Grace Johnston School of Health Services Administration
Dalhousie University CANADA
Beverley Lawson Dalhousie University Halifax, Nova Scotia CANADA
Jun Gao Cancer Care Nova Scotia Halifax, Nova Scotia CANADA
Ruth Lavergne Dalhousie University Halifax, Nova Scotia CANADA
Frederick Burge Dalhousie University Halifax, Nova Scotia CANADA
Paul McIntyre Capital Health Halifax, Nova Scotia CANADA
Eva Grunfeld Cancer Care Nova Scotia Halifax, Nova Scotia CANADA
Background: Our previous research using multiple logistic regression identified
older age, short time between cancer diagnosis to death, and distance
to the palliative care program (PCP) as being associated with lower PCP
enrollment rates. Using new analytic methods, additional variables, a second
district, and updated years of data, we improved the conceptualization
and understanding of predictors and are better able to translate research into
practice. Methods: Multiple logistic regression, hierarchical modeling, and
classification and regression tree (CART) were used to identify subpopulations
with lower PCP enrollment in a retrospective population based linked
administrative records analysis of 4137 adults who died of cancer from
2000 to 2003 in two largely urban districts in a Canadian province. Results:
PCP enrollment rates continued to improve: from 61% in 1996 to 81.6% in
2003 in one district, and from 46.5% in 1994 to 74% in 2003 in the other.
Primary CART findings were that PCP enrollment for persons dying within
12 days of death differed between the districts (27% vs 47%), and were
lower than for those who survived longer (78%). Nursing home residents
>80 years had lower PCP enrollment rates (32%) than younger nursing
homes residents (75%), or non-residents (80%). The hierarchical regression
model included additional variables and showed, for example, that persons
with >32 days in hospital in the last 6 months of life had higher PCP enrollment
(AOR 1.7; 95% CI 1.4, 2.3). Oncology care and increasing Charlsen
co-morbidity ratings were associated with PCP enrollment. Conclusions:
CART analysis produced more relevant cut points and more clearly identified
subpopulations for investigating lower palliative care program enrollment,
ie better translates research into practice. Hierarchical modeling
improved the conceptualization of variables but results did not differ substantially
from traditional multiple logistic regression. Funding was provided
by the Canadian Institutes for Health Research.
64 Oral Presentation
Education and Epidemiology
Is there an effective method to address the educational needs
of health care workers in Latin America Results of an on-going
Distance Learning Program
Presenting author: Jorge Eisenchlas
Authors: Ernesto Vignaroli Palliative Care Unit Hospital Tornú-Fundación
FEMEBA ARGENTINA
Sofia Bunge Hospital Tornú-Fundación FEMEBA Buenos Aires
ARGENTINA
Clara Cullen Hospital Tornú-Fundación FEMEBA Buenos Aires
ARGENTINA
Roberto Wenk Programa Argentino de Medicina Paliativa-Fundación
FEMEBA San Nicolas ARGENTINA
Liliana De Lima IHAPC Houston U. STATES
Mariela Bertolino Hospital Tornú-Fundación FEMEBA Buenos Aires
ARGENTINA
Background: Education for palliative care workers is crucial in order to
meet the needs of patients. Many care providers face several barriers such
as long distances to learning centers and working schedules with limited
flexibility. Long distance learning (DL) helps eliminate these barriers. The
Programa Argentino de Medicina Paliativa of Fundación FEMEBA in
Argentina developed an online distance course in palliative care in Spanish
to address the needs of health care workers in Latin America. Methods: The
courses are tailored for nurses and doctors. Courses started in 2005 using
Blackboard © software and are ongoing. Each course includes ten one-week
modules, covering specific topics such as communication, pain management
and delirium using case discussions and theory. An online assessment
form is completed by the participants before and after the course. Results:
The number of participants for 2005 and 2006 were 50 and 73 respectively.
Most were doctors and had some palliative care education. The average percent
of students who approved the courses increased from 2005 to 2006
(43 and 60% respectively). The most significant advantages of DL as cited
by the participants is not having to travel long distances, the flexibility in
time schedule and having access to a course in Spanish. Preliminary data on
long term changes in attitudes and practice shows that 6 months after the
course students feel more comfortable managing issues such as opioid side
effects, delirium, breaking bad news, and bereavement support.
Conclusions: Results indicate that DL reduces barriers in education.
Challenges for the course organizers include securing funding and the
development of adequate and useful content. Challenges for the students
include securing access to a computer and the internet. Other organizations
and teaching institutions should also look into different alternative methods
to improve palliative care education in Latin America as an effective way to
improve basic knowledge.
65 Oral Presentation
Other symptoms
A systematic review and meta-analysis of the drug management
of cancer-related fatigue (CRF)
Authors: Ollie Minton Division of Mental Health St George’s University of
london UNITED KINGDOM
Paddy Stone St Georges University of London London UNITED
KINGDOM
Alison Richardson Florence Nightingale school of nursing Kings college
London London UNITED KINGDOM
Michael Sharpe School of molecular & clinical medicine University of
Edinburgh Edinburgh UNITED KINGDOM
Matthew Hotopf Department of psychological medicine; Institue of psychiatry
London UNITED KINGDOM
Background: Fatigue is one of the most common symptoms experienced
by cancer patients. Cancer-related fatigue(CRF)is a complex condition with
many physical and psychological components.Studies have examined the
role of certain drugs to alleviate CRF. However there is no universally
agreed evidence-based drug management for CRF. We therefore decided to
undertake a systematic review to appraise and synthesise the current evidence.
Methods: This review used Cochrane review methodology. We
searched the Cochrane register of controlled trials (2nd Quarter 2007),
Medline (1966 to August 2007) and EMBASE (1980 to August 2007) using
a pre-determined list of search terms. In addition we hand searched a number
of cancer journals and identified relevant conference abstracts. Results:
The review identified 27 trials. A combined meta-analysis of two studies
demonstrated that methylphenidate (a psychostimulant) was superior to