many factors, including culture, religion, personal beliefs, and family dynamics playing a role. This can lead to conflicts between the family and the health care team who hold to the societal norms of truth telling and respect for individual autonomy. We will begin this session with a case report of a young adult with metastatic cancer being treated in a pediatric institution for whom truth-telling was resisted by the parents. We will then review the literature regarding truth-telling and disclosing prognosis to children and young adults, followed by an ethical analysis of truth-telling and how it applies to our case. Finally, we will end with a discussion of strategies health care providers can use to assess the appropriateness of truth-telling in individual cases, as well as methods for talking with children and young adults about death.
ObjectivesDistinguish between clinical depression, demoralization, and grief reactions. Explain what demoralization is and how it manifests in serious illness. Describe grief reactions and how they differ from demoralization. Depressive symptoms are common in palliative care patients, though the etiology is often complex. Given the heterogeneity of depression, it can be useful to characterize it as a spectrum. Depressive syndromes occur along this spectrum, only part of which is represented by diagnosable clinical depression. Distinguishing these different syndromes can be difficult, which complicates treatment for patients, thus impacting their quality of life. Demoralization, a psychological reaction to difficulty coping with serious illness, can initially appear to be major depressive disorder. Similarly, grief reactions, not only in response to impending loss of life, but also to loss of function, physical abilities, and other changes common in serious illnesses, can manifest with depressive symptoms. Distinguishing these phenomena is important in order to effectively treat these symptoms in patients at the end of life. In this concurrent session, we utilize our backgrounds in psychiatry, palliative medicine, and social work to explain the similarities and differences between major depressive disorder, adjustment disorders, grief reactions, and demoralization. Through lecture, case studies, and group discussion, we formulate potential treatment approaches, including psychotherapy, medication, and psychosocial interventions from the interdisciplinary team for various manifestations of the depressive spectrum.
ObjectivesUnderstand the impact of community-based PC on costs and revenues. Apply the principles of the business case to getting resources and support needed for community-based PC. Access tools and resources to help quantify and make a compelling business case for communitybased PC proposals. The fact that inpatient palliative care reduces hospital costs is well-established, with much research describing how and why. The business case for inpatient palliative care is clear for hospitals: reducing costs in the context of case-rate payments for hospital care. In contra...
