Palliative and End-of-Life Care

Telemedicine as a tool for early family conferences in critically ill patients transferring to a tertiary care center

Evidence suggests that early palliative care consultations in critically ill patients may be associated with reduced health-care costs while improving family satisfaction. However, critically ill patients at smaller rural hospitals who are often transferred to tertiary care center (TCC) ICUs are often not able to participate in discussions regarding disease processes, prognosis, goals of care, and shared decision making until after they have been transferred. There is a gap in the standard of care related to early communication in this particular group of critically ill patients.

Telemedicine is a tool that we are using to provide family members and treatment teams the opportunity to participate in early family conferences and/or palliative care consultations prior to a patient transferring to a tertiary care center.

We conducted a small retrospective study of these telemedicine family conferences that showed 64% of patients did transfer to a TCC; however, ultimately 58% transferred back to the referring hospital for end of life care. We have also conducted a prospective qualitative study on the experience of participants of these conferences. Family members and clinicians have responded favorably to this form of communication, and we have created a structured intervention for use during these discussions.

We believe this telemedicine intervention will increase family satisfaction, decrease symptoms of posttraumatic stress disorder and anxiety among family members, and align care with patients’ wishes. In order to investigate this further, we are currently conducting a prospective comparative study of a structured telemedicine family conference intervention vs conference conducted after transfer.

Prema R., Menon, MD

Steering Committee Member

Sleep Medicine

AGuide guide to Sleep at CHEST 2013

I hope that you are all gearing up for our meeting this fall in Chicago; as always, the Program Committee has arranged a fantastic meeting with a diverse program, but I wanted to point out a couple of agenda items in the sleep curriculum that I thought would be worth highlighting.

Our postgraduate course on Saturday, October 26, was initially intended as a board review, before the ABIM saw fit to move up the examination date. As a result, this course will instead be a year-in-review, covering the best of the literature over the last 12 months; the session will also be supplemented by the use of an audience response system, allowing the audience to play along and show their knowledge of the newest developments in sleep medicine.

There is a ridiculous number of great sessions on Sunday, including "Management of Insomnia in 2013," developed based on results from our survey in the spring; this session will include a brief primer on cognitive behavioral therapy. Later that day will be one of our NetWork highlights, "Highly Controversial Topics in Sleep Medicine," with discussions on the growing use of sodium oxybate for insomnia and the role of modafinil for cognitive enhancement.

In the afternoon, Dr. Mark Rosekind, member of the National Transportation Safety Board, will be highlighting a session on sleep medicine and transportation safety. The day will be capped off by an evening session led by our NetWork Vice Chair, who will be orchestrating a panel discussion on the future of sleep medicine.

Attendance at Monday’s NetWork Open Forum is a must for anyone wanting to get more involved in the Sleep NetWork. The session will offer a chance to meet with NetWork leadership and to hear about the current activities and priorities of the Steering Committee. We are almost always looking for volunteers for one or more of our ongoing projects; attending the session ensures that you can both sign up and express your interest in person! In addition, you get to hear a great lecture, this year from Dr. Fred Turek.

The rest of the meeting is similarly packed; Tuesday will feature a panel discussion on sleep deprivation and the restriction of resident work hours. Wednesday houses our second NetWork highlight, "Intermittent Hypoxia and OSA Comorbidity," which may make many of us rethink our focus on the apnea-hypopnea index as the prime target for therapy of sleep-disordered breathing. Lastly, Thursday will feature a 4-hour symposium, "Sleep Medicine in 2013," highlighted by the debut of the College’s newest game show, "Who Wants to be a Somnologist?" with prizes for the winners.

For all of these reasons, 2013 is looking to be a spectacular year for sleep medicine education at CHEST, and there are many more sessions that I haven’t enough space to highlight. I sincerely hope that you will join us in Chicago and come by and say "hi" at the NetWork Forum!

Dr. David Schulman, FCCP

Chair

Networks: Telemedicine in Palliative Care, Sleep at CHEST 2013