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2. Discuss specific advantages and disadvan-tages in methadone administration in thedifferent pediatric age groups in light ofmechanism, pharmacodynamics, and phar-macokinetics of this drug.

3. Apply equianalgesic conversion tables topractice safe opioid conversion to metha-done in pediatric palliative care using caseexamples.

More than 15,000 children age 0-17 years diefrom life-limiting conditions each year in theU.S. Data reveal the majority of those childrensuffer from pain during their last weeks of life.The management of children with intractablepain remains a challenge. Methadone mightbe underutilized in pediatric palliative care: Itis a mu-opioid receptor agonist, a NMDA(N-methyl-D-aspartic acid) -receptor antagonist,and blocker of serotonin and noradrenalinere-uptake.This presentation will review the pediatricsafety data and evidence of methadone admin-istration in pediatric pain and symptommanagement. Advantages (such as long half-life-enabling dosing twice or three times perday, efficacy for chronic and neuropathicpain, NMDA receptor antagonist mechanismdwhich reduces tolerance, lower incidence ofconstipation, no active metabolites, safe inrenal failure and stable liver disease, and inex-pensiveness) as well as disadvantages (includ-ing wide dosing variation, potential cardiactoxicity, long half-life leading to accumulationand making quick titration difficult, morecomplex equianalgesic conversion requiringfar longer and closer patient observation) willbe evaluated.Methadone should not be prescribed by thoseunfamiliar with its use. Its effects should beclosely monitored, particularly when it is firststarted and after dose changes. This sessionwill discuss clinical approaches to implement or-ganizational quality and patient safety methodsfor error prevention to ensure safe administra-tion of methadone in advanced pain manage-ment of children.The second half of the session will use a smallgroup approach using a detailed case exampleenabling the participants to practice using anequianalgesic conversion chart to become fa-miliar with incomplete cross-tolerance andopioid conversion to (and rarely from)methadone.

Dying With Dementia, NOT From It:Strategies to Address Palliative Needsof Patients With Coexisting CognitiveImpairment (340)Sonal Mehta, MD, Weill Cornell Medical Center,New York, NY. Jeanette Ross, MD, University ofTexas Health Science Center, San Antonio, TX.Deborah Villarreal, MD, University of Texas HealthScience Center, San Antonio, TX. Eric Widera,MD, University of CaliforniaeSan Francisco, Lark-spur, CA. Paul Tatum, MD MSPH CMD FAAHPM,University of Missouri, Columbia, MO.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Identify patient and provider level barriers to

caring for older adults with dementia.2. Describe effective management strategies for

dealing with pain, behavioral disturbances,and caregiver burden.

3. Review best practices and guidelines to ad-dress the palliative care needs of older adultswith dementia.

Although dementia has become a leading causeof death, it has also become a major comorbidityfor patients suffering from other terminal dis-eases. The prevalence of dementia is estimatedto be 5 million today with estimates increasingto 16 million by 2050. Geriatrics plays an integralrole in palliative care, not only because the ma-jority of deaths occur in older adults but also be-cause chronic illnesses, such as dementia. takea relentless toll on affected individuals and theirfamilies. Providing palliative care to older adultswith dementia requires understanding beyondthe mechanisms of disease: understanding thespectrum of its clinical course, frequent medicaland non-medical complications that arise, care-giver burden, and methods available to assessand manage symptoms at the end of life. Thepurpose of this session is to highlight importantaspects of managing the care of patients withmild-moderate dementia at the end-of-life. Thissession will use a vignette to navigate throughthe care needs of a patient with dementia whois dying of cancer. The first portion of the sessionwill address current gaps and barriers to provid-ing care to older adults in the community whohave dementia. The main portion of the sessionwill examine recurrent obstacles that palliativecare providers face when caring for this popula-tion and provide evidence based guidelines to

Vol. 43 No. 2 February 2012 365Schedule With Abstracts

evaluate and address them. Specifically, we willfocus on the challenges of pain management, be-havioral disturbances, and caregiver burden. Thegoal will be to enhance participants’ skills in pro-viding comprehensive palliative care to olderadults who have dementia but are dying of an-other terminal disease process.

SIG Symposia

Barnstorming, Directing, Producing:Integration of a Clinical Pharmacist Acrossthe Full Spectrum of Palliative CareServices (341)Program Chiefs SIGPamela Moore, PharmD BCPS, Summa HealthSystem and Akron City Hospital, Akron, OH.Steven Radwany, MD FACP FAAHPM, SummaHealth System, Akron, OH.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Compare clinical pharmacist goals of care with

HospiceMedicareConditions of Participation.2. Create a cost-benefit analysis for initially in-

corporating a palliative care pharmacist intheir program and the subsequent role ofthe clinical pharmacist across the full spec-trum of palliative care.

3. Describe the team, patient-centered, andprogram outcomes of having a clinical phar-macist integrated into hospice and palliativecare interdisciplinary care teams.

This presentation will focus on the role, bene-fits, outcomes, and costs of providing active clin-ical pharmacist involvement across the entirespectrum of interdisciplinary teams in an inte-grated hospice and palliative care (HPC) pro-gram. Given the burdens of illness, frailty, andpolypharmacy borne by HPC patients, medica-tion side effects, interactions, and cost becomecentral concerns. Palliative care and pharmaceu-tical care both focus on achieving the best qual-ity of life for patients and families in the settingof their choice. Incorporating a pharmacist di-rectly into the interdisciplinary care of HPC pa-tients across all sites of care is a logical step inthe comprehensive management of symptomsin a safe and cost-effective manner. Presenterswill describe how a pharmacist can be success-fully integrated into the care of patients acrossthe full spectrum of HPC services including

inpatient and extended care facility palliativecare consult services, an inpatient acute pallia-tive care unit, a palliative care outpatient clinicand home, and long term careebased hospicecare. The pharmacist serves as a resource fordrug information in this patient population forwhich evidence-based guidelines are limited andwhere reliable routes of medication administra-tion change frequently. The pharmacist workswith physician and nurse members of the inpa-tient and outpatient services to capitalize on avail-able evidence to develop and revise cost-effectiveand consistent medication options for inpatientand outpatient symptommanagement protocols.Central to the pharmacist role is patient, staff, andphysician education and collaboration regardingthe safe and effective use of medications whichmay be off-label and outside the comfort level ofhealthcare providers and caregivers. Outcomespresented will include job descriptions, net costsavings achieved, protocols developed, and staffsatisfaction with the program. Presenters willalso advocate for expanding specificHPC trainingand certification programs for pharmacists.

Chemotherapy in the Last Two Weeksof Life: When Is It Appropriate? WhenIs It Not Appropriate? (342)Cancer SIGEric Prommer, MD FAAHPM, Mayo Clinic,Phoenix, AZ. Sydney Dy, MD MSc, Johns Hop-kins University Baltimore, MD. Lynn Billing,BSN RN CHPN B-C�, Kimmel Cancer Centerat the Johns Hopkins Hospital, Baltimore, MD.Mary Buss, MD, Beth Israel Deaconess MedicalCenter, Boston, MA. Thomas Smith, MD, VCUMassey Cancer Center, Richmond, VA.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Recognize the impact of chemotherapy ad-

ministration late in the life of the cancerpatient.

2. Recognize treating physician, patient, andfamily factors that lead to late chemotherapyadministration.

3. Identify communication issues that lead tolate chemotherapy administration.

Quality of life is an important outcome for pa-tients who are dying of cancer. Ideally, servicesused near the end-of-life shouldminimize aggres-sive interventions and focus on symptom controland supportive care. Care ‘should also be