Vol. 41 No. 1 January 2011 275Schedule with Abstracts

summary the data support the use of LMWHs inpatients without known metastatic disease.

Comparison of Hospice Eligible (HE) VersusHospice Ineligible (HI) Patients Admitted toa Medical Service: A RetrospectiveStudy (706)Nancy Bael, MD, VA Lyons, East Orange, NJ.Melanie Gonzalez, MPH, Veterans Affairs NewJersey Health Care System, East Orange, NJ. Vic-tor Chang, MD, Veterans Affairs New JerseyHealth Care System, East Orange, NJ. HoulingYan, BS, Veterans Affairs New Jersey HealthCare System, East Orange, NJ. Robert Paulino,MD, James J. Peters Medical Center, Bronx, NY.(All speakers have disclosed no relevant finan-cial relationships.)

Objectives1. Review Hospice Eligibity Criteria.2. Describe the percentage of medical service pa-

tients who are hospice eligible on admission.3. Describe the resource use and survival of pa-

tients who were HE and HI at the time of ad-mission to the Medical Service of a VAMedical Center.

Background. Referral criteria for palliative careconsultations remain unclear.Research objectives. Examine what proportionof patients admitted to a medical service are hos-pice eligible (HE), and associated differences inresource use and survival.Methods. The electronic charts of 93 patientsconsecutively admitted to the medical serviceat a VA medical center in October 2004, were re-viewed for HE, demographics, resource utiliza-tion, and survival. HE was determined by theNational Hospice Palliative Care Organizationguidelines. In 2004, palliative care consultationteams were being established.Results. Ninety-three charts were reviewed. Me-dian age was 70 years (38e92); 44% patientswere Caucasian, 6% White Hispanic, and 48%African American. Admissions by service weregeneral medicine (37%), cardiology (31%), he-matology/oncology (18%), and MICU (12%).Thirty-two patients (35%) were HE. HE patientshad a greater median age (75 years vs 66 years;p < 0.005). Median length of stay was five dayswith no difference between HE and hospice inel-igible (HI) patients; one outlier (385 days) wasin the HE group. Other measures of resourceutilization, such as ICU days, number of

procedures, and radiology studies, did not differbetween the two groups. There were ninedeaths, with 5/27 (19%) rate in HE and 4/51(8%) in the HI group. Median survival of theHE group was 381 days (2e2,195) and 2,030days (2e2,160) for the HI group (p < 0.001).One year after admission, 16/32 (50%) of theHE group, and 15/59 (25%) of the HI grouphad died.Conclusion. At time of admission to a medicalservice, 35% of patients were HE. HE patientshad an increased death rate and decreased sur-vival. Current hospice criteria missed half ofthe patients who died within one year ofadmission.Implications for research, policy, or practice.Hospice criteria may identify candidates for pal-liative care on inpatient medical services. Fur-ther research is needed to develop case-findingcriteria.

Self-Assessment of Clinical Competency: Weand They Don’t Know What They Don’tKnow (707)F. Amos Bailey, MD FACP FAAHPM, Birming-ham VAMC & University of Alabama at Birming-ham, Birmingham, AL. Christine Ritchie, MDMSPH FACP, University of Alabama at Birming-ham, Birmingham, AL. James R. Jackson, PhD,University of Alabama Birmingham School ofMedicine, Birmingham, AL.(All speakers have disclosed no relevant finan-cial relationships.)

Objectives1. List two positive and two negative attributes of

self-assessment of clinical competency.2. Describe the technique of adding pre-post as-

sessment to self-assessment to enrichevaluation.

3. Develop ideas for inclusion of pre-post assess-ment routinely in trainee feedback.

Background. Self-assessment of clinical compe-tency is a common evaluation technique usedfor many types of trainees and settings. Thistechnique is convenient and applicable to a largenumber of skills at one time. More objectiveforms of evaluation such as check-lists to observetrainee-patient encounters, or standardized pa-tients with direct observation are expensive,time consuming, can test competency in onlya few areas, and cause trainee distress. Testingfor content recall with pre- and posttesting

276 Vol. 41 No. 1 January 2011Schedule with Abstracts

requires skilled question writing and in many sit-uations has not been shown to correlate withclinical skills. A possible problem with self-assess-ment is that trainees cannot accurately assesstheir skill before training because they lack aninternal scale on which to measure. In typicalpre-post self-assessment, two kinds of bias are in-troduced: (1) overestimation of skill in traineeswho have significant clinical experience, and(2) underestimation of skill in less experiencedtrainees due to lack of confidence.Research objectives. A possible solution to thesebiases is to ask trainees to do self-assessment be-fore training, and to ask trainees to reevaluatetheir pre-training clinical competency at theconclusion of training (‘‘post-pre’’ assessment).Methods. Twenty medical oncology fellows par-ticipating in a month-long palliative medicinerotation completed a ‘‘post-pre’’ self-assessmentusing a scale ranging from 1 ¼ need basic instruc-tion to 4 ¼ perform independently.Results. The ‘‘post-pre’’ means (below) werelower than the ‘‘Pre’’ means suggesting thatwhen oncology fellows re-evaluated their skillsafter training, they became more aware of theircompetency prior to training.Skill Pre Post-Pre PostPerform a basic pain assessment. 3.6 2.9 3.9Discussing DNR orders 3.7 3.3 3.9Discussing advance directives with patients. 3.02.4 4.0Conclusion. This research suggests that trainees’initial self-assessment can be seen as inaccuratewhen re-evaluated retrospectively.Implications for research, policy, or practice.This can result in under estimation of the im-pact of educational programs.

A Comparison of End-of-Life Characteristicsof Pediatric Cancer Patients WhoParticipated in a Phase I Clinical TrialVersus Those Who Did Not (708)Justin Baker, MD FAAP, St. Jude Children’s Re-search Hospital, Memphis, TN. Javier Kane,MD, St. Jude Children’s Research Hospital,Memphis, TN.(All speakers have disclosed no relevant finan-cial relationships.)

Objectives1. Discuss the differences in end-of-life care

characteristics between pediatric patientswith solid tumors and brain tumors.

2. Discuss the effect of enrollment in a Phase Iclinical trial on end-of-life care characteristicsin pediatric oncology.

Background. End-of-life care (EOLC) discus-sions and decision making are complex and af-fected by psychosocial and biomedical factors.The effect of enrolling in a Phase I clinical trial(P1CT) on EOLC characteristics has not beenexamined in pediatric oncology.Research objectives. Determine if end-of-lifecharacteristics in pediatric oncology differed ifa patient did or did not enroll in a P1CT.Methods.We reviewed the charts of pediatric on-cology patients who died over 3½ years and wereyounger than age 22 at death. We used regres-sion analysis and chi-squared testing statistics toanalyze the effect of enrollment in a P1CT onEOLC characteristics. Patients with hematologicmalignancies were excluded due to low enroll-ment in PICTs; 277 patients were included.Results. (1) There were no significant demo-graphic differences between the two groups.(2) Patients diagnosed with brain tumors hadmore time from do not resuscitate (DNR) orderto death and from first EOLC discussion todeath compared to patients with solid tumors.(3) There were no differences in presence ofa DNR order, length of time from DNR orderto death, number of EOLC discussions, lengthof time from first EOLC discussion to death, lo-cation of death, or hospice enrollment. (4)There was also no difference in the use of thePICU or withdrawal of life support/no escala-tion of treatment orders.Conclusion. In this large cohort of pediatric can-cer patients who died, demographic variablesand EOLC characteristic did not differ betweenchildren who enrolled in a (P1CT) and thosewho did not. The impact of Phase I enrollmenton preferred practices at the end of life and onquality of life should be measured prospectively.Implications for research, policy, or practice. Itis difficult to predict which children and fami-lies will desire to enroll in a P1CT. An individu-alized approach should be utilized whenfacilitating EOLC decision making in pediatriconcology.

Sudden Advanced Illness: An EmergingConcept Among Palliative Care andSurgical Critical Care Physicians (709)Michael Barnett, MD, University of Alabama atBirmingham, Birmingham, AL. Rodney Tucker,