Vol. 43 No. 2 February 2012 373Schedule With Abstracts

MS, MD Anderson Cancer Center, Houston, TX.Takamaru Ashikaga, PhD, University of Vermont,Burlington, VT. Steven Grunberg, FACP, Univer-sity of Vermont, Burlington, VT. MitsunoriMiyashita, PhD, Tohoku University GraduateSchool of Medicine, Sendai, Miyagi.(All authors listed above for this session have dis-closed no relevant financial relationships withthe following exception: Grunberg is on thespeaker advisory board and receives an hono-raria, consulting fees and is a stockholder; isa consultant and receives consulting fees fromHelsinn; is on the advisory board and receivesconsulting fees from Archimedes Pharma.)

Objectives1. Describe how acculturation influences the

preferences for place of end-of-life cancercare among individuals of Japanese ancestryliving in America.

2. Describe how acculturation influencesthe preferences for place of death among in-dividuals of Japanese ancestry living inAmerica.

3. Describe how acculturation influences thepreferences of prognosis disclosure amongindividuals of Japanese ancestry living inAmerica.

Background. Although more than 1.2 millionJapanese Americans, with a wide range of gener-ations, live in America, little is known about theimpact of acculturation on their preferencesabout EOL cancer care.

Research objective. To demonstrate differencesin the preferences about EOL cancer careamong Japanese Americans (JA/A), Japanesein America (J/A), and Japanese in Japan (J/J).

Method. Self-administered questionnaires weredistributed to JA/A and J/A who participatedin two social events in New York and West Virgin-ia and members of two Japanese American orga-nizations. Respondents were asked to state theirpreferences for place of EOL care and death aswell as prognostic disclosure. The question-naires were previously used in a Japanese nation-wide study and its results were used as J/J data.Chi-square tests were used to compare outcomesamong the three groups.

Result. 140 JA/A, 301 J/A, and 2,548 J/J re-sponded to the survey. JA/A and J/A weremore likely than J/J to be older (40%, 31%,17%, respectively, were more than 70 years old;p < 0.0001).

Conclusion. Preferences about EOL cancer carediffer significantly among JA/A, J/A, and J/J,reflecting prevailing attitudes in American/Japanese societies.

Implications for research, policy, or practice.Appreciation of different acculturation levelsamong individuals of Japanese ancestry may im-prove EOL communication.

Validation of a Chinese Version of theSpiritual Needs Assessment for Patients(SNAP) (410-C)Rashmi Sharma, MD MHS, Northwestern Uni-versity, Chicago, IL. Alan Astrow, MD, Maimo-nides Cancer Center, New York, NY. DanielSulmasy, MD PhD, University of Chicago, Chica-go, IL.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Describe the development process for the

Chinese version of the Spiritual Needs Assess-ment for Patients.

2. Describe the study sample.3. Identify the results of the validation process.

Background. Unmet spiritual needs have beenassociated with decreased patient ratings of qual-ity of care, satisfaction, and quality of life. Fewinstruments exist to measure spiritual needs par-ticularly among non-English speaking patientsin the U.S.

Research objective. To validate a Chinese ver-sion of the Spiritual Needs Assessment for Pa-tients (SNAP).

Method. The SNAP consists of 23 total items in 3domains: psychosocial (n ¼ 5), spiritual (n ¼13), and religious (n ¼ 5). The Chinese SNAPwas developed through a translation-back trans-lation process and cognitive pretesting in 8Chinese patients. The Chinese SNAP was admin-istered to a convenience sample of 30 ambula-tory Chinese cancer patients in New York.Internal reliability was assessed by the Cronba-ch’s a, test-retest reliability by Spearman’s corre-lation coefficients, and construct validity bycomparing instrument scores to a previouslyused single item spiritual needs question.

Result. Mean participant age was 65 years, 53%were male, 70% had less than a high schooleducation, and 77% had Medicaid. Twentythree percent were Buddhist, 63% identified

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

no religious affiliation, 83% described them-selves as spiritual but not religious, 33% re-ported unmet spiritual needs, and 60%wanted help meeting their spiritual needs.The Cronbach’s a for the total SNAP was 0.89and for the subscales was: psychosocial ¼ 0.58,spiritual ¼ 0.83, and religious needs ¼ 0.90.Test-retest correlation coefficients were: totalSNAP ¼ 0.72, psychosocial needs ¼ 0.43, spiri-tual needs ¼ 0.73, and religious needs ¼ 0.72.Unmet spiritual needs, as assessed through a sin-gle-item question were not associated with high-er SNAP scores in contrast to results of theEnglish SNAP.

Conclusion. The Chinese SNAP is a reliable in-strument for measuring spiritual needs.

Implications for research, policy, or practice.Lack of correlation between the SNAP and thesingle-item question on unmet spiritual needssuggests that the SNAP may capture patientneeds that Chinese patients would not readilydescribe as spiritual whether due to cultural dif-ferences or educational level.

Benzodiazepines and the Management ofDyspnea in Palliative Care Patients (411-A)Patama Gomutbutra, MD, University ofCaliforniaSan Francisco, San Francisco, CA. DavodO’Riordan, PhD, University of California SanFrancisco, San Francisco, CA. Kathleen Kerr, BA,University of California San Francisco, San Fran-cisco, CA. Stevem Pantilat, MD, University of Cal-ifornia San Francisco, San Francisco, CA.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Describe of the impact of BZD in improving

dyspnea of chronically ill patients.2. Describe dyspnea management in palliative

care setting.

Background. Benzodiazepines (BZD) are com-monly prescribed for relief of dyspnea, yet thereis little evidence describing the efficacy of thetreatment of dyspnea in chronically ill patients.

Research objective. To describe the impact ofBZD in improving dyspnea of chronically illpatients.

Method. A retrospective chart review was under-taken of adults with dyspnea seen by the UCSFPalliative Care Service (PCS) during 2005-2010.Dyspnea was assessed using a four-point

categorical scale (0 ¼ none, 1 ¼ mild, 3 ¼ mod-erate, 4 ¼ severe).

Result. We reviewed charts for 93.6% (308/330)of eligible cases. Patients were 66 years old, male(52%), white (52%), and diagnosed with lungcancer (40%), heart failure ([HF]¼24%), orCOPD (19%). At baseline, most patients had ei-ther mild (53%), moderate (28%), or severe(19%) dyspnea. BZD were prescribed to 37%(n ¼ 113) of patients, with 66% (n ¼ 75) receiv-ing BZD in the first 24 hours of being referred tothe PCS. In multivariate logistic regression, vari-ables associated with receiving BDZ includedconcurrent opioid use (OR ¼ 4.8, 95% CI ¼2.2, 10.3), gender (female: OR ¼ 1.7, 95%CI ¼ 1.1, 3.3), and age (OR ¼ 0.9, 95% CI ¼0.96, 0.99). Overall 56% (n ¼ 172) had a clini-cally meaningful improvement (1-point) in dysp-nea at 24 hours, 38% (n ¼ 117) had noimprovement, and 7% (n ¼ 20) got worse. Amultivariate logistic regression indentified thatthe strongest predictors of a clinically meaning-ful improvement in dyspnea were age (OR ¼1.02, 95% CI ¼ 1.0, 1.03), and being prescribedBDZ (2.3, 95% CI ¼ 1.2, 4.2).

Conclusion. BZD were associated with improve-ments in dyspnea among patients seen in a PCS.

Implications for research, policy, or practice.BZD maybe an appropriate adjuvant treatmentfor dyspnea.

Rapid Treatments for Depression andAnxiety (411-B)Scott Irwin, MD PhD, The Institute for PalliativeMedicine at San Diego Hospice, San Diego, CA.(Irwin has disclosed no relevant financialrelationships.)

Objectives1. Recognize the significance of depression

near the end of life.2. Recognize new data suggesting ketamine and

methylphenidate may rapidly ameliorate de-pression in patients receiving hospice care.

3. Discuss further investigation of ketamine andmethylphenidate for the rapid treatment ofdepression in medically ill patients.

Background. Depression is prevalent and under-treated in patients receiving hospice care. Stan-dard antidepressants do not work rapidly oroften enough to benefit most of these patients.Ketamine and methylphenidate may provide via-ble alternatives in this population.