Subspecialty Training: Hospice and Palliative Medicine.

ABSTRACT: Physiatrists care for patients and families with complex medical needs, and primary palliative care is an important part of the comprehensive rehabilitation care plan. Palliative care improves patient and family quality of life and reduces healthcare costs. Clinical care guidelines for several physiatry patient populations now include the provision of palliative care.Current Accreditation Council for Graduate Medical Education physiatry residency program requirements include foundational palliative care skills. Similarly, current clinical palliative care practice guidelines enumerate standards that apply to the rehabilitation setting. However, there is a dearth of literature on the current state of palliative care training within physiatry programs, and hospice and palliative medicine remains one of the least subscribed physiatry subspecialties.In this article, we describe palliative care, highlight existing literature on palliative care needs within physiatry patient populations, and identify a core physiatry-palliative care skillset. We look both within physiatry and across other specialties to guide recommendations for palliative care education within physiatry residency programs. We also describe opportunities for post-residency fellowship training in hospice and palliative medicine.

Nutrition Education Services Described on National Cancer Institute (NCI)-Designated Cancer Center Websites.

For women diagnosed with breast cancer, healthy weight and enhanced nutrition may improve outcomes. The goal of this study is to examine the nutrition education services available on National Cancer Institute (NCI)-Designated Cancer Centers' websites. In 2017, websites of all 61 NCI-Designated Cancer Centers that provide adult clinical care were reviewed at least twice. Websites were analyzed for the existence and type of expert-directed nutrition education services for breast cancer survivors. Of the 61 websites analyzed, 49 (80%) provided information about nutrition education. Twenty (33%) included only nutrition counseling, three (5%) only nutrition classes, and 26 (42%) both counseling and classes. Forty-six websites included information about nutrition counseling; of these, 39 had an easily identifiable description. Thirty-seven class options were offered, 22% were specific to breast cancer, 16% to subgroups such as young women, 41% were nutrition-only classes, and 24% included skills education. Nutrition services are an important part of breast cancer treatment. This study demonstrated that most NCI-designated cancer centers offered counseling. However, the type of information that was offered varied and services were not always specific to patients with breast cancer. Further research is needed to confirm the presence of services, assess patient access, and demonstrate their efficacy in promoting optimal survivor outcomes.

Outcome Trends of Adult Cancer Patients Receiving Inpatient Rehabilitation: A 13-Year Review.

OBJECTIVE: This study describes characteristics and trends of inpatient rehabilitation among cancer patients within the United States over a 13-yr period. DESIGN: This was a retrospective study of data from the Uniform Data System for Medical Rehabilitation from 2002 to 2014. Patients older than 17 yrs admitted to inpatient rehabilitation facilities with a diagnosis of malignant cancer were included. Trends of rehabilitation outcomes including length of stay, Functional Independence Measure (FIM) Instrument scores, and discharge location were examined. RESULTS: Data from 115,570 cancer patients were evaluated. Mean age was 66 ± 14 yrs and 49% were women. Mean length of stay decreased over time (2002: 14 days to 2014: 13 days; P < 0.0005). Patient's admission total FIM scores decreased over time (2002: 68 ± 18 to 2014: 61 ± 16; P < 0.0005). The FIM change score increased over time (2002: 19 ± 16 to 2014: 25 ± 17; P < 0.0005). The greatest significant functional gains occurred in self care and transfers. Most patients (>70%) were discharged to the community. CONCLUSIONS: Cancer patients receiving acute inpatient rehabilitation demonstrated significant improvements in functional outcomes from admission to discharge. Cancer patients became more independent in important activities of daily living, thereby potentially reducing caregiver burden and ensuring safer discharges back to the community. This study suggests potential benefit of inpatient rehabilitation for appropriate cancer patients.

Women Physicians Are Underrepresented in Recognition Awards From the Association of Academic Physiatrists.

OBJECTIVE: Determine representation by gender for individual recognition awards presented to physicians by the Association of Academic Physiatrists (AAP). DESIGN: Cross-sectional survey was used. Lists of individual recognition award recipients for the 27-yr history of the AAP awards (1990-2016) were analyzed. The primary outcome measures were the total numbers of men versus women physician award recipients overall and for the past decade (2007-2016). RESULTS: No awards were given to women physicians for the past 4 yrs (2013-2016) or in half of the award categories for the past decade (2007-2016). No woman received the outstanding resident/fellow award since its inception (2010-2016). There was a decrease in the proportion of awards given to women in the past decade (2007-2016, 7 of 39 awards, 17.9%) as compared with the first 17 yrs (1990-2006, 10 of 46 awards, 21.7%). Furthermore, compared with their proportional membership within the specialty, women physicians were underrepresented for the entire 27-yr history of the AAP awards (1990-2016, 17 of 85 awards, 20%). According to the Association of American Medical Colleges, the proportion of full-time female physical medicine and rehabilitation faculty members was 38% in 1992 and 41% in 2013. CONCLUSIONS: Women physicians have been underrepresented by the AAP in recognition awards. Although the reasons are not clear, these findings should be further investigated.