NCCN Guidelines® Insights: Palliative Care, Version 2.2021.

Palliative care has evolved to be an integral part of comprehensive cancer care with the goal of early intervention to improve quality of life and patient outcomes. The NCCN Guidelines for Palliative Care provide recommendations to help the primary oncology team promote the best quality of life possible throughout the illness trajectory for each patient with cancer. The NCCN Palliative Care Panel meets annually to evaluate and update recommendations based on panel members' clinical expertise and emerging scientific data. These NCCN Guidelines Insights summarize the panel's recent discussions and highlights updates on the importance of fostering adaptive coping strategies for patients and families, and on the role of pharmacologic and nonpharmacologic interventions to optimize symptom management.

Actor feedback and rigorous monitoring: Essential quality assurance tools for testing behavioral interventions with simulation.

INTRODUCTION: Simulation is a powerful tool for training and evaluating clinicians. However, few studies have examined the consistency of actor performances during simulation based medical education (SBME). The Simulated Communication with ICU Proxies trial (ClinicalTrials.gov NCT02721810) used simulation to evaluate the effect of a behavioral intervention on physician communication. The purpose of this secondary analysis of data generated by the quality assurance team during the trial was to assess how quality assurance monitoring procedures impacted rates of actor errors during simulations. METHODS: The trial used rigorous quality assurance to train actors, evaluate performances, and ensure the intervention was delivered within a standardized environment. The quality assurance team evaluated video recordings and documented errors. Actors received both timely, formative feedback and participated in group feedback sessions. RESULTS: Error rates varied significantly across three actors (H(2) = 8.22, p = 0.02). In adjusted analyses, there was a decrease in the incidence of actor error over time, and errors decreased sharply after the first group feedback session (Incidence Rate Ratio = 0.25, 95% confidence interval 0.14-0.42). CONCLUSIONS: Rigorous quality assurance procedures may help ensure consistent actor performances during SBME.

Intensivists' Religiosity and Perceived Conflict During a Simulated ICU Family Meeting.

CONTEXT: Conflict is frequently reported by both clinicians and surrogate decision makers for adult patients in intensive care units. Because religious clinicians view religion as an important dimension of end-of-life care, we hypothesized that religious critical care attendings (intensivists) would be more comfortable and perceive less conflict when discussing a patient's critical illness with a religious surrogate. OBJECTIVES: The objective of this study was to assess if religious intensivists are more or less likely to perceive conflict during a simulated family meeting than secular colleagues. METHODS: Intensivists were recruited to participate in a standardized, simulated family meeting with an actor portraying a family member of a critically ill patient. Intensivists provided demographic information including their current religion and the importance of religion in their lives. After the simulation, intensivists rated the amount of conflict they perceived during the simulation. The association between intensivist's self-reported religiosity and perceived conflict was estimated using both univariate analysis and multivariable logistic regression. RESULTS: Among 112 participating intensivists, 43 (38%) perceived conflict during the simulation. Among intensivists who perceived conflict, 49% were religious, and among those who did not perceive conflict, 35% were religious. After adjusting for physician race, gender, years in practice, intensive care unit weeks worked per year and actor, physician religiosity was associated with greater odds of perceiving conflict during the simulated family meeting (adjusted prevalence ratio = 2.77, [95% CI 1.12-7.16], P = 0.03). CONCLUSION: Religious intensivists were more likely to perceive conflict during a simulated family meeting.