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

survivorship. The presentation will blend didac-tic materials, clinical case presentations, and fa-cilitated audience participation.

Differentiated Approaches to theDetermination of Code Status: A ParadigmShift (401)Craig Blinderman, MD MA, New York-Presbyte-rian/Columbia University Medical Center, NewYork, NY. Eric Krakauer, MD PhD, Harvard Med-ical School, Boston, MA.(All authors listed above for this session have dis-closed no relevant financial relationships withthe following exception: Krakauer is a salariedemployee of Caris Cohen Dx.)

Objectives1. Describe the rationale for a more differenti-

ated approach todeterminationof code status.2. Describe the role of default options in

healthcare decision making.3. Describe three different approaches for de-

termining code status for each of three clini-cal situations: the chronically ill patient, theterminally ill patient, and the imminently dy-ing patient.

Cardiopulmonary resuscitation (CPR) is at-tempted for virtually all patients with no orderlimiting life-sustaining treatment when theysuffer cardiac arrest, regardless of its etiology.This practice exposes many patients to an in-tervention that is unlikely to bring benefitand that can cause significant harm. We pres-ent an alternative framework for approachingclinical decisions about CPR, grounded bothin the patient’s values and in the professionalobligation to protect patients from harm. Diffe-rentiated approaches are described for threeclinical situations’ the chronically ill patient,the terminally ill patient, and the imminentlydying patient. We suggest a new paradigm forconsidering CPR neither as an option offeredto all patients, nor as the default optionwhen a patient’s wishes are not known. Instead,CPR is a medical intervention with potentialbenefits and burdens that requires a physicianto make a recommendation or decision basedon a patient’s values, the presence and relativestrength of indications and contraindications,and available evidence. Imminently dyingpatients, patients with no chance of recoveryto a degree acceptable to them, and thosewho would only be harmed by resuscitation,should not be offered CPR; doing so

compromises both the quality of care and pro-fessional integrity.

Complementary/Alternative or IntegrativeMedicine: What You Need to Know for theBoards and for Practice (402)Suzana Makowski, MD MMM FACP, University ofMassachusetts Medical School, Worcester, MA.Delila Katz, PharmD, UMass Memorial MedicalCenter, Worcester, MA.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Define CAM, integrative medicine, and their

various componentsdespecially with howthey relate to palliative medicine.

2. Recognize CAM utilization patterns, theircultural influences, and the ethical obliga-tion of clinicians.

3. Cite the evidence of CAM and its clinical ap-plicationdaddress the opportunities andchallenges for clinicians in hospital-basedpalliative care settings and hospices.

Through a series of board-style questions, thisrapid-fire session will review the literature andour current understanding of complementaryand alternative medicine (CAM) or integrativemedicine as it applies to our field of hospiceand palliative medicine.In particular, we will review (a) what we knowabout herbs and supplements; (b) the fivecategories of CAM as defined by the NIH; (c) In-stitute of Medicine’s perspective on CAM withregards to quality patient care and our obliga-tion; (d) trends in use of CAM in the USand our ethical responsibility; (e) evidence andconcerns with regards to herbs/supplements,manual therapies, energy therapies, mind-bodytherapies, and systems approaches; (f) cost-ef-fective and safe approaches for hospice and pal-liative care in using CAM modalities to enhancepatient care; (g) communication and negotia-tion with patients and families who use CAM;and (h) cultural issues in CAM.

Simultaneous Care Studies in Cancer Care:Designing the Best Study (403)Eric Prommer, MD FAAHPM, Mayo Clinic, Phoe-nix, AZ. Michael Rabow, MD FAAHPM, Univer-sity of CaliforniaeSan Francisco, San Francisco,CA. Jennifer Temel, MD, Massachusetts GeneralHospital, Boston, MA. Marie Bakitas, DNScAPRN, Dartmouth-Hitchcock Medical Center,