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delirium propensity and how this impacts thetreatment plan for pain and other symptoms.Wewill compare and contrast risk factors for delir-ium in cancer with geriatrics. A review of the liter-ature surrounding opioids, their metabolites,and parenteral hydration in delirium preventionwill be discussed. Also, we will deconstruct theresults of a large, multi-component preventiontrial in Canada which was ineffective in reducingthe incidence or severity of delirium in end-stagecancer patients.Lastly, we will discuss the use of antipsychotics toprophylax against delirium. This approach hasbeen investigated in a small number of trials inpost-surgical patients. These trials will be re-viewed and the relevance to the palliative carepopulation will be addressed.

Is More Necessarily Better? Managing theComplexities of Polypharmacy in PediatricPatients With Advanced Illnesses (506)Tammy Kang, MD, The Children’s Hospital ofPhiladelphia, Philadelphia, PA. Elissa Miller,MD, Children’sHospital ofPhiladelphia, Philadel-phia, PA. Gina Santucci, MSN APRN-BC, Child-ren’s Hospital of Philadelphia, Philadelphia, PA.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Describe the problem of polypharmacy for

pediatric patients with advanced illnessescared for by pediatric palliative care and hos-pice providers.

2. Identify common drug interactions that havethe potential to negatively impact patients.

3. Strategize ways in which the problem of poly-pharmacy can be minimized for children andfamilies.

Children with complex chronic progressive ill-nesses are increasingly being followed by pediat-ric palliative care teams and hospice providers.Recent studies have shown that the majority ofchildren who utilize pediatric palliative care ser-vices are not imminently dying, rather are livingwith complicated diseases that require the careof multiple subspecialty providers. The complex-ity of illness also leads to patients requiringa multitude of disease and symptom directedtherapies. A recent study of palliative care pa-tients cared for by 6 children’s hospitals in theUS and Canada reports extensive medicationprofiles: the mean number of medications pre-scribed was 9.1 (SD 5.5), with a median of 9

and a range from 0 to 18 medications. Withthe many of these medications requiring multi-ple doses per day, it is not difficult to understandwhy parents often feel more like medical pro-viders than parents. The issue of polypharmacyis not only a logistical one for families but canbe dangerous with the increasing possibility ofdrug-drug interactions and medication side ef-fects that can negatively impact the patient. Thissession will review the background of polyphar-macy in pediatric patients with advanced illnessesutilizing a review of the medical literature and re-port recent multiinstitutional study results to de-scribe the current problem. In addition, we willdiscuss common drug-drug interactions andhow theymightnegatively impact the careof pedi-atric patients. Finally, we will utilize a case baseddiscussion to strategize ways in which we can min-imize this problem for our patients and families.

Gone With the Wind? Palliative Care forPersistently Vegetative Patients (507)Kathryn Walker, PharmD BCPS CPE, Universityof Maryland School of Pharmacy, Baltimore,MD. Christopher Kearney, MD, Union MemorialHospital, Baltimore, MD. Rene Mayo, MSW,Union Memorial Hospital, Baltimore, MD.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Describe the clinical trajectory of persistently

vegetative patients.2. Outline the approach to conducting a pallia-

tive medicine consult for PVS patients.3. Discuss the unique challenges associated

with family meetings to approach goals ofcare discussions in a productive way.

‘‘Her eyes are open, she is looking at medI knowshe is still in there!’’ Persistently vegetativepatientshave been portrayed publically in cases such asTerry Schiavo, Nancy Cruzan, and Karen Quinlanleading to much debate and confusion about ap-propriate care. The theory that a persistently veg-etative state (PVS) is a stable, non-progressivecondition significantly affects the decision-mak-ing process of families and clinicians, althoughthis proves to be a dangerous myth. Over time,thesepatients suffer frommusclewasting, contrac-tures, recurrent pneumonias and other infec-tions, intubations, pressure ulcers and otherdevastating comorbid conditions, ultimately lead-ing to death. These patients often have frequentreadmissions and lengthy stays in the hospital.

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

PVS patients present unique challenges for every-one involved in caring for them.Families andclini-cians often face difficultly in discussing goals ofcare. Clinicians are often frustrated in what theyperceive to be meaningless and futile care, whilefamilies are caught in a commitment made longago. Patients, on the other hand, may be sufferingin a ‘‘dimensionless limbo.’’ Palliative medicinespecialists have an important responsibility in car-ing for these patients and their families.This session will focus on the clinical care of PVSpatients, guidance for families and support forstaff. A series of cases will be presented to illus-trate a practical approach for re-evaluating thetreatment goals for these patients. This ap-proach requires mastering the following skills:exploring the deeper meaning of decisionsmade by families, sharing the burden of decisionmaking with the family, explaining the currentstatus and likely future clinical course, while in-corporating identified spiritual concerns. Mean-ingful goals of care discussions for PVS patientsare often neglected by the medical community,making them particularly challenging. They rep-resent an opportunity for palliative medicinespecialists to spearhead needed reform in thecare of these patients.

SIG Symposia

Supportive and Palliative OncologyLiterature: Quantity, Scope, Design,Challenges, and Opportunities (508)Research SIGDavid Hui, MD MSc FRCPC, MD Anderson Can-cer Center, Houston, TX. Masanori Mori, MD,University of Vermont College of Medicine, Bur-lington, VT. Henrique Parsons, MD, MD Ander-son Cancer Center, Houston, TX.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Review the quantity, scope and design of the

recent supportive and palliative oncologyliterature.

2. Examine the challenges unique to supportiveand palliative oncology research.

3. Discuss strategies for improving the quantityand quality of supportive and palliative on-cology literature.

The absolute number of palliative oncologystudies has increased over time. However the

proportion of palliative oncology publicationsrelated to the greater cancer literature has actu-ally decreased. The supportive and palliative on-cology literature is extremely diverse and highlycomplex. This session aims to provide a compre-hensive overview of the quantity, scope, and de-sign of the palliative care literature baseda recent systematic review, and to identify cur-rent challenges and opportunities for growth.The field of palliative care transects numeroushealth disciplines and domains, and coversa myriad of topics ranging from symptom man-agement to psychosocial care, spiritual issues,health services, communication, decision mak-ing, ethics, education and research methodolo-gies. The study population also varies widely,including patients with various oncologic diag-noses and at different stages of illness, theircaregivers and health professionals. Commonstudy designs to address research questions inthe supportive and palliative oncology literatureinclude case reports, case series, population-based studies, cross sectional surveys, cohortstudies, randomized controlled trials and quali-tative studies. Using a framework for classifyingsupportive and palliative oncology studies sys-tematically, we will discuss various study designsused to investigate different research topics,and highlight areas of deficiency requiring fur-ther research. We will also provide an evi-dence-based review of the many challengesassociated with conducting supportive and palli-ative oncology research, including limited fund-ing, few trained personnel, difficulty inrecruiting patients, high attrition rates, limitednumber of validated outcome measures, andlack of standardized definitions. Finally, wewill discuss practical strategies to advance sup-portive and palliative oncology research. Thelast 10 minutes will be available for questionsand discussions.

Palliative Care for Patients With HIV:Challenges and Controversies (509)HIV SIGChristopher Blais, MD MPH FACP FAAHPM,Ochsner Health System, New Orleans, LA. PeterSelwyn, MD MPH, Montefiore Medical Centerand Albert Einstein College of Medicine, Bronx,NY. Rodney Tucker, MD MMM FAAHPM, UABCenter for Palliative and Supportive Care, Birming-ham, AL. Nancy Hutton, MD FAAP FAAHPM,