Vol. 39 No. 2 February 2010 Schedule with Abstracts 327

harm, yet to not challenge her beliefs may de-prive her of the opportunity to plan appropri-ately for her time with her children.In this highly interactive precourse, clinicianswill gain a deeper understanding of normativecoping and tools to diagnose the patient’s illnessunderstanding and prognostic awareness. Partic-ipants will learn skills to help patients confrontdifficult medical and psychological realitieswhen the clinical situation demands it while pre-serving a therapeutic alliance and helping tosupport compensated coping.

DomainsStructure and Processes of Care; Psychologicaland Psychiatric Aspects of Care

The Butcher, Baker, and Candlestick MakerReturn: Interdisciplinary Goal-BasedApproaches to Delirium Recognition, Work-Up, and Management (P11)Scott Irwin, MD PhD, The Institute for PalliativeMedicine, San Diego, CA. Rosene Pirrello,RPh, The Institute for Palliative Medicine, SanDiego, CA. Jeremy Hirst, MD, The Institute forPalliative Medicine, San Diego, CA. GaryBuckholz, MD, The Institute for Palliative Medi-cine, San Diego, CA. Frank Ferris, MDFAAHPM, The Institute for Palliative Medicine,San Diego, CA.(All speakers have disclosed no relevant finan-cial relationships and will discuss off-label uses.)

Objectives1. Recognize that delirium is under-recog-

nized; understand that it is distressing forthe patient, family, and palliative careteam; and know how to assess for and diag-nose delirium.

2. Describe how to make management decisionsbased on the patient and family goals of carewhile taking into account reasonable medicalgoals of care.

3. Apply and monitor goal-based nonpharmaco-logical and pharmacological interventions torelieve the suffering and distress associatedwith delirium.

Delirium is prevalent in patients with advanced,life-threatening illnesses. It may occur in 80% ormore of these patients and is associated with sig-nificant morbidity and mortality. Behavioral man-ifestations of delirium, such as agitation, mayresult in significant patient and family distress,as well as unnecessary medical interventions and

inpatient hospice admissions. Delirium can alsointerfere significantly with the recognition andcontrol of other physical and psychological symp-toms, such as pain or depression. Appropriategoal-based interventions are usually successfulin reducing negative outcomes.Unfortunately, the symptoms of delirium are of-ten under-recognized, misdiagnosed, and inap-propriately treated in this patient population.Partly, this might be attributed to confusionregarding terminology and inconsistent use ofdiagnostic classifications. In addition, the symp-toms of delirium are varied and can be mistakenfor other psychiatric disorders or simply attrib-uted to the normal dying process.Delirium is often inappropriately treated. How-ever, appropriate, goal-based interventionsfrequently improve outcomes. An accurate diag-nosis is very important, as the treatment of agita-tion or psychoses may vary depending on theetiology, context, and goals of care (ie, reversiblevs. irreversible delirium [including terminal de-lirium], dementia, or schizophrenia).At the end of this interactive, case-based, work-shop presented by two palliative care psychia-trists, two palliative medicine specialists, anda palliative care pharmacist, the audience willbe able to (i) recognize delirium and under-stand related terminology; (ii) compare andcontrast the subtypes and contexts of delirium;(iii) assess, screen, and diagnose delirium; (iv)list and understand the risk factors, causes, anddifferential diagnoses of delirium; (v) apply non-pharmacological and pharmacological manage-ment strategies based on delirium subtypesand goals of care; and (vi) utilize an interdisci-plinary approach to supporting and reducingdistress for patients, caregivers, and staff dealingwith delirium.

DomainsStructure and Processes of Care; PhysicalAspects of Care; Psychological and PsychiatricAspects of Care

Challenging Medication Management Issuesat End-of-life (P12)Mellar P. Davis, MD FCCP, The Cleveland ClinicFoundation, Cleveland, OH. Mary LynnMcPherson, PharmD BCPS CPE, University ofMaryland School of Pharmacy, Baltimore, MD.Ruth Lagman, MD, The Cleveland Clinic Foun-dation, Cleveland, OH. Susan B. LeGrand, MD