Wu, Kelly L.

AbstractBackgroundCalciphylaxis is a debilitating dermatological condition associated with high rates of morbidity and mortality. Palliative care offers a multidisciplinary approach to addressing symptoms and goals of care in patients with serious medical diagnoses. Involvement of palliative services for calciphylaxis is infrequently reported in the literature. The purpose of this report is to assess rates of palliative and pain consultation for patients with calciphylaxis.MethodsThis is a comprehensive, single‐institution retrospective chart review of 121 eligible patients with a diagnosis of calciphylaxis treated at Mayo Clinic in Rochester, Minnesota, from 1999 to 2016. Inclusion criteria were an indisputable diagnosis of calciphylaxis based on clinical, histopathologic, and radiographic features. One hundred twenty‐one patients met inclusion criteria.ResultsFifty‐one patients (42%) received either a palliative (n = 15) or pain (n = 20) consultation, or both (n = 16). Patients with a palliative care consultation were younger compared with those without (mean ages 57 vs. 62 years, P = 0.046). In 104 patients (86%), psychiatric symptoms were not assessed.ConclusionsIn this cohort of patients with calciphylaxis, the majority do not receive palliative and pain care consultations. Psychiatric complications are inconsistently addressed. These observations highlight practice gaps in the care of patients with calciphylaxis.

95 Background: Palliative care (PC) specialists provide supportive care for patients with hematologic diseases (HD). However, the degree of engagement by PC physicians may be limited by the views of both PC physicians & hematologists. Prior studies have surveyed hematologists to identify barriers to delivery of PC, however PC physician views are unclear. This study aimed to examine views of PC physicians toward hematology. Methods: A survey was mailed to a random sample of the AAHPM physician contact list in 2017. Items focused on perceptions of their understanding of HD, comfort providing care, opinions regarding PC & hospice involvement, & beliefs about hematologists. Anonymized responses were assessed on a Likert scale. Statistical testing was based on logistic regression models with generalized estimating equations to account for correlated data within respondents. Results: 538 of 1000 surveys were completed. 51.9% of respondents were male. Community (37.2%), academic (36.7%) & hospice (26.2%) physicians were represented. Respondents were likelier to believe they understand the trajectories of lymphoma & myeloma than leukemia or patients undergoing hematopoietic stem cell transplantation (HSCT) (p < 0.001). They were more comfortable discussing prognosis (p < 0.001) & managing symptoms (p < 0.001) in lymphoma & myeloma than leukemia & HSCT. They were likelier to believe that hematologists’ perceptions of PC physicians limit collaboration rather than their own views of hematologists (p < 0.001). 80.2% agreed that hospice referrals are not made early enough. Conclusions: PC physicians’ understanding of trajectories & comfort caring for patients varies by hematologic disease. They perceive that hematologists’ perceptions are a larger barrier than their own & hospice referrals are delayed. These results provide insights into opportunities for better collaboration with hematologists.