Educational Intervention Enhances Clinician Awareness of Christian, Jewish, and Islamic Teachings around End-of-Life Care.

BACKGROUND: Patients\u27 religious and spiritual values impact their goals and perception of illness, especially at the end of life (EOL). According to the Joint Commission, identifying spiritual beliefs may improve cultural competency and patient-centered care. However, clinicians may be uncomfortable discussing spirituality and unaware of basic religious teachings. OBJECTIVES: To assess clinician understanding and knowledge of key Christian, Jewish, and Islamic teachings around EOL care before and after a one-hour educational intervention through video podcast. DESIGN: After literature review and consultation with religious leaders, a pre- and post-test (10 questions per religion plus demographic questions) to assess knowledge of Christian, Jewish, and Islamic teachings and an educational video podcast were developed. The pretest was administered to healthcare providers, followed by a one-hour educational intervention through a video podcast. Next, a post-test was administered. SUBJECTS: Seventy-three healthcare providers participated in this study. MEASUREMENTS: Differences between pretest and post-test scores were analyzed employing paired t-test tests using SPSS software. RESULTS: The median score on the pretest was Christian: 6 [2-9], Jewish: 6 [4-10], and Islamic: 6 [2-8]. After the educational intervention, the median Christian, Jewish, and Islamic scores improved to 8 [4-10], 9 [6-10], and 10 [3-10], respectively (p \u3c 0.0001). Additionally, the total pretest median score improved from 17 [10-24] to 27 [16-30]. CONCLUSIONS: A one-hour educational intervention through video podcast significantly improved understanding of Christian, Jewish, and Islamic teachings around EOL care. The video podcast enabled easy distribution of the educational session to multiple facilities and providers. Additional research is needed to determine the longitudinal outcomes and impact on patient outcomes of this intervention

Leveraging real-world data to predict cancer cachexia stage, quality of life, and survival in a racially and ethnically diverse multi-institutional cohort of treatment-naïve patients with pancreatic ductal adenocarcinoma

Introduction Cancer-associated cachexia (CC) is a progressive syndrome characterized by unintentional weight loss, muscle atrophy, fatigue, and poor outcomes that affects most patients with pancreatic ductal adenocarcinoma (PDAC). The ability to identify and classify CC stage along its continuum early in the disease process is challenging but critical for management. Objectives The main objective of this study was to determine the prevalence of CC stage overall and by sex and race and ethnicity among treatment-naïve PDAC cases using clinical, nutritional, and functional criteria. Secondary objectives included identifying the prevalence and predictors of higher symptom burden, supportive care needs, and quality of life (QoL), and examining their influence on overall survival (OS). Materials and methods A population-based multi-institutional prospective cohort study of patients with PDAC was conducted between 2018 and 2021 by the Florida Pancreas Collaborative. Leveraging patient-reported data and laboratory values, participants were classified at baseline into four stages [non-cachexia (NCa), pre-cachexia (PCa), cachexia (Ca), and refractory cachexia (RCa)]. Multivariate regression, Kaplan Meier analyses, and Cox regression were conducted to evaluate associations. Results CC stage was estimated for 309 PDAC cases (156 females, 153 males). The overall prevalence of NCa, PCa, Ca, and RCa was 12.9%, 24.6%, 54.1%, and 8.4%, respectively. CC prevalence across all CC stages was highest for males and racial and ethnic minorities. Criteria differentiated NCa cases from other groups, but did not distinguish PCa from Ca. The most frequently reported symptoms included weight loss, fatigue, pain, anxiety, and depression, with pain significantly worsening over time. The greatest supportive care needs included emotional and physical domains. Males, Black people, and those with RCa had the worst OS. Conclusions Using clinical, nutritional, and functional criteria, nearly one-quarter of the PDAC cases in our diverse, multi-institutional cohort had PCa and 62.5% had Ca or RCa at the time of diagnosis. The PCa estimate is higher than that reported in prior studies. We recommend these criteria be used to aid in CC classification, monitoring, and management of all incident PDAC cases. Findings also highlight the recommendation for continued emotional support, assistance in alleviating pain, and supportive care needs throughout the PDAC treatment journey