Integrative Medicine (IM) Providers’ Perceptions of Palliative Care Conversations - A Collaboration between Integrative Medicine for the Underserved (IM4US) and Palliative Care

IM providers treat patients of all ages, at all stages of life. Many IM modalities are well-suited to end-of-life (EOL) care; however, IM providers\u27 comfort with EOL conversations and the adequacy of their training for EOL conversations is unknown. Our goals were to determine 1) how comfortable providers feel talking to patients about EOL issues, 2) how effective providers felt that their formal education was at teaching this skill, and 3) providers’ perceptions of the importance of this skill in their fields. We surveyed 29 IM providers in an IRB-exempt study at the June 2018 IM4US conference in Washington, DC. Most respondents (64%) reported that they are comfortable talking to patients about EOL issues. 70% of respondents felt comfortable modifying their goals from cure-focused to care-focused. However, just 36% of respondents felt that their formal education had been effective at teaching these skills. 93% responded that it is important for practitioners in their fields to skillfully talk to their patients about EOL issues. Despite providers’ perceptions of inadequate formal training in conducting EOL conversations with their patients, the majority of providers responded that they are at least somewhat comfortable in discussing EOL and comfort-focused care with their patients. The majority recognized the importance of conducting EOL discussions skillfully with their patients but only one-third of practitioners felt they had sufficient training. Because the vast majority of IM providers acknowledge the importance of skillful EOL discussions, further research is required to determine the best way to integrate EOL education into IM curricula and whether formal education can effectively teach these skills, so that more IM providers are comfortable with EOL discussions and goal setting in their life-limited patients

Pediatric Headache Experience During the COVID-19 Pandemic

OBJECTIVE: Headache disorders are exceedingly common in children and adolescents. The association between headaches, emotional stress, and disruptions in daily routines are well established. The goal of this study is to compare the experiences of patients with a preexisting diagnosis of a primary headache disorder in terms of headache frequency and severity, lifestyle techniques for headache prevention, screen use, and mood from before and after the onset of the COVID-19 pandemic. METHODS: Patients evaluated by the Headache Clinic at Children\u27s National Hospital between Summer 2020 and Winter 2021 were enrolled in a patient registry. Patients completed a questionnaire examining changes in headache characteristics and lifestyle factors since the onset of the COVID-19 pandemic. RESULTS: A total of 107 patients completed the survey. Since the pandemic\u27s onset, patients reported decreased physical activity (n = 59, 55%), increased frequency of chronic headaches from 40% (N = 42) to 50% (N = 54), and increased constant daily headaches from 22% (n = 24) to 36% (n = 38). Patients reported worsened anxiety (n = 58, 54%), mood (n = 50, 47%), and workload (n = 49, 46%). Sixty-one percent (n = 65) of patients reported using screens for school for more than 6 hours per day. The majority (n = 67, 63%) of patients indicated that they would prefer attending in-person school, with 14% (n = 15) responding that they preferred online school. CONCLUSION: Since the COVID-19 pandemic\u27s onset, pediatric headache patients have experienced increasing headache frequency, worsening anxiety and mood, decreased physical activity, and increased screen usage. Although this study is limited by sample size and observational design, future population-based studies will further elucidate the impact of this pandemic on pediatric headache