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listening. Participants will leave the session witha new skill in their communication toolbox.

Advanced Pulmonary Hypertension:Considerations for Care Planning at Endof Life (427)Jillian Gustin, MD, The Ohio State University,Columbus, OH. Amber Hartman, PharmD,TheOhio StateUniversityMedical Center, Colum-bus, OH. Robert Johnson, MD, The Ohio StateUniversity Medical Center, Columbus, OH.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Explain the pathophysiology of and symp-

toms associated with advanced pulmonary hy-pertension including the mechanisms ofaction of medications commonly used for ad-vanced pulmonary hypertension and theirimpact on symptoms.

2. Discuss the current literature on managingpatients with advanced pulmonary hyperten-sion at the end-of-life.

3. Propose a guideline for providing end-of-lifecare for patients with advanced pulmonaryhypertension.

The survival of patientswithWorldHealthOrgani-zation functional class IV pulmonary hyperten-sion is less than one year if untreated. Althoughinitiation of prostacyclin analogues improvesfunctional status and survival, class IV pulmo-nary hypertension remains a terminal illness.Unfortunately, there is little evidence on howbest to manage these patients at the end-of-life. This session will use case studies of patientsadmitted to our MICU on continous IV prosta-cyclin analogues to discuss the challenges andconsiderations inherent in providing care topatients dying with advanced pulmonary hyper-tension. Briefly, we will describe the pathophys-iology of advanced pulmonary hypertensionincluding a review of associated symptoms.Next, we will outline the pharmacokinetics ofintravenous prostacyclin analogues (epoproste-nol and trepostinil) used for patients with classIV pulmonary hypertension, including theimpact of these medications on patient symp-toms. Given the dearth of literature on end-of-life care for patients with class IV pulmonaryhypertension, we will propose general guide-lines for medical management by extrapolatingfrom studies examining discontinuation or tran-sitions off of other medications with similar

mechanisms (eg, nitric oxide, sildenafil, andprostacyclin) as well as from our own experi-ences. Finally, we will use these cases to examinevarious psychosocial challenges associated withpatients dying from pulmonary hypertension,including considerations for place of death(eg, hospital setting, home hospice, inpatienthospice). A detailed handout will be providedthat outlines our proposed medical manage-ment guidelines for care of patients dyingfrom advanced pulmonary hypertension.

SIG Symposium

Lay Your Hands On Me: Using SimpleOsteopathic Manipulation Treatments(OMT) for Pain in Hospice and PalliativeMedicine Patients (428)Osteopathic SIGGrace Varas, DO, University of Texas MedicalSchool at Houston, Houston, TX. Robert Hunt-er, DO CMD WCC, Providence Medical Group,Huber Heights, OH. Abi Katz, DO MS, SutterVNA and Hospice, Emeryville, CA.(All authors listed above for this session have dis-closed no relevant financial relationships.)

Objectives1. Recognize how OMTcan be used in the Mind-

Body-Spirit approach to total pain relief.2. Identify simple OMT techniques that both os-

teopathic and non-osteopathic HPM practi-tioners can use to treat their patients’ pain.

3. Illustrate the techniques demonstrated un-der the supervision of the presenters.

Osteopathy recognizes that all parts of the bodywork together to create healing. Osteopathic Ma-nipulative Treatment (OMT) is a set of manualmedicine techniques used to relieve pain andother symptoms, restore range of motion andfunction, and enhance the body’s capacity toheal. There are barriers to patients being able toreceive this beneficial adjunct therapy. As of2010, there are only 70,480 DOs, very unevenlydistributed in the U.S. Per AAHPM membershipservices, there are approximately 300 active DOsin the Hospice and Palliative Medicine (HPM)field.Not all DOs practiceOMT.Osteopathic phy-sicians sometimes feel they cannot practice OMTbecause of difficulty mastering techniques or be-cause they do not know how to integrate OMTinto their practice. In HPM specifically, OMT isa useful adjunct pain treatment that has no

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drug-drug interactions and may provide immedi-ate relief.Most osteopathic techniques require significantspecialized education and supervised practiceover time to achievemastery. However, a few tech-niques are easy to reproduceby anon-osteopathicpractitioner, occasionally even by the patientthemself. Myofascial release, soft tissue stretchingand strain-counterstrain techniques specificallyare easy to learn and reproduce inmany differentareas of HPM practice (home to inpatient set-tings). Since learning these techniques does re-quire practice, this presentation will encouragethe attendee to participate in supervised use ofthe techniques in small groups with a partner.This symposium will serve as an introduction tosimple OMT techniques that can be reproducedby both novices and skilled learners.

3:30e5 pm

Concurrent Session

An Interactive Educational Exchange:Sharing Innovative Teaching Materials andMethods (429)Online Interprofessional Training onSpiritual and Cultural Aspects of PalliativeCareMatthew Ellman, MD, Yale University School ofMedicine, New Haven, CT.(Ellman has disclosed no relevant financialrelationships.)

Objectives1. Discuss the basic precepts and goals of palli-

ative care.2. Identify and address patients spiritual and

cultural needs.3. Discuss the roles of members of the interpro-

fessional teamandhowtheycanwork together.

Backgound. Health professional graduates oftenfeel unprepared to provide palliative care, particu-larly regarding spiritual and cultural issues. Fewop-portunities exist for students to learn how toprovide this care as part of an interprofessional pal-liative care team.

Methods. The program begins with an online, in-teractive, multimedia training module that thatenables students to consider spiritual, culturaland clinical issues of a patient with late-stagebreast cancer. Next, a live workshop providesa hands-on opportunity to grapple with palliative

care challenges that cross professional lines andto explore personal spiritual and cultural issues.The workshop culminates in the creation ofa care plan for a palliative patient by interprofes-sional student teams. Participants complete self-and program evaluations (Likert scale: 5 ¼strongly agree; 1 ¼ strongly disagree).

Results. We analyzed data from 14 cycles of theprogram (n ¼ 309), including 205 medical, 65nursing, and 39 chaplain students. Due to lownumbers, we excluded social work students.Means and standard deviations on key self-evalu-ation items for medical, nursing and chaplainstudents respectively were as follows. Greater un-derstanding of: basic precepts and goals of palli-ative care 3.98 (0.93), 4.23 (0.88), 4.10 (1.05);importance of addressing spiritual needs 4.25(0.93), 4.49 (0.73), 4.08 (1.05); role of culturein patients; experience 4.10 (0.92), 4.35 (0.69),4.05 (1.05); contributions of other health careprofessionals/importance of the interdisciplin-ary team 4.32 (0.95), 4.49 (0.87), 4.38 (0.88).Scores for the overall program were: onlinecase and workshop facilitated learning: 4.13(0.92), 4.48 (1.02), 4.46 (0.60); program devel-oped knowledge and skills essential to futurework: 4.13 (0.90), 4.45 (0.91), 4.03 (1.09).

Discussion. The innovation of this program is inits blended curriculum of the independently-completed online module and the collaborativeworkshop, as well as in its incorporation of inter-professional practice into content and learningformat. Analyses indicate that the programmeets its objectives and is well-received.

Conclusion. Our program fills a substantial gapin the education of these student health profes-sionals and is adaptable to other educational set-tings as the online component is easily accessibleand the workshop can include all palliativehealth professionals.

Case-Based Simulation: CriticalConversations Surrounding Resuscitationof the Critically Ill or Injured PatientSangeeta Lamba, MD, UMDNJ-New Jersey Med-ical School, Newark, NJ.(Lamba has disclosed no relevant financialrelationships.)

Objective1. Discuss how to use clear/direct, closed-loop

communication with interdisciplinary teams(simulatedresuscitation).