Quantum Units Education®

Trends and Dynamics

1. Race is an important consideration in understanding causes of death, as the highest mortality rates occur in which of the following?

2. While heart disease remains the leading cause of death among non-Hispanic whites and African Americans, Hispanics die more from which of the following than any other health condition or disease?

3. Hospice as a program of health services grew out of a philosophy of care aimed at improved approaches to symptom management and emotional and spiritual support for dying patients and their families, and its U.S. origins were closely linked to research support.

Evolving Evidence-Based Practices

4. Which of the following is a benefit of Hospice?

5. Hospice benefits may not be extended beyond six months.

6. Hospice care is provided in which of the following?

7. Which of the following is not true with regards to Hospice?

Definitional Clarity

8. Which of the following is defined as “ . . . patient- and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering . . . involves addressing physical, intellectual, emotional, social, and spiritual needs and facilitating patient autonomy, access to information, and choice”?

9. The Coalition to Transform Advanced Care threaded the term ‘advanced illness’ into the field in an effort to describe, “ . . . when one or more conditions become serious enough that general health and functioning decline, and treatments begin to lose their impact.  This is a process that continues to the end of life.”

The Public Federal Sector

10. The National Institutes of Health (NIH) is the main source for EOL PC science related to cancer.

11. In addition to its scientific mission, NCI actively focuses on the translation of research information to its constituents and in creating liaisons with the practice community.

12. Programs have been cultivated through the Geriatric Research Education and Clinical Centers with the goal to do which of the following?

13. Each GRECC has all of the following except:

14. The Comprehensive End-of-Life Care Initiative was initiated as a large-scale effort to increase access to high-quality hospice and palliative care services among veterans.

C. End-of-Life and/or Palliative Care Research Publications: Study Design

15. Which of the following study types seek to develop, pilot, or replicate instruments, scales, or measures?

16. Which of the following study types seek to determine cause and effect or the effectiveness of programs, systems, or interventions?

D. End-of-Life and/or Palliative Care Research Publications: Health Conditions / Diseases

17. EOL PC published research topic categories were developed as a method to ascertain key themes and subject matter trends in the research literature since 1997.

18. Which of the following were of particular interest for EOL PC published topics?

19. Arthritis falls under which of the following health condition / disease categories?

20. Chronic hepatitis B falls under which of the following health condition / disease categories?

21. The majority of publications with a health condition / disease focus concentrated on Alzheimer’s-related themes.

E. End-of-Life and/or Palliative Care Research Publications: Topics Studied

22. Advance Care Planning agreements must be formal, written documents conveying EOL PC preferences.

23. Advance Care Planning was the most frequent theme within the literature.

24. Publications that included the research topic theme of “Care Settings and Types of Care” focused on the locations in which EOL PC was provided and type of care offered.

25. EOL PC publications that had research themes on “Pain, Other Symptoms, or the Management of Symptoms” had a dataset that focused on the management of pain with which of the following?

26. Coded published research themes related to Hospice included publications focused on all of the following except:

27. Mental Health as a topic category included all of the following areas except:

28. The “Mental Health” category included themes of research papers focused on traditions, beliefs, and customs that are found across multi- and cross-cultural settings.

29. The “Education and Training” category included the education of family, relatives, and other caregivers.

30. Which of the following were included in the “Caregivers” topic category?

31. Published studies coded for “Communication” included themes related to communication between patients and health providers, individuals and their family, or communications between health care providers, but did not include ACP and/or Advance Directive topics.

32. The “Prognosis” category refers to topics related to which of the following?

G. End-of-Life and/or Palliative Care Research Publications: Funding Sources

33. From 1997 to 2003, nearly half or more of all funded EOL PC research publications reported receiving funding from nonfederal organizations.

34. Prior to 2008, EOL PC research publications had a higher percentage of funding from federal organizations, whereas after 2008 the majority of funding came from nonfederal organizations.

I. End-of-Life and/or Palliative Care Research Publications: Nonfederal Funding Sources

35. What was the most common type of nonfederal philanthropic organization support reported in the publications?

J. Federal Support of End-of-Life and/or Palliative Care Research: Grants and Funding Trends, FY 1997 - FY 2010

36. In general, a grant application competes for funding against other grants being reviewed in a given fiscal year, but if awarded does not compete for funding in the remaining years of the award.

37. When determining the dollar totals reported to research in a given fiscal year, only the competing awards are factored into the total.

38. Which type of costs are associated with facilities and administration of a grant?

Federal Grants

39. Which of the following types of EOL PC grants were awarded most often?

40. Non-R01 R awards are often exploratory or pilot projects and get funding more often than R01 awards, resulting in higher overall funding levels for non-R01 grants.

What Are the Trends in EOL PC Published Research Topics?

41. Which topic area comprised more than one-third of the total number of published studies, suggesting an ongoing need and an interest to further evidence-based knowledge and outcomes with the topic area?

42. While the number of EOL PC publications focused on advanced neurologic, cardiac, and respiratory conditions increased from 1997 to 2010, the proportion of these topics within publications remained less than 20% for each year.  This finding is important given that the most common causes of death in the United States are all of the following except:

What Are the Funding Sources Cited in the Published Research?

43. Knowing who supports the science of EOL PC is invaluable for identifying the sources of research funding, the fostering of new collaborations, and the building of future initiatives to address EOL PC needs.  In publications where funding sources were not acknowledged, a potential conclusion that a large percentage of investigators are conducting and publishing unfunded work should be considered.

44. While there was a definite trend for increased private, philanthropic support for EOL PC research between 1997 and 2010, actual reporting of private, philanthropic funding fluctuated and lagged behind citations of federal funding.

45. Overall, 30% of all publications cited sole support for the research by a federal agency.

46. The most common type of nonfederal organization reported in research publications were which of the following?

47. Efforts to build public-private collaborations are critical considerations in discussions of strategies to sustain research infrastructure and maintain momentum.

48. Forty-four percent of philanthropic funders felt that palliative care was a ‘low’ or a ‘very low’ priority for their foundations.

What Are the Federal Mechanisms of EOL PC Research Support?

49. Across federal agencies, there has been a threefold increase in the number of new grants for EOL PC research.

Are EOL PC Research Interests and Priorities Changing Over Time? What New Knowledge Gaps Need To Be Addressed?

50. More than half of all published research in the dataset was based on which type of research design?

51. No clinical trial, regardless of potential scientific benefit, should compromise the human care that is the foundation of end-of-life research.

52. EOL PC research must address which of the following issues?

53. The next generation of advance care planning research needs to address all of the following issues for the public and all providers, including generalists, except for:

54. Pediatric palliative and hospice care has expanded its scope to include which of the following?

Opportunities | Building Momentum For The Future

55. Through research, important information has been aimed that dispels the myth that end-of-life care hastens death.

VII. Conclusion

56. The shift from a focus on cure to that of care redirects emphasis on the patient’s needs in terms of compassion, comfort, healing, and respect for preferences of care.