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Quantum Units Education

Science of End of Life and Palliative Care

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?

A. Hispanics

B. Non-Hispanic blacks

C. Non-Hispanic whites

D. Asians

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?

A. Stroke

B. Motor vehicle accidents

C. Cancer

D. Diabetes

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.

A. True

B. False

Evolving Evidence-Based Practices

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

A. Drugs for symptom control or pain relief.

B. Doctor, medical, nursing, and health professional services.

C. Medical equipment and supplies.

D. All of the above are benefits of Hospice.

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

A. True

B. False

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

A. Freestanding hospice centers

B. Nursing homes

C. Long-term care facilities

D. All of the above

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

A. Hospice focuses on curing and caring.

B. Hospice is covered by Medicare, Medicaid, and most private insurers.

C. Hospice services can be stopped for any reason but can also continue as long as patients are certified as eligible.

D. In choosing hospice care, Medicare will still pay for covered benefits for any health problems that aren’t related to terminal illness.

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”?

A. End-of-Life Care

B. Palliative Care

C. Hospice Care

D. All of the above

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.”

A. True

B. False

The Public Federal Sector

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

A. True

B. False

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.

A. True

B. False

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

A. Increase the basic knowledge about the aging process and how diseases of the elderly are best managed.

B. Transmit knowledge to health care providers.

C. Improve the quality of care delivered to elders.

D. All of the above.

13. Each GRECC has all of the following except:

A. A funding component

B. A research component

C. An education component

D. A clinical component

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.

A. True

B. False

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?

A. Quantitative

B. Qualitative

C. Psychometric

D. Experimental

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

A. Qualitative

B. Quantitative

C. Experimental

D. Psychometric

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.

A. True

B. False

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

A. Determining trends in the health conditions / disease topics within the published research literature.

B. Determining which health conditions / diseases represented new or emerging areas of interest.

C. Determining trends for publication of EOL PC research in the areas of interest.

D. All of the above.

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

A. Neurologic

B. Renal

C. Musculoskeletal

D. Other

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

A. Neurologic

B. Renal

C. Hepatic

D. Musculoskeletal

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

A. True

B. False

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.

A. True

B. False

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

A. True

B. False

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.

A. True

B. False

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?

A. Opioids

B. Morphine

C. Methadone

D. All of the above

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

A. Hospice as a setting.

B. Hospice as a cure model.

C. Hospice as a care type.

D. Hospice as a care model.

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

A. Hope

B. Anxiety

C. Bereavement

D. Depression

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.

A. True

B. False

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

A. True

B. False

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

A. Health professionals

B. Health care volunteers

C. Members of the clergy

D. All of the above

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.

A. True

B. False

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

A. Time until death

B. Estimates of time until death

C. Survival or life expectancy

D. All of the above

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.

A. True

B. False

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.

A. True

B. False

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?

A. Academic institutions

B. Private foundations

C. Professional associations

D. Businesses

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.

A. True

B. False

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

A. True

B. False

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

A. Direct costs

B. Indirect costs

C. Neither direct nor indirect costs

D. Both direct and indirect costs

Federal Grants

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

A. Specific research projects using R grant mechanisms.

B. Training and career development grants.

C. Small business awards.

D. G or resource awards.

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.

A. True

B. False

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?

A. Advanced Care Planning

B. Care Settings and Standards

C. Pain and Other Symptom Management

D. All of the above

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:

A. Diabetes

B. Heart disease

C. Stroke

D. Alzheimer’s disease

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.

A. True

B. False

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.

A. True

B. False

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

A. True

B. False

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

A. Academic institutions

B. Professional associations

C. Foundations

D. Private industry

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

A. True

B. False

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

A. True

B. False

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.

A. True

B. False

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?

A. Quantitative, experimental

B. Quantitative, non-experimental

C. Qualitative, experimental

D. Qualitative, non-experimental

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

A. True

B. False

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

A. Patient safety

B. Comparative effectiveness

C. Quality improvement

D. All of the above

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:

A. Age specificity

B. Diversity

C. Health Literacy

D. Education and training

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

A. Medically fragile neonates

B. Adolescent health

C. Children with rare diseases

D. All of the above

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.

A. True

B. False

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.

A. True

B. False

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