Vol. 47 No. 2 February 2014 389Schedule With Abstracts

services and hospitalizations and ineffective andburdensome interventions and less likely to uti-lize palliative care. The success of health systemreform depends largely on the capacity of seri-ously ill patients from diverse backgrounds tomake informed decisions about their healthand health care.

In this immersion learning session, we will uti-lize a variety of multimedia tools and exercises togain an experiential understanding ofthe concepts of limited health literacy andnumeracy and the communication challengesthey pose to all palliative care clinicians. Next,we will identify two concrete strategies to betterassess and manage persons with limited literacyand thereby promote better informed decisionmaking and easier access to palliative care forthese patients and their families.

Choosing (Words) Wisely: Talking withPatients About the Cost of Their Care(TH306)Thomas Smith, MD FACP FASCO FAAHPM,Johns Hopkins Hospital, Baltimore, MD. JoannBodurtha, MD MPH, Johns Hopkins Hospital,Baltimore, MD. Paula Heneberry, LCSW-C,Johns Hopkins Hospital, Baltimore, MD. CyndaRushton, PhD RN FAAN, Johns Hopkins Univer-sity School of Nursing and Bioethics Institute,Baltimore, MD.(All authors listed above had no relevant finan-cial relationships to disclose.)

Objectives1. Define what is already known about in-per-

son discussion of medical care costs withpatients and families.

2. Apply ethical principles and values to situa-tions where options for treatment arelimited by costs.

3. Discuss the adaptation of breaking badnews modules to the discussion of costand integration of cost into a discussionof effectiveness. Learn practical modelsfor negotiating the most difficult parts ofthe discussion, namely when the patientand family want resources and care that isnot available within the healthcareprogram.

The cost of medical care is rising at an unsustain-able rate in the United States and will bereduced (Smith & Hillner, NEJM, 2011) withaccountable care organizations, restrictions,and voluntary campaigns such as the American

Board of Internal Medicine’s ‘‘Choosing Wisely’’campaign. About half of all bankruptcies arerelated to medical costs. Recent work (SommersR, Danis M, Health Affairs, 2013) shows substan-tial barriers to patients’ use of cost in decisionmaking, including a desire for best care regard-less of cost consequences for themselves andothers, disinterest in societal costs, and inexperi-ence with any discussion of costs. These tensionsinevitably lead to conflicts between what peoplewant and what can realistically be providedbased on both medical effectiveness and cost.

There are very few models about how to havethese difficult conversations. How can health-care professionals be trained in and feelcomfortable with discussions about the limita-tion of resources?

Presenters will discuss the very limited avail-able data; models adapted from breaking badnews (for example ‘‘SPIKE,’’ McFarlane, Riggins,Smith, J ClinOnc, 2008); current practices forcrucial conversations we currently have with fam-ilies that involve restrictions such as insisting ondischarge when the family requests more days,and out of pocket costs for genetic tests andchemotherapy. We will explore the underlyingethical issues in professionalism and choicesfor the patient and/or society and resources tohelp healthcare professionals discuss the costof care.

Specific topics include: how and when toraise the issues, how to determine the cost ofvarious medical care items, ways to explain topatients that some desired treatments simplyare not available and why, and the ethicaland social dimensions in which these decisionsare made.

The collaborative process will be illustratedthrough case studies of patients who need ther-apies that are not available within their payorsys-tem, or for whom the available treatment couldbankrupt the family for years to come.

Who Let the Drugs Out, and Who’sProviding Them? (TH307)Mary Lynn McPherson, PharmD BCPS CPE,University of Maryland School of Pharmacy, Bal-timore, MD. Ann Broderick, MD MS, Universityof Iowa Hospitals and Clinics, Iowa City, IA. JoanHarrold, MD MPH, Hospice and CommunityCare, Lancaster, PA.(All authors listed above had no relevant finan-cial relationships to disclose.)