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The coronavirus disease 2019 (COVID-19) crisis has amplified the importance of palliative care to countless patients suffering with and dying from this disease, as well as to their families, communities, and the worldwide cadre of overburdened health care workers. Particularly urgent is the need for spiritual care specialists and generalists to address spiritual suffering given the degree of isolation, loneliness, and vulnerability caused by this pandemic. Although spiritual care has long been recognized as one of the domains of quality palliative care, it is often not fully integrated into practice. All disciplines are ultimately responsible for ensuring that spiritual care is prioritized to improve quality of life and the experience of patients and families facing spiritual emergencies amid the complex life-and-death scenarios inherent to coronavirus disease 2019. Although the pandemic has revealed serious fault lines in many health care domains, it has also underscored the need to recommit to spiritual care as an essential component of whole-person palliative care.

The State of the Science in Spirituality and Palliative Care was convened to address the current landscape of research at the intersection of spirituality and palliative care and to identify critical next steps to advance this field of inquiry. Part II of the SOS-SPC report addresses the state of extant research and identifies critical research priorities pertaining to the following questions: 1) How do we assess spirituality? 2) How do we intervene on spirituality in palliative care? And 3) How do we train health professionals to address spirituality in palliative care? Findings from this report point to the need for screening and assessment tools that are rigorously developed, clinically relevant, and adapted to a diversity of clinical and cultural settings. Chaplaincy research is needed to form professional spiritual care provision in a variety of settings, and outcomes assessed to ascertain impact on key patient, family, and clinical staff outcomes. Intervention research requires rigorous conceptualization and assessments. Intervention development must be attentive to clinical feasibility, incorporate perspectives and needs of patients, families, and clinicians, and be targeted to diverse populations with spiritual needs. Finally, spiritual care competencies for various clinical care team members should be refined. Reflecting those competencies, training curricula and evaluation tools should be developed, and the impact of education on patient, family, and clinician outcomes should be systematically assessed.

The State of the Science in Spirituality and Palliative Care was convened to address the current landscape of research at the intersection of spirituality and palliative care and to identify critical next steps to advance this field of inquiry. Part I of the SOS-SPC two-part series focuses on questions of 1) What is spirituality? 2) What methodological and measurement issues are most salient for research in palliative care? And 3) What is the evidence relating spirituality and health outcomes? After describing current evidence we make recommendations for future research in each of the three areas of focus. Results show wide variance in the ways spirituality is operationalized and the need for definition and conceptual clarity in research in spirituality. Furthermore, the field would benefit from hypothesis-driven outcomes research based on a priori specification of the spiritual dimensions under investigation and their longitudinal relationship with key palliative outcomes, the use of validated measures of predictors and outcomes, and rigorous assessment of potential confounding variables. Finally, results highlight the need for research in more diverse populations.

Context. The National Consensus Project for Quality Palliative Care includes spiritual care as one of the eight clinical practice domains. There are very few standardized spirituality history tools. Objectives. The purpose of this pilot study was to test the feasibility for the Faith, Importance and Influence, Community, and Address (FICA) Spiritual History Tool in clinical settings. Correlates between the FICA qualitative data and quality of life (QOL) quantitative data also were examined to provide additional insight into spiritual concerns. Methods. The framework of the FICA tool includes Faith or belief, Importance of spirituality, individual’s spiritual Community, and interventions to Address spiritual needs. Patients with solid tumors were recruited from ambulatory clinics of a comprehensive cancer center. Items assessing aspects of spirituality within the Functional Assessment of Cancer Therapy QOL tools were used, and all patients were assessed using the FICA. The sample (n ¼ 76) had a mean age of 57, and almost half were of diverse religions. Results. Most patients rated faith or belief as very important in their lives (mean 8.4; 0e10 scale). FICA quantitative ratings and qualitative comments were closely correlated with items from the QOL tools assessing aspects of spirituality. Conclusion. Findings suggest that the FICA tool is a feasible tool for clinical assessment of spirituality. Addressing spiritual needs and concerns in clinical settings is critical in enhancing QOL. Additional use and evaluation by clinicians of the FICA Spiritual Assessment Tool in usual practice settings are needed. J Pain Symptom Manage 2010;40:163e173. 2010 U.S. Cancer Pain

Palliative care is grounded in the biopsychosocial-spiritual model of care. Dame Cecily Saunders noted that the care of the whole person included the treatment of ‘‘total pain:’’ physical, emotional, social, and spiritual. Patients with chronic, life-threatening, or terminal illness often experience pain that is multidimensional. Clinically, it is difficult to separate physical pain from psychosocial, spiritual, and existential suffering. Although patients are often asked to rate their pain on a scale of 1e10, what does an 8/10 mean? Does the scale assess deep suffering and angst? How can we assess for meaninglessness or hopelessness? And more importantly, can suffering be ‘‘treated,’’ that is, reduced to a DSM code to better lend it to biomedical intervention (and risk subsequent medicalization of a universal human experience)? The humanities offer a framework for addressing the nonphysical aspects of chronic illness. Humanities have helped differentiate disease, as the physical entity, from the larger

Patients and Family Caregivers. These efforts are diverse in purpose, geography, and size and represent some of the most ambitious, productive, and thriving consortia to study and improve palliative care. First we will review our experiences in creating and sustaining multisite collaborations, including how to engage stakeholders, review goals, appraise resources and costs, and reconcile the varying interests of members. Next we will provide examples of quality improvement projects and share preliminary results that highlight how rapid assessment and development of best practices can thrive in palliative care. Such examples include a pain management program through the PCQN, a dyspnea and constipation project within the Carolinas Consortium, and implementing an evidence-based concurrent oncology-palliative care model in settings with a majority of minority. During this session we will share our experiences, challenges, and lessons learned in establishing and sustaining five large quality improvement collaborations in palliative care. In addition, we will foster an open dialogue with the audience to promote development of similar programs in their local communities. Together we hope to build a mutual understanding of the power of quality improvement collaborations and a practical path forward so all may participate and benefit.

3. Create an informed and effective clinical, education, and institutional approach to pediatric palliative care. It is often said that ‘‘children are not little adults’’ and nowhere is this more true than in the area of pediatric palliative care (PPC). Although all palliative care shares basic principles, there are clearly many differences. Even the term ‘‘pediatric palliative care’’ tends to conflate diverse age groups with distinct needs, ranging from the perinatal to the neonatal, through childhood, and onto adolescence. For all its uniqueness, PPC is vastly underserved, with few individuals specifically trained or even working in pediatric palliative care; yet children and families have these needs across the country. Adult palliative care clinicians are therefore faced with the challenge of how best to help children and families in their community. This workshop endeavors to help professionals tailor their expert palliative care skills to the needs of this population. The workshop will begin with an interdisciplinary team overview of what is unique and similar in adult and pediatric palliative care. This will be followed by small group case studies and a large group discussion. The three cases are: a fetus prenatally diagnosed with Trisomy 13; a school-age child with a poor prognosis where the parents are seeking maximal (and burdensome) treatment; and an adolescent with cancer that is potentially treatable, but who is refusing the treatment his parents want for him. Multiple issues will be discussed ranging from supporting parents in their grieving and decision making, to coping with clinicians’ own emotional response to the suffering of children, and much in between. The workshop will conclude with small-group and facilitated discussion of concrete steps toward expanding adult-oriented palliative care clinical and education programs to attend to the needs of children and their families. The audience is encouraged to bring suggestions and ideas to share with each other.

‘‘The Fun Stuff’’: Updates on Hospice Regulatory and Compliance Issues and Healthcare Reform Ethics Part A (P7) Joel Policzer, MD FACP FAAHPM, VITAS Hospice and Palliative Care, Ft. Lauderdale, FL. Holly Swiger, PhD MPH RN, VITAS Healthcare Corp, Murrieta, CA. Cherry Meier, MSN RN LNHA, VITAS Healthcare Corp, Madison, WI. Sue Ramthun, Hart Health Strategies, Washington, DC. (All authors listed above for this session have disclosed no relevant financial relationships.) Sponsored by AAHPM

a new or growing program through consultation or mentorship. 3. Summarize how engaging with peers or networks of peers can support efforts to grow or improve a palliative care program. A recent survey of California hospitals showed that the prevalence of palliative care services (PCS) doubled over the past 8 years to 33%, but that 20% of these programs have been operational for a year or less. Whether launching a new program, growing nascent one, or expanding a mature one, PCS leaders need to be able to perform a wide variety of tasks including providing clinical excellence, demonstrating quality and value to a variety of stakeholders, leading a team, engaging with senior leaders at their hospital or health system, cultivating philanthropic support, and crafting job descriptions that are sustainable, among many others. Program leaders need to know what to do, when to do it, and what to avoid. They also need the tools to support and document quality care. Unfortunately, too often program leaders go it alone and fail to take advantage of the many resources available to help. We propose that no one should do this alone and that new programs should develop plans for leveraging the wealth of external resources that are available in our field to support them and help them avoid mistakes, overcome barriers, and adapt and adopt rather than recreate. The goal of this session is to describe some of the external resources that are currently available to people starting or growing a PCS. We will show that assistance can come from many sources: professional organizations, peers and networks, and experts. By taking advantage of these resources new programs can get the support they need to more easily negotiate the challenges they will inevitably face. Perhaps more importantly, leveraging external resources will allow us as a field to pool our knowledge and further our collective goal to provide patients and families with the best care possible.

3. Identify (i) three characteristics that make an outcome measure useful for the research setting, and (ii) two advantages, and (iii) two disadvantages of using parents as proxy respondents. 4. Recognize and justify research designs (eg, qualitative studies, secondary analysis using large databases, cross-sectional, and longitudinal studies) appropriate for various research questions, citing the advantages and disadvantages of each. 5. Identify collaborative opportunities in the pediatric palliative care research community. Specific activities will include