Tales of the Unexpected: Understanding and Responding to Bleeding in the Hospice Setting.

Outcomes 1. Participants will be able to manage all forms of bleeding from minor to catastrophic.2. Participants will be able to describe communication strategies and optimize family support for patients at risk for bleeding in the home hospice setting. Key Message Bleeding in hospice can range from minor to catastrophic, causing distress for patients, families, and staff. This session will provide tools to manage bleeding and support patients and families experiencing this symptom. Abstract Bleeding in hospice settings can occur in patients with advanced solid tumors, advanced liver disease, hematologic malignancies and bone marrow failure. Any form of bleeding is distressing for the patient, staff, or family. A true palliative care emergency occurs when persistent bleeding occurs, with the potential for catastrophic bleeding leading to sudden death. In this situation, even the best plans go awry when teams and families are confronted with severe bleeding. Pharmacological approaches for management are often underutilized due to the lack of knowledge of basic coagulation pathways and the multiple options that do exist. Proper planning and coordination, including the identification of patients at high risk for bleeding, can often minimize the possibility of uncontrolled bleeding and emotional trauma for both the patient and family. This session, which will be conducted by a panel of hematologists, palliative care specialists, and palliative pharmacologists, will help attendees develop strategies for bleeding patients in hospice settings. Cases of bleeding due to weakened vasculature from previous radiation, tumor erosion, rectal/vaginal/oral bleeding complicated by thrombocytopenia or coagulation pathway disorders will be discussed. Attendees will at the end of the session achieve the following goals: 1) Understand the mechanisms of bleeding in advanced cancer, advanced liver disease, and hematologic malignancies.2.) Recognize treatment and drug induced causes of bleeding in the hospice setting;3.) Develop a prognosis-based approach to bleeding patients with advanced cancer, liver disease and hematologic malignancies. 4.) Understand how and when to use systemic therapies and local therapies for bleeding. 5.) Describe communication strategies that optimize family support for patients at risk of bleeding in a home hospice setting. Keywords Emergencies / Refractory Symptom Management / Pharmacotherapeutics / Pharmacopalliation