Hip Fracture Decisions for Nursing Home Residents with Dementia
This article should lead you to talk to your trauma surgeons and/or orthopedists to develop a routine palliative care or hospice consultation for these patients.Robert Arnold, MD is a palliative care doctor at the University of Pittsburgh and a co-founder ofVitalTalk (@VitalTalk). He loves both high and low brow comedy (The Good Place and Nanette), pop culture (the National Enquirer and Pop Culture Happy hour) and music of all kinds (not opera tho!) You can find him onTwitter at @rabob. MorePallimed posts from Bob Arnold can be found here. Morejournal article reviews can be found here. References1. Berry SD,...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 17, 2018 Category: Palliative Care Tags: arnold dementia journal article nursing home pallimed writing group surgery trauma Source Type: blogs

Mandated Queries of the Florida Prescription Drug Monitoring Program: Early Experiences from a Cancer Center-based Outpatient Palliative Medicine Clinic
This article describes our e xperiences in the first month of experience with the new law, although we plan to examine queries for a total of three months before closing this QI project.For the purpose of this QI project, we have documented patients ’ demographics, including each patient’s age, gender and limited identifying information, such as patient names and identification numbers; this data will be de-identified for any statistical analysis planned in the future. We also recorded patients’ main diagnosis and pain symptoms, the numbe r of prescribers listed by the PDMP as well as the dose of the pati...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 14, 2018 Category: Palliative Care Tags: kollas opioids pdmp quality improvement The profession Source Type: blogs

The Future of Hospice and Palliative Medicine Starts with Medical Students
by Kayla Sheehan (@kksheehan)My first day of medical school, I asked the Dean how to start a Hospice and Palliative Medicine Student Interest Group (SIG). Before I became a medical student, I began volunteering for hospice. It changed my life. I learned invaluable lessons about life, death, and healing throughout my nearly five years as a hospice volunteer and I realized these lessons would not be taught in a classroom. Three years into medical school, we are one of the most active groups on campus, and we continue to grow.Assembling the group was not as difficult as one might think. The biggest hurdle is many students sim...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 10, 2018 Category: Palliative Care Tags: medical school sheehan The profession Source Type: blogs

Tell CMS the Payment Proposals Will Hurt Patients with Serious Illness
by Phil RodgersSubmit comments this weekend! Deadline: Monday, Sep 10, 11:59 PM ETRegular Pallimed readers willremember Amy Davis ’ excellent post regardingCMS ’ recent proposed rule updating the Medicare Physician Fee Schedule and Quality Payment Program for 2019. (See thisCMS Fact Sheet to learn more). In this rule, the agency proposes historically bold changes to outpatient evaluation and management (E/M) documentation requirements and payments, among many other substantial changes in the fee-for-service Medicare program.CMS says these proposed changes are designed to " increase the amount of time that ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 7, 2018 Category: Palliative Care Tags: medicare outpatient rodgers The profession Source Type: blogs

Lay Health Workers Increase Documentation of Care Preferences
by Ben SkochReview of Effect of a Lay Health Worker Intervention on Goals-of-Care Documentation and on Health Care Use, Costs, and Satisfaction Among Patients with Cancer. A Randomized Clinical Trial. Patel MI, Sundaram V, Desai M, et al. JAMA Oncology July 2018. doi:10.1001/jamaoncol.2018.2446I ’m sure many, if not most health professionals who have spent time around an oncology unit have encountered patients receiving care in the late stages of their disease and had the thought, “Is this really helping?” Or possibly, “Has anyone asked this patient how they feel about this treatmen t?&rdq...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 5, 2018 Category: Palliative Care Tags: advance care planning journal article pallimed writing group skoch Source Type: blogs

Book Review: My Father ’s Wake: How the Irish teach us to live, love and die by Kevin Toolis
by Rebecca Gagne Henderson (@RebeccaGagne)The tone and theme of this book is set with the profound and moving epigraph from the Iliad:“The generations of men are like generations of leaves. The wind scatters one year’s leaves on to the earth, but when Spring comes the luxuriant forest produces other leaves; so it is with generations of men, one grows as the other comes to an end”. Iliad 6 --145The book is titledMy Father ’s Wake: How the Irish teach us to live, love and die. Mr. Toolis is a writer, journalist and award-winning filmmaker and documentarian. His family has lived for two centuries in a ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 31, 2018 Category: Palliative Care Tags: book book review culture diversity gagne henderson Source Type: blogs

Evidence-Based Prognostication
by Christian Sinclair (@ctsinclair)We are prognosticating beings. It is how we survive. Many everyday decisions begin with an estimation of likely future outcomes. If my first clinic appointment is at 9:15am, and my drive from the hospital to the clinic usually takes 25 minutes, then I need to leave by 8:50am at the latest to give myself time to spare for bad traffic light timing, lack of a good parking spot or some other problem that may delay my arrival. I make my estimates, and go with the safest choice. I could go with my gut and my experience or I could use Waze, an app where I can select where I am leaving from, wher...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 27, 2018 Category: Palliative Care Tags: hpmchat journal article prognosis research sinclair tweetchat twitter Source Type: blogs

To Resuscitate or Not to Resuscitate
by Rebecca Omlor (@BeccaOm15)The code bell goes off overhead calling for a rapid attempt to try to bring a patient back to life. Who is on the receiving end? Is it a frail older adult with dementia, a patient with multiple medical problems, or an otherwise healthy adult who recently underwent a cardiac catheterization for a myocardial infarction?If this was the scenario in 2018, a team would rush to that patient and begin cardiopulmonary resuscitation (CPR) along with advanced cardiac life support (ACLS) including the use of medications and external defibrillation, if indicated, to attempt to revive the patient. While we p...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 25, 2018 Category: Palliative Care Tags: CPR omlor research resuscitation Source Type: blogs

Death Notification as Behavior Modification: Let's think this through
by Ben Skoch (@skochb)Opioid Problem. Opioid Epidemic. Opioid Crisis.Call it what you will (as long as you don ’t use the word narcotic, butthat ’s another article), but the United States has a real issue with opioids right now. It has been much talked about, publicized, criticized, politicized, has left some people ostracized, to a point where the concern has become supersized. Six years ago,a reportstated enough opioid prescriptions were written for every adult in the US to have a bottle of pills, about 259 million. Couple that with thereport from the CDC that over 42,000 people died from opioid (illicit and ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 24, 2018 Category: Palliative Care Tags: behavior change burnout california journal article opioids research skoch The profession Source Type: blogs

Talking it Like it is: Advice from a HPM Fellow to all the New Interns
by Christine BridgesThe hallways are full again after a short June reprieve. Starched white coats, cleaner than it ever seemed possible bustle through the hallways, making up in speed what they lack in direction. They fill each space with eager anticipation. It is almost palpable. It is the scent of July. Each furtive glance at the clipboard in the elevator fills me with longing to tell them the advice I wish had been passed out with my first pager.The biggest challenge ahead of you will be communication. Over the next 3-7 years more often than relieving tension pneumothoraxes, performing thoracenteses, or placing art line...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 22, 2018 Category: Palliative Care Tags: bridges communication intern residency The profession Source Type: blogs

Does Colace (docusate) Work For Constipation? No!
This study was highlighted in theGeriPal Top 25 articles in HPM.- Ed.)Randomized, Double-Blind, Placebo-Controlled Trial of Oral Docusate in the Management of Constipation in Hospice Patients. Tarumi et al. Journal of Pain and Symptom Management, 2013: 45(1), 2-13.Palliative care fellows may wonder about their attendings fixation on bowel movements. It may be because we do not ask medical students to disimpact patients any more or because, given the lack of ambulatory care many residents do, they do not see it as a big deal (Constipation a GREAT topic for those of us who like puns and dad jokes).For patients, how...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 20, 2018 Category: Palliative Care Tags: arnold constipation docusate geripal top 25 pallimed writing group senna Source Type: blogs

Introducing the Pallimed Writers' Group
by Christian Sinclair (@ctsinclair)We used to publish a lot more article reviews here on Pallimed. Sometimes the analysis would be quite deep and sometimes we would just lump together a while bunch of snippets from key articles. I have been keeping an ever-growing list of articles I would love to write up for the site*, but never seemed to have the time to get to them, and then new ones would come out, that I would want to write about, but they too would just get added to the list. At the end of the year, I would look back on key articles for our field and be pretty bummed out that I never got anything published here about...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 20, 2018 Category: Palliative Care Tags: meta sinclair Source Type: blogs

Professional Development for the Whole Team
by Karla Washington (@comokarwash)I entered graduate social work education in 1998. St. Louis Cardinals first baseman Mark McGwire broke the single-season home run record that year. Hearings were held regarding the impeachment of President Bill Clinton, and C éline Dion released a duet with R. Kelly, forming a collaboration that probably sounds preposterous to most people younger than 25. On the technology front, social media as we know it today was years away (Mark Zuckerberg was only 14). Google itself was less than a year old. Its corporate headquart ers were in a garage.Fast forward to 2018. I used Google to obt...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 18, 2018 Category: Palliative Care Tags: social work social worker The profession washington Source Type: blogs

Book Review: “The Four Things That Matter Most” by Ira Byock
by Ben Skoch (@skochb)As someone new to the field of hospice and palliative medicine, I recognize that “The Four Things That Matter Most” by Ira Byock has been around for some time. As I sit down to write this review, I ’m reminded of ajoke from comedian Jim Gaffigan when he referenced people who want to talk about movies many years after they are released. That being said, the book was new to me as I picked through the 10th Anniversary Edition, and it ’s easy to see why this book could easily have many more anniversary editions in the coming years. I was indirectly nudged to read this work while on...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 15, 2018 Category: Palliative Care Tags: book review Byock skoch Source Type: blogs

Pallimed Calendar of Conferences and Events
Most of the items on this calendar are focused on significant national or international conferences, but also include some historical events related to our field. Occassionally regional or local conferences may be included. You can sync this calendar with many dfferent software platforms and apps or just pick certain events to add to your calendar. This list of palliative care and hospice related events and conferences is maintained by Ishwaria Subbiah (@IshwariaMD), Allison Jordan (@doctorjordan), and Christian Sinclar (@ctsinclair).If you would like to help, have feedback or see an error, please contact us via Twitter. (...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 12, 2018 Category: Palliative Care Tags: calendar jordan sinclair subbiah Source Type: blogs

Grief and the Healing Property of Time
This article will not begin to address the complexities presented in suicidal, homicidal, child or antepartum, perin atal, or postpartum bereavement.)For most adults who experience the death of a loved one, they will move through normal grief reactions without any pathology.[11] What I try to reframe are the expectations we have regarding what ’s “appropriate coping”. Sometimes I get called to a family because the patient or family is crying too much; other times it’s because they aren’t crying at all. What I want everyone to know is either response is acceptable. Grief can cause you to withdr...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 10, 2018 Category: Palliative Care Tags: bereavement grief latimer Source Type: blogs

Little Legacies: The Solace and Connectedness of Ellie ’s Boxes
by Kristina Newport (@kbnewport)In 2016, the palliative care community lost a dedicated advocate and compassionate caregiver when Eloise “Ellie” Coyne died. She was well-known to the Virginia Commonwealth University (VCU) Community where she held the position of Volunteer Coordinator but her colleagues knew the all different roles she played for patients and staff on the 11 bed unit: mother, advocate, healer, listener, comforter and mother. Of all the many things Ellie provided to her patients and colleagues, perhaps the most important was here complete acceptance of all people, with an uncanny ability to meet ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 3, 2018 Category: Palliative Care Tags: grief hospital interprofessional newport palliative care The profession volunteer Source Type: blogs

How Proposed Changes to Medicare Documentation Regs Can Impact Palliative Care
by Amy Davis (@MaximizeQOL)(CMS open to comments until Sep 10, 2018. See end of post for details. - Ed.)Centers for Medicare and Medicaid Services (CMS) hasproposed sweeping reforms to documentation requirements, clinician reimbursement, and the Quality Payment Program (QPP), to begin in 2019. (1) If approved in their current form, the changes are likely to have dramatic net negative effects on outpatient palliative care reimbursement. A detailed review and analysis of all 1,473 pages of the Proposed Rule, plus its addenda, would not be practical here. The reader is referred to thecomplete text (1) andothers ’ a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 2, 2018 Category: Palliative Care Tags: billing CMS davis The profession Source Type: blogs

End-of-Life Learning from the Philosophy of Ninjas
The objectives of the ninjas are: first, to use ninjutsu to infiltrate the enemy’s camp and observe the situation.” (Hatsumi, 1988 p. 111).How it applies to hospice: Everyone involved in a hospice situation, including the patient, their loved ones, and the staff, are observing everyone else.* The patient often can be stuck in a role of observation whether they chose to or not because they may be too tired to interact, or the family will talk in front of them to staff.* The family is often on high alert, watching the patient for symptoms or watching the staff and timing our responses.* The staff members are obse...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 30, 2018 Category: Palliative Care Tags: hospice miles ninjutsu perseverance social work social worker spiritual Source Type: blogs

Ninjutsu for the Hospice Patient
The objectives of the ninjas are: first, to use ninjutsu to infiltrate the enemy’s camp and observe the situation.” (Hatsumi, 1988 p. 111).How it applies to hospice: Everyone involved in a hospice situation, including the patient, their loved ones, and the staff, are observing everyone else.* The patient often can be stuck in a role of observation whether they chose to or not because they may be too tired to interact, or the family will talk in front of them to staff.* The family is often on high alert, watching the patient for symptoms or watching the staff and timing our responses.* The staff members are obse...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 30, 2018 Category: Palliative Care Tags: hospice miles ninjutsu perseverance social work social worker spiritual Source Type: blogs

Book Review: “Everything Happens For A Reason and Other Lies I’ve Loved” by Kate Bowler
by Andrew Garcia (@ndyG83)“We can focus on your comfort always means we’re giving up.” I can’t count how many times I’ve heard this sentiment from both patients and other healthcare providers, and to read it both frustrated and encouraged me at the same time. It’s frustrating because to know that what I do, as a palliative care physician, to help patients and their families during some of their darkest, scariest, heartbreaking and most painful moments, is seen as'giving up'when it couldn ’t be any more different. Yet, I also find it encouraging because it reminds me that there is m...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 7, 2018 Category: Palliative Care Tags: book book review cancer garcia patient experience Source Type: blogs

True Confessions On Why I Prescribe Things Without'Evidence '
by Drew RosielleWe have a'required reading'list for our fellowship, which includes a bunch of what I think are landmark or otherwise really important studies. One of them is thisvery well done RCT of continuous ketamine infusions for patients with cancer pain, which showed it to be ineffective (and toxic).We also recently have seen another high-quality study published with negative results for ketamine. This was a Scottish, multi-center, randomized, placebo-controlled, intention-to-treat, and double-blinded study oforal ketamine for neuropathic pain in cancer patients. The study involved 214 patients, 75% of whom were thro...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 6, 2018 Category: Palliative Care Tags: fatigue ketamine methylphenidate neuropathic pain research research issues rosielle The profession Source Type: blogs

True Confessions On Why I Prescribe Things Without'Evidence '
by Drew RosielleWe have a'required reading'list for our fellowship, which includes a bunch of what I think are landmark or otherwise really important studies. One of them is thisvery well done RCT of continuous ketamine infusions for patients with cancer pain, which showed it to be ineffective (and toxic).We also recently have seen another high-quality study published with negative results for ketamine. This was a Scottish, multi-center, randomized, placebo-controlled, intention-to-treat, and double-blinded study oforal ketamine for neuropathic pain in cancer patients. The study involved 214 patients, 75% of whom were thro...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 6, 2018 Category: Palliative Care Tags: fatigue ketamine methylphenidate neuropathic pain research research issues rosielle The profession Source Type: blogs

Let's Stop Claiming That Palliative Care Improves Survival
by Drew RosielleHospice and palliative care community, I'm calling for a moratorium on all blanket, unqualified claims that hospice and palliative care improve survival.Let's just stop doing this.There has never been any actual evidence that palliative care (PC) interventions improve survival in patients, but since thelandmark Temel NEJM 2010 RCT of early outpatient palliative care for lung cancer patients showed a clinically and statistically significant improvement in longevity in the PC arm, I have heard and all read all sorts of statements by palliative people and all sorts of others (hospital executives, policy m...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 30, 2018 Category: Palliative Care Tags: lung cancer palliative palliative care quality of life rosielle temel The profession Source Type: blogs

Let's Stop Claiming That Palliative Care Improves Survival
by Drew RosielleHospice and palliative care community, I'm calling for a moratorium on all blanket, unqualified claims that hospice and palliative care improve survival.Let's just stop doing this.There has never been any actual evidence that palliative care (PC) interventions improve survival in patients, but since thelandmark Temel NEJM 2010 RCT of early outpatient palliative care for lung cancer patients showed a clinically and statistically significant improvement in longevity in the PC arm, I have heard and all read all sorts of statements by palliative people and all sorts of others (hospital executives, policy m...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 30, 2018 Category: Palliative Care Tags: lung cancer palliative palliative care quality of life rosielle temel The profession Source Type: blogs

Don't ask a dying man if he wants bacon or sausage
by Lizzy MilesIt has been four years since I first wrote the article“We Don’t Know Death: 7 Assumptions We Make about the Dying” for Pallimed. You would think that with four more years of experience I would feel more confident in my knowledge about my job and my patients. I don ’t.In fact, I ’m still uncovering assumptions that I make when working with patients who are dying.Recently, I discoveredAssumption #8: Dying patients want to be in control.I had so many reasons and examples to believe this, from the very beginning of my hospice work. I came to this conclusion after just a short timevol...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 14, 2018 Category: Palliative Care Tags: communication control hospice lizzy lizzy miles psychosocial social work social worker Source Type: blogs

Don't ask a dying man if he wants bacon or sausage
by Lizzy MilesIt has been four years since I first wrote the article“We Don’t Know Death: 7 Assumptions We Make about the Dying” for Pallimed. You would think that with four more years of experience I would feel more confident in my knowledge about my job and my patients. I don ’t.In fact, I ’m still uncovering assumptions that I make when working with patients who are dying.Recently, I discoveredAssumption #8: Dying patients want to be in control.I had so many reasons and examples to believe this, from the very beginning of my hospice work. I came to this conclusion after just a short timevol...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 14, 2018 Category: Palliative Care Tags: communication control hospice lizzy lizzy miles psychosocial social work social worker Source Type: blogs

Pallimed Birthday - Lucky 13
by Christian SinclairAnniversaries are a fun time to celebrate, but the fun ones end in numbers in 0 or 5. For other anniversaries, it is a good time to take stock, reflect on the past and look towards the future.Today is our 13th anniversary of Pallimed, which Dr. Drew Rosielle started in 2005 when blogs wereTHE thing to do in social media. We also spent many of those early years helping people understand the power of communication through social media with projects like#hpm chat on Twitter, encouraging tweeting from conferences and the advocacy power of ourPallimed Facebook page. With that focus, we have drifted awa...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 8, 2018 Category: Palliative Care Tags: meta sinclair Source Type: blogs

The Not-Quite Annual ASCO Round-Up - 2018 edition
by Drew RosielleTheAmerican Society of Clinical Oncology annual meeting, besides being a feast for the pharmaceutical business news pages (google'ASCO'and most of the hits will be about how announcement X affected drug company Y's stock), is also one of the premiere platforms for publishing original palliative-oncology research. So every year I try to at least scan the abstracts to see what's happening, and I figure I might as well blog about it. It's tough to analyze abstracts, so I'll mostly just be summarizing ones that I think will be of interest to hospice and palliative care folks. I imagine I've missed some good one...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 6, 2018 Category: Palliative Care Tags: artificial nutrition ASCO cannabanoid code status conference reviews fatigue hpmglobal marijuana mindfulness mucositis neuropathic oncology pain race rosielle scrambler Source Type: blogs

Studying for the 2018 Hospice and Palliative Medicine Boards
We have started to get a lot of questions about how best to study for the 2018 Hospice and Palliative Medicine Board Exam. Yes, that one that many of us took a little less than 10 years ago and now it ’s coming due. Or the one that you need to take after completing your fellowship this year.So, to help answer these question, we at Pallimed and GeriPal have created a quick guide to the top 5 resources we use to prep for the boards:AAHPM's Intensive Board Review Course: the ultimate live in-person prep that includes a pretty stellar cast of speakers including Mary Lynn McPherson, Kim Curseen, Sandra Sanchez-Reilly...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 25, 2018 Category: Palliative Care Tags: Blogs to Boards meta The profession Source Type: blogs

Join the #hpm Tweet Chat This Week in a Research Initiative with the Brain Cancer Quality of Life Collaborative
The Pallimed community is invited to participate in the #hpm Tweet Chat this week which help inform and shape a comparative effectiveness research proposal being designed by the Brain Cancer Quality of Life Collaborative, an initiative led by a team of patients, care partners, advocates, neuro-oncologists, and palliative care professionals.The #hpm Tweet Chat is this Wednesday, April 25th, 6-7p PST/9-10p ET.Topics for the chatare available here, in the #hpm chat ’s blog post,How might we introduce palliative care to people with complex neurological conditions, by Liz Salmi and Bethany Kwan, P...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 22, 2018 Category: Palliative Care Tags: #hpm brain cancer btsm tweetchat twitter Source Type: blogs

Social Media at the 2018 Annual Assembly of Hospice and Palliative Care
by Christian Sinclair (@ctsinclair)The Annual Assembly of AAHPM and HPNA is this week and if you are going to Boston, or staying home to keep things running smoothly, social media can help make your conference experience be transformative. Since 2009, the Assembly has been making use of Twitter to provide additional insight, commentary and sources for the multiple sessions each day. Now things are expanding to dedicated conference apps, Facebook and Instagram. And for the first year ever we have Twitter contests.The official hashtag of the conference:#hpm18 (works on Twitter, Facebook, Instagram), use it in every...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 12, 2018 Category: Palliative Care Source Type: blogs

Handy Hints for Attending a National Healthcare Conference - Updated!
by Christian Sinclair (@ctsinclair)In the early years of Pallimed, I was brand new to going to national conferences focused on healthcare. It was exciting, exhausting and at times overwhelming. I started collected little bits of wisdom I picked up from others and some I discovered myself. They were compiled into theoriginal Handy Hints for a National Meeting back in 2005, with updates along the way. With theAnnual Assembly of Hospice and Palliative Care coming up this week, I thought I should revisit them since I have not updated it since 2011. Please feel free to comment and leave thoughts from your own experience.Updated...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 12, 2018 Category: Palliative Care Tags: conference sinclair Source Type: blogs

Frequently Asked Questions about Health Care Power of Attorney (HCPOA)
by Lizzy Miles (@LizzyMiles_MSW)Sometimes when we encourage patients to complete a Health Care Power of Attorney (HCPOA), the patient declines the offer based on mistaken assumptions they have about the document. We never want to push a patient into doing something they don't want to do, however, sometimes their resistance is based on a misunderstanding. In an attempt to help address mistaken beliefs and/or concerns, I created a FAQ for our patients. This also can be used for staff as talking points for the discussion.I don ’t need one, I am my own decision-maker and I always plan to be.As long as you are able to spe...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 19, 2018 Category: Palliative Care Tags: advanced directives communication conversation hcpoa lizzy miles social work Source Type: blogs

2018 12th Annual Pallimed-GeriPal Party
by Christian Sinclair (@ctsinclair)Every February the questions start rolling in, " When is the Pallimed-GeriPal party? " Just so you know and can mark it on your calendars from here to eternity, it has a standing reserved spot on Thursday night at 9pm local time the week of the Annual Assembly of Hospice and Palliative Care (but just to be clear it is not an official part of the meeting). And as always, feel free to invite and bring any colleagues or new friends with you as this is not an exclusive crowd.So for 2018, that means you should clear off the evening of March 15th. We will, of course, be doing our trad...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 16, 2018 Category: Palliative Care Tags: conference geripal party sinclair Source Type: blogs

Did You Have To Say “Yet”?
by Ryan Nottingham and Gregg VandeKieft (@vandekieftg)A middle-aged man* came to our ambulatory palliative care clinic with his family. With the exception of his recently diagnosed brain tumor, he was in peak physical condition. His diagnosis weighed heavily on his family and his personality changes and angry outbursts left them frayed. He did not feel the same burden as his family since these outbursts came to him in the form of blackouts. We could visualize him as a man of few words before his diagnosis, someone who would speak up with a dry one-liner. During this visit, his humor was touched with acidity. As we began ou...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 15, 2018 Category: Palliative Care Tags: nottingham pharmacist physician vandekieft Source Type: blogs

Proposed Medicare Changes to Limit Opioid Prescribing
by Chad KollasOn February 1, 2018, the Centers for Medicare& Medicaid Services (CMS)published its Advance Notice of Methodological Changes for Calendar Year 2019. Included in these proposed rules were several directives intended to reduce" Opioid Overutilization ” (see p. 202), including formal adoption of the “90 morphine milligram equivalent (MME) threshold cited in the CDC Guideline, which was developed by experts as the level that prescribers should generally avoid reaching with their patients (p. 203). ” CMS proposed “adding additional flags for high-risk beneficiaries who use ‘p...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 4, 2018 Category: Palliative Care Tags: CMS health policy kollas medicare opioids Source Type: blogs