National Academies Webinar on Opioids in Serious Illness This Thursday
by Christian Sinclair (@ctsinclair)Many of us who work in palliative care and hospice have seen a major shift in how patients and families respond to opioid prescribing for pain in serious illness. Because of the significant impact of opioid abuse on communities across the country, many new policies and rules are being put in place to reduce the prescriptions of opioids. Of course, this also places a burden on prescribers and patients seeking to utilize opioids judiciously for pain from advanced disease.For the past few years, I have represented the AAHPM at the Roundtable on Quality Care for People with Serious Illness ho...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 26, 2018 Category: Palliative Care Tags: conference health policy opioids Source Type: blogs

Nope. We STILL Shouldn't Claim Prolonged Survival in Hospice and Palliative Care
by Drew Rosielle (@drosielle)A group of investigators from Tulanerecently published a meta-analysis in Annals of Behavioral Medicine indicating that outpatient palliative care improves survival and quality of life in advanced cancer patients (free full-text available here, although I'm not sure if that's permanent).Perhaps you'll remember inJune of this year when I pleaded with our community to stop claiming that palliative care prolongs survival (my littleTwitter rant about this starts here).My basic plea was this:Hospice and palliative care community, I'm calling for a moratorium on all blanket, unqualified claims that h...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 2, 2018 Category: Palliative Care Tags: journal article outpatient pallimed writing group research research issues rosielle The profession Source Type: blogs

NEW Clinical Practice Guidelines for Quality Palliative Care Released!!
by Christian Sinclair (@ctsinclair)Happy Halloween!Today is the beginning of a new era in palliative care as the4th edition of the Clinical Practice Guidelines for Quality Palliative Care (aka NCP Guidelines) are being released into the wild to begin changing practices all over!Well, that is the plan and the hope, of course. With any sort of guidelines or statement document, the real work comes AFTER they are published.DOWNLOAD THE GUIDELINES TODAY!To be effective, policymakers, front-line clinicians, and healthcare leaders need to make time in their hectic schedules to review these new guidelines, compare what they a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 31, 2018 Category: Palliative Care Tags: guidelines ncp sinclair Source Type: blogs

Antipsychotics Don't Help ICU delirium
by Drew Rosielle (@drosielle)It just gets worse and worse for the idea that antipsychotics have efficacy for delirium.Last year Iposted about the RCT of haloperidol, risperidone, or placebo for delirium symptoms in'palliative'patients. I'm pretty sure I called for more controlled,'high quality,'trials, and we are lucky enough to have another.This one is arandomized, double-blinded, registered, controlled trial of haloperidol, ziprasidone, or placebo for ICU delirium, just published in NEJM.The trial took place in a geographically diverse group of US-based intensive care units. They enrolled adult patients in medical or sur...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 25, 2018 Category: Palliative Care Tags: delirium icu journal article rosielle Source Type: blogs

On Football, Palliative Care, and Quality Measurement
by Arif Kamal (@arifkamalmd)Transition into the Fall months means one thing for a boy like me from the Midwest – it’s football season. Snare drum cadences, referee whistles, and the crunch of linemen helmets were the soundtrack to many memorable evenings growing up. In football, winning requires strategy and execution, while embracing the humility that even the most exquisite gameplan, well steeped in planning and expertise, can fall flat. Though the two worlds seem unrelated, I often think of football analogies when approaching palliative care quality improvement.Football offenses across college and profession...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 5, 2018 Category: Palliative Care Tags: conference kamal patient reported outcomes quality improvement Source Type: blogs

On the Importance of Mental Health Check-Ups for Palliative Care Clinicians
by Polly ChesterAs silly as this may sound to people who have never experienced a mental health issue, when one is used to a dystopian inner world, feeling happy for a consistent period of time can be a bit of a worry. For those of us who ’ve had mental health concerns in the past and a baseline mental state that just allows us to lurch through life in a state of veritable chaos, calm and pleasant periods of time are a source of anxiety because we wonder if the next mental health calamity is just around the corner. One might consid er psychological temperature-taking should be done just like going to your general pra...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 3, 2018 Category: Palliative Care Tags: chester grief mental health The profession Source Type: blogs

Challenges Faced by Blended Families at End of Life
This article, however, is addressing situations in which the family system is not working smoothly and is an attempt to explore how we, as professionals, approach these situations.Alternatively, in some blended family situations, it is one or more of the children who are the primary caregivers and the second spouse is the one who is the reluctant caregiver.While you want to have an awareness of family dynamics, you do not want to have a position on them. It would be very easy to side with the caregiver who is involved and complaining about others who are not involved. But you don ’t know the history of the family and...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 1, 2018 Category: Palliative Care Tags: communication documentation family goals of care hospice language miles social work stepfamily Source Type: blogs

The Power of a Pause
by Kayla Sheehan (@kksheehan)October TW, Dizon ZB, Arnold RM, Rosenberg AR.Characteristics of Physician Empathetic Statements During Pediatric Intensive Care Conferences With Family Members: A Qualitative Study. JAMA Network Open. 2018;1(3):e180351. doi:10.1001/jamanetworkopen.2018.0351Ask any patient what qualities they desire in a physician, and empathy will almost always make the list. A physician ’s ability to demonstrate empathy has beenshown to significantly impact patient outcomes1,increase patient satisfaction2, andraise physician “compassion satisfaction,” which may hinder burnout (3). Though muc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 28, 2018 Category: Palliative Care Tags: communication journal article NICU open access pallimed writing group pediatrics sheehan Source Type: blogs

Conference Review: PainWeek 2018
by Rabia Atayee (@RabiaAtayee)For the past 10 years, in addition to several conferences more specific to palliative and hospice care, I have attendedPainWeek (#PainWeek). I find great value in attending PainWeek as it strengthens my palliative practices through interactions expanding beyond traditional palliative care trained disciplines. With an average of 2,000+ attendees, there is an opportunity to interact with pain anesthesiologists, addiction specialists, and physical therapists trained in pain interventions among other specialists. During one session, I was sitting next to a JD who is preparing for a prescription dr...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 26, 2018 Category: Palliative Care Tags: atayee conference conference reviews pharmacist Source Type: blogs

Alcohol Pad = Aromatherapy = Nausea Relief?
by Bob Arnold (@rabob)In general, I am a cynic and a nihilist. That means when reviewing the literature, I find most glasses half empty rather than half full (OK, probably this is true in life, but that is TMI). I am very unlikely to try a new treatment based on one study.For every rule, however, there is an exception. I am completely enthralled with aromatherapy and thus found anarticle in the Annals of Emergency Medicine by Beadle on isopropyl alcohol nasal inhalation for nausea in the emergency department. It was a randomized controlled trial which made it swoon-worthy. The only problem was it was a placebo trial and so...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 24, 2018 Category: Palliative Care Tags: arnold emergency department journal article nausea ondansetron pallimed writing group research vomiting Source Type: blogs

Building Resilience through Contemplative Care
by Ann AllegreAs professionals in end-of-life care, our responsibilities can seem overwhelming. As with other clinicians, we have burdens of too many patients to see, too much time spent in documenting, and hassles with insurance companies. In hospice and palliative medicine, we are impacted by the additional challenges of seeing so much suffering, grief and tragedy. While we have good tools to address most types of physical suffering, there is much suffering among our patients and their families that does not respond to medical interventions. After I had been working full-time in hospice and palliative care for a few year...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 23, 2018 Category: Palliative Care Tags: allegre compassion The profession Source Type: blogs

International Palliative Care Education - EPEC-Peds
By Stacy S. Remke (@StacyRemke)In about 2004, our program embarked on a regional pilot project to teach healthcare workers – doctors, nurses, social workers, chaplains, and others – to provide pediatric palliative care. Our region is the Upper Midwest: Minnesota, Iowa, Wisconsin, North and South Dakota. “Join pediatric palliative care,” we joked, “and see the world!!”Little did we know.From these first steps began a truly humbling and inspiring journey across many continents and into many communities.Much of this started when a project I was involved with –Education in Palliative a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 21, 2018 Category: Palliative Care Tags: international pediatrics remke Source Type: blogs

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