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

An Impromptu Group Conversation With Women in Hospice and Palliative Medicine
Collectively written by Allison Jordan, Katie Harmoney, SarahScott Dietz, Jeanette Ross, Emily Hahn, Meredith MacMartin, Christian Sinclair, Rachel ThienprayoonWaking up today February 3rd, I (Christian) saw a discussion on our Facebook private messages for the Pallimed page about what we should post for National Women Physician Day (which is held on February 3rd the birthday of Elizabeth Blackwell, the birthday of the first US woman physician.) Jeanette hadfound the 2016 Pallimed post written by Meredith MacMartin and we posted that, but then I thought it would be great to write some fresh content on this new celebration....
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 3, 2018 Category: Palliative Care Tags: dietz hahn harmoney macmartin ross sincliar The profession thienprayoon women Source Type: blogs

Innovation and Design at End of Life: Tea with Ivor Williams
by Lizzy MilesThe day before the inauguralEndwell Conference in San Francisco, I had the opportunity to sit down for tea with Ivor Williams. Ivor ’s Endwell biography listed in the program is what caught my attention.Ivor is Senior Design Associate at theHelix Centre, based in St Mary ’s Hospital in London; founder of the research and consultancy groupBeing and Dying; and co-founder ofHumane Engineering, designing digital products that explore the use of technology for health and social good.Ivor ’s focus at theHelix Centre is on innovation at end of life. I really didn't know what that meant, but I wante...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 31, 2018 Category: Palliative Care Tags: design helix hospice innovation ivor williams lizzy miles social worker tea Source Type: blogs

Exploring Team Composition in Palliative Care
By Brianna Morgan (@BriannaMorganNP) and Elise Tarbi (@EliseConant)Amidst rapid growth in the number of palliative care programs,the December 2017 issue of the Journal of Palliative Medicine calls for a pause to consider the blueprints for how we build moving forward. In the issue,Kousaie and von Gunten (2017) compare two hospitals, one that has an established advanced practice nurse only model of palliative care delivery (APN model), and a second hospital implementing an interdisciplinary team including physicians, APNs, social workers, chaplains, and pharmacists (team model) for the same purpose. Compared to the APN mode...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 27, 2018 Category: Palliative Care Tags: advance apn morgan nurse physician research tarbi team teamwork The profession Source Type: blogs

It ’s Not the Death, It’s the Dying: Moral Distress in Palliative Care
by Vickie LeffEvery day, we get involved in unbelievable and incredible situations. Tragedy, sadness, horrific trauma, despair, and hopelessness all wrap themselves around the cases we drop into. We step onto the stage and become part of the story.Moral distress – the discomfort, angst, and frustration related to situations in which we think we know the “right thing” to do, but cannot due to the situation – is endemic to palliative care and hospice work. Some examples are:Aggressive chemotherapy for a dying cancer patient with days to live.Dumping the truth on a patient overwhelmed and alone.Fo...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 19, 2018 Category: Palliative Care Tags: moral distress social work social worker Vickie Leff Source Type: blogs

Top 10 Pallimed Posts of 2017
by Christian Sinclair (@ctsinclair)Looking back at 2017, we didn't publish a ton of posts (only 50!*), but we had some that clearly resonated with people and continue to be popular since we keep seeing them show up on social media. Working closely with her, I already knew the great qualities Lizzy Miles brings to Pallimed as a writer and an editor, but looking at the top 10, her experience as a hospice social worker has led to a knack for insightful and practical posts. Her posts also seem to be meaningful to clinicians in multiple settings in addition to patients and families. So here are the top 10 posts of 2017 based on...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 15, 2018 Category: Palliative Care Tags: delirium dignity film hospice LGBTQ meta sinclair The profession Source Type: blogs

Looking Ahead to 2018 for Palliative Care and Hospice
by Christian SinclairIn 2016, I made a list of upcoming events in palliative care and hospice. For some reason, it fell off my list of to-do's in 2017, but I wanted to bring it back because it is good to see all the important things happening in our field. Here are some of the things to put on your calendar right now, so you do not miss them! If you want to help out with maintaining this, it would be great to have a colleague and it doesn't take that long, please email me (below). We could even go crazy with the Google Calendar and make different ones that are relevant to different disciplines/interests, international and ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 8, 2018 Category: Palliative Care Tags: conferences meta Source Type: blogs

Blue Ribbon Patients: A Tool to Protect from Unnecessary Transitions
by Rick Strang (@rickstrang)Bed pressures in busy hospitals often means that less acute patients are moved to different wards in order to make space for patients admitted from the emergency department. We are often faced with some difficult decisions in our current NHS. End of Life (EoL) patients seem particularly at risk of being moved, which can be very distressing for families, friends, the patient and the care teams. It is also quite common for these moves to occur into the night or at weekends. These periods are covered by site managers, bed managers, and on-call clinicians rather than the usual ward teams and therefo...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 7, 2018 Category: Palliative Care Tags: actively dying death/dying England hospital strang transition Source Type: blogs

Diary of a New Hospice Volunteer
By Lizzy MilesI had forgotten that I had written about my first few days as a hospice volunteer. I just discovered it while I was looking through some old electronic files. Now, ten years later, with more education and a career in hospice, I still notice that some things never change. You would think that I would be more certain about things, but I don't think I am. However, I believe that uncertainty is a necessary part of the job. I've written about howwe don't know death. When we are uncertain, that means we are evaluating our behavior and how it's perceived by others. I now believe it's good to be a little bit nervous ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 5, 2018 Category: Palliative Care Tags: hospice lizzy miles social work uncertainty volunteer volunteering Source Type: blogs

Palliative Care Resolutions for 2018
by Christian Sinclair (@ctsinclair)Happy New Year! As we look towards the future that is now 2018, many of us make promises which can be difficult to keep, but always with the purpose of working towards the best version of ourselves. (In a way it is kind of like a quality improvement project!) Often these resolutions are personal: exercise 5 times a week, eat more healthy, learn a new language, read more books, spend less time on my phone. Sometimes these resolutions reside in our professional spheres of influence. I thought it would be interesting to see what some hospice and palliative care colleagues are resolving to do...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 1, 2018 Category: Palliative Care Tags: meta sinclair Source Type: blogs

Moving Palliative Care Upstream - Can we ever be TOO early?
By Christian Sinclair (@ctsinclair)The growth of palliative care in the community and outpatient settings has been one of the more popular stories in our field in the past few years. No longer is palliative care only available to serve in the intensive care units, but the demand for person-centered, family-oriented, symptom-based care with an emphasis on communication and decision-making is being heard in the earlier stages of illness. Serving patients and families in clinics and in their home is unleashing the true potential of palliative care. Even in my own work leading our outpatient efforts in an academic cancer cente...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 27, 2017 Category: Palliative Care Tags: cancer clinic denmark europe hpmchat outpatient research sinclair tweetchat Source Type: blogs

Natural Disaster Planning for At-Risk Hospice Patients
This article is the first in a series about our hospice’s response to the storm emergency.We triaged patients to maintain their safety, based on their risk of flooding at home and the risk of electricity loss (especially for patients who relied on high oxygen flows). We moved high risk patients to care centers with low flood risks and back-up electrical generators. This included moving at-risk patients out of hospice care centers, assisted living, nursing homes, or their homes.At my care center, we took 16 single-occupancy rooms, and set it up for 30 patients and their families (double-occupancy for all but 2 rooms)....
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 18, 2017 Category: Palliative Care Tags: disaster emergency preparedness hospice hurricane inpatient rich room weather Source Type: blogs

Pallimed Roundup: #Endwell17 Attendees and Speakers Reflect on Personal Meaning of Ending Well
Curated by Lizzy MilesLast week, I attended theEndwell Symposium in San Francisco. (You could read my reviewhere). Collectively, we were examining how we can improve the end of life experience for all. It occurred to me as we talked about individual desire and diversity that the attendees might have unique expectations and hopes for their own personal ending. So I asked around. You'll note some trends, but also some very unique answers.What would it mean for you personally to “end well?”“Being present to the experience. I don’t want to control it, I just want to know.”-Karen Van DykeSenior Car...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 15, 2017 Category: Palliative Care Tags: conference endwell endwell 17 lizzy miles ostaseski roundup Source Type: blogs

Why I'm Bored With the Debate About Physician Assisted Suicide
by Drew Rosielle (@drosielle)I ’m a little bored of all the discussion about physician-assisted suicide. Mostly it’s because legalizing PAS is going to have zero impact on nearly all of my patients, and I think the significant amount of press and energy it gets is a distraction from other things which actually would improve t he lives (and deaths) of the patients and families I care for as a palliative doc.The last time I blogged about PAS waspart of my euphemisms series last year, when I elaborated why I did not like terms like ‘assisted death’ or ‘aid-in-dying’ and prefer ‘assist...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 13, 2017 Category: Palliative Care Tags: ethics euthanasia/suicide health policy rosielle Source Type: blogs

Conference Review: 2017 End Well Symposium – Design for the End of Life Experience
By Lizzy Miles (@LizzyMiles_MSW)End Well advertised itself as“a first of its kind gathering of design, tech, health care and activist communities with the goal of generating human-centered, interdisciplinary innovation for the end of life experience.”  I feel privileged to have been able to attend. The Symposium was capped at 400 attendees and sold out early. There was a serendipitous momentary technology glitch that allowed me and two friends to register after it was sold out. Fortunately, the organizers graciously agreed to squeeze us in since we had paid.The single-day event took place at the Interconti...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 11, 2017 Category: Palliative Care Tags: end of life End Well miles Source Type: blogs

National Hospice and Palliative Care Month: Divide and Conquer
by Christian Sinclair (@ctsinclair)Now thatNational Hospice and Palliative Care Month (NHPCM) is in the books for 2017, December is a good time to reflect on what these awareness months can (and cannot) accomplish and how we can make a better strategy for the future. Awareness campaigns have blazed brightly through the bracelet and ribbon eras, and are firmly in the social media era with no signs of stopping (other than possibly fatigue from so much awareness about awareness campaigns.)No single group is technically is in charge of National Hospice and Palliative Care Month. Very few calendar-based advocacy campaigns (CBAC...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 4, 2017 Category: Palliative Care Tags: hospice palliative sinclair The profession Source Type: blogs

The Emotions of the Dying
By Lizzy MilesIn my role as a hospice social worker, I find that there are recurring concerns expressed by family and friends of the dying. These are some of my responses to their worries. Mostly I find that I am normalizing behavior that they find confusing or unsettling, while also validating their discomfort. Families often feel helpless and I do my best to reassure them that what is happening with the patient is part of the process of dying.I am careful to be mindful of faith/cultural beliefs of the patient and family so as to not suggest an explanation that is outside of their dogma.RestlessnessRestlessness is a commo...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 1, 2017 Category: Palliative Care Tags: dying emotions letting go life review lizzy miles restlessness social worker Source Type: blogs

Documentation Design: Palliative Care Notes in the EHR Era
by April Krutka (@April918) and Christian Sinclair (@ctsinclair)DOCUMENTATION...who knew this one word could provoke so many emotions among health care clinicians? Say this word, and you will hear stories of triumph and defeat. From universal required elements in the admission history and physical, progress notes and discharge summaries to the specialty specific language of advance care planning and pain assessments, there is a constant pressure to get all the pieces to fit correctly. Moving from analog to digital offered much hope, but also new problems. Before we even start typing or dictating a new note, most of the suc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 27, 2017 Category: Palliative Care Tags: documentation krutka sinclair Source Type: blogs

LGBTQ at the End-of-Life: Needs and Challenges
By Vivian LamHolistic care is essential in the mission to fully meet a patient's needs. And a holistic perspective is the backbone of end of life and palliative care--it's the basis of having an interprofessional team that acknowledges that quality of life is multifaceted, and lives are diverse. But getting to know a patient enough to be able to be " holistic " can be difficult. And in the case of LGBTQ individuals, getting to know the patient as a whole is not only all the more important —it’s integral.According to a2016 Gallup survey, 4.1% of U.S. adults openly identify as LGBTQ, or around 10 millio...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 13, 2017 Category: Palliative Care Tags: closet end of life gay hospice lesbian LGBT LGBTQ palliative transgender vivian lam Source Type: blogs

Defining Dignity at End of Life: One Question to Ask Hospice Patients
By Lizzy MilesI start every new hospice patient interaction with a hello. I introduce myself and then ask for permission to sit and visit. It is not uncommon for the patient to start off on guard, wary. By the time patients meet me, they have been through a lot of medical interactions. They have been asked a lot of questions.I tell them I have just one question. I sometimes notice an exhale.Whew. She ’s not going to grill me.Dignity In Care, developed from research byDr. Harvey Max Chochinov, starts with the Patient Dignity Question (PDQ). It is a simple, open-ended question: “What do I need to know about you a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 4, 2017 Category: Palliative Care Tags: Chochinov Cubs dignity dignity therapy hospice lizzy miles social worker Source Type: blogs

Conference Review: 2017 Palliative and Supportive Care in Oncology Symposium - Day 1
by Christian Sinclair (@ctsinclair)It is a testament to the growth and mainstream acceptance of palliative care, that there is a sub-sub-specialty two-day conference like the#PallOnc conference held in San Diego this past weekend. If you have not heard of this meeting yet, and the majority of your work in that intersection between oncology and palliative care, I would highly recommend considering it in the future. This is the 4th consecutive year the meeting has been held, and I applaud the commitment of the four co-sponsoring organizations (AAHPM, ASCO, ASTRO and MASCC). Kristina Newport and Shanthi Sivendranreviewed this...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 30, 2017 Category: Palliative Care Tags: conference reviews oncology palliative sinclair Source Type: blogs

Quality Improvement – The Science of Making Care Better for All
by Arif Kamal (@arifkamalmd)It seems everywhere a person turns, there ’s nonstop discourse regarding healthcare quality, particularly the relationship of meeting quality metrics to demonstrating lower costs and higher value. As palliative care further immerses itself into usual healthcare delivery, it behooves our workforce to adeptly apply quality improvement skil ls to translate our sense of “what is right” into the usual practice of “what is done.” Meeting these demands takes skills and practice, rooted in an evolving evidence base around quality improvement science.It may confuse some to h...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 23, 2017 Category: Palliative Care Tags: conference kamal quality Source Type: blogs

Building Certification for Hospice and Palliative Care Social Workers - Take the Survey!
by Megan Mooney(Take the Hospice and Palliative SW Job Analysis survey before October 5th if you are a social worker. If you are not a social worker,encourage social workers in hospice and palliative care that you know to take it!)What is Evidence Based Practice?The Institute of Medicine (2001) defines evidence-based medicine as “the integration of best researched evidence and clinical expertise with patient values” (p. 147). According to Social Work Policy Institute (2010) evidence-based practice (EBP) is defined as the combination of research interventions, clinical experience, values, and client preference t...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 2, 2017 Category: Palliative Care Tags: mooney social work social worker Source Type: blogs

Palliative Care in the Time of Hurricane Harvey
by Ishwaria Subbiah (@IshwariaMD)Trouble BrewingBetween the network news and many institutional emails on hurricane preparations, we at MD Anderson knew were in for something ‘big.’ Harvey made landfall on August 25th as a Category 4 hurricane about 190 miles southwest of Houston. The outer bands brought rain without any major disruptions to our practice. As expected, upon landfall, Harvey rapidly weakened but stalled over Texas. The subsequent two days brought a level of rainfall best described as apocalyptic. The institution’s leaders activated the ‘ride-out’ team where the core essential ph...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 27, 2017 Category: Palliative Care Tags: disaster hurricane subbiah The profession weather Source Type: blogs

Moving From Research to Implementation to Research in Palliative Care, Part 1
by Christian SinclairIn 2003, I began my hospice and palliative medicine (HPM) fellowship in Winston-Salem, NC. I was a solo fellow in a new program, and as luck would have it, I had loads of time to dedicate myself to learning. Since my wife, Kelly, was beginning her pediatric emergency medicine fellowship in Kansas City at the same time, I only had my dog and my fellowship to worry about. I always enjoyed reading articles and imagined how it would apply in my own practice. But when it came down to it, I was never really able to implement much of what I was reading, let alone have the numbers to benchmark against the rese...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 25, 2017 Category: Palliative Care Tags: ESAS non-pain symptoms quality research research issues Source Type: blogs

Lorazepam, Haloperidol, and Delirium
JAMA Internal Medicinehas published a double-blind,randomized, placebo-controlled trial of adding lorazepam to haloperidol in patients with advanced cancer and agitated delirium. (We had a heads up about this trial because it waspresented at ASCO earlier this year.) If there ever was a sort of consensus in HPM about how we should be treating delirium, my sense is that it ’s been shattered by the recentRCT of low-dose haloperidol vs risperidone for delirium in Australian palliative care unit patients, showing those drugsworsened delirium symptoms. So, it seems like we should all see what we can learn from this newly p...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 25, 2017 Category: Palliative Care Tags: antipsychotics delirium research issues rosielle Source Type: blogs

Preparing to Show Up: Writing Practices that Serve
by Jennifer WilhoitSeveral months ago I wrote a piece for this blog aboutnature practices we can do in hospice settings, and when preparing for visits with families and people who are dying. I stressed the vital importance of self-care as we serve individuals with such acute and ever-changing needs. I also reminded the reader that we do not engage our hospice work in a vacuum, but as ordinary humans ourselves with the vagaries of everyday life pressing in on us. We show up to our families and friends; we show up to those we are called to serve in hospice contexts. But how well do we remember to show up to ourselves with su...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 20, 2017 Category: Palliative Care Tags: hospice intervention Jennifer Wilhoit nature nurture reflect self care Self reflection TEALarbor volunteer writing Source Type: blogs

“Going Palliative” is Not a Thing
by Staci MandrolaI love the segment onLast Week Tonight with John Oliver called “How is this still a thing?” His snarky Britishness targets everything from the Sports Illustrated Swimsuit issue to ‘Why do we dress up as other races?’ The skits start out funny but leave you questioning and unsettled.I hope “going palliative” ends before it shows up on “How is this still a thing?” How do I know " going palliative " is a thing? The phrase is popping up in the academic medical center where I practice palliative care. [And many other hospitals too - Ed.] PT/OT has s...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 18, 2017 Category: Palliative Care Tags: culture hospice mandrola palliative Source Type: blogs

Privilege and Palliative Care
by Denise HessAn American pastor recently visited Australia and encountered a curious practice. At the start of meetings, any kind of meeting not just religious ones, she found it is common practice to begin with what is called an “acknowledgment of country.” According to reconciliation.org.au:An Acknowledgement of Country is an opportunity for anyone to show respect for Traditional Owners and the continuing connection of Aboriginal and Torres Strait Islander peoples to Country. It can be given by both non-Indigenous people and Aboriginal and Torres Strait Islander people.And it goes something li...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 11, 2017 Category: Palliative Care Tags: culture hess open access psychosocial race Source Type: blogs

How HBO's The Leftovers Parallels Our Work in Palliative Care
By Shayna Rich and J. MaggioThe HBO showThe Leftovers has a deceptively straightforward science fiction premise: What happens to people left behind after a Rapture-like event? The Rapture is an apocalyptic event prophesied in the New Testament where people chosen by God disappear into Heaven. In the show, roughly two percent of the world ’s population--about 140 million people--mysteriously disappear in an instant. Unlike the popular Christian book and film seriesLeft Behind, The Leftovers is agnostic to the cause of the sudden departure. Some characters believe it was the Christian Rapture, but other characters disa...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 5, 2017 Category: Palliative Care Tags: arts leftovers media spirituality/religion tv Source Type: blogs

The Role of Hospice and Palliative Medicine in Education
Discussion topics:T1: What are the main systemic barriers to good communication in healthcare?T2: What is your favorite education tool? (Think broadly!)T3: What is your favorite “high-yield” question to ask patients? Patients, what’s the one Q you want your HCP to ask?Meredith MacMartin is a palliative care physician atDartmouth-Hitchcock Medical Center in Lebanon, NH. (Source: Pallimed: A Hospice and Palliative Medicine Blog)
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 28, 2017 Category: Palliative Care Source Type: blogs

Should Clinicians Be More (or Less) Politically Active?
by Christian SinclairPolitics and healthcare are occupying much of the news cycle this summer with all of the discussions around the possible repeal of the Affordable Care Act (AKA Obamacare). On one hand it can viewed as must-see reality TV with all of the drama and back and forth arguments with passionate opposition. Late-night TV hosts help turn the drama into satire and give everyone a good laugh and some entertainment. Yet it is important to see that this will greatly impact the care of the patients we see every day.To be honest, it was not until a few years ago that I started to see the power of getting more politica...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 26, 2017 Category: Palliative Care Tags: AAHPM health policy politics sinclair tweetchat twitter Source Type: blogs

Choice: The Hidden Curriculum in Palliative Care
By Paul CarrThank you to Dr. Naheed Dosani and the excellent team at William Osler Health Centre for inspiring this post.What three words describe the essence of palliative care for you? When I asked my friends, family, and colleagues, the most common answers are: pain management, personal and spiritual support, and end of life planning. Those are all key components. But what quickly became apparent to me during my palliative care elective is that excellent palliative care providers embrace the role of enabling patients and families to make well-informed choices.I have taken a long and untraditional route to arrive in the ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 17, 2017 Category: Palliative Care Tags: choice communication goals palliative paul carr Source Type: blogs

Palliative Care & CHF: PAL-HF trial
The main results of PAL-HF - a randomized, controlled trial of specialty palliative care team involvement in advanced heart failure patients -  have just been published in the Journal of the American College of Cardiology (DOI: 10.1016/j.jacc.2017.05.030. Clinicaltrials.gov registration here). This is an important, well-done study, with encouraging results - specialty PC improved the quality of life of patients with HF. I'll discuss the results in more details in this post.The study was done by a multi-disciplinary team of palliative& cardiology investigators at Duke. This week's publ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 14, 2017 Category: Palliative Care Tags: chf heart failure research research issues rosielle Source Type: blogs

Upstream Palliative Care and Dissecting Hope From Hype in Oncology
by Christian SinclairWorking in an outpatient cancer center, I frequently encounter the conversation about whether the next cancer treatment regimen is ‘worth it.’ Patients and families consider may interpretations of worth; financial being one of course, but also physical side effects, the emotional toll of investing faith into ‘one more treatment’ and hoping that it works. These conversations are challenging as they weigh biological, medi cal, spiritual, social, personal, emotional and other issues, so there is no neat equation which can easily tell you if the benefits or the risks are greater.The...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 28, 2017 Category: Palliative Care Tags: sinclair tweetchat Source Type: blogs

Perusing ASCO 2017 - AKA Time for Lorazepam
(Source: Pallimed: A Hospice and Palliative Medicine Blog)
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 8, 2017 Category: Palliative Care Tags: ASCO cancer oncology pallonc research research issues rosielle WaPo Source Type: blogs

Persuing ASCO 2017 - AKA Time for Lorazepam
Photo from ASCO Mediakit. © ASCO/Danny Morton 2017TheAnnual Meeting of the American Society of Clinical Oncology was last week. It ’s been my observation over the years that much of the best palliative-oncology and supportive-oncology research is presented at ASCO each year, before it’s actually published (if it ever gets published).  So I always dig through the palliative/EOL/supportive/psychooncology abstracts each year to see what's happening. Below is a gently annotated list of the abstracts that caught my eye the most, for your perusal and edification. Undoubtedly, these are my idiosyncratic...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 8, 2017 Category: Palliative Care Tags: ASCO cancer oncology pallonc research research issues rosielle WaPo Source Type: blogs

Stand Up! For Each Other as the Year Marches on
By Vickie LeffStand Up! was 2017 ’s theme for Social Work Month. As many of us know, social workers are excellent advocates; advocacy it is a core skill that is integral to our teaching, profession, and interventions. In celebration of that theme, as March concludes, I want to challenge you to spread that enthusiasm and charter a cross the palliative care universe this year. After all, palliative care is a team sport, defining itself not whole until a physician, nurse and social worker (at a minimum, with ideally many more disciplines involved) are members. This is not a random collection of professionals, but a calc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 1, 2017 Category: Palliative Care Tags: advocacy interprofessional self-care social work social worker teamwork Vickie Leff Source Type: blogs

Looking Forward to #hpm Chats in 2017
InJuly 2010, Christian and I had a conversation about finding ways to bring people together online to connect, collaborate and learn more about topics in hospice and palliative care. We had seen some fascinating discussions with#hcsm, the health care social media community and decided to launch the#hpm chat as a weekly interdisciplinary discussion of issues in hospice and palliative care. I never imagined how this idea would develop into such a vibrant community where caregivers, doctors, nurses, social workers, volunteers and people with a variety of experiences have joined in to discuss topics on our weekly conversations...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 28, 2017 Category: Palliative Care Source Type: blogs

Book Review: Gratitude by Dr. Oliver Sacks
By Karen B. KaplanReading Dr. Sacks ’ farewell book with its mournful black cover was like going through a typical day on the job as a hospice chaplain. Just like my patients, this famous author, well-known for his medical narratives such asThe Man Who Mistook His Wife For A Hat: And Other Clinical Tales lists his regrets, his triumphs, his hopes, and his efforts to make sense of the life that he had led. In a word, this book is about how he dealt with his approaching end. Many of us can relate to his regrets, which included wasting time, being shy, and not traveling more. He also hoped to love and work as long ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 20, 2017 Category: Palliative Care Tags: book review gratitude karen Kaplan sachs Source Type: blogs