Addressing The Range of Patient Beliefs About COVID-19
by Lyle Fettig (@FettigLyle)I ’ve been thinking about my role as a physician in responding to skepticism about a range of COVID topics, especially as we approach the holidays and all the tension about difficult recommendations to forgo traditional Thanksgiving dinners. As I think about our current situation, I can’t help but recall an encounter I had with a patient many years ago.In winter 2008 after President Obama was first elected, I saw a woman in clinic who said she was disappointed by the election result. She cited a jaw dropping falsehood about what she thought his election would mean for healthcare, and...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 21, 2020 Category: Palliative Care Tags: communication covid fettig Source Type: blogs

Chlorpromazine in Delirium FTW!
by Drew Rosielle (@drosielle)David Hui, Eduardo Bruera, and colleagues havepublished another important delirium trial out of MD Anderson which I thought was worth blogging about in detail.In some ways it's related to thesame group's RCT a few years ago of lorazepam added to haloperidol for agitation in hospitalized advanced cancer patients with delirium (showing the lorazepam quite effectively reduced agitation via presumably a sedating effect). As I pointed out in the Palllimed post about that trial, while they labeled their patient group as'agitated delirium in advanced cancer', in essence it was really a sedation for te...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 23, 2020 Category: Palliative Care Source Type: blogs

Patient Access to Notes is Coming! Is Palliative Care Ready?
by Christian Sinclair (@ctsinclair)Patients and families across the US are about to get a close look under the hood of electronic health records in just a few weeks. Starting in November, the21st Century CURES Act is putting in place the rules for patient access to their health records including the clinical notes of the clinicians. Your organization is possibly planning for this new access to be flicked on like a light switch in the inky dark of night. Some of you may be shocked and seeing this for the first time, some of you have seen glimmers, some of you are well prepared, and some have had your eyes long adjusted and ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 19, 2020 Category: Palliative Care Tags: opennotes sinclair Source Type: blogs

Obstetrics and Gynecology Needs Palliative Care
by Nathan Riley " Can you all, please, just leave us alone? "One particular experience with the death of a newborn stands out in my mind. Moments after birth the baby was breathless, and the neonatology team could not intubate. All of the kingdom ’s pediatric surgeons and other specialists rushed to labor and delivery to no avail. The baby was born with a four centimeter gap in his trachea, an irreparable condition. The mother sat there, holding her dying baby as he took his last breaths while physicians, nurses, and residents were busy as usual. Click-clacking away on computers. Adjusting blankets. As...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 24, 2020 Category: Palliative Care Tags: gynecology obstetrics palliative care pediatrics prenatal riley Source Type: blogs

Why Writing Down the Good Stuff Can Keep Out the Bad
by Michala Ritz and colleaguesIn today ’s current world of social isolation and virtual EVERYTHING, it is easy to get sucked down an endless rabbit hole of negativity, sad stories of sickness and death, and scary projections of the future. It is now normal to wake up, wonder about family and friends near and abroad, and monitor the vol atile stock market – all while sipping our morning coffee worrying what bad news tomorrow may bring.Those lingering questions keep us up at night, like monsters under our beds.“What if I lose my job?”“What if my parents contract COVID?”“How will my p...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 21, 2020 Category: Palliative Care Tags: covid friedman gratitude kamal nicolla ritz shin The profession Source Type: blogs

Moral Distress and COVID-19: Worlds Collide
by Vickie Leff (@VickieLeff)As a clinical social worker, I am often approached by my medical colleagues asking for support and a listening ear around difficult cases, understanding their own reactions, team dysfunction, and moral distress. In the middle of this COVID pandemic, Social Workers, Chaplains, Nurses, Physicians, Respiratory Therapists, Child Life Specialists, etc. are all likely experiencing an increase in moral distress. This is due to the necessary change of focus from “patient-centered” to “community -based” approach, and resource allocation issues such as PPE shortage, health inequiti...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 14, 2020 Category: Palliative Care Tags: covid hapc hpm leff moral distress social work social worker Source Type: blogs

Book Review: " From Here To Eternity: Traveling the World to Find the Good Death " by Caitlin Doughty
by Jared Rubenstein (@DrJRubenstein)Caitlin Doughty is a mortician, funeral home owner, author, and activist who strives to instill more death positivity into our classically death-avoidant culture. Through her writing, websitecaitlindoughty.com,podcast andnumerous YouTube videos she utilizes her signature voice and style to both educate and entertain. In her book,From Here To Eternity: Traveling the World to Find the Good Death, Ms. Doughty treats the author to a whirlwind tour of different cultural practices around death throughout the world. In equal parts travelogue and ethnography, the reader gets to experience eight ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 31, 2020 Category: Palliative Care Tags: book review Source Type: blogs

Prioritizing in Palliative Medicine: Why Quality of Life Suffers with Racism
by Michelle Christopher and Sonia Malhotra (@SoniaMKhunkhun)The silence was palpable. Two of us continued to speak about our concerns about the way Black lives were treated and how important it was to address these concerns among us for the betterment of our patients. If we couldn ’t understand this among colleagues, how would we ever understand what our patients, a predominantly Black population at a safety net hospital, went through?- - - - - - - - - - - - -As the COVID pandemic started and we saw the first surge of patients flood our hospitals, we watched our patients, colleagues and broader community come togethe...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 13, 2020 Category: Palliative Care Tags: christopher malhotra race The profession Source Type: blogs

I see you. I'm grateful.
by Holly Yang (@hollyby)Thoughts as I drove to work at the hospital today:For people and families who stay 6 feet away and wear a mask, buff, or bandana when they work out near others, enjoy busy outdoor spaces, or walk their dog, I see you. I ’m grateful.For grocery, retail, postal, delivery, restaurant and all other essential workers who take care of us with careful hygiene, clean spaces, and by showing up and being professional despite encountering lots of stressed out people, I see you. I ’m grateful.For good citizens who are kind and respectful to grocery, retail, postal, delivery, restaurant and all other...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 30, 2020 Category: Palliative Care Tags: covid yang Source Type: blogs

National Healthcare Decisions Day in the Era of COVID
by Emily Riegel (@emriegel)“Why did I keep stressing what was and was not normal, when nothing ... was?” -- Joan Didion,The Year of Magical Thinking“Certainty? In this world nothing is certain but death and taxes.” -- Benjamin FranklinIn normal times, under non-pandemic circumstances, yesterday being April 15 would have marked the United States ’ traditional Tax Day. With one certainty, taxes, already rescheduled, we know that we are not in certain or normal times. This year, the novel coronavirus pandemic elevates the immediacy of that other certainty: death.Since 2008, April 16 is designated...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 17, 2020 Category: Palliative Care Tags: advance care planning covid nhdd riegel Source Type: blogs

Delivery of Effective Telehealth
Palliative Care Colleagues,At MGH, we have been learning a great deal about the delivery of effective telehealth in the palliative care setting through our multi-center PCORI REACH PC trial of standard in person palliative care vs telehealth palliative care. We are happy to share with you some of what we have learned in case it may be useful to you and your teams who may be asked to conduct virtual visits in the context of mitigation related to COVID-19. We have found that telehealth can lend itself well to the important work that we do. Below you will find some of the resources we have used to train and support clinicians...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 18, 2020 Category: Palliative Care Tags: greer jackson telehealth temel Source Type: blogs

14th Annual Pallimed Party (aka Un-Meeting)
by Christian SinclairWell, I know we all wish we were in San Diego learning from each other, seeing old friends, and making new ones, but the fact is we are not doing that. I still want to honor the spirit of the annual Pallimed Party, even though throwing a party does not feel like the right optics. So let's call it an un-meeting.So how will this work? I'm not quite sure, so bear with me. It is going to be kind of experimental so if being an early adopter is your thing, I totally get it if you are out. But a small group of us are going to try to do something virtually. It will primarily consist of the online platform Slac...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 18, 2020 Category: Palliative Care Tags: party sinclair Source Type: blogs

The Voice and Role of Palliative Care in the Era of COVID-19
by Suzana Makowski (@suzanakm)Theguidelines outlined in the recent letter co-sponsored by Pallimed and Geripal serve as important reminders of key messages for clinicians: social distancing, handwashing, use of personal protective equipment to help flatten the curve of viral spread, adhering to protocols about screening, testing and even triaging.I would advocate for another layer of engagement in this effort. Palliative care as a specialty is uniquely positioned to address the people who are likely to be disproportionately affected by the disease: the chronically ill and the aged. After all, this population is the demogra...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 17, 2020 Category: Palliative Care Tags: covid emergency preparedness makowski Source Type: blogs

The Dizzying Experience of Healthcare in the Time of a Pandemic
By Lyle Fettig@fettiglyleCheck out the Pallimed COVID-19 Resource page here. - Ed.I love theletter co-published by Pallimed and Geripal about COVID,and you should read that too. As an erstwhile (for now) Pallimed contributor, I thought I'd toss in my two cents with some additional thoughts/reflections based on week 1 of preparing for the COVID pandemic as a palliative care physician.Over the last week, I've operated mentally in most of these lanes:1. Primary prevention and public health:Through extensive advocacy for social distancing and widespread testing. I have talked about it with my patients and my own family and fri...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 17, 2020 Category: Palliative Care Tags: covid emergency preparedness fettig Source Type: blogs

A Letter of Support For You and Thoughts About COVID-19
Co-published March 13th onGeriPal andPallimedDear Hospice and Palliative Care community,We are sad we cannot be together this year at the Annual Assembly and deeply concerned about the growing risk of the novel coronavirus. We want to send you a bit of encouragement, and some thoughts on how we can take care of ourselves, our teams, and our community in the setting of this new pandemic.We have always “punched above our weight” as a field, and the secret to that has been hard work, community, and being smart.We don ’t have to tell you to work hard. You and your teams know how to do this.1) Start social dis...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 13, 2020 Category: Palliative Care Tags: covid emergency preparedness pandemic rosielle sinclair smith tatum Widera yang Source Type: blogs

A Letter of Support For You and ThoughtsAbout COVID19
Co-published March 13th onGeriPal andPallimedDear Hospice and Palliative Care community,We are sad we cannot be together this year at the Annual Assembly and deeply concerned about the growing risk of the novel coronavirus. We want to send you a bit of encouragement, and some thoughts on how we can take care of ourselves, our teams, and our community in the setting of this new pandemic.We have always “punched above our weight” as a field, and the secret to that has been hard work, community, and being smart.We don ’t have to tell you to work hard. You and your teams know how to do this.1) Start social dis...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 13, 2020 Category: Palliative Care Tags: covid emergency preparedness pandemic rosielle sinclair smith tatum Widera yang Source Type: blogs

Mandated Queries of the Florida Prescription Drug Monitoring Program: A Three-Month Experience from a Cancer Center-Based Outpatient Palliative Medicine Clinic
This article represents the findings from the queries over the first three months ’ queries and brings further clarity to our initial findings.Methods This quality improvement (QI) project was reviewed and approved by the Orlando Health/UFHealth Cancer Center Joint Oncology Committee for 2018-19. We began recording results of all E-FORSCE queries occurring after the law ’s implementation of July 1, 2018 through September 30, 2018. We informed each patient that the PDMP query had become mandatory in Florida, and we discussed the results of each query with each patient. Each query examined the last 12 months of t...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 18, 2019 Category: Palliative Care Tags: kollas opioid pain quality improvement statte Source Type: blogs

Community Living for Hospice Patients: Don't " Put " People in Nursing Homes
by Lizzy Miles (@LizzyMiles_MSW)No one should ever be “put” in a nursing home. You might agree with this statement because you don’t like nursing homes, but that is not what I’m saying. The word “put” is offensive when you are describing a person, unless you are talking about putting a 3 year old in the time out corner because he colored on the walls.I would like to make the argument that no adult wants to be ‘put’ anywhere. You put dishes away, you do not put people away. When we are facing a situation in which the care needs exceed the family member’s ability, there a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 1, 2019 Category: Palliative Care Tags: caregiver caregiving communication geriatrics miles nursing home reframing social work social worker Source Type: blogs

Part 6 - Why Is Cancer Pain So Special?
by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 5th post in a series about opioids, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesPart 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Ano...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 6, 2019 Category: Palliative Care Tags: cancer opioids pain rosielle The profession Source Type: blogs

Part 5 - Why Do We Lump the Non-Cancer Pain Syndromes Together?
by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 5th post in a series about opioids, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesPart 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Ano...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 6, 2019 Category: Palliative Care Tags: opioid pain rosielle The profession Source Type: blogs

Part 4 - Everything We Were Taught About High Doses Was Wrong, and the Same Hand-Crafted Graph
by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 4th post in a series about opioids, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesPart 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Ano...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 5, 2019 Category: Palliative Care Tags: opioids pain rosielle The profession Source Type: blogs

Part 3 - Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Another Hand-Crafted Graph
by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 3rd post in a series about opioid, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesThis is Part 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 4, 2019 Category: Palliative Care Tags: opioids pain rosielle The profession Source Type: blogs

Part 2 - We Were Wrong 20 Years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid Doses
by Drew Rosielle (@drosielle)This is the second in a series of several posts about many aspects of my current thinking about opioids.The first post is here:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Over-prescribing fueled the current drug overdose epidemic, and many of us who thought we were stamping out needless suffering contributed to the epidemic.A lot of what I read and believed about opioids early on in my career was wrong.I ’m old enough to remember those heady days in which there was a pretty large and ‘successful’ movement in American medicine to gr...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 3, 2019 Category: Palliative Care Tags: opioids pain rosielle The profession Source Type: blogs

A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.
by Drew Rosielle (@drosielle)Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.This is the first in a series of several posts about many aspects of my current thinking about opioids, with a focus on how my thinking about opioids has changed over the years.Opioids, opioids, opioids. The working title of these series of posts was in fact “Goddamned Opioids and the Goddamned Opioid Crisis’ because it’s a confusing time out there. A lot of us in palliative care have watched the unfolding, devastating, opioid overdose crisis in the US with dread and horror, as well as th...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 3, 2019 Category: Palliative Care Tags: opioids rosielle The profession Source Type: blogs

Remembering Kathy Brandt: Hospice and Palliative Care Advocate
by Christian Sinclair (@ctsinclair)As some of you may already now, we lost a great voice and energy in our field of palliative care and hospice yesterday, August 4th, when Kathy Brandt died at home with her wife,Kimberly Acquaviva and son, Greyson. Kathy was diagnosed with ovarian cancer in January of 2019. Kathy most recently worked on the National Consensus Project Guidelines, 4th edition, as the writer and editor, which was released in 2018. She had over 30 years experience in the aging and end-of-life issues and was helpful to many organizations as theprincipal and founder of the kb group.In addition to all that work o...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 5, 2019 Category: Palliative Care Tags: sinclair Source Type: blogs

March Madness, Palliative Care Style
by Sarah Rossmassler (@srossmassler)and Diane Dietzen (@ddietzen)As a part of our palliative care team ’s educational efforts for the medical residents at Baystate Medical Center, a 712-bed tertiary care academic medical center in Springfield, MA, we prepare and present an academic half-day about twice a year. This year, since our turn came in March, we organized the teaching around a March Madness theme. We had a ton of fun preparing it and felt it was an engaging format for both the palliative care faculty and the residents. In the spirit of Christian Sinclair’s call to use the format in palliative care (as N...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 26, 2019 Category: Palliative Care Tags: dietzen education interprofessional march madness rossmassler sports The profession Source Type: blogs

Living an Intentional Life: This is Water
by Bob Arnold (@rabob)I am not sure what led me to go from thinking about data and evidence in the literature to waxing philosophical recently. It may be that I saw Rufus Wainwright in concert and heard him sing “Hallelujah” with his sister, Lucy Roache Wainwright (Google it). It may be that one of our cardiology fellows died suddenly of unknown reasons and everyone at my hospital is a little fragile. Or that I was just on service and trying to balance the existential realities of sadness and dying with teaching learners and dealing with institutional budget cuts. But when I sat down today and tried to think of...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 22, 2019 Category: Palliative Care Tags: arnold david foster wallace The profession Source Type: blogs

Celebrating 14 Years of Creating Content and Finding Emerging Creative Clinicians
by Christian Sinclair (@ctsinclair)Another year has passed and we arecelebrating the 14th Anniversary of Pallimed. Digitally speaking, 2005 is a pretty long time ago, before Twitter started and when YouTube was only 4 months old. I want to emphasize that what Drew Rosielle startedwith a single blog post as a 3rd year resident is something all of us are capable of doing. You have knowledge to share with a wider audience. At the time Drew was not an expert in hospice and palliative medicine, but he had passion, and he put his work where people could find it. The goal was not to build a brand or build followers, but to share ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 8, 2019 Category: Palliative Care Tags: meta sinclair Source Type: blogs

In Hospice, Time is an Illusion
by Lizzy Miles (@LizzyMiles_MSW)Lately I ’ve been thinking a lot about the perception of time and how it affects our patients. Because their time is limited, their perception of time and its value can often be magnified. This is our job, but this is the patient’s LIFE. We have to remember that for our patients, they may be hyper-focuse d on time. How do we help them feel good about timing and the time we spend with them? We can do this by being mindful of how we use our time with them and also how we show respect for their time.Set expectationsThere is research in the ambulatory care arena that says that patien...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 22, 2019 Category: Palliative Care Tags: hospice perception social worker time Source Type: blogs

Comfort Care, Whatever Does That Mean?
by Michael Pottash (@mpottash)Comfort Care, whatever does that mean? This is the important question asked by my colleagues Anne Kelemen and Hunter Groninger in the September 2018 issue of JAMA Internal Medicine. The term is ubiquitous and its interpretation influences how patients with end stage illness are cared for at the end of their lives. In their article they argue that the language of Comfort Care is confusing and easily misunderstood. They suggest improving the understanding around end of life care and moving to a less ambiguous term for care of the dying. I worry that any term to describe dying care will always be...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 4, 2019 Category: Palliative Care Tags: comfort hospice hospital icu JAMA Internal Medicine palliative care pottash The profession Source Type: blogs

We, Too
by Abby Rosenberg (@AbbyRosenbergMD)I didn ’t want to be another “me too” story. I am becoming one, now, because I believe in the power of a collective voice.You see, there is something terribly lonely about experiencing sexual harassment. And, there is something incredibly powerful about the quiet moment when you finally, bravely, share your story. There is something bittersweet about knowing you are not alone.Sexual harassment in medicine is common. Over 50% of women medical students experience it before they graduate.(1) Disparities in women ’s salaries, grant-funding, academic rank, and leadersh...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 28, 2019 Category: Palliative Care Tags: discrimination harassment rosenberg The profession Source Type: blogs

Confessions of a First Time Presenter
By Kristin Edwards (@KristinMDCT)I ’ve been attending theAnnual Assembly of Hospice and Palliative Care (AAHPM/HPNA) for nearly a decade, but this is the first year I presented a concurrent session. As I return to work, the glow from my 15 minutes of Friday morning fame fading away, I wanted to share a few thoughts for those who, might feel intimidated about submitting an abstract.An abstract can only be accepted if it is submitted.I spent years coming up with ideas for a presentation, but ultimately deciding they were not good enough. A trusted mentor encouraged me to submit my ideas anyway. He saw value in the proc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 22, 2019 Category: Palliative Care Tags: AAHPM conference Edwards HPNA Source Type: blogs

A High Level Review of Medical Marijuana
This article isn ’t going to change your practice. Why am I reviewingBraun et al. ’s survey regarding oncologists’ beliefs, practices, and knowledge regarding medical marijuana use? 1. I went to a Willie Nelson concert and my clothes still reek of marijuana; 2. One of my palliative care fellows is interested in understanding Palliative Care clinicians ’ educational needs regarding marijuana; 3. I visited a dispensary in Pennsylvania where I was told medical marijuana treats diseases ranging from opioid addiction to headaches to nausea and vomiting (in pregnant woman). This annoyed me and I wanted to...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 14, 2019 Category: Palliative Care Tags: arnold marijuana oncology physician Source Type: blogs

Getting Advocacy Right
by Christian Sinclair (@ctsinclair)Anarticle about end-of-life care has been making the rounds this week by Haider Warraich, MD from the online magazine Vox. Titled, " The way we die will be considered unthinkable 50 years from now " , it is part of a series asking 15 experts to think about how the actions we take now will look like errors in 2070. I have seen people on Facebook and Twitter share it with quotes pulled or superlatives attached. Yet when I read it, I didn't feel the same enthusiasm; I felt frustrated.When you read the article, key points seem to be very supportive of palliative care and hospice eff...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 7, 2019 Category: Palliative Care Tags: physician sinclair The profession warraich Source Type: blogs

Palliative Care Social Work: A Year of Leadership
by Vickie Leff(@VickieLeff) and Allie Shukraft(@Alifrumcally)It has been an amazing year for those of us who are palliative care social workers. The4th edition of National Palliative Care Guidelines, published this fall, addingseveral psychosocial focused domains to the list of best care practices.1 Many of the 8 domains specifically highlight the expert skill set of social workers on the interdisciplinary team. Palliative care social workers were delighted to see these highlighted in the guidelines. Palliative Care teams work best when they allow members to practice to the top of their license. Although there is often ove...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 30, 2019 Category: Palliative Care Tags: certification leff shukraft social work SWHPN Source Type: blogs

The 2019 Annual Assembly Social Media Recap
by Christian Sinclair (@ctsinclair)The sun and fun of Orlando has come and gone for those of us lucky enough to steal away from our day jobs and attend the Annual Assembly of Hospice and Palliative Care. Hopefully everyone learned a lot, got re-energized and found their way back home safely.Thanks to the work of Lori Ruder, (@loriruder), Kristi Newport (@kbnewport), Allie Shukraft (@alifrumcalli) Pallimed was present in force a the meeting through Twitter (@pallimed). Beyond recapping some sesisons and re-tweeting the best tweets from the meeting we also used a few engagement techniques like #hpmRookie19, #hpmBingo and the...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 18, 2019 Category: Palliative Care Tags: conference sinclair twitter Source Type: blogs

Social Media at the 2019 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 Orlando, 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 third year in a row, the Tweet of the Day (#hpmTOTD) will bring you the highlights of the conference and #hpmBingo will help make sure you do as mu...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 11, 2019 Category: Palliative Care Tags: AAHPM conference HPNA sinclair social media social work SWHPN Source Type: blogs

Decision-Making in the ICU - The Problem Is Us
byDrew Rosielle (@drosielle)Annals of Internal Medicine has published a fascinating trial of a web-based surrogate decision-making tool aimed at improving decisions for patients receiving prolonged mechanical ventilation in an ICU.It's one of the most fascinating trials I've read in a long time, and also somewhat of a monster (in size/scope of data presented) - there are 4, lengthy online supplements attached to it (!), which is daunting, and so I'm mostly just going to write here about what I find most interesting about it.Which is that I think this may be the trial which should convince us all that what's'wrong'with ICU ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 10, 2019 Category: Palliative Care Tags: advance care planning annals of internal medicine communication hospital icu journal article prognosis rosielle The profession Source Type: blogs

2019 #hpmParty - The 13th Annual Pallimed - GeriPal Party
by Christian SinclairThe Annual Assembly of Hospice and Palliative Care is only a week away, and it is time to announce the details for the 13th Annual Pallimed-GeriPal Party!Just so you all know from here to eternity, the answer to the question of " When is the Pallimed-GeriPal party? " is 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). We love meeting other hospice and palliative care clinicians and advocates, so feel free to invite and bring any colleagues or new friends with you as this is not an ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 5, 2019 Category: Palliative Care Source Type: blogs

Introversion and Hospice & Palliative Care: Insights from ‘Quiet’ by Susan Cain
by Ben Skoch (@skochb)I made some interesting observations during my first ever trip to the AAHPM National Assembly in Boston, almost a year ago. It seemed to me that I was not the only one favoring my phone screen over introducing myself to hundreds of new people. My new Twitter follower to friends IRL ratio ( ‘In Real Life,’ for those wondering) was about 25:1. I noticed people often trying to find seats in a lecture hall at least a few spaces away from others, to a point where some rooms looked like those old science problems involving the diffusion of a gas.I wondered to myself how many people here are intr...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 20, 2019 Category: Palliative Care Source Type: blogs

Goodbye to Compounded Analgesic Creams
This study is one of the largest and best-designed study I'm aware of of these creams, and the findings are pretty clear: such creams benefit patients via placebo mechanisms, aka they don't work.Note that there is a separate body of research on some other topicals which should not be confused with this study. Eg, the 5% lidocaine patch for post-herpetic neuralgia, topical capsaicin for a variety of neuropathies, and at least some topical NSAIDs for osteoarthritis, and topical opioids. I'm not broadly endorsing those either - it's complicated - however they weren't tested here and the take home point is we should stop makin...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 11, 2019 Category: Palliative Care Source Type: blogs

A Randomized Controlled Trial for Fan Therapy in Dyspnea
by Bob Arnold (@rabob)Winter suits me just fine since I do not like heat. I have a lot of sympathy for patients with chronic obstructive lung disease who do not have an air conditioner during the summer. I am told that there is nothing worse than sitting in hot, humid weather and not being able to breathe.As a palliative care physician, I love fans. When my patients are short of breath and opiates do not work (1,2) I send their families down to the local ACE hardware store to buy a hand-held fan. Therefore, I was excited tosee an article in the Journal of Pain and Symptom Management on fan therapy being effective in treati...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 11, 2019 Category: Palliative Care Tags: arnold dyspnea journal article JPSM Source Type: blogs

Grieving with Mr. Pickles: Thoughts on Showtime ’s ‘Kidding’
by Christine Bridges“I don’t think I could stand to be around that much death. All that sadness!” When I announced my career change and plan for a Hospice and Palliative Medicine (HPM) fellowship the reaction of most, in healthcare or not, was concern for my emotional wellbeing. Internally my initial response was : 1. Why do people think that death is reserved for HPM alone? and 2. Death and grief are all around, they are a part of life.Perhaps it is my current vocation, but it seems that modern media agrees. Death and grief are showing up in unexpected formats. Most recently the new ‘dramedy’...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 8, 2019 Category: Palliative Care Source Type: blogs

First Ever Medical Humanities Chat (#MedHumChat)
Hey#medtwitter, I'm toying with the idea of starting a narrative medicine twitter chat. each week we discuss a poem, essay, short story (something very brief!) relevant to medicine and our experience. Would folks be interested? Would you participate? Does this already exist?— Colleen Farrell, MD (@colleenmfarrell)December 16, 2018by Christian Sinclair (@ctsinclair)What started off as a spontaneous tweet by resident Colleen Farrell, MD (@colleenmfarrell) generated a swell of interest from the health care Twitter community and now is being fully realized with the first Medical Humanities chat on Twitter (#MedHumCha...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 2, 2019 Category: Palliative Care Tags: arts humanities sinclair tweetchat twitter Source Type: blogs

Writing a Book
by Robert MacauleyI could write a book about that …But do I really want to? That ’s the question I asked myself a few years ago, when I was invited by Oxford University Press to submit a formal proposal for a comprehensive book on the ethics of palliative care. So I reached out to mentors for advice, and they all said the same thing: Enlist twenty of your friends to each write a chapter, and you can be the editor.Sage advice, which I didn ’t take. Partly because I like challenges. Partly because I don’t really like the unevenness of multi-author texts. And partly because I drastically underestimate...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 1, 2019 Category: Palliative Care Tags: ethics macauley The profession writing Source Type: blogs

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