How Spiritfarer Helped Me Through the Pandemic
by Matthew Tyler (@PalliDad)During what can only be described as a challenging year, I found Thunderlotus ’s gameSpiritfarer just in the nick of time. In this “cozy management game about dying,” you assume the role of a young woman named Stella who is charged with shuttling spirits to the gates of the afterlife. Unexpectedly,Spiritfarer served as both an escape from and means of processing my experience as a healthcare worker during the pandemic.From top to bottom,Spiritfarer exudes tranquility. The animations are bright and vibrant, and the music is soothing yet melancholy, invoking nostalgia for younger...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 14, 2021 Category: Palliative Care Tags: covid grief palliative care pandemic Tyler video games Source Type: blogs

Two Ways to Share your Palliative Care and Hospice Stories
by Christian Sinclair (@ctsinclair)This past few days, I came across two great opportunities that I wanted to share with a wider audience of hospice and palliative care clinicians.First is the podcast and radio show, Radiolab. I've always appreciated the nuance and simplicity the creators can bring to complex issues. They are looking for voice memos from people who work in end-of-life care. They are also looking for patients and families who have been impacted by this work. All you have to do is record a 60-seconds or less voice memo and email it to wnycradiolab@gmail.com. Make sure to include your name, city, and your pos...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 14, 2021 Category: Palliative Care Tags: media sinclair The profession Source Type: blogs

PROP ’s Disproportionate Influence on U.S. Opioid Policy: The Harms of Intended Consequences
ConclusionDespite being turned back from an effort to bluntly reduce opioid prescribing by the FDA in 2013 based on a lack of scientific evidence for its position (17,18), PROP has had a disproportionate effect on opioid policy in the Untied States for almost a decade. PROP found a willing federal regulatory partner in the CDC, and while PROP may not have “secretly written” the 2016 CDC Pain Guidelines (75), they certainly enjoyed disproportionate representation on CDC’s review panels and Core Expert Group (23-25) in a process that lacked transparency (22, 23, 26, 27). When the CDC admitted that its Pain ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 3, 2021 Category: Palliative Care Tags: CDC health policy kollas opioids pain prop Source Type: blogs

Choosing Palliative Care as a Medical Specialty
by Sylvia Lane (@sylv_lane)There are few things more introspective than deciding on a specialty in medicine. The decision forces you to analyze what interests and values you hold but also who you are as a person. How do you solve problems? How do you work with others? What brings you joy? As a third-year medical student, I was able to try on many specialties. Rotating through various fields allowed me to soak up knowledge from almost every type of healthcare professional. But this experience comes with a heavy burden of choosing a future career path.From the beginning, I knew that I was not like most of my fellow medical s...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 9, 2021 Category: Palliative Care Tags: lane learner medical school medical student residency The profession Source Type: blogs

What Is Grief, If Not Love Persevering?: A Palliative Perspective On WandaVision
by SarahScott B. Dietz (@SDietzMD)WARNING: THIS POST CONTAINS SIGNIFICANT SPOILERS FORWANDAVISION.In January,WandaVision released on Disney+, promising a weekly serial centered around two romatincally involved and familiar Marvel characters, Wanda Maximoff (aka Scarlet Witch) and Vision. The advertisements showed a black and white, vintage look to the show, and gave few clues as to exactly how it would tie in with the rest of theMarvel Cinematic Universe. Fans were intrigued for many reasons, chief among them being that the last time we saw Vision,he was dead. (CW-Superhero violence/death)I dove intoWandaVision like many f...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 7, 2021 Category: Palliative Care Tags: comics dietz grief media television Source Type: blogs

Advance Care Planning? Meh. - Part 2
by Drew Rosielle (@drosielle)This is Part 2/2 of a couple posts about advance care planning (ACP).The last post outlined why there are really good reasons to believe that ACP (completion of health care directives and the healthcare conversations that occur around healthcare directive (HCD) completion, implemented on a broad scale) does not lead to any better, patient-centered outcomes, particularly when evaluated as a health intervention to be applied across a population (which is how ACP is typically conceptualized and researched).In the prior post, I perhaps obnoxiously promised that I thought one of the most important A...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 31, 2021 Category: Palliative Care Source Type: blogs

Advance Care Planning? Meh. - Part 1
by Drew Rosielle (@drosielle) (no degrees)Several years ago I was giving a talk in front of a mostly palliative care audience and asked, "How often do you find yourself, in the care of your patients, saying to yourself something like'Thank the stars this patient has a healthcare directive (HCD)'? " The overwhelming answer was a bunch of shrugs and people agreeing occasionally (but not routinely) HCDs are helpful.For something that seems so central to our work, why is it that so many of my colleagues that day were lukewarm about their utility?It's fair to say that the last few months have been a controversial one ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 29, 2021 Category: Palliative Care Tags: advance care planning rosielle Source Type: blogs

On the Value of Social Work in Palliative Care
by Vickie Leff (@VickieLeff)Another year, another study proving the value of the palliative care social worker. Edmonds et al (2021) found that when a social worker was involved in a palliative care consultation, whole-person care components were more likely to be addressed, including addressing psychological (82% vs 18%) and spiritual needs (92% vs 8%) and documenting advance directives (90% vs 10%). This adds to what we already knew: involvement of social work impacts quality of care and patient satisfaction (Auerbach, 2007; O ’Donnell et al., 2018).It surprises me that despite much research and team role developme...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 22, 2021 Category: Palliative Care Tags: hospice leff palliative care social work social worker Source Type: blogs

Palliative Care Social Worker Infographic
(Source: Pallimed: A Hospice and Palliative Medicine Blog)
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 22, 2021 Category: Palliative Care Tags: leff social work social worker Source Type: blogs

What Remains of Edith Finch? - A Video Game Review
by Matthew Tyler (@PalliDad)Fortunately for me, the pandemic has not interfered with my life-long hobby: video games. I finally got around to playingWhat Remains of Edith Finch, a game that received high praise for its short but engrossing Lovecraftian-esque narrative. What I experienced was a surprisingly insightful exploration of humanity ’s relationship with death.Coincidentally, I had just readBJ Miller ’s opinion piece “What is Death?” in The New York Times and was struck by the parallels between it and What Remains. This game illustrates how one may “fold death into our lives,” and...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 15, 2021 Category: Palliative Care Tags: game Tyler video games Source Type: blogs

Pallimed GeriPal Virtual Gathering 2021
by Christian Sinclair (@ctsinclair)Short notice, but yes, there will be a Pallimed/GeriPal virtual party this year.Never missed a year! Have we planned a lot around this? No. Do we want to see friends and colleagues and meet new people? Yes. Can we do it with minimal expectations? We hope so!We are not sure what to expect, but when we did this in person there was never that much of a plan anyway, except where to go next, and even that was up for improvisation.So what might we do. Probably hang out in different Zoom rooms talking about different subjects, playing games, talking about palliative care things, or maybe not pal...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 17, 2021 Category: Palliative Care Tags: geripal sinclair Source Type: blogs

Confronting Stigma From Opioid Use Disorder in Cancer Care
by Fitzgerald Jones, Ho, Sager, Rosielle and MerlinHave you ever been so distressed by a perspective piece that it kept you up at night? The type of rumination that fills you with so much angst that you have no choice but to act. This is exactly how we felt when we read theAAHPM Quarterly Winter 2020 Let ’s Think About It Again.1 (member paywall)The column, which is structured as a sort of written debate in which two authors argue a clinical question, describes a case of a 45-year-old man with severe substance use disorder (SUD) recently diagnosed with extensive-stage small-cell lung cancer. He was offered ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 30, 2021 Category: Palliative Care Tags: ftigerald jones ho merlin rosielle sager Source Type: blogs

Confronting Stigma From Opioid Use Diorder in Cancer Care
by Fitzgerald Jones, Ho, Sager, Rosielle and MerlinHave you ever been so distressed by a perspective piece that it kept you up at night? The type of rumination that fills you with so much angst that you have no choice but to act. This is exactly how we felt when we read theAAHPM Quarterly Winter 2020 Let ’s Think About It Again.1 (member paywall)The column, which is structured as a sort of written debate in which two authors argue a clinical question, describes a case of a 45-year-old man with severe substance use disorder (SUD) recently diagnosed with extensive-stage small-cell lung cancer. He was offered ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 30, 2021 Category: Palliative Care Tags: ftigerald jones ho merlin rosielle sager Source Type: blogs

Fostering Student Interest in Palliative Care
by Christian Sinclair (@ctsinclair)Most palliative care teams love to have medical students on service, but the access may be variable. Some schools make palliative care rotations mandatory, some optional, while others make it hard to find or " build your own. " I do outpatient palliative care, so I see medical students less often than my inpatient colleagues, but we do get a number of nursing students, pharmacy residents, psychology learners rotating with our clinic at the University of Kansas Medical Center. Having learners rotate is an excellent way to teach primary palliative care skills, to help learners ear...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 29, 2021 Category: Palliative Care Tags: learner sinclair student Source Type: blogs

Social Media Stats for Palliative Care Journals 2020
by Christian Sinclair (@ctsinclair)Over the past two years I have been working to increase the profile of theJournal of Pain and Symptom Management as the associate editor of social media. In that time, I have come to make a few observations on the current state of social media use by palliative care journals and researchers that I would like to share with you dear readers along with some statistics. Could I make all of this into a paper, published in one of said journals? Possibly. But curiously enough I am looking to effect positive change quickly, so for now we will go with a blog, some Tweet threads and data visualizat...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 18, 2021 Category: Palliative Care Tags: research research issues sinclair social media twitter Source Type: blogs

Olanzapine FTW for Nausea Outside of CINV
by Drew Rosielle (@drosielle)A few months agoan interesting olanzapine study was published which I have been meaning to write a post about. It's important because while olanzapine has really established itself in the last decade as a highly effective antiemetic for chemotherapy induced nausea and vomiting, and is now in multiple CINV guidelines (eg Antiemetics: ASCO Guideline), etc, we don't have a lot of data for its efficacy for nausea outside of CINV, and so a well-done RCT is welcome.The study is amulti-center, US, adult, randomized, placebo-controlled, double-blind trial of olanzapine for nausea in advanced cancer pat...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 1, 2021 Category: Palliative Care Tags: anorexia cachexia nausea olanzapine rosielle Source Type: blogs

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