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Is it Death Denial or Death Defiance?
by PJ MoonA phrase in Dr. Dieter ’s recent Pallimed piece, "Facing the Abyss: Planning for Death, " usefully resurfaced a notion I ’ve had for 12 years now. It started when a professor I was working under remarked how the " death denial thesis " may not really be valid anymore in geriatric/end of life publications and discourse.Combing through the literature, my professor ’s hunch rang true, but only faintly so. To be clear, it wasn’t that issues of human mortality were given special spotlight by journal editors and varying authors, but rather the matter was generally portrayed in ways that did not neatly fit the c...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 13, 2017 Category: Palliative Care Tags: death denial death management moon Source Type: blogs

Show us your #PallimedValentines
Last year the NorthEast Palliatiors from Carolinas Healthcare shared part of their team wellness activity with a Valentine ' s day theme. This year they shared more Valentine ' s cards they made and even a team-built poem:An Ode to Palliative Care.SinceFebruary is National Heart Month, and Valentine ' s is next week, we would love to see the creativity of your hospice and palliative care teams! I ' m sure you have at least one Interdisciplinary Team meeting next week, and you probably have some time allotted for education or self-care/team wellness, so let ' s see what you can do!Check out our slideshow below or ouralbum o...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 11, 2017 Category: Palliative Care Tags: cardiovascular meta UGC Source Type: blogs

An Ode to Palliative Care
Ode to Palliative CareRoses are redViolets are bluePalliative care, we dedicate these love words,Solely to you.You met us where we were at yesterday,Even met with the patient and family again today,Tomorrow you will meet as a given,Forever and always.Palliative care you came along,Asked the tough questions like no one before,Palliative care you spoke to my soul and captured me fully,And forever more.Palliative care I give you my heart,To take care of my family and all that is me,You lit a fire and spark,Can you see?Palliative care you ask me about QOL and make me happy,As only the team approach can,Having you in my corner ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 11, 2017 Category: Palliative Care Tags: frechman pallaitive poetry self-care Source Type: blogs

The Clinical Social Work Role in Interprofessional Practice with Nurses in Palliative Care and Hospice
By Vickie LeffSusan Blacker, et.al provided an excellent article “Advancing Hospice and Palliative Care Social Work Leadership in Interprofessional Education and Practice.” 1 The authors describe the importance of interprofessional collaboration in palliative care, and strategies to address barriers. Increasing curriculum and practice presence are essential to improving this effort.I would like to add and highlight a practical example of interprofessional practice that can:1. help build resilience for nurses2. serve as a model for clinical social work perspective and problem solving3. increase the understanding of...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 10, 2017 Category: Palliative Care Tags: CSW debriefing social work social worker Vickie Leff Source Type: blogs

14 Ways Hospice Patients Have Said They're Ready to Die
Compiled by Lizzy MilesThese are statements made by hospice patient to me over the years indicating their readiness to die." If something is going to happen, let it happen. Life is getting less interesting as the days go by. "" Sometimes I wonder why they ' ve all gone and I ' m still here. "" When I go to bed I always wonder if this will be the time I die. "" I ' ve done it all I ' ve seen it all. I could step out. "" I ' m ready to get up and jump around "" I ' m 93 and anything can happen at any time. I have no qualms. "" I was put on this earth to die. Today is just as good as tomorrow. We ' re all going to die. I can ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 8, 2017 Category: Palliative Care Tags: hospice lizzy miles quotes ready to die Source Type: blogs

ASCO Supports Concurrent Palliative Care for People with Advanced Cancer
by Christian SinclairTheAmerican Society of Clinical Oncology recentlypublished the strongest call for concurrent palliative care in oncology. Released online on Halloween 2016, and published in the Journal of Clinical Oncology just last month, this Clinical Practice Guideline (CPG) should be in the pocket of every palliative care team as they meet with their oncology colleagues to collaborate on better care for patients.The guideline holds more weight and expands the scope compared to the 2012 Provisional Clinical Opinion which emerged after the Temel article. In 2010,NEJM published a randomized control trial (RCT) of pal...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 7, 2017 Category: Palliative Care Tags: ASCO guidelines non-pain symptoms oncology sinclair Source Type: blogs

Facing the Abyss: Planning for Death
By Kevin Dieter“The hurrier you go, the behinder you get.”Puzzlingly, the older and more “seasoned” I become, the more this bit of Amish wisdom is true. Especially when it comes to reading. I don’t have time to read. So, I was surprised when I found myself reading a recent publication from the National Quality Forum. However, as serendipity would have it, I am so glad I did. This publication, “Strategies for Change: A Collaborative Journey to Transform Advanced Illness Care“ had me hooked with the introduction. They had the beautiful audacity to suggest that physicians can and do have the ability to engage in...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 6, 2017 Category: Palliative Care Tags: advanced directives conversation death cafe Dieter Go Wish goals planning for death prepare for death Source Type: blogs

We are mortal humans, we suffer and love, hopefully together, and then we each die.
by Drew RosielleI went into medicine because I thought it ' d be something practical, to help people.I majored in English and Religion at the University of Iowa in the early 1990s, and didn ' t have clear career plans. I guess I thought I ' d become an English professor. Late in my undergraduate days I was enamored with the more experimental sides of 20th Century poetry (Gertrude Stein, Lorine Niedecker) and figured I ' d go on to grad school. To make ends meet in college, I got a part-time job cleaning a group home overnight for teenage boys with profound developmental disabilities. I liked to stay up late, and I could cl...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 1, 2017 Category: Palliative Care Tags: ethics ethics/law politics rosielle Source Type: blogs

What Does the Scan Tell Us? An analysis of oncology outpatient visits
Discussions: Insights Into Why Patients Misunderstand Their Prognosis, " which was published online early in the Journal of Oncology Practice. (OPEN ACCESS PDF!)The researchers analyzed recordings of oncologists and patients with stage IIIA, IIIB, or IV non-small cell lung cancer in the outpatient setting. These recordings were from another large study and are over a decade old now. But as the authors pointed out, there is not strong evidence that outpatient communication strategies have changed wholesale in oncology, (although treatment options have changed drastically with the introduction of checkpoint inhibitors, but t...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 30, 2017 Category: Palliative Care Tags: clinic communication journal article oncology outpatient prognosis sinclair Source Type: blogs

AAHPM/HPNA 2017 Annual Assembly Preview - Overview
by Christian Sinclair(Join up with other Pallimed readers going to the Annual Assembly on the Facebook Events page.)In less than a month, more than 3,000 nurses, physicians, and others will be gathering in Phoenix, AZ to attendThe Annual Assembly of Hospice and Palliative Care (PDF Brochure here).The Assembly returns to Phoenix for the first time since the 2004 meeting, which also happened to be my first Annual Assembly. The 2004 meeting was held in a small resort (Tapatio Cliffs!) a little north of Phoenix. This year we are in the main convention center because it has grown so much over the years.This year ' s Annual...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 28, 2017 Category: Palliative Care Tags: AAHPM conference conference reviews sinclair TEDMED twitter Source Type: blogs

Changing Treatment Options in Delirium - No More Antipsychotics?
by Drew RosielleIntroductory CommentsThis is a post to share my thoughts about therandomized, controlled trial of haloperidol, risperidone, or placebo for delirium in ' palliative care ' patients, published recently in JAMA Internal Medicine.Big hat tip to my fellows - Drs Amanda Hinrichs, Elena Wahmhoff, and Alison Feldman, whose discussion of the paper at a recent fellows ' rounds helped me think through the study, as well as theAAHPM Connect communities bulletin board ' s discussions (BTW, have really appreciated these bulletin boards the last couple years and am grateful to AAHPM for pulling it off so well!).Geripal, a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 28, 2017 Category: Palliative Care Tags: antipsychotics delirium journal article MDAS NuDESC rosielle Source Type: blogs

The Dying Don ’t Need Your Permission to Let Go
This article is the seventh in a series of articles where I take each assumption from the original article and explore the concept in greater depth to include implications and possible interventions. In my last article, I wrote about theassumption that hospice patients will reveal the secrets to the universe.Here is our next assumption: You should tell your loved one, “It’s okay to let go.”The idea that a dying person is waiting for permission from their loved ones permeates many articles about the final days of dying. There is some truth to the idea that some patients may linger because they worry about the ones the...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 20, 2017 Category: Palliative Care Tags: assumptions bedside family intervention lizzy lizzy miles social work social worker Source Type: blogs

#hpm Chat on Hiatus until Spring 2017
by Christian Sinclair (@ctsinclair)As another year starts winding down, it is always a good reminder to take stock of what you value. After 319 weekly chats in 6.5 years, #hpm chat is going on our first ever hiatus. This was a hard decision for Meredith MacMartin and myself, the two lead co-moderators. We have had numerous conversations about the sustainability of weekly #hpm chats going into 2017 with only two co-moderators. There is a lot of work that goes into developing weekly programming, making sure the hosts are ready, ensuring diverse topics and hosts, editing blog posts, and promoting the chat. And that is all bef...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 15, 2016 Category: Palliative Care Tags: hpmchat sinclair tweetchat twitter Source Type: blogs

Decision Making at the End of Life: Joint #patientpref and #hpm Tweetchat
By Meredith MacMartinFred was a sick guy. He had been diagnosed with COPD years ago, and more recently developed heart failure, and although he and his wife Nancy tried to stick with his medication regimen and monitor his salt intake, his shortness of breath had been making it harder and harder to even get around the house. He followed regularly with his primary care doctor, and talked about what he would want in terms of medical care if and when he got sicker. His wife knew that he didn ’t want to go to the hospital if it could be avoided, and that he definitely did not want to end up in an ICU on a ventilator, or getti...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 7, 2016 Category: Palliative Care Source Type: blogs

In the Company of Death; In Consortium Mortis
By Mark Ligorski#1. BeginningsJust like in superhero movies, there is always a back story. This is mine.After graduating medical school in 1981, I went to work at St. Vincent ’s Medical Center on Staten Island for the next two years, the first spent in rotating through the different areas of medicine and surgery and then a year of Internal Medicine. 100 hour work weeks were typical, with on call shifts every 3rd or 4th night.People stayed in hospital for weeks at a time; there were still wards with four to six patients. Intensive and cardiac care units were still pretty new. TheKaren Ann Quinlan case ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 3, 2016 Category: Palliative Care Tags: advanced directives code status CPR ligorski respirator Source Type: blogs