Preparing to Show Up: Nature Practices that Serve
This article offers some very basic nature-based practices that we can use on a regular —if not frequent—basis with little preparation in moments in which we find ourselves: depleted, enervated, or in need of clarity. I have been a hospice volunteer for more than sixteen years, while also serving the deep needs of people in transition through my private professional practice. What I’ve learned from both of these endeavors is that showing up to “the other” in an engaged, dynamic manner is not only essential for them; I must show up to myself in such a way, too. We need to maintain a daily conne...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 17, 2017 Category: Palliative Care Tags: hospice intervention Jennifer Wilhoit nature reflect self care Self reflection volunteer Source Type: blogs

On Language: Why We Should Avoid Saying " So Young "
By Amanda HinrichsThere is a brief phrase I hear uttered in the halls of the clinic or the hospital, a phrase I have said myself, and it ’s a phrase that concerns me. This phrase, “so young,” is uttered by new and experienced clinicians, often when talking about patients who are seen as being too young for the illness(es) they have. This phrase conveys objectivity and societal statistics, but is also laden with personal judgeme nt, empathy, and sadness.As I enter my career in adult palliative medicine, I have been thinking more and more about the importance of language and the way we, the medical communit...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 15, 2017 Category: Palliative Care Tags: amanda hinrichs bias label language lifespan palliative young Source Type: blogs

Bringing Humanity Back to Medicine: A Book Review of " Attending " by Ronald Epstein
by Lyle FettigWhen debriefing after a difficult communication encounter led by a fellow or resident, I ’ll often start by asking the trainee, “how do you think it went?” There are times when I thought the encounter went very well, yet the trainee leaves the room with a worried look. Perhaps the trainee clearly explained the medical facts, demonstrated ample empathy, and carefully talked about t he next steps, so I’ll be a bit surprised when the trainee says, “It went horrible.” I’ll ask why, and I’ll get a bemused look in response. “Because I made the patient cry,&rdquo...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 1, 2017 Category: Palliative Care Tags: book depression fettig humanity media mindfulness review The profession Source Type: blogs

Extremis Documentary Falls Short at Oscars, Wins Over Palliative Care
by Christian SinclairLast night at the Oscars, there sure was a lot of excitement for many of my friends and colleagues, and I'm not just talking about the surprise ending with La La Land winning Best Picture, then losing it in a tragic mistake of envelopes, to another well-deserving film Moonlight. That is because many of my friends and colleagues are strong advocates and wonderful clinicians who are vocal about excellent care at the end of life.The filmExtremis, which was released in April 2016 at the Tribeca Film Festival, was nominated for An Academy Award for Best Documentary Short Subject, but up against top competit...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 27, 2017 Category: Palliative Care Tags: extremis film sinclair zitter Source Type: blogs

SWHPN 2017 Conference Reflection
By Abigail LatimerAlthough I have three years of hospice clinical social work, I am only six months into my career with inpatient palliative care. I learned aboutSWHPN (Social Work Hospice& Palliative Care Network) and quickly applied and received the scholarship to attend the conference. It was beyond any previously held expectation and I left in awe of the work that is being done from around the country and world. As I sat next to great leaders like Dr. Grace Christ, Terri Altilio, LCSW and Shirley Otis-Green, LCSW, OSW-C (to name a few) I felt humble and as Susan Blacker, MSW, RSW and Susan Hedlund, LCSW, OSW-C...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 26, 2017 Category: Palliative Care Source Type: blogs

Social Media to Enhance the 2017 Annual Assembly
by Christian SinclairThe Annual Assembly of AAHPM and HPNA is right around the corner and if you are going to Phoenix, or staying home to keep things running smoothly, social media can help make your conference experience be transformative. Since 2009, the Assembly has been making use of Twitter to provide additional insight, commentary and sources for the multiple sessions each day. Now things are expanding to dedicated conference apps, Facebook and Instagram. And for the first year ever we have Twitter contests.The official hashtag of the conference:#hpm17 (works on Twitter, Facebook, Instagram), use it in every twe...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 20, 2017 Category: Palliative Care Tags: facebook sinclair twitter Source Type: blogs

Warming Hearts, Cloaking Grief
By Lori RuderHe moves over and she snuggles in close to her fianc é. She pulls their blanket over them. A special blanket made just for this moment. “I love you” she murmurs, soaking in his face and his warmth. “Goodnight lovebirds,” his mother teases as she turns out the lights.This moment is both tender and tragic: tender because they are demonstrating their love for each other, tragic because this is happening in the ICU. Her fianc é is on life support and he is dying. He moved over because I moved him over to make room for her in his narrow hospital bed. I repositioned his ven...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 15, 2017 Category: Palliative Care Tags: blanket cancer comfort icu lori ruder Source Type: blogs

11th Annual Pallimed and GeriPal #hpmParty at #hpm17
Come one, come all to the 11th annual Pallimed / GeriPal party during the Annual Assembly of AAHPM and HPNA! And right after SWHPN's conference too!In keeping with tradition, we will host it on the Thursday of the Assembly (Feb 23rd). We will start atLustreat around 8 PM and move on from there toHanny's at 10pm (and then who knows what). Like always though, these are rough estimates of time, so if you want to know the details, follow the hashtag#HPMparty on Twitter.Also, feel free to invite and bring anyone, as this is no exclusive crowd.Ways to follow: #HPMparty twitter feedPallimed Twitter feed&n...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 15, 2017 Category: Palliative Care Tags: geripal meta party Source Type: blogs

Warming Hearts, Cloaking Grief
By Lori RuderHe moves over and she snuggles in close to her fianc é. She pulls their blanket over them. A special blanket made just for this moment. “I love you” she murmurs, soaking in his face and his warmth. “Goodnight lovebirds,” his mother teases as she turns out the lights.This moment is both tender and tragic: tender because they are demonstrating their love for each other, tragic because this is happening in the ICU. Her fianc é is on life support and he is dying. He moved over because I moved him over to make room for her in his narrow hospital bed. I repositioned his ven...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 15, 2017 Category: Palliative Care Tags: blanket cancer comfort icu lori ruder Source Type: blogs

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 i...
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 on Facebook...
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 understa...
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 ...
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 h...
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 clean the ...
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, ...
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 A...
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, as per us...
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 ...
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 g...
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 c...
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

How Reimbursement Is Changing For Palliative Care - MACRA
by Stacie Sinclair(Register for the free webinar here)There is no disputing that recent events mean a huge shift in the direction of health care in the coming years. Although we ’re learning more each day about what programs will stay and what will go, there remains tremendous uncertainty that only time will clarify. Yet in this period of transition, there is at least one major program that the nation’s best health policy minds agree is here to stay: MACRA’s QPP!WHAT DO THOSE CRAZY ACRONYMS MEAN?TheMedicare Access and Children ’s Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA) is...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 19, 2016 Category: Palliative Care Tags: AAHPM CAPC CMS HPNA macra medicare mips nhpco palliative care profession sinclair Source Type: blogs

FAQ for New Hospice Volunteers: 15 Simple Questions You're Afraid to Ask
By Lizzy MilesBefore I was a hospice social worker, I was a volunteer. I was so nervous to visit my first patient. Over time, I became more comfortable. Through the course of switching careers from volunteer to social worker, I attended volunteer training at several organizations. There is a lot of really good information provided, but sometimes hospice staff forget what it's like to be NEW. These are the questions I had when I first started. Once I gained experience, and went to school for further training, I decided it might be helpful to write out the answers for others who are just embarking on their hospice journey. I...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 16, 2016 Category: Palliative Care Tags: conversation hospice lizzy lizzy miles palliative volunteer Source Type: blogs

A Collaborative Journey to Transform Advanced Illness Care
by Amy K. ShawThe healthcare system is undergoing a fundamental shift from care geared primarily toward medical or clinical needs to care that addresses the needs of the person as a whole. The forces driving this change are two-fold. First, a consumer-focused movement is gaining increased momentum amidst widespread recognition that better patient engagement improves healthcare quality and lowers costs. Second, significant changes in national policy require ongoing monitoring and measurement to assure progress towards the goal of person-centered care for those with advanced illness. In January 2016, the Centers for Medicare...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 15, 2016 Category: Palliative Care Tags: #hpm CTAC hpmchat NQF Source Type: blogs

Symptoms of Cancer May Include Fatigue, Unexplained Weight Loss, Fever and Foreclosure
by Bridget BlitzAs a palliative care social worker, I provide home visits to patients and families to explore how they are coping with complex medical issues, which resources they need, how we might add services that could reduce caregiver strain, and talk to them about their goals of care and about their wishes for the life they have left. Startling to me, within these discussions, is the depth of fear and anxiety about finances that leave these individuals struck with more than a horrible illness. They now have to absorb the real possibility of being without a permanent home in addition to adapting to new treatments, sym...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 14, 2016 Category: Palliative Care Tags: bankruptcy financial social work social worker Source Type: blogs

The Illusion of Impermeability
by Laura PatelAs I sat in my hospice interdisciplinary group meeting, reviewing the many patients who have died in the past two weeks as well as our new patients, there was a slight break in the discussion. Being ever the multitasker, Iclicked on a NY Times article I have been meaning to read and scanned the first two sentences: “When my husband died from cancer last March at age 37, I was so grief-stricken I could barely sleep. One afternoon, I visited his grave — in a field high in the Santa Cruz Mountains, overlooking the Pacific Ocean — and lay on top of it. I slept more soundly than I had in weeks.&r...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 13, 2016 Category: Palliative Care Tags: kalanithi patel Source Type: blogs

The Doctor and the Rabbi: A Healing Conversation About End-of-Life Care
by Rev. Rosemary Lloyd“It routinely makes me hurt inside when patients and family are admitted to an ICU, as most have rarely if ever considered what care they truly want, or not. It is heart breaking to try and help them assimilate it all, and all too frequently decisions are left for families, with left over feelings that may linger for years.”This is what Dr. Jeff Dichter, an ICU Medical Director wrote gratefully to Rabbi Esther Adler of Mount Zion Temple in Saint Paul, Minnesota afterher sermon on Yom Kippur, a major holy day in the Jewish calendar.“As health care professionals,” he continued, &...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 12, 2016 Category: Palliative Care Tags: chaplain lloyd spiritual spirituality spirituality/religion Source Type: blogs

10 Take Home Lessons from the CAPC 2016 National Seminar
By Laura PatelI was fortunate to attend the 2016 CAPC conference in Orlando. Below are some of the most notable pearls I will be taking home with me.1. Palliative care is about the relief of suffering. This requires a multifaceted approach and is something that case management based or disease management based programs do not address.2. Palliative care clinicians are uniquely situated to comment on and participate in healthcare transformation. We need to be advocates and “rabble rousers” (per Dr. Martha Twaddle) to encourage our healthcare system to embrace a focus on prevention and well-being, not only on dise...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 2, 2016 Category: Palliative Care Tags: CAPC conference education patel Source Type: blogs

Engaging The Communities We Serve
by Tacy Silverberg-UrianA cultural transformation of our perspectives on dying and end of life (EOL) care is slowly beginning to take shape. There has been a significant rise in the number of mortality- and EOL-related newspaper articles, books, and documentaries. There has also been a grassroots public campaign called the Conversation Project, which is focused on initiating conversations on dying. The federal government, particularly the centers of Medicare and Medicaid, have proposed various EOL initiatives. In 2014 the IOM (Institute on Medicine) laid out a comprehensive position paper entitled “Dying in America: ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 2, 2016 Category: Palliative Care Tags: Atul Gawande Being Mortal community death death cafe death over dinner death/dying five wishes Silverberg-Urian van Meines Source Type: blogs

Cases: Use of Steroids as Adjuvants for Pain Management
Conclusion:Although there is no definitive, absolute proof that use of dexamethasone as an adjuvant agent for symptom management does not confer a potential increased risk of infection, we do have literature indicating that steroids are used to help manage and treat certain infections, and that there has not been evidence of increased new infections when used in a single dose post-operatively. The clinical take away here is that it okay to consider the use of a steroid, especially in a low dose for a short period of time, in managing pain of an inflammatory etiology (such as pleurisy), and when compared to the potential ri...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 31, 2016 Category: Palliative Care Tags: cancer hematology opioids pain riegel steroids Source Type: blogs

Building Faith in the Power of The Conversation
by Rev. Rosemary LloydWhen the senior minister of Old South Church in Boston, Massachusetts, Rev. Dr. Nancy Taylor, began her sermon one Sunday morning she raised a lot of eyebrows.“Mary,” she began, “you are going to die.” She started pointing out people in the church and telling them that they are going to die. Young and old, men and women, she called out congregants by name and reminded them that death is not a dirty secret; it’s a fact of life. Her sermon continu ed, weaving in humor to diffuse the tension and ultimately generating chuckles and nods of understanding from the crowd.“T...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 26, 2016 Category: Palliative Care Tags: chaplain communication community conversation project lloyd spirituality spirituality/religion Source Type: blogs

Palliative Care for Caregiver Distress
by Sujin Ann-YiAccording to theCaregiving in the US 2015 research report (PDF) conducted by the National Alliance for Caregiving (NAC) and American Association of Retired Persons (AARP), 43.5 million adults in the US have provided uncompensated care to an adult or a child in the past year. The same report found caregivers provide on average 24.4 hours per week of support to their family member. Spouses were found to provide on average 44.6 hours per week and almost 25% of caregivers provide 41 hours per week.Caregivers refers to family members who provide ongoing continuous care, typically without any compensation, fo...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 24, 2016 Category: Palliative Care Tags: ann-yi anxiety cancer caregiving depression tweetchat twitter Source Type: blogs

" Incompatible With Life, " Compatible With Love: Perinatal Hospice and Palliative Care
by Amy KuebelbeckIt's a relatively new phenomenon: With advances in prenatal testing, some parents who are happily anticipating the birth of their baby instead receive the devastating news that their baby is expected to die.Then what? Often, the default recommendation is to terminate the pregnancy and try again. A growing number of parents prefer to continue their pregnancies and embrace their babies'lives for however long they might last, even if that time is only before birth. But a distressing number of these parents report feeling abandoned by their caregivers and even chastised and criticized for choosing this path.[1...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 17, 2016 Category: Palliative Care Tags: hospice pediatric PedPC perinatal Source Type: blogs

Servant Leadership in Palliative Care
by Beth Fahlberg PhD, RN, CHPN and Robert Toomey, EdD, MALeaders are needed in palliative care who can provide the direction for current and future development. We recently wrote an article on Servant Leadership as a model for emerging Nurse leaders, which got us thinking about how Servant Leadership is a model that is also fitting for palliative care. There are many different models of leadership, yet the Servant Leadership model is particularly appropriate for palliative care.Characteristics of servant leaders include: the ability to listen, empathy, healing, stewardship, commitment to the growth of others, and being ski...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 12, 2016 Category: Palliative Care Tags: fahlberg leadership The profession toomey tweetchat twitter Source Type: blogs

Five Tips for Effective Quality Improvement in Palliative Care (#3 will blow you away)
by Arif KamalApologies for the “clickbait” title to the blog post; scouring the internet it seems that hyperbole works to get readers’ attention, certainly among entertainment sites and maybe increasingly within presidential politics. But it seems I had little choice; the fifth word of my title is “Quality”, which exci tes very few people. Bear with me, I promise this will get good.Quality improvement is critical for palliative care organizations to build and sustain success within their clinical missions. Those who are watching and evaluating us, including patients, caregivers, health systems...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 5, 2016 Category: Palliative Care Tags: kamal quality research issues twitter Source Type: blogs

Mindfully Conquering Burnout and Cultivating Self-Compassion
by Robert GerardSome thoughts on a transformative program recently completed atUpaya Zen CenterI stared atthis Tweet because I could not fathom how everybody could be this happy.Everyone appeared to sparkle with joy, and I felt an astonishing resentment and discontent by what they must have accomplished. This Tweet rapidly crystallized an awareness that I had not been taking care of myself. I feared my capacity to feel happiness for others had vanished for keeps. There was no denying it was a sign ofburnout. I had become physically tired at the end of the work day. Time and again I was emotionally drained and needed to sit...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 29, 2016 Category: Palliative Care Source Type: blogs

Grief is Not Self-Pity: Joan Didion ’s The Year of Magical Thinking
by Vivian Lam“Life changes fast.Life changes in the instant.You sit down to dinner and life as you know it ends. The question of self-pity. ”When does grief become “self-pity”? What is the “proper” way to grieve?Joan Didion begins writing what would becomeThe Year of Magical Thinking a few days after her husband, John Dunne, dies from a heart attack. Coupled with the mounting health crises of her daughter, Quintana, Didion ’s world is thrown out of joint. In the ongoing aftermath of these tragedies, Didion, acclaimed novelist and literary journalist, copes by doing what she ha...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 28, 2016 Category: Palliative Care Tags: book Didion grief lam magical media review Source Type: blogs

Number One Palliative-Themed Movie? Wit
by Amy Clarkson(Margaret Edson,author of Wit, will be speaking at the 2016 Palliative Care in Oncology Symposium, so we are sharingthis review from our Arts and Humanities site, originally published in 2009. - Ed.)There are many movies out there with palliative themes, as we can attest to withour top 10 movie post, which garnered much comments. One of my all time favorites, also made number 1 on our top 10 palliative-themed movies list; Wit.I first saw this movie in medical school. In fact,according to the IMDb, this movie is known for being shown at medical schools as an example of how not to practice medicine. Also,...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 8, 2016 Category: Palliative Care Tags: cancer film media play review Source Type: blogs

What Makes Up High-Quality Primary Palliative Care in Oncology?
by Ross AlbertI'm surprised that I ’m not hearing more about the recent ‘Guidance Statement ’ put out by the collaboration of ASCO and AAHPM on “Defining High-Quality Palliative Care in Oncology Practice.” (OPEN ACCESS PDF) It ’s a report that provides some very interesting insight into what pieces of primary palliative care should be part of general medical oncologists’ practice.When I read it the report, I was pleased to see that it waspublished in ASCO ’s journal, and I noted the impressive list of authors. My eyes briefly glazed over as the discussion moved to Delphi...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 7, 2016 Category: Palliative Care Tags: AAHPM ASCO breast cancer colorectal cancer lung cancer oncology Source Type: blogs

PCHETA has a date with a subcommittee! Thank your rep!
by Christian SinclairHey all you hard-working palliatricians and hospice clinicians, we have some pretty exciting news for you! This Thursday Sep 8th, thePalliative Care Hospice Education and Training Act (PCHETA - H.R. 3119/S. 2748) is going on a first date with the House of Representatives Subcommittee on Health (who even has their ownhashtag #SubHealth).So what does this mean?This legislative hearing includes PCHETA and 4 other bipartisan bills focused on improving public health that are being considered for further advancement to the full committee level and eventual consideration in the house. If it goes well, we are ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 6, 2016 Category: Palliative Care Source Type: blogs

Do hospice patients reveal the secrets to the universe?
This article is the sixth 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 the assumption thatfamily matters will get resolved.Here is our next assumption: The secrets to the universe will be revealed.I admit I went into hospice work with the expectation that I would have profound experiences at the bedside with dying patients. How could one not have this expectation when we see articles about famous last words, such as theNPR article about Steve Jobs saying, “Oh...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 5, 2016 Category: Palliative Care Tags: assumptions door expectations family intervention lizzy miles psychosocial secrets social work universe Source Type: blogs

August 2016 Pallimed Recap
by Christian SinclairAugust 2016 has left the building along with a lot of heat, rain and wildfires.Here is a recap of all of our posts from August 2016. We know there are some you may have already bookmarked, but forgot to read, or maybe you liked it so much you want to share it again.Make sure to follow, engage, like and comment with us onFacebook,Twitter,Google+,Pinterest,Tumblr,Instagram andLinkedIN. We always appreciate it when you recommend us to your peers and social media makes it very easy!CommunicationPalliative Chemotherapy: An Oxymoron by Rebecca Gagne HendersonHumanities/Media ReviewsRedefining " Dea...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 4, 2016 Category: Palliative Care Tags: book burnout cancer chemotherapy comments facebook icu instagram media neuro NICU oncology pediatrics research review self care social media The profession twitter Source Type: blogs

August 2016 Palliative Care Review
by Christian SinclairSome August highlights from non-core HPC journals focusing on palliative care and hospice topics. Anyone who would like to explore any article in depth for a future Pallimed post iswelcome to contact us.Nondisclosure by Dr. Abby Rosenberg, published in JAMA, is a wonderful opportunity to examine if we are doing the right thing for a patient. Having reconnected with the mother of a teenage patient who died 6 years ago, the doctor and the mother were able to talk about the struggle to disclose to Sam, the patient, that he was dying. Dr. Paul Rousseau offers a great analysis of the faulty-thinki...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 31, 2016 Category: Palliative Care Tags: cancer CPR ethics geriatrics JAMA journal article narrative opioids pain research review surgery Source Type: blogs

What happens when it ’s you?
by Michael FratkinNobody was prepared when Barbara ’s husband died quickly last month. It turns out, he was both covering for her difficulties and caring for her 24 hours a day. Barbara was accompanied throughout life by a profound depression and, for 40 years by a man who was many things. Strong with integrity and a dedication to Barbara, he had a 24/7 obsession with Fox News. No one, especially his family, described him as nice. He pretended she was functioning reasonably well, even after an anoxic brain injury took its toll three years ago. Since his death, Barbara’s two daughters suspended their own lives a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 30, 2016 Category: Palliative Care Tags: fratkin hpm hpmchat tweetchat Source Type: blogs

Photovoice Roundup: Self Care
We asked hospice and palliative care professionals to answer us via a picture, " What is your self care activity of choice? "We learned a lot about our colleagues from this exercise. Everyone had unique answers for ways in which they comfort themselves. (Source: Pallimed: A Hospice and Palliative Medicine Blog)
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 26, 2016 Category: Palliative Care Tags: lizzy miles photovoice roundup self-care Source Type: blogs

Building Resilience in Clinicians to Prevent Burnout
by Arif KamalOn the topic of palliative care clinician wellness, we are starting to recognize that there is some good news to counter all the bad. First, the bad news. If you ’re reading this, and you believe that burnout has not touched your professional life, then it is likely that the colleagues sitting to the immediate left and right of you are not so lucky. Recent survey data of over 1300 palliative care clinicians highlight a sobering statistic: almost two-thir ds of our colleagues report burnout (Kamal JPSM 2016). This is among the highest rate of all medical disciplines, and significantly higher than the 45% ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 23, 2016 Category: Palliative Care Tags: burnout kamal The profession Source Type: blogs

Redefining “Death in Dignity”: Sherwin Nuland’s How We Die
by Vivian LamWe begin with an image of Sherwin Nuland as a bright-eyed third year medical student, cutting open a dead man ’s chest and cupping his heart with bare hands.After several moments of desperation, the man, James McCarty, roars a death rattle that stops Nuland in his tracks. We look upon a vivid scene of carnage and defeat —Nuland is soaked with sweat and blood, sobbing and “demanding that he live, screaming his name into his left ear as though he could hear me, and weeping all the time with the frustration and sorrow of my failure, his” (7). Dave, the intern on duty, comes into the room a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 17, 2016 Category: Palliative Care Tags: book lam media review surgery Source Type: blogs