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Photovoice Roundup Call for Submissions: Self Care
Introducing a new fun visual roundup for Pallimed.org Your mission, should you choose to accept it... Send us ONE square photograph from your life that represents your self-care activity of choice. Tell us in ONE sentence about this activity. " I like to bowl because it makes me feel young again. " The fine print: Photos must be original, by author. Include one sentence description.   Include your name, hospice/palliative care role and Twitter handle (if you have one). Submission of photo indicates a release for publication on Pallimed.org We may not be able to publish all entrie...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 29, 2016 Category: Palliative Care Tags: call for submissions photo photovoice roundup self care Source Type: blogs

Pallimed Roundup: The Best Advice
The editors of Pallimed are proud to announce a new editorial feature: Pallimed Roundup. In these articles we will publish a collection of quotes culled from palliative care professionals around the world. Looking back on the early days in your hospice and palliative career, what is the best advice you received? “Best advice - find a mentor and be a mentor!” – Shirley Otis-Green, MSW, MA, ACSW, LCSW, OSW-C Twitter: @sotisgreen Learn from your patients... “Thinking back to all of the wonderful mentors I had over the years, I always go back to my very best mentors---patients and their caregivers...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 27, 2016 Category: Palliative Care Tags: boundaries mentor palliative reflect roundup self-care Source Type: blogs

Against Euphemisms - Part 4 - Assisted Death
by Drew Rosielle (This is the last of four posts by Drew on the language we use in hospice and palliative care. You may want to read his reflection on 10 years of practice or his other posts on euphemisms - " Comfort Care, " " Palliative Sedation, " and " Compassionate Extubation. "  - Ed.) " Assisted Death " - So many problems here. A) To start with, I don't see a need to replace'euthanasia' or'physician-assisted suicide' or'assisted suicide' with new terms. Because those terms have, at the end of the day, well-defined, internationally agreed-upon definitions. The pub...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 26, 2016 Category: Palliative Care Tags: ethics/law euphemisms euthanasia/suicide rosielle The profession Source Type: blogs

It is as simple as saying “Hello, my name is…”
by Christian Sinclair This weekend I was on-call for our inpatient palliative care consult service. As I reviewed the list, I knew only a handful of the patients from seeing them earlier in the week. We had three new consults and had to make a handful of follow-up visits for symptom control and goals of care discussions. Many of the people I met this weekend, I had never met before and I knew we would need to start talking about very challenging issues within in a short order of time. Thankfully I had a simple tool, that made these potentially awkward situations much easier for me, the patients, the families and staff: a ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 25, 2016 Category: Palliative Care Tags: communication The profession tribute Source Type: blogs

Hope is a Hot Button
by Kathy Kastner As life draws to an end, hot buttons need only be barely touched to set off flares of righteousness. Hope is one such hot button, and often seems attached to ‘false’ – which crushes hope dead. I rail every time I hear the righteous pronounce: “You don’t want to give them false hope.’ Why is hope so contentious when benefits have proven huge? From Dr. Jerome Groopman ’s The Anatomy of Hope : " Belief and expectation -- the key elements of hope -- can block pain by releasing the brain's endorphins and enkephalins, mimicking the effects of morphine. In s...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 24, 2016 Category: Palliative Care Tags: chat hpmchat kastner tweetchat Source Type: blogs

Against Euphemisms - Part 3 - Palliative Sedation
"Palliative Sedation."Golly I hate this one. Frankly 'terminal sedation' was better, because it was at least less confusing, but  neither of them are clear or transparent, and particularly 'palliative sedation' is just so confusing and potentially laden with too many meanings to be ever useful. There are so many clinical scenarios out there in which someone is sedated (deliberately, or as an aftereffect of trying to control pain/anxiety/dyspnea/etc; deeply or lightly; continuously until death vs temporarily as respite) in circumstances that the average person would agree would be 'palliative' or 'of-palliati...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 20, 2016 Category: Palliative Care Tags: euphemisms palliative sedation rosielle The profession Source Type: blogs

Mindfulness Prayer to Begin IDT Meetings
by John FlorianI am a hospice chaplain working in Central Ohio and am asked in that role to provide a prayer at the beginning of our interdisciplinary team meetings. I want the prayer to be truly interfaith and non-denominational, but even more importantly, I want the prayer to meet the team where it is in the moment, and to inspire them in their work. I use a mindfulness bell to set the tone for the prayer and to create a space in the day.Here is a prayer I created for our team:(mindfulness bell)Let's take a deep breath . . . and find our spiritual center (pause)May God bless our ministry today.We call to mind the patient...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 17, 2016 Category: Palliative Care Tags: chaplain idg idt mindfulness prayer spirituality Source Type: blogs

Against Euphemisms - Part 2 - Compassionate Extubation
by Drew Rosielle(This is the second of four posts by Drew on the language we use in hospice and palliative care. You may want to read his reflection on 10 years of practice or his first post on euphemisms - "Comfort Care." - Ed.)Euphemistic phrase #2 that I'd like to never hear again: "Compassionate extubation."By which people typically mean 'extubating someone who is on invasive mechanical ventilation who is not expected to survive long, to a plan of care that focuses on symptom alleviation.'What bugs me about it is the use of the term 'compassionate' to try to encompass the idea of a dying patien...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 13, 2016 Category: Palliative Care Tags: euphemisms icu rosielle The profession Source Type: blogs

Passing the Hospice and Palliative Medicine Boards
by Christian SinclairCongrats to all of the 200+ new attending hospice and palliative medicine (HPM) physicians who completed fellowship at the end of June. We've already compiled advice on how to be the best physician you can be, but now you are probably starting to think about passing the HPM boards come November 7th, 2016*. (Same goes for those fellows who finished in 2015, since the board exam is on a two-year cycle.)You will find some good information on the American Academy of Hospice and Palliative Medicine (AAHPM) subspecialty certification page. But beyond knowing the blueprint and areas covered by the exam, what ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 12, 2016 Category: Palliative Care Tags: Blogs to Boards sinclair The profession Source Type: blogs

JAMA Got It Wrong: Giving Prognostic Information to Families of Critically Ill Patients Is Not the Same as Palliative Care
by Elizabeth LindenbergerI know I am not alone in my disappointment this week with the authors’ conclusions in “Effect of Palliative Care-Led Meetings for Families of Patients with Critical Illness: A Randomized Clinical Trial.” The study intervention involved the provision of an informational brochure and two focused meetings specifically designed to provide families with information about prognosis. The study found no difference in most outcomes between usual care and the intervention, and PTSD symptoms were in fact increased in the intervention group. The authors concluded that "these findings do ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 11, 2016 Category: Palliative Care Tags: communication families family JAMA Lindenberger palliative prognosis prognosticate Source Type: blogs

Building Online Community in Hospice and Palliative Care
by Christian T Sinclair In this digital age, it is common to hear how devices isolate us from real authentic relationships. There are books written about how no one gets together once a week at the bowling alley or the coffee house, to just talk with friends and build that valuable relationship glue. I chuckle when I hear these concerns, because what I have experienced has been quite the opposite with the weekly #hpm chat on Twitter.*(If you just saw the hashtag or the word Twitter and you immediately thought “I don’t do Twitter,” stick with me until the end!) Next Thursday marks the 6th anniversary of #h...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 8, 2016 Category: Palliative Care Tags: chat hpmchat sinclair tweetchat Source Type: blogs

Against Euphemisms - Part 1 - Comfort Care
by Drew RosielleWell, I've been practicing palliative medicine for 10 years - 11 including my fellowship. So I feel like maybe I can take off my young turk hat, and put on my grumpy old man socks (I'm looking at you Bob Arnold and David Weissman) and start complaining.What I wanted to complain about is the use of euphemistic, moralistic, and/or confusing terminology in our field, to describe our clinical work, and suggest we'd all be better off if we just said what we mean, as cleanly as possible. All of medicine has this problem, but palliative care you are my tribe, so this is what I'm going to complain about today and o...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 7, 2016 Category: Palliative Care Tags: euphemisms rosielle The profession Source Type: blogs

When Dying isn't Enough for Family to Forgive
This article is the fifth 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 People don ’t want to be alone when they die. Here is our next assumption: Family matters will get resolved. A bestselling book by Dr. Ira Byock, The Four Things That Matter Most , suggests that at the end of the day, or at the end of life, it all boils down to these simple thoughts: “Please forgive me,” “I forgive you,” “Thank yo...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 1, 2016 Category: Palliative Care Tags: assumptions Byock family forgive lizzy miles reconciliation relationship resolve triangulation Source Type: blogs

When Dying isn't Enough for Family to Forgive
This article is the fifth 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 People don’t want to be alone when they die.Here is our next assumption: Family matters will get resolved.A bestselling book by Dr. Ira Byock, The Four Things That Matter Most, suggests that at the end of the day, or at the end of life, it all boils down to these simple thoughts:“Please forgive me,”“I forgive you,”“Thank you,”and &ld...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 1, 2016 Category: Palliative Care Tags: assumptions Byock family forgive lizzy miles reconciliation relationship resolve triangulation Source Type: blogs

Looking Back on 10 Years of Palliative Medicine
by Drew RosielleJuly 1, 2006 was the day I became a staff palliative care physician at the Medical College of Wisconsin, after having completed my fellowship there. So it's been 10 years I've been doing this, and I've been reflecting a little on what's changed in those years. So here are my thoughts. I don't want to pretend all of these are profound, most of them have been said by others before, and better, but things have changed in these 10 years - I've changed - and I decided to write a little about it. Much of this is just my own perceptions of things, a lot of them are my own misconceptions probably, and I don't want ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 30, 2016 Category: Palliative Care Tags: opioids palliative care physician rosielle The profession Source Type: blogs

The Clare Project and " What Matters Most? " to young people with advanced cancer
by Karen J. Wernli In the summer of 2014, my sister-in-law, a new mother, died of cancer after 11 years with her disease. Although doctors gave her the best care they could, as a health researcher focused in cancer care, I wanted to do better for people like Clare. Then, at a scientific conference that fall, I learned that others had the same desire. Representatives from the National Cancer Institute were asking for studies to improve care for adolescents and young adults, including at the end of life. On the plane home, I started working with my research ideas. I realized that to know what young people with advanced-stag...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 29, 2016 Category: Palliative Care Tags: cancer pediatrics tweetchat twitter young adult Source Type: blogs

The Clare Project and "What Matters Most?" to young people with advanced cancer
by Karen J. Wernli In the summer of 2014, my sister-in-law, a new mother, died of cancer after 11 years with her disease. Although doctors gave her the best care they could, as a health researcher focused in cancer care, I wanted to do better for people like Clare. Then, at a scientific conference that fall, I learned that others had the same desire. Representatives from the National Cancer Institute were asking for studies to improve care for adolescents and young adults, including at the end of life. On the plane home, I started working with my research ideas. I realized that to know what young people with advanced-stage...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 29, 2016 Category: Palliative Care Tags: cancer pediatrics tweetchat twitter young adult Source Type: blogs

Pallimed Roundup: Advice to Graduating Palliative Fellows
The editors of Pallimed are proud to announce a new editorial feature: Pallimed Roundup. In these articles we will publish a collection of quotes culled from palliative care professionals around the world.Our first question was: What advice would you give to graduating palliative fellows? “Let the patient's and family's goals be your guide. You will be, and should be involved in discussions of discharge planning, financial and insurance issues, hospice and mortality statistics, but your true north should remain the goals of your patient and family.”-Ross Albert, MD PhD“Keep loving your patients till the e...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 20, 2016 Category: Palliative Care Tags: advice albert bloise Bruera Byock cleary fratkin graduation palliative quotes roundup rousseau yang zacharias Source Type: blogs

Hospice and Palliative Care in Six Words - Celebrating Pallimed's 11th Anniversary
by Christian Sinclair Eleven years ago today Drew Rosielle posted his first post to pallimed.blogspot.com* about Hospice and Palliative Medicine becoming slated to be officially recognized as a specialty by ABIM and ABFM! We had a great year commemorating our 10th year anniversary . We posted 123 new posts to pallimed.org, a new 4-year high (that we are planning on breaking this year!) The Pallimed Facebook page flew past 10,000 likes , #hpm chat is still going strong , and we are starting to explore other social media platforms like Instagram . We still have a lot of work to do ahead this year, like: further establish...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 8, 2016 Category: Palliative Care Tags: meta sinclair Source Type: blogs

Hospice and Palliative Care in Six Words - Celebrating Pallimed's 11th Anniversary
by Christian Sinclair Eleven years ago today Drew Rosielle posted his first post to pallimed.blogspot.com* about Hospice and Palliative Medicine becoming slated to be officially recognized as a specialty by ABIM and ABFM! We had a great year commemorating our 10th year anniversary. We posted 123 new posts to pallimed.org, a new 4-year high (that we are planning on breaking this year!) The Pallimed Facebook page flew past 10,000 likes, #hpm chat is still going strong, and we are starting to explore other social media platforms like Instagram.We still have a lot of work to do ahead this year, like:further establishing the Pa...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 8, 2016 Category: Palliative Care Tags: meta sinclair Source Type: blogs

How to be an Advocate for Hospice and Palliative Care
by Lauren Drew Front line caregiving is an all-consuming job. Even if you are technically “off the clock,” you are still carrying the emotional exhaustion of your day. You may work twelve hour shifts, and return home to care for your own family. Finding time for self-care is nearly impossible. I fully understand why most hospice and palliative care providers tell me that they just “don’t have the capacity” for advocacy. To them, advocacy is something that requires tons of time, or maybe a PhD in Political Science, or a close friendship with a Member of Congress. It requires none of these thing...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 7, 2016 Category: Palliative Care Tags: #hpm advocacy drew health policy hpmchat politics tweetchat Source Type: blogs

Communication & Practice: Re-Imagining the End-Of-Life Experience
by Stacey Tinianov Transformative change takes time and effort yet these epic journeys always begin with single steps. With bite-sized change in mind, how might we encourage little shifts in the way we communicate and practice to catalyze big change in re-imagining the end-of-life experience? Redesigning Communication If we would like to re-imagine the end-of-life experience, might we begin to reconsider our terminology as it relates to death? “She lost her battle with cancer.” Winners and loser conversations may be better suited for discussions around play-off games. When someone dies from their illness,...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 1, 2016 Category: Palliative Care Tags: communicaiton death openIDEO patient tinianov Source Type: blogs

Communication & Practice: Re-Imagining the End-Of-Life Experience
by Stacey TinianovTransformative change takes time and effort yet these epic journeys always begin with single steps. With bite-sized change in mind, how might we encourage little shifts in the way we communicate and practice to catalyze big change in re-imagining the end-of-life experience? Redesigning Communication If we would like to re-imagine the end-of-life experience, might we begin to reconsider our terminology as it relates to death? “She lost her battle with cancer.” Winners and loser conversations may be better suited for discussions around play-off games. When someone dies from their illness, claimi...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 1, 2016 Category: Palliative Care Tags: communicaiton death openIDEO patient tinianov Source Type: blogs

Tell Me a Real Story
by Staci Mandrola Charlotte is three and a half years old. She loves stories. I tell real stories. John tells made up stories. The first words we hear when Charlotte walks in the house are “Tell me a story, PaPa!” Stories put me on a path more than 40 years ago. The path to being a doctor and then a hospice and palliative medicine doctor. I listened to my grandmother tell stories about her physician father leaving the house to check on a woman in labor or a dying patient. He might not return for days. His payment ranged from a chicken to a milk cow to a beat up John Deere. I listened to my dermatologist father ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 10, 2016 Category: Palliative Care Tags: mandrola narrative physician The profession Source Type: blogs

Beyond the Primary Caregiver: Supporting the Other People in a Palliative Patient ’s Circle
This article addresses systems theory and how we can provide support for additional people in the palliative patient ’s life, beyond the primary caregiver. This is the fifth article in a series of joint conversations about the similarities and differences with pediatric and geriatric specialty populations. (Read the other posts: Developmental Life Cycles , Social Work Research , End-of-Life Decisions , Getting Started ). In many articles about hospice and palliative care, there is an additional emphasis placed on supporting the caregiver in addition to the patient.  In our work with patients, we are often a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 9, 2016 Category: Palliative Care Tags: caregiver caregiving family hospice miles palliative PCG Shukraft social work social worker systems theory Source Type: blogs

Beyond the Primary Caregiver: Supporting the Other People in a Palliative Patient’s Circle
This article addresses systems theory and how we can provide support for additional people in the palliative patient’s life, beyond the primary caregiver. This is the fifth article in a series of joint conversations about the similarities and differences with pediatric and geriatric specialty populations. (Read the other posts: Developmental Life Cycles, Social Work Research, End-of-Life Decisions, Getting Started).In many articles about hospice and palliative care, there is an additional emphasis placed on supporting the caregiver in addition to the patient.  In our work with patients, we are often asked to ide...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 9, 2016 Category: Palliative Care Tags: caregiver caregiving family hospice miles palliative PCG Shukraft social work social worker systems theory Source Type: blogs

Measures that Matter in Advanced Illness Care
by Meredith MacMartinI was drawn to the field of palliative care by something subjective, the feeling of deep satisfaction from providing goal-aligned care for my patients, and the desire to do that better. In training, I came to realize that while much of our work lies in the qualitative realm, the key to doing it better lies in the underlying structure and frame of good communication, symptom management, and care coordination. It is no surprise to me, then, that palliative care is embracing the increasing emphasis on healthcare quality and value; in other words, the quantitative measures that underlie the qualitative exp...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 27, 2016 Category: Palliative Care Tags: macmartin quality Source Type: blogs

Making Palliative Care Stand out on Capitol Hill - Apr 27 - Virtual Lobby Day
by Christian SinclairSure all this political smack talk in a presidential election year has probably got you a little bit jaded and tired. Yet, you have a chance to make a difference in lives of people you will never see by helping solidify the foundation of education and training for palliative care and hospice.This Wednesday April 27, 2016 is designated as the Virtual Lobby day for PCHETA (Palliative Care and Hospice Education and Training Act). On Wednesday, advocates from over 30 different organizations are working together to tell their legislators about PCHETA and why it should be supported in both the House and the ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 25, 2016 Category: Palliative Care Tags: pcheta politics sinclair Source Type: blogs

" Why (not) me? " Why doctors do it differently......
In this study, almost 90% of surveyed physicians, presumably healthy, would forego resuscitation efforts for themselves. In our next   #hpm chat , on Wednesday, April 20th, 2016, let ’s unpack this head-scratching situation together--not just for doctors, but for all of us…nurses, social workers, chaplains, program folks… that have reason to think differently about the nature of modern dying and our desired intensity of medical treatment. Topic 1:   What do you think about those of us in healthcare, with knowledge about the limitations of modern medicine, choosing less of...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 18, 2016 Category: Palliative Care Tags: #hpm death dying medical services medicine models of care modern medicine palliative care Source Type: blogs

"Why (not) me?" Why doctors do it differently......
In this study, almost 90% of surveyed physicians, presumably healthy, would forego resuscitation efforts for themselves.In our next #hpm chat, on Wednesday, April 20th, 2016, let’s unpack this head-scratching situation together--not just for doctors, but for all of us…nurses, social workers, chaplains, program folks… that have reason to think differently about the nature of modern dying and our desired intensity of medical treatment.Topic 1: What do you think about those of us in healthcare, with knowledge about the limitations of modern medicine, choosing less of it?  Topic 2: What ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 18, 2016 Category: Palliative Care Tags: #hpm death dying medical services medicine models of care modern medicine palliative care Source Type: blogs

A Rose by Any Other Name...Complimentary Therapies in Palliative Care
by Susan Thrane, RN, PhDNon-western, non-medical, non-allopathic modalities have been called by many names: complementary and alternative medicine (CAM), integrative, supportive, adjuvant, placebo and hooey just to name a few. Whatever you call them (I prefer complementary or integrative), modalities such as massage, yoga, aromatherapy, guided imagery, meditation, energy therapies such as Reiki, Healing Touch, Therapeutic Touch, or creative art therapies (these include dance/movement, art, and music therapies provided by a trained therapist) do require training for the person providing th...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 5, 2016 Category: Palliative Care Tags: adolescents alternative therapy cam children complementary therapy infants integrative therapy palliative care pediatric pediatrics symptoms Source Type: blogs

Physicians Recieving Botox Score Lower on Empathy and Patient Satisfaction
by Abe R. Feaulx, Pallimed Special Reporter Researchers published a new study in JMAC (The Journal of Middle Aged Concerns)  reporting interesting findings related to a recent study on the effect of various anti-aging cosmetic procedures on providers’ ability to emote empathy to patients and families. Providers in the study were randomized into two groups: one group received injections of an inactivated toxin commonly used as a facial muscle paralytic into their foreheads, while the second group received placebo injections. Over the course of the following month, the providers were scored, by their patients, on ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 1, 2016 Category: Palliative Care Tags: feaulx Source Type: blogs

CDC Chronic Pain Guidelines: Not so bad, but...
by Tom QuinnIn case you didn’t notice, the US Centers for Disease Control published their long-awaited (dreaded?) “CDC Guideline for Prescribing Opioids for Chronic Pain.” It made a pretty big splash: Five editorials plus the full Guideline in the online Mar 15 JAMA, front page New York Times feature article, the first hour on NPR’s “Diane Rehm Show,” (Mar 17) and multiple others. It is specifically aimed at primary care prescribers, who write about half of the scripts for opioids in the US. It is intended to “support clinicians caring for patients outside the context of active can...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 30, 2016 Category: Palliative Care Tags: CDC ethics opioids pain quinn The profession Source Type: blogs

Do You Feel The Churn?
by Dr. Linda Liotti, D.O.Do you feel the Churn?  Over the last thirty years, there have been changes in the hospice and palliative care industry. Years ago, nurses carried a case load of 12 – 15 patients. Each patient was seen on a regular basis, their needs and concerns taken care of by the nurse and multidisciplinary team on a weekly basis. Most patients would be followed until death, however a few graduated from hospice when the IDT found they had stabilized.Recently speaking with several colleagues, we noted a trend which suggests the turnaround time from admission to death continues to shrink. When we atten...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 29, 2016 Category: Palliative Care Tags: churn compassion fatigue length of stay Source Type: blogs

Time of Death: Some Patients Prefer to Die Alone
This article is the fourth in a series of articles where I will 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 Family will want to be with their loved one when they are dying.Here is our next assumption: People don’t want to be alone when they die.This may be an unpopular assertion within my own hospice industry for me to advocate for leaving a patient alone sometimes. Hospices have entire programs devoted to assuring patients and families that they will not ever be alone...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 28, 2016 Category: Palliative Care Tags: assumptions hospice lizzy miles NODA social work social worker time of death Source Type: blogs

Thank a Clinical Social Worker Today
By Vickie LeffMarch is Social Work Month – a great excuse to take a moment and celebrate the work that clinical social workers do in palliative care. But, hang on, perhaps we should be doing more than that. Can we adjust our lens settings and challenge ourselves to see clinical social work differently?Palliative Care is a team sport; the standard model of practice includes an MD, NP and CSW. My challenge to all of you would be to make sure you are all equal partners in our unequal medical world. CSW’s can’t bill for in-patient visits, we can’t generate RVU’s for the hospital system, and it&rsq...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 27, 2016 Category: Palliative Care Tags: clinical CSW palliative social work social worker Vickie Leff Source Type: blogs

NephMadness and Palliative Care - A Novel Education Concept
In this study the entire cohort showed a survival advantage with dialysis care but on further subgroup analysis, patients over the age of 80 did not gain additional time on earth by choosing dialysis. In this case dialysis did not extend life. Nephrologists need to start to train ourselves away from the reflex that dialysis is a way to extend life. In some easily identifiable patient groups it provides as much harm as benefit. And this is just counting days alive. If you compare the quality of those days, perhaps by looking at Tamura's Functional status study, dialysis begins to look especially grim. This makes me happy th...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 23, 2016 Category: Palliative Care Tags: #hpm education hpmchat nephrology topf tweetchat twitter Source Type: blogs

Palliative Care in Nephrology - So Many Opportunities!
by Christian SinclairIf you asked most people to name what types of illness would most likely benefit from palliative care support, cancer is probably at the top of that list, followed by cardiac disease, and possibly neurologic disorders. Nephrology on the other hand is not often seen as a common area for the approaches of palliative care. At most HPC conferences I go to, I may see only one topic exploring the unique palliative issues surrounding renal disease, despite the significant functional and symptom burden of advanced kidney disease.Thanks to social media I have found a group of nephrologists who are open to the c...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 21, 2016 Category: Palliative Care Tags: nephrology sinclair Source Type: blogs

Depression matters - we should ask about it
by Kristina Newport, MDAs we care for patients with serious illness, we frequently encounter depressed mood. Multiple studies have shown depression independently contributes to morbidity and mortality, and yet most of us do not systematically screen for it. This is again illustrated in Lloyd-Williams’ et. al recent study of 629 patients with advanced cancer attending palliative care day centers in England. Patients in this study identified as moderately to severely depressed on the PHQ-9 died three weeks sooner than those with no or only mild depression. A similar result was identified in patients who reported consid...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 1, 2015 Category: Palliative Carer Workers Tags: depression newport psych Source Type: blogs

Why the thickened liquid challenge is important
Empathy via participation is a technique that probably deserves wider attention in health professions education. Drs Eric Widera and Alex Smith and the team at UCSF have come up with the ingenious Thickened Liquids Challenge. Thickened liquids can be a treatment that is overly used and poorly understood for any person who has swallowing difficulties. Most clinicians will be familiar with the terms ‘nectar-thickened’ and ‘honey-thickened’ from any experience in geriatrics or neurology. So taking the popularity of the ALS Ice Bucket Challenge and mashing it up with a likely non-harmful* experiential o...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 29, 2015 Category: Palliative Carer Workers Tags: geriatrics speech Source Type: blogs

National Drug Facts Week with Pharmacy Professor Mary Lynn McPherson!
by Mary Lynn McPherson, PharmD, MA, BCPSThis week is National Drug Facts Week! Why do we tell patients to take furosemide on an empty stomach? Ok, it’s not quite “why did the chicken cross the road” but it’s still an important drug fact! The answer is that taking furosemide on an empty stomach doubles the bioavailability and clinical response! If you want to learn about additional awesome drug facts – tune in this Wednesday evening, January 28, 2015 at 6 pm PST/9 pm EST for the #hpm tweet chat! We’ll also be talking about the utility/futility of medications as patients approach the e...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 28, 2015 Category: Palliative Carer Workers Tags: mcpherson opioids pharmacy Source Type: blogs

2015 Pallimed and GeriPal Party - Philadelphia!
Time to gather your peers and join fellow readers of Pallimed and GeriPal for our annual party at the Annual Assembly of AAHPM and HPNA (and anyone still in town after SWHPN's conference on Monday and Tuesday!). Since the last two years were such a success with the progressive party, we will be doing that again this year. We will begin at McGillin’s at 8pm. After that follow the hashtag #HPMparty or our Facebook event page where we will be posting updates on the next location. All are welcome, this is no exclusive crowd. There will be many writers from both websites at the party and we always like to meet readers and...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 26, 2015 Category: Palliative Carer Workers Tags: meta sinclair social networking Source Type: blogs

Results of 2014 Stories of the Year in Hospice and Palliative Medicine
by Christian Sinclair, MD, FAAHPMThe results are in and the public* has had their say!The top story of the year in hospice and palliative medicine for 2014 is Atul Gawande's "Being Mortal" being published and becoming a best seller on numerous lists.  The honorable mention for story of the year was the Institute of Medicine publishing the Dying in America: Improving Quality and Honoring Individual Preferences near the End of Life. Here is the full list with links of all the top stories.Here is the complete list of the top stories by category with the notable person or organization indicated in parentheses.St...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 25, 2015 Category: Palliative Carer Workers Tags: poll sinclair year in review Source Type: blogs

January 2015 HPMJC: Palliative Care and heart failure in primary care
by Katherine Sleeman and Tara WhitburnOn Monday 26th January 2015 from 8-9pm London Time (3-4p New York/ET and Noon-1p California/PT) we will be holding the monthly twitter journal club for hospice and palliative medicine: #hpmjc. The aim of the journal club is to provide an informal multidisciplinary forum for discussion of latest research findings, and we hope you will join us!You can find some more information about the journal club #hpmjc here in a previous Pallimed post. The paper for discussion this month is ‘Palliative Care among Heart Failure Patients in Primary Care: A Comparison to Cancer Patients Us...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 24, 2015 Category: Palliative Carer Workers Tags: heart failure hpmjc sleeman social media tweetchat twitter whitburn Source Type: blogs

Review of The Conversation: A Revolutionary Plan for End-of-Life Care by Angelo Volandes
by Andi Chatburn, DOAs a palliative care physician, The Conversation by Dr. Angelo Volandes is a book I want to see being read, passed along and read again in every coffee shop, book club and doctors’ lounge in my community. Volandes describes his new book The Conversation as a memoir, but in truth it is a “how-to” guide for having tough discussions in the context of serious illness. It is a “quick-start” for ubiquitous primary palliative care. Nothing in this book will be earth-shattering or revolutionary to the Palliative Care physician- it chronicles our every day experience. What makes Vol...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 23, 2015 Category: Palliative Carer Workers Tags: advance care planning book chatburn review Source Type: blogs

Palliative Care Everywhere!
by Cory Ingram, MD This Wednesday I look forward to a conversation on how palliative care principles and practices are able to be embedded across health systems in to various disciplines and delivery forms. Palliative care principles when applied in various clinical situations improve the quality of care for patients and families and even their longevity and care affordability. For the first time in history our society is experiencing an unprecedented medical and social situation. It is unprecedented that people are living longer, requiring more complex care, and experiencing more burdens of illness and treatment and dying...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 14, 2015 Category: Palliative Carer Workers Tags: ingram palliative care social media The profession tweetchat twitter Source Type: blogs

Hospice and Palliative Care: The Year in Review 2014
by Christian Sinclair, MD, FAAHPMLooking back on 2014, it seemed like hospice and palliative care issues were constantly in the news. But then again, I may be standing in the single loudest position in the echo chamber of palliative care. Even with the awareness of that bias, it is clear to me that we had many significant events this year in our field that will really influence where we go in 2015 and beyond. (Although if you look at the graph below hospice and palliative care are steady to declining in percentage of search on Google.)We have never done a formal year in review here at Pallimed, and now that we are finally ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 13, 2015 Category: Palliative Carer Workers Tags: book film hospice HuffPo media philanthropy sinclair social media twitter WaPo year in review Source Type: blogs

POLL - Hospice and Palliative Care: The Year in Review 2014
We would love to hear what you thought about the tops stories for hospice and palliative care in 2014.  Have some fun and take our survey!  If you want to learn more about the stories you see in this poll take a look at our year-end wrap up.Loading... (Source: Pallimed: A Hospice and Palliative Medicine Blog)
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 13, 2015 Category: Palliative Carer Workers Tags: media sinclair survey The profession Source Type: blogs

Sharing your genius in hospice and palliative care
by Allie Shukraft, LCSWA, MSW, MATThis morning was like many on the weekends.  I got up before the rest of the humans in the house, fed the dogs and let them out while I tooled around in the kitchen. The room was, I'll be honest, a typical after-holiday mess, so it took me a few minutes to notice the small package that had come unannounced in the mail the day before.  It was addressed to me, like so many boxes had been in the weeks leading up to Christmas, but unlike those other boxes, I had no recollection of ordering this one.  I opened the package, eager to see what I had forgotten that I had ordered only...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 12, 2015 Category: Palliative Carer Workers Tags: collaboration Shukraft social work The profession Source Type: blogs

Using validation to prevent crazy making in caregivers
by Debra Parker Oliver, MSW, PhD and Jessica Oliver Tappana, MSW I have worked as a hospice social worker, administrator, and researcher for 35 years. I now find myself a hospice caregiver for my husband who has Stage IV cancer. Despite my professional experience, I have had to learn many things about being a caregiver. Perhaps one of my most important lessons has been the unexpected experience of feeling “crazy”. I find my day-to-day reality is often in contrast to others around me, leading me to question my sanity. This is a new and unfamiliar distress not found in caregiving literature. It is however, not un...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 9, 2015 Category: Palliative Carer Workers Tags: caregiving oliver social work tappana Source Type: blogs