The Role of Hospice and Palliative Medicine in Education
Discussion topics:T1: What are the main systemic barriers to good communication in healthcare?T2: What is your favorite education tool? (Think broadly!)T3: What is your favorite “high-yield” question to ask patients? Patients, what’s the one Q you want your HCP to ask?Meredith MacMartin is a palliative care physician atDartmouth-Hitchcock Medical Center in Lebanon, NH. (Source: Pallimed: A Hospice and Palliative Medicine Blog)
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 28, 2017 Category: Palliative Care Source Type: blogs

Should Clinicians Be More (or Less) Politically Active?
by Christian SinclairPolitics and healthcare are occupying much of the news cycle this summer with all of the discussions around the possible repeal of the Affordable Care Act (AKA Obamacare). On one hand it can viewed as must-see reality TV with all of the drama and back and forth arguments with passionate opposition. Late-night TV hosts help turn the drama into satire and give everyone a good laugh and some entertainment. Yet it is important to see that this will greatly impact the care of the patients we see every day.To be honest, it was not until a few years ago that I started to see the power of getting more politica...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 26, 2017 Category: Palliative Care Tags: AAHPM health policy politics sinclair tweetchat twitter Source Type: blogs

Choice: The Hidden Curriculum in Palliative Care
By Paul CarrThank you to Dr. Naheed Dosani and the excellent team at William Osler Health Centre for inspiring this post.What three words describe the essence of palliative care for you? When I asked my friends, family, and colleagues, the most common answers are: pain management, personal and spiritual support, and end of life planning. Those are all key components. But what quickly became apparent to me during my palliative care elective is that excellent palliative care providers embrace the role of enabling patients and families to make well-informed choices.I have taken a long and untraditional route to arrive in the ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 17, 2017 Category: Palliative Care Tags: choice communication goals palliative paul carr Source Type: blogs

Palliative Care & CHF: PAL-HF trial
The main results of PAL-HF - a randomized, controlled trial of specialty palliative care team involvement in advanced heart failure patients -  have just been published in the Journal of the American College of Cardiology (DOI: 10.1016/j.jacc.2017.05.030. Clinicaltrials.gov registration here). This is an important, well-done study, with encouraging results - specialty PC improved the quality of life of patients with HF. I'll discuss the results in more details in this post.The study was done by a multi-disciplinary team of palliative& cardiology investigators at Duke. This week's publ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 14, 2017 Category: Palliative Care Tags: chf heart failure research research issues rosielle Source Type: blogs

Upstream Palliative Care and Dissecting Hope From Hype in Oncology
by Christian SinclairWorking in an outpatient cancer center, I frequently encounter the conversation about whether the next cancer treatment regimen is ‘worth it.’ Patients and families consider may interpretations of worth; financial being one of course, but also physical side effects, the emotional toll of investing faith into ‘one more treatment’ and hoping that it works. These conversations are challenging as they weigh biological, medi cal, spiritual, social, personal, emotional and other issues, so there is no neat equation which can easily tell you if the benefits or the risks are greater.The...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 28, 2017 Category: Palliative Care Tags: sinclair tweetchat Source Type: blogs

Perusing ASCO 2017 - AKA Time for Lorazepam
(Source: Pallimed: A Hospice and Palliative Medicine Blog)
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 8, 2017 Category: Palliative Care Tags: ASCO cancer oncology pallonc research research issues rosielle WaPo Source Type: blogs

Persuing ASCO 2017 - AKA Time for Lorazepam
Photo from ASCO Mediakit. © ASCO/Danny Morton 2017TheAnnual Meeting of the American Society of Clinical Oncology was last week. It ’s been my observation over the years that much of the best palliative-oncology and supportive-oncology research is presented at ASCO each year, before it’s actually published (if it ever gets published).  So I always dig through the palliative/EOL/supportive/psychooncology abstracts each year to see what's happening. Below is a gently annotated list of the abstracts that caught my eye the most, for your perusal and edification. Undoubtedly, these are my idiosyncratic...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 8, 2017 Category: Palliative Care Tags: ASCO cancer oncology pallonc research research issues rosielle WaPo Source Type: blogs

Stand Up! For Each Other as the Year Marches on
By Vickie LeffStand Up! was 2017 ’s theme for Social Work Month. As many of us know, social workers are excellent advocates; advocacy it is a core skill that is integral to our teaching, profession, and interventions. In celebration of that theme, as March concludes, I want to challenge you to spread that enthusiasm and charter a cross the palliative care universe this year. After all, palliative care is a team sport, defining itself not whole until a physician, nurse and social worker (at a minimum, with ideally many more disciplines involved) are members. This is not a random collection of professionals, but a calc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 1, 2017 Category: Palliative Care Tags: advocacy interprofessional self-care social work social worker teamwork Vickie Leff Source Type: blogs

Looking Forward to #hpm Chats in 2017
InJuly 2010, Christian and I had a conversation about finding ways to bring people together online to connect, collaborate and learn more about topics in hospice and palliative care. We had seen some fascinating discussions with#hcsm, the health care social media community and decided to launch the#hpm chat as a weekly interdisciplinary discussion of issues in hospice and palliative care. I never imagined how this idea would develop into such a vibrant community where caregivers, doctors, nurses, social workers, volunteers and people with a variety of experiences have joined in to discuss topics on our weekly conversations...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 28, 2017 Category: Palliative Care Source Type: blogs

Book Review: Gratitude by Dr. Oliver Sacks
By Karen B. KaplanReading Dr. Sacks ’ farewell book with its mournful black cover was like going through a typical day on the job as a hospice chaplain. Just like my patients, this famous author, well-known for his medical narratives such asThe Man Who Mistook His Wife For A Hat: And Other Clinical Tales lists his regrets, his triumphs, his hopes, and his efforts to make sense of the life that he had led. In a word, this book is about how he dealt with his approaching end. Many of us can relate to his regrets, which included wasting time, being shy, and not traveling more. He also hoped to love and work as long ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 20, 2017 Category: Palliative Care Tags: book review gratitude karen Kaplan sachs Source Type: blogs

Why I Became a Certified Hospice and Palliative ICU Nurse
by Lori RuderMarch 19 is Certified Nurses Day, a day set aside to honor nurses who improve patient outcomes through certification in their specialty. The American Nurses Credentialing Center (ANCC) states: “A registered nurse (RN) license allows nurses to practice. Certification affirms advanced knowledge, skill, and practice to meet the challenges of modern nursing.”As an ICU nurse, I see the challenges of modern nursing as witnessing sicker patients undergoing extreme measures; attempting to extend the length of life but not necessarily the quality of life. ICU nurses have 24/7 intimate contact with their pat...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 19, 2017 Category: Palliative Care Tags: credentialing icu nurse nursing ruder The profession Source Type: blogs

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