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

Behind the Scenes: Media Watch by Barry Ashpole
by Barry R. Ashpole(Being avid fans and readers of Barry Ashpole and Media Watch (sample issue) for years, we wanted to share his story and background with you. - Ed.)Keeping abreast of current thinking in almost any field of endeavour is a challenge. Health professionals, as an example, are often hard pressed to keep abreast of what is being published or reported – monitoring emerging trends or tracking what or who informs the decision or policy making processes. Generally speaking, a health professional’s scope of practice dictates to a greater or lesser extent what sources of information he or she accesses, ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 17, 2016 Category: Palliative Care Tags: ashpole media Source Type: blogs

Trisomy 13 and 18: When a lethal condition is no longer lethal
by Jenni LinebargerWhat is a “lethal condition” really? How does the definition change as medical advances are made? Several times a year, I meet parents who’ve had providers tell them that their baby has a “lethal diagnosis” (or worse, that the diagnosis is “incompatible with life”) when testing detects trisomy 13 or trisomy 18. Such dire prognostication sets the stage for all future interactions with the health care community. For some, it becomes a rallying cry to prove providers wrong, for others it becomes a sealed fate. For all, it declares a level of certainty that we just d...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 15, 2016 Category: Palliative Care Tags: ethics hospital linebarger NICU pediatrics surgery Source Type: blogs

Worse than death?...Dependence
This study out of Philadelphia surveyed 180 hospitalized patients with serious illness on their views of various health states, and how severe or unacceptable they considered them. What was fascinating was that the scale used was based on death as the benchmark on their Likert scale—“wors e than death, neither better nor worse than death, a little better than death, somewhat better than death, or much better than death.”The study revealed that in this group of patients with advanced cancers, heart failure, and COPD, health states with significant dependence on machines and on care from other people were f...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 13, 2016 Category: Palliative Care Tags: albert cancer death/dying heart failure pulmonary/copd research Source Type: blogs

FOUR Score: Coma scales and prognosis in the ICU
by Drew RosielleIn neuro-critical care, prediction of outcomes is often tricky because of the wide variability in the ability of the brain to recover and the usual long periods needed before seeing what is the limit of recovery. Most people are familiar with the Glasgow Coma Scale, but back in 2009 Mayo Clinic Proceedings published a study of the FOUR score), which presents some prognostic data for ICU patients. FOUR ='Full Outline of UnResponsiveness.'(It is also written as 4S. - Ed.)This was a single institution study (Mayo Rochester) primarily designed to investigate whether the FOUR score is a reliable c...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 10, 2016 Category: Palliative Care Tags: icu neuro open access prognosis rosielle Source Type: blogs

FOUR Score: Coma scales & prognosis in the ICU
by Drew RosielleIn neuro-critical care, prediction of outcomes is often tricky because of the wide variability in the ability of the brain to recover and the usual long periods needed before seeing what is the limit of recovery. Most people are familiar with the Glasgow Coma Scale, but back in 2009 Mayo Clinic Proceedings published a study of the FOUR score), which presents some prognostic data for ICU patients. FOUR ='Full Outline of UnResponsiveness.'(It is also written as 4S. - Ed.)This was a single institution study (Mayo Rochester) primarily designed to investigate whether the FOUR score is a reliable c...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 10, 2016 Category: Palliative Care Tags: icu neuro open access prognosis rosielle Source Type: blogs

Palliative Chemotherapy: An Oxymoron
By Rebecca Gagne HendersonI was inspired to write this after reading the series of posts on Pallimed titled “Against Euphemisms” by Drew Rosielle. At its very best, the term “Palliative Chemotherapy” is an oxymoron. At its worst, it is a treatment that robs the patient and family of quality of life and valuable time may have been spent doing the things that are important to them.As a palliative consultant on a campus which does not house a cancer center my referrals typically come from hospitalist attending physicians rather than oncologists. I cannot begin to tell you the number of conversations I ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 1, 2016 Category: Palliative Care Tags: cancer chemotherapy euphamisms gagne henderson palliative rebecca Source Type: blogs

July 2016 Pallimed Review
by Christian SinclairJuly 2016 was a great month! New fellows started,advocates told the hospice story on Capitol Hill and online, theAAHPM held it's Summer Institute. Good things all around.Here is a recap of all of our posts from July 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 andLinkedIN. And nowcatch us on Instagram, where we have grown quickly in the past month. And we always appreciate it when you recommend us to your pee...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 31, 2016 Category: Palliative Care Tags: review sinclair Source Type: blogs

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