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

First #hpm chat of 2015: reflections and a way forward
by Meredith MacMartinThe start of a new year is a natural time to pause and reflect, looking both back and forward, from past successes to future challenges. Self-reflection is a particularly useful skill in the field of palliative medicine, which requires us to navigate deep and often challenging waters with patients and families, touching on topics that often affect us personally. 2014 was a big year for palliative care, with publication of the IOM report Dying In America, CAPC’s Payer-Provider Toolkit and changes to hospice regulations that prompted scrutiny of hospice agencies. For the first #hpm Tweetchat of the...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 7, 2015 Category: Palliative Carer Workers Tags: hospice macmartin palliative social media The profession tweetchat twitter Source Type: blogs

Stuart Scott and fighting metaphors in medicine
ESPN sportscaster Stuart Scott's recent death has given the American public a chance to reflect on what it means to live with a cancer diagnosis. His speech at the ESPY awards in the summer of 2014 was widely hailed as an inspiration to people with cancer. Obviously, the Jimmy Valvano Award for Perseverance with the ties to cancer research (Jimmy V Foundation) and Scott's own public image as someone being treated for cancer made it a very poignant moment.I encourage you to watch the whole video to best understand the context and tone of his delivery; a great speech by any measure (transcript here). What intrigues me is his...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 6, 2015 Category: Palliative Carer Workers Tags: media palliative sinclair Source Type: blogs

Cases: Benign Prostatic Hypertrophy (BPH) as a hospice diagnosis?
Conclusion: In this case, a simple condition that is easily treatable in most men became one that we expected to lead to Mr. K’s death. However, the diagnosis that led it to become life-limiting was Mr. K’s dementia, and the heavy burden which BPH treatments would have placed on him. Mr. K’s daughter based her decision on Mr. K’s values, saying that if the father she was raised by was able to see himself in his current condition, he would have wanted both to stay in place and to be allowed to die with dignity. Forced catheterization and antipsychotic treatment might have prolonged his life by years ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 6, 2015 Category: Palliative Carer Workers Tags: cases childers emergency care hospice medications POLST urology Source Type: blogs

December 2014 Pallimed Review: Posts and Comments
If you have not noticed by now, we have really started to increase our publishing output, so since some great articles may fall off your radar, we will start doing a monthly review to make sure you didn't miss something really good. And if you are one of the few hundred subscribers with a daily option, do not forget you can always change to MWF or weekly!Our two most popular posts this month on social media were Emily Riegel's letter to the spouses of palliative care professionals and Bob Arnold's case review of when emotions or facts are at the center of goals of care discussions. Good ones to share with your teams m...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 2, 2015 Category: Palliative Carer Workers Tags: meta sinclair Source Type: blogs

Surf culture: paddling out
by Holly Yang, MDI try to greet each new year by jumping into the ocean and catching a wave. If I'm good about it (and not on call) I try to meet the dawn of the new year in a special kind of hello and thank you. So... I guess it's a good time to highlight a bit of surf culture. Why surfing?  Well, because it is an integral part of who I am, but also because it illustrates beautifully how different ideas of culture impact how we see life and death, and celebrate who we are and were. Culture is a funny word, and is probably overused.  We tend to view it through the eyes of ethnicity, nationality, or faith, but we ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 1, 2015 Category: Palliative Carer Workers Tags: culture death/dying spirituality yang Source Type: blogs

An open letter to the spouses of palliative care professionals
by Emily Riegel, MDMy darling,Some time ago you and I had a crazy idea that it could be the two of us against the world. In our naiveté we thought we had a connection previously unknown to any other human couple. We, in our love, became a superior being that transcended the “you” and the “I.” We agreed that Pablo Neruda’s Sonnet XVII was written about us.Of course, between then and now, life has happened, just as it happens for all couples.Our days are busy with children and meetings and work and parents and meals and errands and sick cats and lost keys, and sometimes in the routine of ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 31, 2014 Category: Palliative Carer Workers Tags: riegel The profession Source Type: blogs

Mind the Gap: Specialty Social Workers’ Request for Research
This article is the second article in a series of planned joint conversations into these populations. (See post #1 here)Where are the gaps in the literature for social workers? Allie: Although there is some great writing out there in the field of hospice and palliative care (HPC) social work (The Journal of Social Work in Palliative and End of Life Care, for example), there are still large gaps that exist in the HPC social work literature. First off, there is very little in the way of research on measurable outcomes in psychosocial palliative and hospice care specifically. There is research into this work with specific il...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 30, 2014 Category: Palliative Carer Workers Tags: dignity therapy dual process geriatrics literature miles Omega pediatrics psychosocial research Shukraft social work SWHPN Source Type: blogs

REVIEW: Consider the Conversation 2: Stories about Cure, Relief, and Comfort
by Beth Budinger Fahlberg PhD, RN, CHPNA physician, when asked how he wants to live at the end-of-life, states “I want to die in my own bed in my bedroom, holding my wife.” Yet how do most Americans die? In a hospital room after prolonged multi-system health issues, with a seemingly endless series of hospitalizations, procedures, tests, treatments and medications, and self-care regimens. This discrepancy between the “ideal” view of death and the reality of death in America today is the challenge explored in the new award-winning documentary, Consider the Conversation 2: Stories about Cure, Relief, a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 28, 2014 Category: Palliative Carer Workers Tags: fahlberg film public education public engagement television tv Source Type: blogs

Finding respect in modern health care
When I was in college, I had the opportunity to work with Mother Teresa at the Home for the Dying and Destitute in Calcutta, India. The mission of the sisters was simple; love the least of these. Specifically they did this by bringing in the unwanted and abandoned at the end of life, and giving them a bed, meals if they could eat, and a place to die in the company of another. The home was sparse by anyone’s account; an open room with a slab concrete floor lined with mats placed on the concrete 3 feet apart. The medications available were even sparser, the only real means of eliminating pain being the ability to hold...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 26, 2014 Category: Palliative Carer Workers Tags: clarkson empathy The profession Source Type: blogs

Last minute gift idea
by Holly Yang, MDDear HPM colleagues,For those of you who celebrate Christmas (and for those of you who are waiting patiently for the after Christmas sales), you'll be happy to know that there is still a chance to ask your friends and relatives for a gift, one they can get online without going to that crazy mall or fighting through traffic. Heck, give the present to yourself!Ask CMS to pay providers for having advance care planning conversations. There are codes now (yay!), just no reimbursement (insert frowny emoji here).  BUT... the comment period to CMS is open until Dec. 30th, so if you are a procrastinator, not t...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 24, 2014 Category: Palliative Carer Workers Tags: advance care planning advocacy CMS yang Source Type: blogs

Getting On​​​: HBO sleeper comedy not shy about delicate topics
(Note: we have a short poll about your thoughts on this show. It doesn't matter if you have seen it or not. Let us know what you think - Ed.) by Chris Okon"Getting On" is an HBO series about the daily and often absurd experiences of nurses, doctors, attendants, and patients in the "Billy Barnes" extended care wing of the fictional Mt. Palms hospital in southern California. ​Some viewers may be offended by the gallows humor that threads through each scenario, and so viewer discretion is advised. For others who don't mind, and in fact appreciate, the dark humor that's possible with any human interaction...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 23, 2014 Category: Palliative Carer Workers Tags: geriatrics hospice nursing home okon The profession tv Source Type: blogs

Free Continuing Education Credit for Palliative Care Topics (aka MJHS Palliative Webinar Series)
by Russell K. Portenoy, MD(Sometimes a simple idea comes along and while revolutionary, you sit there thinking, why didn't I do that? Many organizations and academic departments have great content experts, probably lecturing to learners every week. But who among us have consistently made these available for free online, in addition to providing free CE credits. We all have access to those tools, but someone did it first and with a year long commitment to teaching. Pallimed asked Dr. Russell Portenoy to explain the origins of a simple yet innovative project, the MJHS palliative care webinar series. Maybe we could see this r...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 22, 2014 Category: Palliative Carer Workers Tags: education FOAM portenoy webinar Source Type: blogs

Tramadol-induced hypoglycemia: another reason not to use it
This study adds further evidence that this is just not true, and that we should add hypoglycemia as a risk, even in patients who do not have diabetes. Eric Widera, MD is co-founder of GeriPal and fellowship director at UCSF. We are happy to have him post on Pallimed for the second of 3 posts owed to Pallimed from GeriPal for the World Series of Blogs wager of 2014.Fournier JP, Azoulay L, Yin H, Montastruc JL, Suissa S (2014). Tramadol Use and the Risk of Hospitalization for Hypoglycemia in Patients With Noncancer Pain. JAMA Internal Medicine PMID: 25485799 (OPEN ACCESS!) (Source: Pallimed: A Hospice and Palliative Medicine Blog)
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 21, 2014 Category: Palliative Carer Workers Tags: open access opioids pain research Widera Source Type: blogs

Palliative Care and Mental Illness
Robin Williams’ death prompted a small flurry of tweets and articles looking for more awareness of and attention to mental health. Earl Quijada (@equijada) and I had a short exchange that really got me thinking about how we view mental illness in the medical world. Our palliative care team cares for a fair number of patients with serious medical illness (cancer, heart failure, etc) who also have serious mental illness (SMI) such as profound depression, bipolar disorder, schizophrenia, etc. In my experience, there are unique challenges to providing the best care to these patients for both their health-care providers a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 27, 2014 Category: Palliative Carer Workers Authors: Meredith MacMartin Source Type: blogs

Cases: Second-Line Anti-emetic Therapies for Refractory Chemotherapy-Induced Nausea and Vomiting (CINV)
Discussion:Nausea and vomiting (NV) are commonly reported side effects with chemotherapy.1 The primary pathway for NV involves the chemotherapy drugs directly stimulating the chemoreceptor trigger zone (CTZ), in the area postrema at the base of the fourth ventricle. Activated receptors in the CTZ transmit signals to the vomiting center in the brainstem to produce NV. Receptors in the CTZ include serotonergic receptor 5-hydroxytryptamine type 3 (5-HT3), dopaminergic (D2) and neurokinin type 1 (NK-1) receptors. In addition, chemotherapy can damage GI mucosa causing local release of 5-HT3 neurotransmitters by gut enterochrom...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 25, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Building a Better Mortality Prediction Rule
You will often hear the lament from people within and outside of the hospice and palliative care fields, that doctors are pretty bad at making effective prognostication. Patients and families frequently search for a predictable road map to understand the course they are likely on, and even when they cede the understandable uncertainty to the physician, the doctors will often reply with an unhelpful retorts like, “I don’t know what may happen. There is only one person who does.” I doubt all of those physicians are referring to Dr. Mark Cowen, but they may want to take notice of what he and his colleagues a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 22, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

A Handful of Medication: The challenge of pill burden
If you’ve ever helped as a caregiver to someone in the twilight years of their life, or perhaps you yourself are at this stage, you may have noticed when it was medication time that there were a lot of pills. It is true there are exceptions to this rule, those individuals who only take one or two medications a day. However this is the exception, and there doesn’t seem to be much middle ground. Either you are on pages worth of medication, or hardly any as you begin to enter the last stages of life. The first question is, how does this happen? A large culprit to this phenomenon stems from the expectations for the...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 18, 2014 Category: Palliative Carer Workers Authors: Amy Clarkson Source Type: blogs

We Don’t Know Death: 7 Assumptions We Make about Dying
(Welcome a new contributor to the Pallimed Blog! Lizzy Miles, MA, MSW, LSW is a hospice social worker in Ohio who has also contributed to the Pallimed: Arts and Humanities site with a post on bucket lists in a Smurfs game. Yes, you read that right. She is best known as the the person who brought the Death Cafe concept to the US. We are very excited to be working with Lizzy! - Ed.)The worst thing anyone ever said to me was, “You think you know everything, but let me tell you:  you don’t know jack!” I was six weeks into my social work internship at a hospice and it was my student supervisor who decided...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 15, 2014 Category: Palliative Carer Workers Authors: Lizzy Miles Source Type: blogs

When I Walk: What Living With Multiple Sclerosis Is Like
Think about what you did to get ready this morning. If you are able-bodied that is a relatively simple thing right?  To get out of bed, use the bathroom, get showered, get dressed eat some breakfast and then get out and go somewhere else. But what is not just getting ready but living life like for people with disabilities?Jason DaSilva gives a very personal insight of what it is like to have a progressive disability as he documents his life with multiple sclerosis in the documentary “when I walk”. At age 25, DaSilva was a successful independent filmmaker who after noticing his vision was blu...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 12, 2014 Category: Palliative Carer Workers Authors: Jeanette Ross Source Type: blogs

#hpm Tweetchat 07.23.2014 - The Importance of Language
Language represents symbols and the meaning of those symbols depends on the nature of our interaction. When sitting in a clinic and receiving bad news, patients will cling to every word. Doctors may choose words carefully, avoiding some terms and emphasizing others. Patients and families, listening carefully to each word, walk away from these emotionally charged interactions, often hearing different words, and many times finding different meaning. Vinay Prasad studied the written words used in the Oncology literature, specifically the word “cure”. Defining cure as the chance someone will die of cancer being no ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 23, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Hospice and Palliative Medicine Tweetchat reaches 200th chat
When I first began exploring the health care Twittersphere in late 2008, there were not a lot of people there, and explaining it to others and expand the network was pretty challenging. Six years later, the understanding of Twitter as a space to advocate and influence is well understood in the realms of sports, entertainment, politics and news. Well, we too in hospice and palliative care have made a significant impact on Twitter even if it is in the smaller niche of Health Care. One of the tent poles for people to gather and find each other has been the weekly Hospice and Palliative Medicine Tweetchat. Having seen the succ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 16, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Deadline for Comments on HPM Fellowship Update July 2
Apologies for the late notice, but I only heard yesterday about the deadline today (July 2, 2014) to the ACGME update to the Hospice and Palliative Medicine Fellowship requirements.  These updates do not come around too often and this is the first significant chance for an update since the accreditation became official in the late 2000s. Here are some of the key files for your reference:Impact Statement (only 5 pages - summarized below)Program Requirements (24 fun-filled pages)Review and Comment Form (you need to complete this and send it to familymedicine@acgme.org)Whether you agree or disagree it...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 2, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Cases: Legacy Projects at the End of Life
Discussion:Suffering, both physical, psychological and existential, is an important topic for seriously ill patients (1). The 2005 National Consensus Project on Quality Palliative Care highlighted the importance of understanding and addressing patients’ emotional and spiritual needs (2). Emotional and spiritual suffering are important factors that can contribute to the development of patients’ and caregivers’ depression and anxiety (3,6).  Various interventions are available to address emotional and spiritual distress.  One example is legacy project. These projects provide meaning-based coping t...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 30, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Prison Terminal: The Last Days of Private Jack Hall
Until I watched the documentary prison terminal I had not given much thought to what the end of life is like for a prisoner serving a life time sentence.  The Prison Terminal film was nominated for a 2014 Academy Award in the category of Documentary Short Subject and it is currently being shown in the channel HBO. Filmmaker Edgar Barens transports us to the inside the Iowa state maximum security prison recording how the terminally prisoner Jack hall lives his final 6 months (even his last breath). As the film evolves we meet 82 year old Jack Hall who was once a decorated World War II veteran who fought in battle ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 30, 2014 Category: Palliative Carer Workers Authors: Jeanette Ross Source Type: blogs

Empathy, Goals of Care & Training Opportunities to Improve Your Communication Skills and Teaching
Empathy plays an important role in all of healthcare communication, but it's especially heightened when clinicians are working with patients with serious illness and their families.  Journal of Palliative Medicine published an article by Vital Talk's Tony Back and Bob Arnold recently about the role empathy can play in the delineation of goals of care for seriously ill patients.  Empathy without any specific action is valuable to the suffering person.  Merely being understood often times has some ameliorative impact on the suffering person and fosters a therapeutic relationship, even when some problems cannot...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 21, 2014 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs

National Healthcare Decisions Day April 16th, 2014
What a great thrill it is to see something start from a small local idea and take on a full national impact. National Healthcare Decisions Day (NHDD) is today, Wednesday, April 16th, 2014 and so many more organizations are getting involved, beyond those who might naturally be inclined to assist their community with advance care planning. Many healthcare organizations, employers and communities are mobilizing today and this week to make sure that patient’s preferences wishes are being documented and recognized by the medical community. I even saw it on my health insurance employee wellness homepage!Since the manufactu...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 16, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Cases: "Am I really going to have to live like this?": The Role of Octreotide in Patients with Persistent Nausea and Vomiting after Venting Gastrostomy
Discussion:Malignant bowel obstruction can occur with any cancer but is most commonly associated with advanced ovarian cancer, where it occurs in up to 50% of patients. It generally indicates a poor prognosis and carries a heavy symptom burden predominated by nausea, vomiting and abdominal pain. Patients with carcinomatosis, like Ms BB, are generally not candidates for surgical correction of the obstruction or endoscopic stenting. Fortunately, medical management can be very effective. Abdominal pain is treated with opioids and nausea is treated with metoclopramide in partial obstructions and haloperidol in complete obstruc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 10, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Pediatric Hospice is First in the Country with Emoji-Based Pain Map
April 1, 2014 by Abe R Feaulx, Special Reporter Pediatric Hospice of the Silicon Valley watches emerging trends in technology very closely. Seeing patients who had already staked a preference for Apple products, they wanted to make sure they could understand and relate to them differently then they would to children who grew up on Android based platforms, and the small minority that have Windows, Blackberry or Palm Pilot smartphone experience.  Social Worker Jo King emphasized, "We noticed that the iOS children in our program would communicate using almost exclusively using Emoji. And we thought, how ca...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 1, 2014 Category: Palliative Carer Workers Authors: Abe R Feaulx Source Type: blogs

Innovative Palliative Fellowship Using Snapchat for Family Meetings
April 1, 2014 by Abe R Feaulx, Special Reporter  Dr. Arya Kiddenme, a palliative care fellow at University of State College Medical School is preparing for a potentially very tense family meeting. The patient is unresponsive in the ICU and the family is having a difficult time coping with a sudden decline in their condition. When it is time to get ready to enter the room, Dr. Kiddenme quickly remembers to grab her iPhone 5s. “Can’t forget the most important tool!” She sits down to begin the family meeting, opens up the Snapchat app, and sends off a short introductory video clip. In a few seconds the ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 1, 2014 Category: Palliative Carer Workers Authors: Abe R Feaulx Source Type: blogs

Preserve HPM's Efforts to Improve Care for the Seriously Ill
For a long time hospice and palliative medicine have been wearing the mantle of outsider; never really understood by the rest of health care, or even the public, a growing group of clinicians and advocates kept pressing to deliver great quality and compassionate care. You might even hear insiders lament about how it is tough to get any respect or attention from some of the bigger, powerful organizations in health care locally, regionally and nationally. Well I’m here to tell you, we have made a BIG breakthrough, because the cool kids are starting to ask us to come sit at their table. But this doesn't happen for free...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 31, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Hospice Medical Director Certification Board - Deadline March 24th
The deadline for application for the first Hospice Medical Director Certification Board is tonight, Monday, March 24th at 11:59pm CT.  Surprisingly, we have not really commented on the HMD Certification on Pallimed yet, which is unfortunate because I believe this is a really great step forward to elevating the quality of Hospice Medical Directors in the US. It has been a long time in the making after getting the initial seed funding from the American Academy of Hospice and Palliative Medicine. Having been fellowship trained in Hospice and Palliative Medicine (HPM) at a program based in a community hospice (Thanks Hosp...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 24, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Remembering Palliative Care Pioneer: Marion Pohlen Primomo, M.D.
May 15, 1920-March 1, 2014 When I think of people who have paved the way to make my professional career possible I think of Dr Marion Primomo. Not only was she one of the first women physicians; It is fair to say that she is the mother of the hospice movement in Texas.  She was one of the founders of the first hospice in San Antonio in 1978. She was a Founding Member of the Academy of Hospice and Palliative Medicine and the International Association of Hospice and Palliative Medicine.  In the 1980s, she had established an elective for medical students on their family medicine rotation in which medical students vi...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 18, 2014 Category: Palliative Carer Workers Authors: Jeanette Ross Source Type: blogs

It's Here! 2014 AAHPM/HPNA Annual Assembly in San Diego
Hopefully many of you are arriving (or have already arrived in San Diego) for the AAHPM/HPNA Annual Assembly.  I love this conference and this is my 11th year in a row, that I have been lucky enough to attend. There is great knowledge and wonderful camaraderie here, and I want to make sure that no matter where you are, you can take advantage of all this week has to offer.If you are at the conference, please consider using Twitter as a way to spread information. Every year participation has grown and diversified way beyond the walls of the conference halls.  We've talked a lot about the benefits of Twitter at a Me...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 12, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Join the Pallimed & GeriPal party at the AAHPM/HPNA/SWHPN 2014 Annual Assembly
The annual Pallimed / Geripal party is back on for this year's AAHPM/HPNA/SWHPN 2014 Annual Assembly.   We are going to do a similar progressive party as we did at the 2013 annual meeting in New Orleans.  What does this mean? Basically we will start off at the Field Irish Pub at 9am on Thursday March 13, and as the evening progresses, we will be moving to different locations.  The only way to find out where we are is to use social media and follow on of the Pallimed/Pallimed feeds, or the #HPMparty hashtag. Date: Thursday, March 13th.  Start time 9pm.  End time TBDWhere: De...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 10, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Dr. Sherwin Nuland, Surgeon, Author of 'How We Die' is Dead at 83
This morning while browsing through my New York Times app (I’m so modern!), I was saddened to see the obituary for Dr. Sherwin B. Nuland, who wrote the impressive and ground breaking 1994 National Book Award winner, “How We Die: Reflections on Life’s Final Chapter” (Amazon Affiliate Link). I know many hospice and palliative care professionals likely have this black and white paperback sitting on their bookshelf. Maybe they picked it up at a used book sale like I did, or maybe it was passed onto them by a mentor, but I wonder how many of the current practicing generation of professionals have actuall...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 5, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

"Prison Terminal" Documentary Nominated for OSCAR
I’m know I’m not alone in pining for in-depth portrayals in mainstream culture of the complexities in caring for people near the end of their lives.  Working in palliative care and hospice allows us to witness (and sometimes be part of) wonderful stories of love, forgiveness and redemption.  Stories that would seem to fit in any high quality film or TV show come naturally in our field.  So tonight when the Academy Awards are being handed out, keep an ear out for Prison Terminal: The Last Days of Private Jack Hall.  It may only be mentioned right before a commercial break, or not at all on th...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 2, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Response to Misleading WaPo Hospice Article: Part the Third
(If you missed Part 1 or Part 2, click on the links. If you don’t have time, here is the quick summary. The Washington Post published an article December 26th, 2013 claiming hospice care was taking billions from Medicare presumably in waste and fraud. This series offers a critical review debunking the claims and offering a more insightful view of the challenges hospices face. Today Dr. Scott tackles some statistics and the way forward - Ed. Sinclair)One of the consistent errors made by people commenting on this story, either in the comments sections or on social media, is the failure to understand the difference betw...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 9, 2014 Category: Palliative Carer Workers Authors: Bruce Scott Source Type: blogs

Response to Misleading WaPo Hospice Article: Part the Second
(If you missed Part 1, you can read it here. If you don’t have time, here is the quick summary. The Washington Post wrote an article December 26th, 2013 claiming hospice care was taking billions from Medicare presumably in waste and fraud. This series offers a critical review debunking the claims and offering a more insightful view of the challenges hospices face. - Ed. Sinclair) 6) Did these hospices enroll patients inappropriately? This is the element that most needs to be addressed. The only real way to assess this is by checking the documentation for the individual hospices in question. If there had been a report...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 8, 2014 Category: Palliative Carer Workers Authors: Bruce Scott Source Type: blogs

Response to Misleading WaPo Hospice Article: Part the First
This article was very badly written. It is quite deceptive, the statistics are frequently wrong or cherry-picked, and the conclusion does not follow from the premises asserted. I was surprised that such a poor piece of journalism should fool so many people who should know better. Let’s start with the headlines: “Hospice firms draining billions from Medicare” and “Medicare rules create a booming business in hospice care for people who aren’t dying”. If they had instead chosen a headline of “Hospice firms save Medicare gobs and gobs of money while improving quality of life and honori...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 7, 2014 Category: Palliative Carer Workers Authors: Bruce Scott Source Type: blogs

A Chance to Make a Difference in Hospice and Palliative Care
As you finish out the year this evening, you may be reminded that you still need to get a few more tax deductible charitable contributions in before the clock strikes midnight.  How do I know what you are thinking?  Because the data shows that New year's Eve is one of the most beneficial days for charitable giving.So as you are planning your last few donations, I want to urge you to consider donating to the American Academy of Hospice and Palliative Medicine's Shaping the Future Campaign.  To honor the 25th anniversary of the Academy and help impact the next 25 years, the Academy has embarked on it's first e...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 31, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Dismiss Simulation for Palliative Medicine Communication Training? Not So Fast
Conclusion While the results of this trial are disappointing, the negative results may reflect how challenging it is to study patient centered outcomes of educational interventions.  This study also gives us an opportunity to reflect on how to define the patients who benefit most from communication training interventions, when the benefit is most likely to occur, and which trainees/practitioners might be in the best position to receive the intervention.  No doubt, there are other interventions which may improve clinician communication in pivotal conversations, and we should also reflect on ways to improve the stu...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 23, 2013 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs

20 Ways to Discuss Advance Care Planning With Your Family Over The Holiday
We present a variety of ways to get to the topic: some humorous and edgy, some will work for you, others clearly won't, but we wanted to provide a range of scenarios!“Do you think this delicious turkey had a living will?”“All I want for Christmas is for you to tell me your thoughts on artificial life support and your ideas regarding an acceptable quality of life. Fa-la-la-la-la---la-la-la-la.”“Whoever assigned their Health Care Power of Attorney this year gets pumpkin AND apple pie for dessert!”“The holidays can be so depressing sometimes.”“You want to know what increas...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 27, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

NHPCO Releases 2013 Facts and Figures for Hospice Care in America
Every Fall the National Hospice and Palliative CareOrganization releases the Hospice Facts and Figures report, just in time for National Hospice and Palliative Care Month. The format overall is relatively the same with some minor differences.  Overall, the same trends we have seen over the past few years have kept going in the same direction with the same velocity: Increased # of patients served* (1.5M) Increasing average length of service (71.8d) Decreased median length of service (18.7d) Slightly higher percentage of elderly patients served Higher diversity of patients served Increasing percentage of non-cancer d...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 30, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs