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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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