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National Academies Webinar on Opioids in Serious Illness This Thursday
by Christian Sinclair (@ctsinclair)Many of us who work in palliative care and hospice have seen a major shift in how patients and families respond to opioid prescribing for pain in serious illness. Because of the significant impact of opioid abuse on communities across the country, many new policies and rules are being put in place to reduce the prescriptions of opioids. Of course, this also places a burden on prescribers and patients seeking to utilize opioids judiciously for pain from advanced disease.For the past few years, I have represented the AAHPM at the Roundtable on Quality Care for People with Serious Illness ho...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 26, 2018 Category: Palliative Care Tags: conference health policy opioids Source Type: blogs

Nope. We STILL Shouldn't Claim Prolonged Survival in Hospice and Palliative Care
by Drew Rosielle (@drosielle)A group of investigators from Tulanerecently published a meta-analysis in Annals of Behavioral Medicine indicating that outpatient palliative care improves survival and quality of life in advanced cancer patients (free full-text available here, although I ' m not sure if that ' s permanent).Perhaps you ' ll remember inJune of this year when I pleaded with our community to stop claiming that palliative care prolongs survival (my littleTwitter rant about this starts here).My basic plea was this:Hospice and palliative care community, I ' m calling for a moratorium on all blanket, unqualified claim...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 2, 2018 Category: Palliative Care Tags: journal article outpatient pallimed writing group research research issues rosielle The profession Source Type: blogs

NEW Clinical Practice Guidelines for Quality Palliative Care Released!!
by Christian Sinclair (@ctsinclair)Happy Halloween!Today is the beginning of a new era in palliative care as the4th edition of the Clinical Practice Guidelines for Quality Palliative Care (aka NCP Guidelines) are being released into the wild to begin changing practices all over!Well, that is the plan and the hope, of course. With any sort of guidelines or statement document, the real work comes AFTER they are published.DOWNLOAD THE GUIDELINES TODAY!To be effective, policymakers, front-line clinicians, and healthcare leaders need to make time in their hectic schedules to review these new guidelines, compare what they a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 31, 2018 Category: Palliative Care Tags: guidelines ncp sinclair Source Type: blogs

Antipsychotics Don't Help ICU delirium
by Drew Rosielle (@drosielle)It just gets worse and worse for the idea that antipsychotics have efficacy for delirium.Last year Iposted about the RCT of haloperidol, risperidone, or placebo for delirium symptoms in ' palliative ' patients. I ' m pretty sure I called for more controlled, ' high quality, ' trials, and we are lucky enough to have another.This one is arandomized, double-blinded, registered, controlled trial of haloperidol, ziprasidone, or placebo for ICU delirium, just published in NEJM.The trial took place in a geographically diverse group of US-based intensive care units. They enrolled adult patients in medi...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 25, 2018 Category: Palliative Care Tags: delirium icu journal article rosielle Source Type: blogs

On Football, Palliative Care, and Quality Measurement
by Arif Kamal (@arifkamalmd)Transition into the Fall months means one thing for a boy like me from the Midwest – it’s football season. Snare drum cadences, referee whistles, and the crunch of linemen helmets were the soundtrack to many memorable evenings growing up. In football, winning requires strategy and execution, while embracing the humility that even the most exquisite gameplan, well steeped in planning and expertise, can fall flat. Though the two worlds seem unrelated, I often think of football analogies when approaching palliative care quality improvement.Football offenses across college and professional leag...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 5, 2018 Category: Palliative Care Tags: conference kamal patient reported outcomes quality improvement Source Type: blogs

On the Importance of Mental Health Check-Ups for Palliative Care Clinicians
by Polly ChesterAs silly as this may sound to people who have never experienced a mental health issue, when one is used to a dystopian inner world, feeling happy for a consistent period of time can be a bit of a worry. For those of us who ’ve had mental health concerns in the past and a baseline mental state that just allows us to lurch through life in a state of veritable chaos, calm and pleasant periods of time are a source of anxiety because we wonder if the next mental health calamity is just around the corner. One might consid er psychological temperature-taking should be done just like going to your general practit...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 3, 2018 Category: Palliative Care Tags: chester grief mental health The profession Source Type: blogs

Challenges Faced by Blended Families at End of Life
This article, however, is addressing situations in which the family system is not working smoothly and is an attempt to explore how we, as professionals, approach these situations.Alternatively, in some blended family situations, it is one or more of the children who are the primary caregivers and the second spouse is the one who is the reluctant caregiver.While you want to have an awareness of family dynamics, you do not want to have a position on them. It would be very easy to side with the caregiver who is involved and complaining about others who are not involved. But you don ’t know the history of the family and the...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 1, 2018 Category: Palliative Care Tags: communication documentation family goals of care hospice language miles social work stepfamily Source Type: blogs

The Power of a Pause
by Kayla Sheehan (@kksheehan)October TW, Dizon ZB, Arnold RM, Rosenberg AR.Characteristics of Physician Empathetic Statements During Pediatric Intensive Care Conferences With Family Members: A Qualitative Study. JAMA Network Open. 2018;1(3):e180351. doi:10.1001/jamanetworkopen.2018.0351Ask any patient what qualities they desire in a physician, and empathy will almost always make the list. A physician ’s ability to demonstrate empathy has beenshown to significantly impact patient outcomes1,increase patient satisfaction2, andraise physician “compassion satisfaction,” which may hinder burnout (3). Though much debate sur...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 28, 2018 Category: Palliative Care Tags: communication journal article NICU open access pallimed writing group pediatrics sheehan Source Type: blogs

Conference Review: PainWeek 2018
by Rabia Atayee (@RabiaAtayee)For the past 10 years, in addition to several conferences more specific to palliative and hospice care, I have attendedPainWeek (#PainWeek). I find great value in attending PainWeek as it strengthens my palliative practices through interactions expanding beyond traditional palliative care trained disciplines. With an average of 2,000+ attendees, there is an opportunity to interact with pain anesthesiologists, addiction specialists, and physical therapists trained in pain interventions among other specialists. During one session, I was sitting next to a JD who is preparing for a prescription dr...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 26, 2018 Category: Palliative Care Tags: atayee conference conference reviews pharmacist Source Type: blogs

Alcohol Pad = Aromatherapy = Nausea Relief?
by Bob Arnold (@rabob)In general, I am a cynic and a nihilist. That means when reviewing the literature, I find most glasses half empty rather than half full (OK, probably this is true in life, but that is TMI). I am very unlikely to try a new treatment based on one study.For every rule, however, there is an exception. I am completely enthralled with aromatherapy and thus found anarticle in the Annals of Emergency Medicine by Beadle on isopropyl alcohol nasal inhalation for nausea in the emergency department. It was a randomized controlled trial which made it swoon-worthy. The only problem was it was a placebo trial and so...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 24, 2018 Category: Palliative Care Tags: arnold emergency department journal article nausea ondansetron pallimed writing group research vomiting Source Type: blogs

Building Resilience through Contemplative Care
by Ann AllegreAs professionals in end-of-life care, our responsibilities can seem overwhelming. As with other clinicians, we have burdens of too many patients to see, too much time spent in documenting, and hassles with insurance companies. In hospice and palliative medicine, we are impacted by the additional challenges of seeing so much suffering, grief and tragedy. While we have good tools to address most types of physical suffering, there is much suffering among our patients and their families that does not respond to medical interventions. After I had been working full-time in hospice and palliative care for a few year...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 23, 2018 Category: Palliative Care Tags: allegre compassion The profession Source Type: blogs

International Palliative Care Education - EPEC-Peds
By Stacy S. Remke (@StacyRemke)In about 2004, our program embarked on a regional pilot project to teach healthcare workers – doctors, nurses, social workers, chaplains, and others – to provide pediatric palliative care. Our region is the Upper Midwest: Minnesota, Iowa, Wisconsin, North and South Dakota. “Join pediatric palliative care,” we joked, “and see the world!!”Little did we know.From these first steps began a truly humbling and inspiring journey across many continents and into many communities.Much of this started when a project I was involved with –Education in Palliative and End of Life Care for Pedi...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 21, 2018 Category: Palliative Care Tags: international pediatrics remke Source Type: blogs

Hip Fracture Decisions for Nursing Home Residents with Dementia
This article should lead you to talk to your trauma surgeons and/or orthopedists to develop a routine palliative care or hospice consultation for these patients.Robert Arnold, MD is a palliative care doctor at the University of Pittsburgh and a co-founder ofVitalTalk (@VitalTalk). He loves both high and low brow comedy (The Good Place and Nanette), pop culture (the National Enquirer and Pop Culture Happy hour) and music of all kinds (not opera tho!) You can find him onTwitter at @rabob. MorePallimed posts from Bob Arnold can be found here. Morejournal article reviews can be found here. References1. Berry SD,...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 17, 2018 Category: Palliative Care Tags: arnold dementia journal article nursing home pallimed writing group surgery trauma Source Type: blogs

Mandated Queries of the Florida Prescription Drug Monitoring Program: Early Experiences from a Cancer Center-based Outpatient Palliative Medicine Clinic
This article describes our e xperiences in the first month of experience with the new law, although we plan to examine queries for a total of three months before closing this QI project.For the purpose of this QI project, we have documented patients ’ demographics, including each patient’s age, gender and limited identifying information, such as patient names and identification numbers; this data will be de-identified for any statistical analysis planned in the future. We also recorded patients’ main diagnosis and pain symptoms, the numbe r of prescribers listed by the PDMP as well as the dose of the patient’s opio...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 14, 2018 Category: Palliative Care Tags: kollas opioids pdmp quality improvement The profession Source Type: blogs

The Future of Hospice and Palliative Medicine Starts with Medical Students
by Kayla Sheehan (@kksheehan)My first day of medical school, I asked the Dean how to start a Hospice and Palliative Medicine Student Interest Group (SIG). Before I became a medical student, I began volunteering for hospice. It changed my life. I learned invaluable lessons about life, death, and healing throughout my nearly five years as a hospice volunteer and I realized these lessons would not be taught in a classroom. Three years into medical school, we are one of the most active groups on campus, and we continue to grow.Assembling the group was not as difficult as one might think. The biggest hurdle is many students sim...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 10, 2018 Category: Palliative Care Tags: medical school sheehan The profession Source Type: blogs