#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

"What would you do if it were your kid?" - An Invitation for Empathy
(Ed. - Please welcome Jennifer Linebarger, MD, MPH, FAAP to Pallimed.  Jennifer joins us and will be helping beef up our pediatrics focus here at Pallimed. We are thrilled to have her! - Sinclair) I had just begun reading Dr. Danielle Ofri's latest book, "What Doctors Feel: How Emotions Affect the Practice of Medicine", when I opened The New England Journal of Medicine to find David Korones' essay "What would you do if it were your kid?" As he points out, nearly all of us have been asked, have heard this "plea to share with them, as a partner, the heavy burden of decision making." A...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 24, 2013 Category: Palliative Carer Workers Authors: Jenni Linebarger Source Type: blogs

World Hospice and Palliative Care Day 2013: Palliative care as a human right
This Saturday October 12th, 2013 is World Hospice and Palliative Care Day (www.worldday.org) and if you are in the United States like me (and most Pallimed readers), the majority (if not all) of your palliative care advocacy efforts are local, regional or national.  Outside of the UK, Australia or Canada, I'll admit to being fairly naive for most of my career when it comes to the palliative care access issues in the rest of the world.  I've explored and participated somewhat in the global health issues of symptom control and pain access, but the local and national needs always seemed to take precedence.   ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 11, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

God doesn't give you more than you can handle: helpful or unhelpful?
In the face of a crisis, many people are challenged to find constructive and meaningful ways to engage in conversation and so often they fall back on platitudes. Simple, hopeful, semi-philosophical phrases we have heard in many other situations may sound important to the speaker, but the receiver finds them meaningless and tone deaf. I'm sure you have heard many of these uttered to patients by well-meaning family friends, and even health care professionals: "This too shall pass.""Stay strong.""Think positively.""I'm sure it will be OK.""It is what it is.""God won't ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 4, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

No More Excuses: Having tough talks in pediatrics
“What words can be uttered? Your turn just slightly and there it is: the death of your child. It is part symbol, part devil, and in your blind spot all along, until, if you are unlucky, it is completely upon you. Then it is a fierce little country abducting you; it holds you squarely inside itself like a cellar room – the best boundaries of you are the boundaries of it.” – Shirley Jackson, from “People Like That Are the Only People Here,” in Birds of America* *             *         ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 24, 2013 Category: Palliative Carer Workers Authors: Emily Riegel Source Type: blogs

Australians Don't Like Polypharmacy, What About You?
Patients attending an ambulatory consulting service in Adelaide, Australia were queried regarding their feelings about stopping medications, and the results were reported in JAGS recently.  The subjects, age 71 on average, were taking an average of ten medications.  Most subjects thought they were taking a "large number" of medications and 92% said they'd be willing to stop one or more medication "if possible." Big shocker for Pallimed readers, I'm sure. Who wants to take ten medications? This survey included a geriatrics population and was published in a geriatrics journal.  But if&nbs...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 20, 2013 Category: Palliative Carer Workers Authors: Lyle Fettig, MD Source Type: blogs

Predicting Survival After CPR: Can we GO-FAR?
JAMA Internal Medicine (JIM, you'll always be Archives of Internal Medicine to me) has published a study of an outcome prediction tool for in-hospital cardiac arrest. Specifically, a tool to predict the rates of neurologically intact survival after an in-hospital arrest. The developers of the tool call it GO-FAR (Good Outcome Following Attempted Resuscitation). One could imagine ways of re-titling it FORe-GO, if one chose to spend one's time imagine such things. This is the best tool of its kind that I've seen, although one needs to be very clear about what it's actually predicting. The paper mostly describes, in d...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 12, 2013 Category: Palliative Carer Workers Authors: Drew Rosielle MD Source Type: blogs

The Long Journey of a Research Article
 Most health care providers are in a hurry and have little time to devote to reading medical articles. Often browsing just the title and summary, they want to know, “what does this mean for me or my patients?” They have little time to get into the details of how the study was done, who participated, or even the results. This short post is an attempt to demystify the research process to encourage health professionals to seek more from the studies they read and to pass on these findings to others in the field who can make a difference. As an illustration, I will use a recent publication from our research tea...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 9, 2013 Category: Palliative Carer Workers Authors: David and Debbie Source Type: blogs

Take the Survey on HPM Burnout
In the previous post you learned about the long journey of research.  Well now is your time to contribute.  Researchers from the Duke Clinical Institute have been reaching out this summer to look for participants of all disciplines to participate in this survey on stress and burnout in hospice and palliative medicine.  So take 15 minutes (now, because you know you wont get to it later) and finish this quick survey.  And then if you really want to earn a gold star, forward it to people in the field with a personal endorsement. (If you already took it earlier this summer, do not take it again.) ----------...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 9, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Prescribe Long Acting Opioids? You Must Know About REMS
Here is the simple version: If you prescribe long acting opioids then you (and all your prescribing co-workers) should sign up for the FREE FDA/DEA mandated REMS training hosted by AAHPM on September 10th (yes, tomorrow!) andOctober 11th. Here is the (semi-)long version: The FDA and DEA have noticed the public health risk caused by long acting opioids being used inappropriately.  One part of their remedy is to increase training for prescribers of opioids.  The AAHPM along with 9 other interdisciplinary organizations (Collaborative on REMS Education CO*RE) are working to provide the educational activity....
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 9, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Cases: "Do you have something stronger than this dilaudid?" The case for opioid rotation
Discussion: Opioid rotation, or trial of an alternative opioid, is commonly practiced when a patient’s pain responds poorly to one opioid or intolerable side effects develop. These intolerable side effects may include nausea, vomiting, sedation, or even hyperalgesia. Although rotation is a common practice, a Cochrane review in 2004 found that evidence to support the practice for opioid rotation was anecdotal and in non-controlled studies. Randomized trials were suggested. Since that time, several prospective studies have been performed where opioid analgesic effect was inadequate or side effects to the opioid were i...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 6, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

The Bereavement Counselor: Public Misperception
(Please welcome Rea Ginsberg, LCSW-C, ACSW, BCD to Pallimed. She is a retired Director of Social Work Services and Hospice Coordinator. She has extensive experience working with both children and elderly adults mostly in hospitals and long term care facilities. - Sinclair) I’ve learned that people will forget what you said, People will forget what you did, But people will never forget how you made them feel. -- Maya Angelou We are often asked, How can you do that? How can you stand to do that work? Such a dreary subject. Grim but supposedly necessary. Don’t you get depressed with all the talk of dying? Facin...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 5, 2013 Category: Palliative Carer Workers Authors: Rea Ginsberg Source Type: blogs

ASCO and AAHPM Team up on Quality Improvement
“I’m seeing the road that I’ve traveled A road paved with heartache and tears And I’m seeing the past that I’ve wasted While watchin’ the bubbles in my beer” - Bob Wills I’ve always preferred Bob Wills’ “…bubbles…” to Don Ho’s “Tiny Bubbles”. The former always feel more contemplative, but also remind me to continue to break out of the doldrums…the usual…don’t take the world as it sits today as the way it will always be. For those looking to break new ground and collaborate on enhancing palliative ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 5, 2013 Category: Palliative Carer Workers Authors: John Hennessy Source Type: blogs

Cases: Anti-epileptic Medicines for Pain Management
Discussion:  Tri-cyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and anti-epileptic drugs (AEDs) are the mainstays of adjuvant therapy for neuropathic pain.  This Case of the Month will focus on oral anti-epileptic neuropathic pain analgesics. Due to lack of head-to-head data, evidence is presented as numbers needed to treat (NNT) and numbers needed to harm (NNH). For instance, an NNT of 5 for 50% pain reduction means for every 5 patients treated with a drug, only 1 of them would achieve a 50% reduction in pain. Gabapentin (Neurontin) and pregabalin (Lyrica) are considered firs...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 30, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Hospice is Still Special
When socializing with fellow young physicians, most of whom are not in palliative medicine, I am reminded, in Hospice and Palliative Medicine, I have the unique opportunity to share time and attention with my patients. We reflect on “the old days” of medicine, where physicians had long standing relationships with their patients which allowed them to more easily direct medical decision-making which was appropriate for the individual patient. I often tell others I chose this field because it is the closest thing to that particular kind of medicine, where we can still do ‘the right thing’ for patients,...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 23, 2013 Category: Palliative Carer Workers Authors: Kristina Newport Source Type: blogs

How Wellness Programs Support Palliative Care in Cancer Related Fatigue
This article was co-written with Sami Papacek a Certified Cancer Exercise Specialist at the University of Kansas Cancer Center. (Source: Pallimed: A Hospice and Palliative Medicine Blog)
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 22, 2013 Category: Palliative Carer Workers Authors: John Hennessy Source Type: blogs

Subscribers Moving to A New Email Delivery Platform
We are moving to a new email delivery system called MailChimp from the old delivery system Feedblitz.  (Yeah, all new companies seem to have silly names. I can't stop them.).  What does this mean for you? 1) No more random ads on the emails 2) Ability to choose your subscription frequency: Daily (Full Post) MWF (Full Post) Weekly (Digest Version - short snippet of each post in the past week) 3) Ability for us to better understand the reasons why emails don't get delivered 4) Prettier looking emails that make you want to read and click 5) Clearer credits for the authors contributing to Pallimed If you wer...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 21, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Hospice and Palliative Online Efforts Featured in The Atlantic
As longtime readers will know, we here at Pallimed have advocated for social media being an effective change agent for issues relevant to hospice and palliative care for many years. With a thriving blog community (43! But we could always use more blogs!*), a strong Twitter presence of senior leaders and new leaders, a weekly Tweetchat since 2010 and several quality Facebook pages, the specialty which emphasizes communication skills at the bedside has done a good job communicating to the world as well. Paul Bisceglio (@PaulBisceglio) from The Atlantic featured some of these efforts and the newer trend of being very o...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 21, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

The agony & the ecstasy of EBM in symptom management
So, I decided I might blog a little again. Probably the occasional Journal Club of the Cloud-type posts. Christian and fellow bloggers, thank you for all you do in keeping Pallimed thriving and relevant. So, Eduardo Bruera & colleagues at MD Anderson have published the results of their long-awaited follow-up trial to their 2006 double-blinded, placebo controlled trial suggesting that methylphenidate (MP) is no better than placebo for cancer-related fatigue (CRF). Original 2006 trial here New 2013 trial here Journal of Clinical Oncology editorial on the 2013 trial here (hat tip to this editorial for pointin...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 7, 2013 Category: Palliative Carer Workers Authors: Drew Rosielle MD Source Type: blogs

Cases: Pain vs. Sufffering and the Role of the Pastoral Care
Discussion:  This was a process that was not resolved as in our modern media. The resolution was assisted by others in the Palliative Care Team, the Transplant Team, Unit Staff, Pastoral Care, Providence, and, of vital importance, her family members who realized her mortality and took ownership of her suffering and their contribution to the dysfunction in their household. In many of the rooms of the hospital are laminated Comparative Pain Scales with 1 being expressed as smiling demonstrating 'No Pain' to 10 being 'Unbearable/Excruciating Pain'. Modern technology addresses this pain well. Suffering of the soul, min...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 26, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Experience Cancer Through a Video Game
(Today we have our first post from Meredith MacMartin (@GraniteDoc), a palliative care doctor in New Hamsphire, who referenced this video game in a Tweetchat several weeks back. I'm pleased to welcome her to Pallimed and I know you will enjoy this thought provoking post. ~ Sinclair) My brother-in-law Dennis is seriously into video games. He’s a designer and programmer who has worked with NASA on using video game technology for training and community outreach purposes, and who is passionate about expanding the use of gaming for entertainment and especially education. I’ve had many conversations w...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 26, 2013 Category: Palliative Carer Workers Authors: Meredith MacMartin Source Type: blogs

Proposed Changes to Organ Donation Blur The Line on End of Life Care
Rolling into work this morning, NPR reported on a radical change in organ donation policies which could profoundly change how palliative care is perceived and how families and health care professionals make those very challenging decisions at the end of life.  At the heart of the effort is an attempt to increase the number of organ donors of course but the ethical question is in how to achieve that noble goal. Among the changes under consideration is the ability for hospitals and organ procurement organizations (OPOs) to make their own policies on how to approach families and patients about organ donation instead of f...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 24, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Home Palliative Care: Is there proof in the pudding?
This month, the Cochrane Collaboration has released a review of home palliative services for adults with advanced illness and their caregivers. The authors, led by Barbara Gomes, MSc, PhD, set the primary outcome as occurrence of death at home. Secondary outcomes included the time the patient spent at home, satisfaction with care, management and degree of pain and other symptoms, symptom burden, physical function, quality of life and caregiver pre and post bereavement outcomes. Economic data was also examined and included hospital costs, other institutional care costs, community care costs, informal care costs, and equipme...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 20, 2013 Category: Palliative Carer Workers Authors: Emily Riegel Source Type: blogs

Father's Day Without Your Father
I drove from Kansas City to Oklahoma to bury my father in a Veteran's Cemetery two years ago this summer, not long after Father's Day. I have not really thought much about that day in the following two years.  Which now feels kind of strange. Shouldn't I be think about it like a normal grieving adult child? It occurs to me now as I anticipate my wife and kids to celebrate my tenure as a father, that days like these are also memorial days for so many people.  Although I have talked with many people who have also lost one or both of their parents, it never really occurred to me as it is this week, the profound imp...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 14, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Origins: Debra Parker Oliver, PhD, MSW
David and Debbie relax before the first chemo treatment (Photo Credit: David's Videoblog) This summer you may meet many superheroes at your local cinema.  A frequent story telling device in the superhero genre is the origin story.  By showing how a superhero emerged from humble beginnings and transformed into a powerful force for good, one can give meaning to context and motivations and lead to a better understanding of who that person is.  In meeting many hospice and palliative care professionals over my career I have always enjoyed hearing how they discovered the field.  For some it is a startling ne...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 11, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Pallimed 8th Anniversary - You've Just Been Pep Talked
Back in March, the contributors of Pallimed got together for a hard conversation. We were only missing a few people but it was still a sizable gathering at a restaurant late one evening in New Orleans. We have met at Academy meetings before, really to check in with each other and how all of us were doing in our professional and personal lives.  But this was a little different.  None of us were posting with much regularity for the previous 18 months.   Compared to where we were in 2008, 2009, and 2010 we all recognized we had many more responsibilities and working on Pallimed really didn't alwa...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 8, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Cases: What Do I Say To My Kids?
DISCUSSION: Young children who are informed of their parents’ terminal illness are less anxious than those who are not told , but many terminally ill parents are daunted by this emotionally stressful task. Deciding how to break the news to children is made more difficult when taking into account the developmental level of each child. Palliative Care Teams often have several books available that guide parents through the process of discussing death and dying with their children. Parents’ abilities to apply the information in these books can be further enhanced with a session provided by the behavioral medicine c...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 7, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs