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Palliative Care in Nursing Homes: Discussion of a Multinational Trial with Lieve Van den Block

Nursing homes are a tough place to do palliative care.  There is extremely high staff turnover, physicians are often not present except for the occasional monthly visit, many residents die with untreated symptoms usually after multiple hospitalizations and burdensome life-prolonging treatments, and specialty palliative care - well that is nowhere to be found in most nursing homes outside of hospice.  So what can we do to improve the palliative care outlook in nursing homes?

On todays podcast we talk with Lieve Van den Block about her recent palliative care intervention that was published in JAMA IM this week.  Lieve led a multicomponent intervention to integrate basic nonspecialist palliative care in in 78 nursing homes located in 7 different European countries.  Just take a moment to grasp the size of this study - 7 counties, 78 nursing homes.  I struggle with just trying to improve palliative care in one site!

We discuss with Lieve the results of the study, her take on why they got…
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State of the Science in Hospice in Palliative Care: Who should go and why?

If you're like me, then you can't get enough of these exciting meetings with high concentrations of hospice and palliative care researchers: the National Palliative Care Research Center's Annual Foley Retreat, the Palliative Care Research Cooperative Group meetings, the Beeson meeting, and more.  All of these meetings have high concentrations of engaged palliative care researchers. 

Similarly, the annual palliative care assembly sponsored by AAHPM and HPNA has a considerable amount of research programming. 

So, you might ask, why would one attend the brand-new-first-ever-of-it's-kind State of the Science in Hospice and Palliative Care Meeting? This new meeting, which will overlap with the end of the annual assembly and continue through Sunday in San Diego (March 20-22).

How is this meeting different from the regular assembly meeting?  I put the question to the meeting's co-chair Nick Dionne-Odom, who replied:
The Annual Assembly Meeting has primarily centered on clinic…
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Allowing for Chemotherapy in Hospice: A Podcast About Concurrent Care With Vince Mor

A recent study by Vince Mor published in JAMA Oncology found that veterans with advanced lung cancer treated in Veterans Affairs (VA) Medical Centers with high hospice use were more likely to receive concurrent cancer care and also less likely to receive aggressive care. On top of that, veterans treated at facilities with high levels of hospice use also incurred lower costs of care.  

This is a strong case for the concept of concurrent care in which individuals can avoid the "terrible choice" between hospice and life prolonging therapies.   On this weeks podcast, we interview the lead author, Vince Mor, about this study and whether concurrent care is ready for prime time outside of a integrated health care system like the VA.

We also put a plug in the end for the NIA Imbedded Pragmatic AD/ADRD Clinical Trials (IMPACT) Collaboratory that Vince is helping to lead.   If you want to learn more about the collaborators, click here.

by: Eric Widera







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Health Navigators Improve Dementia Care: Podcast with Kate Possin and Sarah Dulaney

Do you remember the scene from the movie The Graduate where Ben's dad says, "One word: Plastics"?

Well, I write this blog post from the National Palliative Care Research Center's annual Foley retreat, a who's who of palliative care researchers.

The words on everyone's lips: "Lay Health Navigators."

This is not to draw equivalency between environmentally destructive materials and people who help those with serious illness and caregivers navigate our complex health care system.  Rather, it's to point out that revolutions occur in palliative care research just as they do in business.

In this week's podcast, we talk with Kate Possin, PhD and Sarah Dulaney, RN CNS of UCSF about the Care Ecosystem project.  In this remarkable study, published in JAMA Internal Medicine, lay health workers helped caregivers of persons with dementia navigate the health care system by providing support, education, and care coordination with dementia specialists.  The…
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