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Showing posts from May, 2014

Support Veterans' Access to Hospice

Memorial Day/Decorations Day In Columbia, MO the parade went off without a hitch. The Golden Eagles parachuted right onto their marks amongst the various downtown buildings at the start of the parade and of course they nailed their landing. It is a fitting time for all of us to pause and remember those servicemen who died while serving their country. And in fact, it is an appropriate time to honor all veterans for their service. I have always enjoyed working with the Veterans Administration (VA). My hospice is an active participant in We Honor Veterans. And I have always found the quality of care delivered locally to be superb, and I think the VA leaders that I have personally known are dedicated to their jobs and superb leaders, so I have found recent news reports of access problems quite disappointing. But this Memorial Day, I want to bring to your attention a less publicized access issue that impacts veterans: access to hospice. Current statute does not require t

The Geriatrician Syndrome

I recently attended the AGS Meeting in Orlando as a rising 3rd year medical student. I was there to present my work on family caregivers, which was well received and even garnered some international attention. Not only did my research resonate with clinicians and researchers on a professional level, but they were also personally touched by the unique and heartbreaking stories of these unpaid caregivers. These were individuals who tirelessly gave their time and energy to tend the health care needs of a loved one without accepting pay or gratitude, even at the expense of their own physical and mental wellbeing. I was enthused by the opportunity to share my findings, but when people came up to me to extend their congratulation's for receiving the AGS Clinical Student Research Award, I was not as excited to talk about that. Instead of saying, “Thank you, I am delighted and honored,” I wrote off such worthy recognition by responding, “They probably didn’t have anyone else to give it to

Is standard oncology care killing patients?

In 2010, the Temel article reported that early palliative care prolongs survival in patients with Non-Small Cell Lung Cancer (NSCLC).   As a palliative care physician, I would love to believe that excellent symptom control attention to patients’ goals of care would increase a patient’s quantity of life as well as quality of life.   However, I find it somewhat implausible that palliative interventions would prolong life in patients with NSCLC.   What is the mechanism by which goals of care discussions delay the progression of cancer?   How do opioids and other symptom management medications prolong life?   Since the basic finding was that patients randomized to early palliative care lived longer than patients randomized to standard care, we must seriously consider the conclusion that standard oncologic care is shortening life. How might evidence-based, standard of care oncology therapies that have been proven to prolong survival in randomized trials actually shorten life?   One pos

"Palliative chemotherapy" - a term that should be laid to rest

by: Alex Smith, @AlexSmithMD What is this term "palliative chemotherapy"?  Are the words "palliative" and "chemotherapy" so incompatible that their combination is an oxymoron?  Is this term a useful term? Who is it useful for?  Doctors?  Patients?  Researchers? We got talking about this in our palliative care journal club this month as we discussed an outstanding recent  study by Alexi Wright published in the BMJ.  The study investigates the association between receipt of "palliative chemotherapy" and place of death for adults with advanced cancer.  The study finds there is an association, and this finding raises all sorts of interesting points about how we might explain chemotherapy to patients who are months away from death.  See Mike Rabow's terrific commentary here . We've blogged before about how in the United Kingdom they prioritize honoring a patient's "preferred place of death" in the same way we prioritiz

Geri and Pal getting together at the American Geriatrics Society Meeting #AGS14

The American Geriatrics Society is having its annual meeting this week and it is chock-full of goodies for those interested in palliative care and geriatrics. The one thing you must do if you are in Orlando is join us for the Palliative Care SIG at Mulino’s lounge on Thursday from 6:00-7:30pm . Rumor has it that Steve Smith, CEO of AAHPM, will be there too, as well as the ever elusive Paul Tatum. Here are a couple of other events that you should consider attending while at #AGS14 that combine the two best fields in health care. This is only a partial list of palliative care topics at #AGS14 as this year’s schedule is full of good stuff (comment below if you want to shout out a session). Wednesday: The jointly sponsored session by AGS and AAHPM on "Tools For Success: Care Of Adults With Multimorbidity In Hospice and Palliative Care."  From 100-5:30 pm. Room Asia 2. Thursday: Do Unto Others: Doctors’ Personal End-of-Life Resusitation Preferences and Their A

The Importance of Language

by: Bridget Sumser, LMSW The world of palliative care is well served in reviewing thoughtfully, the language we use on a daily basis. In a talk I gave recently on assessment and interventions for patients and caregivers struggling with depression, I circled back repeatedly to the therapeutic power of how we communicate. The vision is simple, but the practice requires diligent attention to word choice. How can we communicate in ways that affirm the personhood and wholeness of patients and families? How can we do this both in their presence and in rounds/team meetings? A common example: Question: What's her (the patient's) code status? Answer: "She is a DNR" How many times a day do you hear this? If you are like me, and working in an acute care setting, probably more times than you can count. As such, you might be wondering what the big deal is. However, in this example, we have confused the patients code status with her self hood. She is not in fact a

Nurses week: celebrating GeriPal nurse scientists

Diagram by Florence Nightingale showing that deaths in the British Army during the Crimean war due to preventable infectious diseases (blue wedges) far outnumbered deaths due to wounds (red) or other causes (black). by: Alex Smith @AlexSmithMD It's nurses week!  Please take a moment to thank the nurses in your life for the extraordinary work that they do. For GeriPal, let's take a few moments to focus this year on thanking the many amazing nurse scientists in geriatrics and palliative care. This is a list of a few of the many nurse scientists who have pushed hard on the boundaries of what is known in geriatrics and palliative care.  I've just listed a first few to get the ball rolling. Mary Naylor - Developed the Transitional Care Model, research focuses on helping older adults with chronic conditions receive high quality care and avoid unnecessary hospitalizations. June Lunney - Described and provided empirical evidence for functional trajectories toward th