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Showing posts from 2017

Prognostication in Hospice and Palliative Care - A Podcast with Christian Sinclair

For this weeks podcast, we talk all about prognostication with Christian Sinclair (@ctsinclair).  Christian is a palliative care physician at University of Kansas Medical Center, past president of AAHPM, recent AAHPM "Visionary" awardee, and Pallimed social media guru.

We go over a lot of topics at the heart of prognostication in hospice and palliative care including:
The importance that prognostication plays in daily practice, especially in goals of care discussionsHelpful tools and skills to estimate prognosis How prognosis changes the way we think about prescribing opioidsHow to think about prognosis when it comes to hospice eligibility and why it may be that one of the most important tools used for prognostication in the hospice setting, the hospice eligibility guidelines, were last updated over two decades ago. So we have a ton to talk about and we would love for you to continue this discussion in the comments section of this blog, on Facebook, or on twitter.  We also …

Palliative Care, Chronic Pain, and the Opioid Epidemic: GeriPal Podcast with Jessie Merlin

I recently had the fortune to hear Dr. Kathy Foley talk about palliative care and the opioid epidemic.

First, let me say that Dr. Foley is a GIANT in the field of palliative care.  She has probably done more to improve access to opioids globally for people with serious illness than anyone else in the world.  She's so big the National Palliative Care Research Center retreat (where I saw her speak) is named the Foley retreat.

Second, it was remarkably courageous of her to speak on this particular issue, as Dr. Foley was unfairly vilified in the popular press for initiating the opioid epidemic with a small paper on 38 patients she published with Russ Portenoy.  (Here's a link to a more thoughtful treatment of the story Netflix doesn't cover, and the pernicious role of big pharma, particularly Purdue, the makers of Oxycontin).

Third, let me say that if you ever have the chance to see Kathy Foley speak -- go.  Just go.  She's a brilliant speaker.  She is sharp as nails and…

Tom Gill on Distressing Symptoms, Disability, and Hospice

by:Alex Smith @AlexSmithMD

In this week's GeriPal Podcast, sponsored also by the Journal of the American Geriatrics Society, we talk with Tom Gill, MD, Professor of Medicine at Yale.

With guest co-host Dan Matlock, MD, from the University of Colorado, we talk with Tom about his recent JAGS publication on the relationship between distressing symptoms, disability, and hospice enrollment.  Tom conducted this study in a long running cohort of older adults that has made a number of outstanding contributions to the GeriPal literature (see links).

Major points:

Restricting symptoms start 6 months before death, but most folks didn't enroll in hospice until 2 weeks before deathDisability increased markedly over the last months of life, and precipitated hospice use, but most hospice and palliative care programs are not set up to help with a persons daily needs.  There's a mismatch between the need for daily assistance and the hospice and palliative care services offered.
Tom's s…