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Showing posts from January, 2017

Vicki Jackson on Building the Evidence Base for Palliative Care

Tremendous amount of exciting new data coming out of one of our nation's oldest palliative care services: Massachusetts General Hospital (MGH) just celebrated a 20 year anniversary.  Please see the links below to recent articles and posts, including new studies about early palliative care in bone marrow transplant and early stage GI cancers coming out of MGH.

In today's podcast we interview Vicki Jackson, chief of the palliative care service at Massachusetts General Hospital, the service that provided the palliative care intervention in these trials.  Vicki is known as one of the best palliative care providers in the world.  She also happens to be refreshingly plain spoken.

We talk about many topics, including: how palliative care in bone marrow transplant and GI malignancies is unique, palliative care "pearls" in these populations, what it's like going into a "new" territory for palliative care, and what's next at MGH.

https://soundcloud.com/gerip…

A Podcast with Dame Cicely Saunders

Yes, we have a podcast with Dame Cicely Saunders, the founder of the modern hospice movement.  No, it's not one of the GeriPal podcasts, although that would have been a very impressive feat.  Rather, Saunders is one of the "castaways" of BBC's Desert Island Discs originally published in 1994, slightly over a decade before her death (click here for the podcast).   
The format of the show is that guests are asked to imagine they are cast aways on a desert island.  They must pick recordings to take with them and discuss the reason why they are bringing them.  They also discuss their lives and what they have learned along the way.

Saunders discussed her schooldays, how she trained as both a nurse and doctor, the development of  St. Christopher's Hospice, euthenasia, and, shocking, how she fell in love with one of her patients.

I've had a chance to read a lot about Saunders, but there is something about hearing her voice that really makes recordings like these s…

House Calls are Old-School

Dr. Heidmann on the way to an apointment.
This sunny Saturday morning, I drove to a couple of house calls in my Northern California rural county, situated behind the redwood curtain. Covering both hospice and my program, Redwood Coast PACE (Program of All-Inclusive Care for the Elderly), the day is brisk with phone calls. I am listening to Bruce Springsteen read his autobiography, Born to Run, which makes the house call miles fly by. Bruce's story speaks to me about coming from almost nothing and practicing until you start to make something beautiful. He had an imperfect family, no money and little education. This hard scrabble existence is still a real one for so many people, including many of those I serve. And the fact is in small town America, providing healthcare can feel like a hard scrabble existence. People are astoundingly sick, reminding me of my rotations through San Francisco General Hospital, but without the resources of a large tertiary medical center. Lack of resour…

Advance Care Planning Volunteer Certification?

The Colorado Health Foundation has recently funded a host of proposals around our state to increase advance care planning (ACP) in Colorado.The proposals I’ve heard about seem quite innovative.Many, including ours, are utilizing a volunteer workforce to implement the ACP.Some of us at the University of Colorado, in partnership with our friends at the Denver Hospice, are working on a project to create a “certification program” for advance care planning volunteers.I keep thinking of it as being similar logistically to CPR certification.Obviously, that analogy is not perfect – ACP volunteers don’t have to do chest compressions…and CPR volunteers don’t have to have skills in communication.However, the idea of a program where someone can learn the basics, practice, get feedback, and become certified is really exciting to me.
Through our development, we’ve begun to wonder and question our assumptions about what a volunteer can do.We are hoping to get some input.We’ve put together a very shor…

How to Incorporate the Results of a New Trial of Palliative Care in Lung and GI Cancers

by: Eric Widera (@ewidera)

A little over 6 years ago, Jennifer Temel and colleagues published a trial of patients with newly diagnosed metastatic non–small-cell lung cancer showing that early integrated palliative care significantly improved quality of life and other measures like symptom control.   Now we have a follow-up study published this week evaluating early integrated palliative care for patients with newly diagnosed incurable lung or non-colon GI cancers.

A brief overview of the study

350 patients with newly diagnosed incurable cancers were randomized to early palliative care integrated with oncology care compared with usual oncology care.    The patients had to be within 8 weeks of a diagnosis of incurable lung or noncolorectal GI (pancreatic, esophageal, gastric, or hepatobiliary) cancer.   They also couldn’t have a history of therapy for metastatic disease, and had to have a reliatively good functional status (ECOG 0-2).

Those who got palliative care in addition to usual c…