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What Does the Scan Tell Us? An analysis of oncology outpatient visits
Discussions: Insights Into Why Patients Misunderstand Their Prognosis, " which was published online early in the Journal of Oncology Practice. (OPEN ACCESS PDF!)The researchers analyzed recordings of oncologists and patients with stage IIIA, IIIB, or IV non-small cell lung cancer in the outpatient setting. These recordings were from another large study and are over a decade old now. But as the authors pointed out, there is not strong evidence that outpatient communication strategies have changed wholesale in oncology, (although treatment options have changed drastically with the introduction of checkpoint inhibitors, but t...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 30, 2017 Category: Palliative Care Tags: clinic communication journal article oncology outpatient prognosis sinclair Source Type: blogs
Changing Treatment Options in Delirium - No More Antipsychotics?
by Drew RosielleIntroductory CommentsThis is a post to share my thoughts about therandomized, controlled trial of haloperidol, risperidone, or placebo for delirium in ' palliative care ' patients, published recently in JAMA Internal Medicine.Big hat tip to my fellows - Drs Amanda Hinrichs, Elena Wahmhoff, and Alison Feldman, whose discussion of the paper at a recent fellows ' rounds helped me think through the study, as well as theAAHPM Connect communities bulletin board ' s discussions (BTW, have really appreciated these bulletin boards the last couple years and am grateful to AAHPM for pulling it off so well!).Geripal, a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 28, 2017 Category: Palliative Care Tags: antipsychotics delirium journal article MDAS NuDESC rosielle Source Type: blogs
I ’m sorry your mom died, but I cannot help you now. Here’s why.
Dear Mrs. J,
I would like to express my deepest condolences on the passing of your mother. She was a magnificent woman, and I had the pleasure of being her doctor for almost a decade. It was a pleasure. During our short visits, she regaled me with stories of childhood and often gently sprinkled in advice gleaned from years of experience. Even as she began to decline, we would sit together in the nursing home, and she would reach out to hold my hand. She was a gift, your mother. A gift that I in no way deserved.
I’m sorry she got cancer. As a physician, there is no word worse than the word “metastases.” It...
Source: Kevin, M.D. - Medical Weblog - January 12, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/jordan-grumet" rel="tag" > Jordan Grumet, MD < /a > Tags: Physician Palliative care Source Type: blogs
Bishop Tutu ’s Plea Prompts Personal Meditation on Assisted Suicide
By Myra ChristopherI worked late Tuesday night and was listening to NPR as I always do during my short commute home when I heard that, in celebration of his 85th birthday, Bishop Desmond Tutu announced that he supports physician-assisted suicide and “prays that politicians, lawmakers and religious leaders have the courage to support the choices that terminally ill citizens make in departing Mother Earth with dignity and love.” I was stunned.At age 30, I decided to spend my life working to improve end-of-life care and that the way that I would do that would be by “doing ethics.” I would spend my life...
Source: blog.bioethics.net - January 11, 2017 Category: Medical Ethics Authors: Practical Bioethics Tags: Health Care advance care planning assisted suicide end of life planning medical ethics physician assisted suicide syndicated Source Type: blogs
Why Now? Concerns About End-Of-Life Health Care Policy
In Anne Scitovsky’s 1984 review of end-of-life health care costs she too wondered why the issue was receiving increased attention just then. Perhaps, she thought, the impetus was that health care expenditures had recently risen to 10 percent of GDP. But it was more than that. Hospice coverage under Medicare was introduced just a year earlier, many papers looking at escalating end-of-life costs for cancer patients were being published, and professional and popular books and movies on death and dying were appearing almost monthly. The tone was clear: If only patients were told the truth, they would never choose treatments ...
Source: Health Affairs Blog - December 19, 2016 Category: Health Management Authors: Vincent Mor Tags: End of Life & Serious Illness Featured Dying in America hospice Palliative Care Source Type: blogs
Is there a difference between a good and bad prognosis? It depends.
It was recently pointed out that one of my partners had made an error in a patient’s electronic hospital chart. Did I want to correct the mistake? Curious, I looked at the computer screen. There in 12-point-black-on-white Cambria was the culprit documentation. The words were:
“Our therapy goal is palliative. Prognosis is good.”
Now, this was clearly not what the author had intended. In common practice when someone is so sick that we are focusing on purely palliative ends, comfort care, it means that the patient’s prognosis is limited, bad, even grim. If the prognosis is “good,” we have more lofty goals than jus...
Source: Kevin, M.D. - Medical Weblog - December 14, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/james-c-salwitz" rel="tag" > James C. Salwitz, MD < /a > Tags: Physician Cancer Source Type: blogs
Not all patients share the same views on end of life
As an oncologist, I have witnessed patients go home and heard later how they died there, surrounded by family and friends. I have seen others die in a hospital room, comforted by the care of the inpatient team even as they depart this earth. These are the ones that stick with me and what I think about when I hear the term a “good death.” It’s what I would want for myself: dignity, serenity and comfort.
The reality of the end of life is that not everyone shares my view of what constitutes a good death. I’ve come to realize that when a patient has a very different view of the end of life from mine, it can be very dif...
Source: Kevin, M.D. - Medical Weblog - December 14, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/don-s-dizon" rel="tag" > Don S. Dizon, MD < /a > Tags: Physician Palliative care Source Type: blogs
Alzheimer's Care Killing our Parents with “Kindness”
We were proud of the fact that we had managed to honor our promise to never put her in a nursing home; and that, she was still able to continue living with dignity in her own home.By Shira SebbanAlzheimer's Reading Room“Who authorized this patient to be administered morphine?” The hospital geriatrician’s voice was stern as he addressed the staff clustered around my mother’s bed. “She’s for active care, not for palliative care – she’s going home!”Dying from Dementia, Suffering Often UnnecessaryWith the doctor finally on side, I felt like I had won a battle –the battle to stop the morphine, which the hosp...
Source: Alzheimer's Reading Room, The - December 7, 2016 Category: Neurology Tags: care of dementia patients care of dementia patients at home dementia care elderly dementia care help alzheimer's help with dementia care Hospice Care memory care palliative care Source Type: blogs
In the Company of Death; In Consortium Mortis
By Mark Ligorski#1. BeginningsJust like in superhero movies, there is always a back story. This is mine.After graduating medical school in 1981, I went to work at St. Vincent ’s Medical Center on Staten Island for the next two years, the first spent in rotating through the different areas of medicine and surgery and then a year of Internal Medicine. 100 hour work weeks were typical, with on call shifts every 3rd or 4th night.People stayed in hospital for weeks at a time; there were still wards with four to six patients. Intensive and cardiac care units were still pretty new. TheKaren Ann Quinlan case ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 3, 2016 Category: Palliative Care Tags: advanced directives code status CPR ligorski respirator Source Type: blogs
Symptoms of Cancer May Include Fatigue, Unexplained Weight Loss, Fever and Foreclosure
by Bridget BlitzAs a palliative care social worker, I provide home visits to patients and families to explore how they are coping with complex medical issues, which resources they need, how we might add services that could reduce caregiver strain, and talk to them about their goals of care and about their wishes for the life they have left. Startling to me, within these discussions, is the depth of fear and anxiety about finances that leave these individuals struck with more than a horrible illness. They now have to absorb the real possibility of being without a permanent home in addition to adapting to new treatments, sym...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 14, 2016 Category: Palliative Care Tags: bankruptcy financial social work social worker Source Type: blogs
The Illusion of Impermeability
by Laura PatelAs I sat in my hospice interdisciplinary group meeting, reviewing the many patients who have died in the past two weeks as well as our new patients, there was a slight break in the discussion. Being ever the multitasker, Iclicked on a NY Times article I have been meaning to read and scanned the first two sentences: “When my husband died from cancer last March at age 37, I was so grief-stricken I could barely sleep. One afternoon, I visited his grave — in a field high in the Santa Cruz Mountains, overlooking the Pacific Ocean — and lay on top of it. I slept more soundly than I had in weeks.” Suddenly, ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - November 13, 2016 Category: Palliative Care Tags: kalanithi patel Source Type: blogs
10 Great Alzheimer's Care Keyword Searches
The Alzheimer's Reading Room is designed to help Alzheimer's caregivers and dementia professionals to find information, advice and solutions to problems they face each day.By Bob DeMarcoAlzheimer's Reading RoomWe provide the Alzheimer's and dementia communities not only with advice,but with advice and solutions that work.Our goal is to help all caregivers, regardless of stage, to improve their caring techniques, and to improve their communication with persons living with dementia.The goal of the Alzheimer's Reading Room is to Educate and Empower Alzheimer's caregivers, their families, and the entire Alzheimer's community.T...
Source: Alzheimer's Reading Room, The - November 8, 2016 Category: Neurology Tags: alzheimer awareness alzheimer's care alzheimer's keywords dementia care family caregiving google alzheimer help alzheimer's help with dementia care Source Type: blogs
National Health Observances for November
There are several days and the month itself dedicated to raising awareness about various health topics in November. From the National Health Observances put together by the National Health Information Center, we have American Diabetes Month, Bladder Health Month, COPD Awareness Month, Diabetic Eye Disease Month, Lung Cancer Awareness Month, Lung Cancer Awareness Month, National Alzheimer’s Disease Awareness Month, National Family Caregivers Month, National Healthy Skin Month, National Hospice Palliative Care Month, and National Stomach Cancer Awareness Month. In addition these are special days and weeks in November, ...
Source: BHIC - November 4, 2016 Category: Databases & Libraries Authors: Kay Deeney Tags: General Public Health Source Type: blogs
A physician ’s compassion well has run dry
As she lay on the gurney telling me she was tired and having vaginal bleeding yet again, I was doing my own biopsy of her medical record.
It stated very clearly that palliative care and hospice had been recommended to her for her end-stage gynecologic cancer. So, why, I’m thinking, highly annoyed, is she now in the ER, late at night, creating problems for me? Why could she just not accept that she was dying and there was nothing left to be done?
I babbled some nonsense about how I would check some lab work and get back with her, but in truth, I was thinking only of the stack of patients yet to wade through, the lab, x-ra...
Source: Kevin, M.D. - Medical Weblog - November 2, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/desiree-la-charite" rel="tag" > Desiree La Charite, MD < /a > Tags: Physician Emergency Source Type: blogs
I ' m Losing My Friends
Right now I have two friends in hospice care. One I have known for only about six months but we have gotten pretty close. She was in my knitting group and when I met her she was on palliative care only for pancreatic and other cancers that she has been treated for over 20 years. She is on hospice care at home and no longer goes to knitting. We have talked on the phone and skyped regularly over the past four weeks but it is unclear how much longer this will go on.The other friend is the husband of a very old friend (friends for more than 40 years) and has been treated for stage IV colon cancer for nearly seven years. His di...
Source: Caroline's Breast Cancer Blog - November 2, 2016 Category: Cancer & Oncology Tags: cancer death friends hospice Source Type: blogs
