Sunday, March 17, 2013

State of the Science from the 2013 AAHPM Annual Assembly

The State of the Science plenary is one of my favorite traditions at the AAHPM Annual Assembly.   This year, Jay Horton and Kim Johnson took the lead in presenting analyses of some of the previous year's most important hospice and palliative medicine research.  For those attendees interested in seeing their slides again, you can find them here.

Some of the research below further confirms our previous understanding of the state of the science (for instance, the studies on the low utility of feeding tubes in many circumstances).  Other studies provide quality randomized controlled trial data on questions which have nagged our field but where previous RCT data are minimal or completely lacking (e.g. parenteral fluids near end of life and ketamine for cancer pain).

We'd love to hear what you think about each study.  Feel free to comment on the blog.  If you like a study, you can further disseminate it by Retweeting it directly from this post! 










Sunday, March 17, 2013 by Lyle Fettig, MD ·

Friday, March 15, 2013

David and Debbie Oliver's AAHPM Plenary: Comforting Others While Living With Illness

One could write pages about David and Debbie Oliver's remarkable plenary presentation Friday at the American Academy of Hospice and Palliative Medicine Annual Assembly in New Orleans.  David has stage IV nasopharyngeal carcinoma and has taken his cancer journey to the public.  Before I go any further, I'll refer you to David's book, "Exit Strategy: Depriving Death of Its Strangeness," Paul Tatum's Interview with David at Geripal from August 2012, and below, see a clip from David's Cancer Videoblog in which he talks about cancer and palliative care.


Of the many themes which arose from their presentation, I was especially struck by David's statements about the disclosure of his diagnosis to others and his frequent need to comfort the person receiving the news.  Our culture struggles with the language to respond when surprised by the news that someone we know or meet has a serious illness.  David talked about his 94 year old mentor telling him, "don't panic, don't struggle, relax, and accept it" in the face of the illness, and he's really taken the advice to heart.  Yet I'm sure that many people he meets project their own fears about developing a serious illness, and thus assume that every day is a monumentally and persistently dour struggle.  (I've had medical students and others remark to me before about a terminally ill patient, "how can they be in such a good mood?" as if this were forbidden once the illusion of immortality has been cast aside.)

I think David has the right formula for responding to people.  He deprives death of it's strangeness by providing comfort to them.

I ask most patients what they have told their loved ones and how their loved ones are coping with the patient's illness.  I don't routinely ask patients how others respond to the news of the illness.  What happened when you told your hairdresser?  The doorman?  Your colleagues?  Was their response comforting, unsettling, or downright bothersome?  Do you feel comfortable talking to others about it?  Perhaps those conversations go well.  But when they don't go well, it results in social and psychological suffering.  As David said today, "Don't move too quickly through the (anticipatory) grief!" (i.e. I'm still alive and treat me like I am!)

I briefly surveyed twitter and a few people in person, and there was general agreement that this type of question usually isn't asked (at least by many physicians) although some responded saying that they did usually or always ask about how others respond to their illness disclosure.  I hope this is an opportunity to reflect on the value of this line of questioning and how we might help patients communicate more effectively with those around them in the interest of their social well-being.

Here's a study which further clarifies the emotional work of disclosing a breast cancer diagnosis.

Friday, March 15, 2013 by Lyle Fettig, MD ·

Monday, March 11, 2013

What The AAHPM Annual Assembly Means To Me


I really love my field. Both sides hospice and palliative medicine. Both sides academic and community. Both sides profit/not for profit. Both sides friends and soon to be friends. Because to me they are not really sides or artificial tribes that exist because we humans really like to label things into groups.  To me this is one whole big family and the Annual Assembly feels like a really good family reunion to me. Not the family reunion of TV or movie tropes where everyone dreads it, but the real type of family reunion where you see people you have not spoken with in a year or more, but you drop right into a regular conversation like you see each other every day.

2013 will be my 10th Annual Assembly in a row.  I started in 2004 in Phoenix, AZ and have enjoyed each year more and more.  I'm sure some of you may be asking how my colleagues let me go so often.  Well some years I only went for one day or less like in Tampa, when I flew in for the Pallimed party on Friday night and left Saturday afternoon. These past few years I have been on the board which is pretty much mandatory attendance.  Other years, I submitted and had talks selected which helped insure a trip to the Annual Assembly.  No matter, I just wanted to try and get there and see my HPM family again.

I love the learning that goes on there.  Fantastic lectures, new ideas, meeting incredibly smart and talented people who love this field with an intense passion.  Sometimes I have tried to explain these feelings to family or friends, and I get some quizzical looks about why a medical conference has me so filled with anticipation.  So that is how this blog post came to life.

I will be posting on Twitter (#hpm13), the Pallimed Facebook Page, and guest blogging on the AAHPM blog all this week, so if you are not able to go please follow along and share the learning.  I will also be taking my camera everywhere I go, because I have realized I have not taken nearly enough pictures at the Annual Assembly in relation to how important the people there are to my life.  So if I see you I will likely ask to take a picture with you, because there are a lot of memories that are fading already after 10 short years.

Please share below what gets you excited about the Annual Assembly

Photo Credit:  "secondline" by Flick User Swampier

Monday, March 11, 2013 by Christian Sinclair ·

7th Annual Pallimed and Geripal Gathering

Are you excited about the AAHPM/HPNA/SWHPN 2013 Annual Assembly this week?  I hope you or at least your colleagues are able to attend.  We will be continuing the tradition of gathering readers and contributors to this blog and Geripal.  It has grown over the years naturally and we are excited to meet other people you may only nknow by a screen name or email address.

There will be a strong Pallimed contingent this year with Drew Rosielle, Lyle Fettig, Jeanette Ross, Holly Yang, Suzana Makowski, Thomas Quinn, and Amber Wollesen in attendance, so please rech out and say hello.

We do have a date and time for the party - Thursday night starting around 9pm, so you have enough time to have dinner with colleagues and friends.

But we don't exactly have a location...or locations...or maybe we do and we are keeping it a secret...regardless we aren't saying quite yet.  If you have any tips on a good location that is easy to get to, please email us, tweet us (#hpmparty), or post a suggestion on our Facebook page.

You can also RSVP on the Facebook Event page if you may be joining us so we can make sure and get you the update. We will be using #hpmparty to announce the location as well.

Here we come New Orleans!!!

2010 Boston

by Christian Sinclair ·