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Wednesday, December 30, 2015

Fast Facts and Concepts Now Hosted at

Many Pallimed readers have noted that Fast Facts and Concepts (commonly know as Fast Facts) is no longer hosted on the Center to Advance Palliative Care website. We reached out to Sean Marks and he wanted to let you all know about this transition. - Ed

To all Fast Facts and Concepts Readers:

We are very enthused about the expanding readership of Fast Facts and Concepts over the last several years. In 2014, the original electronic home for Fast Facts, EPERC, shut down. Thankfully, CAPC agreed to electronically disperse Fast Facts for the year of 2015. Having CAPC disperse Fast Facts for 2015 greatly contributed in us reaching new readers and authors. It also enabled us to keep Fast Facts as a freely available educational resource for our field.

In the middle of 2015, the founding Editor-in-Chief of Fast Facts, David Weissman MD, helped spearhead the first state-wide network for Palliative Care clinicians named the Palliative Care Network of Wisconsin or PCNOW. The weblink for PCNOW is This website is now the electronic home for the entire library of Fast Facts. Please be patient as we work on kinks with the website, but because we are in direct control of the website, it has been much easier to update previously published Fast Facts and respond to reader feedback.

There are many collaborative partnerships we have in the pike which we are very excited about. Thanks to our volunteer authors, peer review panel, and editors, we are confident that Fast Facts will continue to be a useful “just in time” educational resource for our field.

Sean Marks MD
Editor-in-Chief Fast Facts and Concepts
Medical College of Wisconsin

Wednesday, December 30, 2015 by Christian Sinclair ·

Monday, December 14, 2015

The Importance of Medication Take-Back Programs

by Christian Sinclair

When it comes to pain and opioids, many hospice and palliative care clinicians work to fight against the stigma and fear surrounding these important and powerful medications. We provide education on how how to take opioids safely and how the medications can be most effective to control pain for patients with a serious illness. Despite these efforts to educate, there still may be gaps in knowledge for patients and families and rarely the education can be misperceived as promotion to more hesitant patients, families (and other clinicians).

So how do we balance the stigma-reducing education and appropriate access to opioids, while also respecting the growing public health issues of prescription drug overdose, including suspicion and fears about 'narcotics'?*

Let's review the education about controlled substances in hospice and palliative care organizations. Examine your own practice patterns. What standardized education is provided for patients? Items to cover may include:

  • Safe storage and handling
  • Symptom and medication tracking
  • Drug interactions
  • Preventing diversion
  • Tolerance vs dependence vs addiction
  • Side effects including constipation
  • Medication disposal

Your practice, group, or organization may be covering some of these topics but possibly not all of them routinely for every patient.  Making this education uniform and standard includes teaching at critical moments such as initiation of opioid therapy, change of opioid medication, and even considering 6- or 12-month intervals to review.

One area many palliative care and hospice programs could be of more assistance is helping patients and families identify safe ways to dispose of opioids (or any medications). In my clinical experience, hospice nurses do a good job of discussing medication disposal with families after the death of a patient. Multiple strong medications may have been prescribed as death neared and the medications clearly do not need to be in the home after the patient has died. But outside of that very unique circumstance, do we talk about medication disposal once patients stop taking certain medications?  In my experience, maybe not as often as we should.

I've been familiar with the National Medication Take Back Day for a few years now, but I'm still surprised how many clinicians are not yet aware of it. Supported by the FDA and DEA, this program encourages local pharmacies and law enforcement to work together to securely receive tons (yes, tons!) of medications from shoeboxes and medicine cabinets around the country. Local areas may do this more often than yearly and the FDA also maintains a list of places to dispose of medications all year round. Get familiar with the places near you.

Even simple pamphlets can increase safe disposal rates from 2% to 27%. Still abysmally low, but, hey, we should be starting somewhere. An increasing issue is the response to the important public health concern over opioid deaths. More laws will make it harder to get patients with severe pain access to these important medications. Massachusetts has been seriously flirting with a bill that would limit opioid prescriptions to 7-day fills. The hospice and palliative care community can help preserve this access with visible demonstrations of a responsible approach to these medications.

So what do you do in your own organization? Are there any standard forms or education you would share with the wider community?

Resources for opioid information:
FDA Safe Disposal of Medications
AAHPM Opioid REMS Education (CME Available)
Patient Counseling Document (via CO*RE-REMS)
Pallimed posts about opioids

Christian Sinclair, MD, FAAHPM is a palliative care physician at the University of Kansas and editor of Pallimed. In his spare time he likes to read FDA, DEA and CDC websites.

*Please if you are health care do not refer to opioids as narcotics. I did in this piece to drive home a point. Use of the word narcotic in place of opioid in your documentation, education and communication with patients, families and other providers only reinforces the stigma that these medicines are either illicit, purely addictive or only dangerous. The term narcotic should be reserved for the Vice squad and TV Crime dramas when referring to Federal Regulations regarding heroin and cocaine among other illicit drugs. Even 'narcotic counts' is pretty inaccurate since on any nursing unit it may include other controlled substances like Ritalin, anti-psychotics, and benzodiazepines among other medications. Maybe we could make a more accurate term like 'Controlled Substances Count' (aka CSC). This is a long tangent for an asterisk, isn't it.

Image credit: Many Pills via Allen County Wastewater District
Image Credit: Connecticut K-9 Narcotics Unit by fairygift via Amazon

Monday, December 14, 2015 by Christian Sinclair ·

Tuesday, December 8, 2015

Benefits to Certification: Increasing the Standard of Hospice Care

by Allison Lundberg

The hospice industry is growing faster than ever. A study from AARP stated that “…for the next 18 years, boomers will be turning 65 at a rate of about 10,000 a day. As this unique cohort grows older, it will likely transform the institutions of aging…”. Therefore, just as hospitals had to accommodate for the growth of babies in the OB/GYN years ago, hospices will now have to accommodate for the growth of aging individuals today.

What does this mean for hospices? As shown in the 2015 NHPCO Facts and Figures, the rate of patients served by hospice continues to be on an upward trend, as well as the number of US hospice programs. Although there has been consolidation in the hospice industry, an increase of patients will cause the number of hospice physicians to increase as well. There is already a shortage of hospice physicians in the industry, so what will the industry face in 10 years? 20 years?

So where does the Hospice Medical Director Certification Board (HMDCB) come in? HMDCB is a standalone certification board offering certification to eligible physicians. Hospice physicians can apply to take our exam and earn the Hospice Medical Director Certified® (HMDC®) credential. The difference between HMDCB and the ABMS/AOA certification is that HMDCB offers an experiential practice pathway.

HMDCB has 3 pathways to certification:
1. Certification: already being AMBS/AOA certified in the HPM subspecialty
2. Practice: having two (2) years of work experience in hospice during the previous 5 years
3. Training: successful completion of a 12-month clinical HPM training program

With these three ways to qualify, it opens doors to those who may not have the means to currently be certified through ABMS/AOA. HMDCB always encourages those who are able to participate in a fellowship program do so, but it is understood that many physicians enter the hospice industry mid-career, and taking a year off may not be possible. HMDCB seeks to certify all deserving physicians who have the knowledge and skills to hold the industry to a high standard of care.

With heightened regulations, it is necessary that hospice physicians stay up to date and knowledgeable about standards in the industry. HMDCB hopes to relieve suffering and improve quality of life by promoting the excellence and professional competency of hospice medical directors and hospice physicians.

Join the discussion Wednesday, December 9 at 9pm ET/6pm PT on Twitter using the hastag #hpm

 for the latest on the Hospice Medical Director Certification process.
on Twitter for all the latest on #hpm chats.

If you are new to Tweetchats, you do not need a Twitter account to follow along. Try using the search function on Twitter. If you do have a Twitter account, we recommend using, for ease of following.

You can access the transcripts and analytics of #hpm chats through @Symplur. 

Allison Lundberg is the Account Manager for the Hospice Medical Director Certification Board. 

Image credit: Source: U.S. Census Bureau, Population Division, Release Date: December 2014

Tuesday, December 8, 2015 by Pallimed Editor ·

Monday, December 7, 2015

The Problem with Death Avoidance

by Amy Clarkson

We have a serious problem on our hands. It’s been around for decades, but it seems to be getting worse. Our problem? Death avoidance.

As a society, we keep getting farther away from the reality that death is inevitable. Death has gone from being something visible and an accepted part of life, to something invisible and far too easy to deny.

In the 1800s just as photography was coming into existence it was common to have a post mortem photograph taken just after someone died. These photographs were displayed in the home as a constant reminder of the loss. Death was something that happened in the home. Generations lived near each other, so it was common to have grandchildren present during the last days, as well as in the home around the deceased’s body during the day or two of the vigil and wake before burial.

Even the funeral processions were more visible. As loved ones walked behind a horse drawn carriage carrying the coffin in a slow mournful way, there was no escaping the knowledge of who had died, and all could see the family mourn openly.

Mourning in the 19th century also lent itself to something more visible. Loved ones dressed in black for a period of months to years. This custom allowed others to be reminded of death’s presence on a daily basis.

In our modern sophistication, we have drastically altered most of these past traditions. We don’t always live near family, and our elderly often are hidden away in nursing homes for their last months and years. Death occurs not in the home, but in hospitals and long term care facilities. Our distaste of death has seeped into funerals, which now are called a “celebration of life” with embalming practices to attempt to make the deceased look as alive as possible. We aren’t allowed to grieve for long, it’s too uncomfortable to face death. Mourners are subtly pushed to ‘get over’ their grief quickly and friends prefer not talking about it.

The word death itself is greeted as a morbid term. We use phrases such as “he passed away” or “he went to be with Jesus” to make it easier to say. I’ve seen it done in my own field. People don’t want to say ‘hospice’ because of its association with death, and prefer using the term ‘palliative care’ to push the reality of dying farther away. Another subtle trend is to use the phrase end of life, instead of saying someone is near death. The switch from life to death, diminishes our discomfort with death.

Recently I’ve had people say that even ‘end of life’ is too harsh. Should we come up with a new word for that period of life at the end? Perhaps we could call it the blue period. That way we cannot only avoid the word death but the word end as well.

What harm has our denial caused? Increased futile and sometimes painful treatments at the end, increased fear surrounding death and diminished meaning of life to name a few. We must remember that it is the realization of our mortality that gives us a reason to live.

Dr. Clarkson is a hospice physician for Southwind Hospice in Pratt, KS. This post was originally published in Dr. Clarkson's End Notes column for the Pratt Tribune. It is re-published here with the author's permission under a Creative Commons license.

Photo credit: "The Grim Reaper" by Trish Steel via Wikimedia Commons under Creative Commons Attribution-Share Alike 2.0 Generic license. 

Monday, December 7, 2015 by Amy Clarkson ·

Tuesday, December 1, 2015

Storytelling and Advocating for Palliative Care

by Lauren Drew

NHPCO recently released its newest video on the benefits of palliative care. How can we as a community best advocate for palliative care? What resources do you think are lacking in this area? What are the biggest problems you have when creating and implementing palliative care programs? Let’s have a robust discussion on where palliative care is going in 2016, and how we can all be better advocates for its expansion.

NHPCO Director of Palliative Care Judith Skretny (tweeting tonight from @NHPCO_News) will join Senior VP of Communications Anita Brikman (@AnitaBrikman) and other NHPCO staff to facilitate this important conversation.

Chat Question 1: How do you use storytelling to help promote palliative care? Does it work?
Chat Question 2: What gaps do you see when advocating for Palliative Care? How can we fill them?
Chat Question 3: What is your goal for advancing palliative care in the next year? What help do you need to accomplish this?

For examples of Storytelling as Advocacy see Deadra's Story from the Moments of Life campaign.

Tuesday, December 1, 2015 by Pallimed Editor ·

Giving Tuesday Options for Hospice and Palliative Care

by Christian Sinclair

Today is Giving Tuesday, the anti-dote to all our frenzied consumer spending on Black Friday and Cyber Monday. More hospice and palliative care organizations are making it easy for all of us to get into the Giving Tuesday spirit, so I wanted to just highlight a few notable examples. If you have examples of other hospice and palliative care groups highlighting Giving Tuesday please add them in the comments.

The American Academy of Hospice and Palliative Medicine is featuring the Global Access Scholarship fund to bring international doctors from developing countries to the AAHPM/HPMNA Annual Assembly. AAHPM already funds 10 scholars at a cost of $5,000 each to cover travel and lodging. (32 over the past 5 years). But this year there were some outstanding candidates and they are hoping to bring an additional three doctors to the meeting.  So far they are at $1250 of the $15,000 goal, but I'm sure there are more of us out there that realize how important this is and can make this happen! Go to the GoFundMe page and let's crowdfund this together!

And even more crowdfunding on the international front, Death Cafe London, which was featured here on Pallimed last month, is still chugging along to their goal to make a real bricks and mortar place for people to be open about end-of-life issues. (This is not tax-deductible, but rather an investment/ownership in a non-profit.) Check them out on Crowdfunder (UK).

Not quite a Giving Tuesday appeal, but more HPC organizations are starting to feature passive giving programs like Amazon Smile. Perfect for online shoppers! By going to, you can sign up for the charity of your choice and Amazon will give 0.5 percent of your purchases to the charity of your choice. Some of our bigger organizations are on there (AAHPM, NHPCO, NHF, CHPCC)  as well as many local hospice and palliative care programs.

Rainbow Hospice and Suncoast Hospice Foundation are other hospice organizations that are making Giving Tuesday part of their broader campaign of appeals.

Happy Giving Tuesday!

Christian Sinclair, MD, FAAHPM is the editor of Pallimed, and a big fan of making charitable donations to good hospice and palliative care causes.  In fact, I will match the first $250 to any of the above hospice or palliative care organizations if you show me your donation because of this post! You can tweet, comment, or email me proof.

by Christian Sinclair ·

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