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by Christian Sinclair (@ctsinclair)

Last week, many hospice and palliative care clinicians and advocates received the unfortunate news that the 2022 Annual Assembly of Hospice and Palliative Care (#hapc22) was moving from hybrid (both in person and virtual) to virtual only. The board of directors of AAHPM and HPNA "considered the current strain on health care systems, personnel and their families" when making the decision. And then one week later, many presenters found out their presentations were not going to be in the virtual-only assembly. That is immensely disappointing. I received notice that my talks - on which colleagues and I had spent hours working - were canceled too. I was shocked at first, then mad, a little incredulous, then sad I would not get to share my work with a wider audience. Online, others shared similar emotions about the bad news. It really stinks.

I think it is critical to direct the majority of ire at COVID, which threw us all a curve ball with omicron. Honestly going into October and November, many clinicians I know were beginning to regain that hope and return to normal. The clinic visits were more often in-person (rather than telehealth). We had meetings with small groups in big rooms. All signs pointed to "Yes!" An in-person Annual Assembly in Feb 2022 seemed possible. So when you feel angry, make sure to direct that anger at COVID..

As for mitigation of risk, or different strategies, or communication planning around this issue, it is reasonable to ask for more information from the two organizations, but let's make sure we are asking the right questions and the right people. The strategy is the responsibility of the board of an organization. The staff of an organization is responsible for executing on the plan set out by the board. Boards need to make very difficult decisions. From personal experience, those conversations before the decision can also be quite challenging. I think the business meetings for both HPNA and AAHPM should be high on your priority list if you want to hear more about how we got here. If you want more information or have issues with how things were handled, reach out to board members to tell them what is important to you.

One thing to keep in mind is that leadership is likely feeling some of the same emotions we are feeling. I know this from personally working with the AAHPM and HPNA staff. They put a lot of time and effort into making the 2022 Annual Assembly happen, and now a lot of that work is lost. So when reaching out to them for clarification or giving feedback, make sure to appreciate the ripple effects of COVID and that many of these decisions are often more difficult than they appear on the surface.

And if you still don't like how leaders are making decisions, then consider running for a volunteer position. Influence in a way that you think is best. There are always volunteer roles to fill. And it offers a perspective that things are often more difficult than they appear on the surface.

And lastly,I'm sorry that your work and the work of your colleagues and mentees won't get the attention of a national meeting. And yet, the good work is done. It just needs a little extra effort to find a home. Like one of my favorite quotes from Austin Kleon, "Do good work, and put it where people can see it." Already online, there are venues like HAPC Virtual Didactics, Friday Chalk Talk, GeriPal, and even Pallimed, making themselves available to repurpose or rework content. Honestly, this is something I would love to see our field do more of. Don't stop at "Well, I presented at the Annual Assembly. My work is done here." Call up colleagues at other institutions and let them know you have an excellent presentation for their next grand rounds. Do a media tour for the field: pitch your content to your local news media or write an editorial for national outlets like NYT, WaPo, The Atlantic, etc. Write a paper and publish it in an academic journal. Some of this you can do all on your own, some of it may require activating your mentor and peer network. So yes, feel your feelings, and then get to work finding a home for your great work. All is not lost.



For more Pallimed posts about AAHPM.
For more Pallimed posts about conferences.
For more Pallimed posts by Dr. Sinclair click here.



Christian Sinclair, MD, FAAHPM is a palliative care physician at the University of Kansas Health System, editor-in-chief of Pallimed,and trying to keep up a resolution to write more about palliative care in 2022.

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By Kristin Edwards (@KristinMDCT)

I’ve been attending the Annual Assembly of Hospice and Palliative Care (AAHPM/HPNA) for nearly a decade, but this is the first year I presented a concurrent session. As I return to work, the glow from my 15 minutes of Friday morning fame fading away, I wanted to share a few thoughts for those who, might feel intimidated about submitting an abstract.

An abstract can only be accepted if it is submitted.

I spent years coming up with ideas for a presentation, but ultimately deciding they were not good enough. A trusted mentor encouraged me to submit my ideas anyway. He saw value in the process even if it meant I might get rejected. The process was an opportunity to learn what messages I wanted to share, develop the ideas fully, and receive feedback, thereby refining those messages. That said, only approximately 20% of abstracts are accepted for presentation at the AAHPM’s Assembly, and getting the rejection can sting. It is helpful, therefore, to have an alternate plan beforehand, whether it be submission to a journal, blog, or other conference, or to rework it and submit again in the future.

“I don’t have any collaborators” probably means “I haven’t reached out.”

I often limited myself because I thought I didn’t know anyone in the field with whom to collaborate, and hadn’t considered collaborating with those outside the field. Last year, when I had an idea worthy of submission, I reached out via AAHPM Connect, an online community for those in hospice and palliative medicine, and quickly found several people willing to collaborate. Multiple professional venues provide ways to find potential collaborators, such as list-serves, social media, and collegial networks.

Submitting an abstract with others helps you and your colleagues grow.

One of the most rewarding things in my daily practice is helping others grow, especially across levels of experience, disciplines, or specialties. Collaborating with others on a presentation was a powerful way to get non- PC colleagues exposed to palliative care, early-career colleagues enthusiastic about national involvement, and experienced colleagues invested in mentoring junior colleagues.

Work done in collaboration almost always turns out better.

The initial vision I had for our presentation was adequate, but it was so much better after several rounds of group discussion. Each of us brought a different perspective, skill set, and experience. Far from being limited by people you may worry are “the weakest link,” the presentation was all the more powerful thanks to the diversity of thought and contagious enthusiasm. And we had a lot of fun in the process.

You have something to offer!

Wisdom comes with experience and applied knowledge. Attendees at health care conferences include many who are primarily clinical. You do not need to conduct randomized controlled trials to have a good idea for submission. While scientific studies are critical for advancing our field, there is also value in showing how clinicians have effectively integrated research into clinical practice or created effective models for delivering care.

Presentations honor our patients and renew our compassion.

In palliative care, we learn from the experiences our patients and families generously share with us. When we present at a conference, even if we don’t discuss specific patient stories, we share what our patients have taught us. By sharing those lessons with a broader audience, we may help bring purpose to some of the suffering. We experience renewed compassion when we interact with participants after a presentation, who connect us with others who have similar experiences.

Find a mentor to guide you.

Mentors may have experience navigating implicit expectations for abstract and publication submissions. Mentors may be senior to you and can also be peers; powerful learning goes both ways. I had the great fortune to work with a mentor through the AAHPM Mentor Match program. Mentor Match is an online part of AAHPM where members can find other members willing to be mentors from specific backgrounds or in specific areas. Especially if you have a specific skill to develop, reach out to find a mentor in that area.

Drafting an abstract requires a relatively small investment of time, but comes with so many personal and professional benefits. The personal learning, professional connections, renewed enthusiasm, and growth opportunities are well worth the risk of rejection. So if you have an idea you’ve considered, think about reaching out to your community, get input from others, and take a chance to submit.

The deadline for AAHPM concurrent session abstracts for 2020 is May 1st, 2019.

Kristin Edwards, MD, FAAHPM is the medical director of Palliative Care at Yale New Haven Health - Bridgeport Hospital. Her passion is palliative care, medicine, education, and resilience. You can find her on Twitter at @KristinMDCT.

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by Christian Sinclair (@ctsinclair)

The Annual Assembly of AAHPM and HPNA is this week and if you are going to Orlando, or staying home to keep things running smoothly, social media can help make your conference experience be transformative.  Since 2009, the Assembly has been making use of Twitter to provide additional insight, commentary and sources for the multiple sessions each day. Now things are expanding to dedicated conference apps, Facebook and Instagram. And for the third year in a row, the Tweet of the Day (#hpmTOTD) will bring you the highlights of the conference and #hpmBingo will help make sure you do as much as you can while at the Assembly.If you don't know how to use Twitter to your full potential, just keep an eye out for Tweet Pros and don't be shy. If you just want some general tips for attending the Annual Assembly read up on our handy hints for attending a national conference.

The official hashtag of the conference: #hpm19 (works on Twitter, Facebook, Instagram), use it in every tweet this week!

The Pallimed Network will feature content across multiple platforms.

Pallimed Network Accounts

• Twitter (@pallimed) - run by Allie Shukraft, Kristi Newport and Christian Sinclair during the conference
• Facebook - run by Megan Mooney-Sipe and our volunteer team
• Instagram (@pallimedblog) - run by Christian Sinclair
• Website
• Don't forget to read up on #hpmParty which happens every Thrusday night at 9pm of the Annual Assembly each year.
• Vote for your favorite Tweet of the Day by including the hashtag #hpmTOTD. 2017 - 2018

Official Annual Assembly Social Media Links
American Academy of Hospice and Palliative Medicine: 

• Twitter (@AAHPM)
• Facebook
• Facebook Event page
• Instagram (@AAHPM)
• Website
• CONNECT Forum
• Temporarily change your Facebook Profile to have a #hpm19 frame

Hospice and Palliative Nurses Association:

• Twitter (@HPNAinfo)
• Facebook
• Instagram (@HPNA1986)
• Website

Social Work Hospice and Palliative Care Network (Not formally part of the Assembly, but having a conference right after)

• Hashtag #SWHPN19
• Twitter (@SWHPN)
• Facebook
• Facebook Event Page
• Website

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by Christian Sinclair (@ctsinclair)

The Annual Assembly of AAHPM and HPNA is this week and if you are going to Boston, or staying home to keep things running smoothly, social media can help make your conference experience be transformative.  Since 2009, the Assembly has been making use of Twitter to provide additional insight, commentary and sources for the multiple sessions each day. Now things are expanding to dedicated conference apps, Facebook and Instagram. And for the first year ever we have Twitter contests.

The official hashtag of the conference: #hpm18 (works on Twitter, Facebook, Instagram), use it in every tweet this week! (Are you wondering why the hashtag for our interprofessional field/assembly is #hpm and not #hpc? Read more here.)

The Pallimed Network will feature content across multiple platforms and will include the HPM chat account from Twitter.

Pallimed Network Accounts

• Twitter (@pallimed) - run by Allie Shukraft, Kristi Newport and Christian Sinclair during the conference
• Twitter (@hpmchat) - run by Lori Ruder and Ashley Deringer during the conference
• Facebook - run by Megan Mooney-Sipe and our volunteer team
• Facebook event page (#HPMparty) - Team effort with GeriPal
• Instagram (@pallimedblog) - run by Christian Sinclair, with behind-the-scenes looks using Instagram Stories
• Website

Official Annual Assembly Social Media Links
American Academy of Hospice and Palliative Medicine: 

• Twitter (@AAHPM)
• Facebook
• Facebook Event page
• Instagram (@AAHPM)
• Website
• CONNECT Forum
• Temporarily change your Facebook Profile to have a #hpm18 frame

Hospice and Palliative Nurses Association:

• Twitter (@HPNAinfo)
• Facebook
• Instagram (@HPNA1986)
• Website

Social Work Hospice and Palliative Care Network (Not part of the Assembly, but having a conference right before)

• Hashtag #SWHPN18
• Twitter (@SWHPN)
• Facebook
• Facebook Event Page
• Website

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by Christian Sinclair

Politics and healthcare are occupying much of the news cycle this summer with all of the discussions around the possible repeal of the Affordable Care Act (AKA Obamacare). On one hand it can viewed as must-see reality TV with all of the drama and back and forth arguments with passionate opposition. Late-night TV hosts help turn the drama into satire and give everyone a good laugh and some entertainment. Yet it is important to see that this will greatly impact the care of the patients we see every day.

To be honest, it was not until a few years ago that I started to see the power of getting more politically involved as a physician. . I thought that dutifully voting was doing my part as a citizen. Nowhere in my education was it ever modeled for me that I should use my training and experience as a doctor to help influence public policy. Talking to legislators? I don’t have enough time. I’m a busy doctor. Emailing legislators? They probably hear from other people. Reading up on the pros and cons of new legislation and how it may impact me as physician? That is why I pay dues to professional societies and their lobbyists.

A few years ago, I got the chance to go to a Hill Day with the American Academy of Hospice and Palliative Medicine. The morning started off great with legislators and their staffers coming to tell us about the importance of the public voice in a thriving democracy. It was just like being back in High School in American History class with Mr. Horvath! We were given our assignments for the afternoon to walk around Capitol Hill and meet our Representatives and Senators and tell them why we supported the Palliative Care and Hospice Education and Training Act (PCHETA).

Despite speaking on the merits of hospice and palliative care to thousands of people over the years, this setup for a small meeting with political leaders was intimidating. As legislators, they seemed distant and removed from my everyday life, but yet they were critically important to the function of government. Reflecting back on the passage of the Medicare Hospice Benefit, I tried to muster up the courage of those empowered volunteers of the early 1980’s. Many of us would not have careers if they had not knocked on Senators doors and told the story of people at the end of life.

Sitting in Senator Roberts office, I waited with my advocacy team. We struck up a conversation with the other people waiting to visit the Senator. They were from the United Motorcoach Association and mentioned in the course of our small talk they had been here before. I was bewildered. What important policy issues could the United Motorcoach Association have to talk about? Were they more important than the care of hospice and palliative care patients? But then it hit me. They have every right to be here, to advocate for their interests, to represent their story. And if they were here telling their story and I didn’t show up today, Senator Roberts would have no knowledge of what I care deeply about. If we don’t show up and tell our story, then no one is going to care enough to reach out to us to find out more information and therefore other policy priorities will be advanced long before ours.

So knowing that physicians vote less often than the general population (and even less often than lawyers), how politically involved should we get on behalf of our profession and more importantly on behalf of our patients? This will be the topic of the July 2017 #hpm Tweetchat too so if you want to join the conversation, get on Twitter at 9p ET on July 26th. You can also add your comments below.

Christian Sinclair (@ctsinclair) is a palliative care doctor at the University of Kansas Health System, and immediate past president of the American Academy of Hospice and Palliative Medicine. He writes for Pallimed when he doesn't have other deadlines impending.

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by Stacie Sinclair

(Register for the free webinar here)

There is no disputing that recent events mean a huge shift in the direction of health care in the coming years. Although we’re learning more each day about what programs will stay and what will go, there remains tremendous uncertainty that only time will clarify. Yet in this period of transition, there is at least one major program that the nation’s best health policy minds agree is here to stay: MACRA’s QPP!

WHAT DO THOSE CRAZY ACRONYMS MEAN?
The Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA) is a bipartisan law that repealed the Sustainable Growth Rate and established a brand-new Quality Payment Program (QPP). The QPP, which goes into effect on January 1, 2017, will accelerate the movement towards payment for value by creating two new clinician payment tracks: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). In the early years of these programs, clinicians participating in MIPS will see positive or negative adjustments to their Medicare Part B billing depending on their “performance”, while clinicians participating in qualifying Advanced APMs will receive a 5% bonus on top of their Part B billing. Ultimately, the track clinicians participate in will depend on many factors, the most important being the amount of RISK their practice accepts.

AND WHY DOES THIS MATTER FOR PALLIATIVE CARE?
First – this is how clinicians will be paid! In years 1 and 2, eligible clinicians (ECs) include physicians, physician assistants, nurse practitioners, clinician nurse specialists, and certified registered nurse anesthetists who bill Medicare Part B for more than $30,000 and see more than 100 Medicare patients annually. And while the implications will vary based on practice size, work environment, participation in an ACO or other APM, etc., the more proactive you are, the more likely you are to be successful!

Second – the emphasis on performance and APMs represents a HUGE opportunity for palliative care. Palliative care is vital to value-based care, as it demonstrably improves quality of care and quality of life for seriously ill patients, and in so doing, helps the health care system avoid unnecessary utilization and spending. At its most basic level, the transition to value means that hospitals and health systems are increasingly on the hook for cost and quality outcomes. So whether you’re an independent program looking to partner, or a team within a large system that deserves more attention, rapid QPP implementation means that there are going to be more leaders looking for “solutions” that we know palliative care can provide!

SO WHAT DO I DO NOW?
Clocking in at over 2,000 pages, there is no question that the final regulations for the QPP are complicated and confusing. But help is on the way! On November 29, 2016, the National Coalition for Hospice and Palliative Care (NCHPC) is sponsoring a FREE WEBINAR to describe provisions of the final rule and next steps (click this link to register). Experts from the Center to Advance Palliative Care (CAPC), the American Academy of Hospice and Palliative Medicine (AAHPM), the Hospice and Palliative Nurses Associations (HPNA), and the HealthCare Chaplaincy Network (HCCN) will be on hand to clarify who will be most affected and activities that palliative care clinicians should be doing right now.

Again, you can register for the webinar by going to this link. And feel free to send me any questions you have in advance – Stacie.Sinclair@mssm.edu!


JUST CAN’T WAIT UNTIL NOVEMBER 29 TO LEARN MORE?
The Centers for Medicare and Medicaid Services (CMS) has developed a fantastic QPP website that walks users step-by-step through the various components of the MIPS and Advanced APM tracks. It includes interactive tools, fact sheets, and other resources, and CMS is providing regular updates as new information becomes available. And if you need just a little more palliative care flavor in your research, be sure to check out the last NCHPC webinar that our all-star team held in early June, describing the basics of the proposed rule.

We look forward to seeing you on November 29!

Stacie Sinclair, MPP, LSWA is the Policy Manager at the Center to Advance Palliative Care (CAPC). If you enjoyed this post, be sure to check out other scintillating takes on health policy and palliative care from the CAPC staff at https://palliativeinpractice.org/health-reform-quarterly/.

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by Ross Albert

I'm surprised that I’m not hearing more about the recent ‘Guidance Statement’ put out by the collaboration of ASCO and AAHPM on “Defining High-Quality Palliative Care in Oncology Practice.” (OPEN ACCESS PDF) It’s a report that provides some very interesting insight into what pieces of primary palliative care should be part of general medical oncologists’ practice.

When I read it the report, I was pleased to see that it was published in ASCO’s journal, and I noted the impressive list of authors. My eyes briefly glazed over as the discussion moved to Delphi methodology, but a few quick Wikipedia searches on study-design later, I was back on track, diving into the data. I am, of course speaking about that in jest—these statements and guidelines need to be rigorous and they need to be done with well-defined methodology.

The group essentially did the following:

1. Gather a bunch of very smart oncologists and palliative care professionals.
2. Give them a list of nearly 1000 statements of specific actions that might be part of high-quality primary palliative care practice in oncology.
3. Have them decide if those items are definitely/maybe/not part of primary palliative care that oncologists should regularly be doing.

The panel also grouped these practices into “Domains” for organization: End-of-Life Care, Communication and Shared Decision Making, Advance Care Planning, Appropriate Palliative Care and Hospice Referral, Symptom Assessment and Management, Carer Support, Coordination and Continuity of Care, Psychosocial Assessment and Management, and Spiritual and Cultural Assessment and Management.

The panel’s views on the different domains were informative. The highest percentage of items which the panel endorsed as “Included” in primary palliative practice by oncologists were in the realms of End-of-Life Care, Communication and Shared Decision Making, Advance Care Planning—more than 75% of items assessed were deemed to be part of standard practice. The lowest percentage was in Coordination and Continuity of Care, Psychosocial Assessment and Management, and Spiritual and Cultural Assessment and Management—with less than 50% of the items assessed deemed part of standard primary palliative practice by oncologists.

These numbers don’t mean that oncologists aren’t interested in any Coordination of Care though—It means, for example, that while the item “Communicating current prognosis to primary care [provider]” was thought to be included within their regular scope, that “Obtaining family/surrogate feedback regarding clinic practice of coordination and continuity” was thought not to be—again, they looked at nearly 1000 specific actions.

As a palliative care physician, I found the data included on symptom management most interesting. The report showed a figure with 23 symptoms ranked in order of whether items related to them were thought to be “Included” or “Uncertain” to be part of oncologists’ general practice (also remember that there was a third “Not Included” category, to put this data into perspective). Chemotherapy-related toxicity, nausea and vomiting, dyspnea, fatigue—over 90% of the items were thought to be “Included” as part of standard practice. Pain—66% of the items evaluated were deemed part of standard practice, and 33% “Uncertain.” Depression and anxiety—only 27% and 20% of these items were thought to be “Included” as part of primary palliative care activities for oncologists.

So how do we use this data? Again, the report doesn’t show that oncologists aren’t interested in treating depression, or aren’t interested in psychosocial aspects of their patients. But, it does show that there were pieces of the care of depression, and pieces of psychosocial care that might fall outside of what oncologists might be doing in their practices. This tells me that while I, the palliative care specialist, might be able to help control a patient’s nausea or fatigue, this panel notes that the general oncologist might feel that they’ve got those symptoms mostly covered. But instead, as the collaborating consultant, it sounds like extra support with pain, anxiety and depression, and extra psychosocial and spiritual care would be welcome. It also seems that while a physician or APRN might have value being placed in an oncology clinic, we really need to pull in our social workers, psychologists, and chaplain colleagues to care for patients in aspects that oncologists are likely least comfortable performing as part of their standard practice.

Dr. Ross Albert is the chief of the division of palliative medicine at Hartford Hospital, and the medical director for the Hartford HealthCare at Home Hospice teams, in Hartford CT.


Reference:
Bickel KE, McNiff K, Buss MK, Kamal A, Lupu D, Abernethy AP, Broder MS, Shapiro CL, Acheson AK, Malin J, Evans T, Krzyzanowska MK. “Defining High-Quality Palliative Care in Oncology Practice: An American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement.” Journal of Oncology Practice. Published online August 16, 2016.

Image Credit: From the article cited above. 

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by Christian Sinclair

This is the Saturday, March 12, 2016 preview for the AAHPM and HPNA Annual Assembly. To learn more about this conference check out our overview, or see the previews for Wednesday, Thursday, and Friday.

More early-riser sessions with the indefatigable Mary Lynn McPherson doing her new drug highlight talk, New Drugs and Drug News: The 411 and Implications for Palliative Care. The early session that gets me excited is the one on steroids: The 13 Most Debated Questions About Using Steroids in Patients with Advanced Cancer Experiencing Pain and Nausea: What We Do and What The Evidence Recommends by White, Bull, Blaney and Stahl.

When it comes to comedy and research, there are few who can make it work. Maybe Improbable Research or xkcd, but not many others, except for the State of the Science presentation, this year presented by Dionne-Odom and Smith. Reliably incorporating clever and relevant jokes, this one is a must-see. Especially because we should be doing all the things highlighted in state of the science. They usually cover 6-10 studies and if we just did the things discussed in them each year, all our programs could be improving year over year.

After that you have some tough choices to make. Some big names are talking at the same time, but in different rooms: Charles von Gunten, Amy Abernethy, Diane Meier, Thomas Smith. You have to go with the topic that interests you most, but with choices like that you shouldn't be disappointed. Plus Twitter can help you catch highlights from the other rooms!

At noon is a special town hall-like panel with leaders from AAHPM, HPNA, and NHPCO on Critical Conversations: End-of-Life Care Treatment Options. This is such an important topic to the hospice and palalitive medicine community because we have members working in states where physician-assisted death is legal, and others where it is illegal but being considered. I'm very interested in how this session goes, because we need to have open dialogue about these large cultural forces which influence our work.

In the afternoon on the last day, you get your last chance to hear from the Developing Country Scholars who can help put our local barriers and opportunities in a whole new light. Maybe even inspire you to reach out to a international program and see how you may contribute. "Why Do I Still Hurt?" An Integrated mode of Survivorship and Palliative Care by Chwistek, Ewerth, Gallagher Amrhein and Ebersole is something I see a need for as I do more work in an outpatient clinic. There is a huge gap here and palliative care cannot fill it alone. And to finish off the day, I'm struggling between talks on organ donation, inotropes in advanced heart failure and opioid dosage errors. I guess I'll just have to buy the recordings!

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by Christian Sinclair

This is the Friday March 11, 2016 preview for the AAHPM and HPNA Annual Assembly. To learn more about this conference check out our overview, or see the previews for Wednesday, Thursday and Saturday.

As noted in the first preview, you have the stellar early-riser concurrent sessions, but the gem will be the plenary speaker Candy Chang who created the "Before I die..." walls project.  I'm thankful the conference  organizers recognize the importance of cultural influence in hospice and palliative care. Candy Chang helps encourage the conversation long before people become patients. You can read more about this project from our 2012 post on it by Dr. Holly Yang.

After the plenary, two sessions really caught my eye: Dignity Therapy: Narratives at the End of Life by Weckmann, White and Montross Thomas and "Bas Sona": Healing versus Sedating Using a Celtic Framework for Total Pain by Dieter, Waitkevich, Williams and Berry. Having read so much about Dignity Therapy, it will be nice to hear directly from practitioners applying the knowledge. And with Bas Sona, you got me hooked because I have no clue what it is, and my curiosity gene has been tickled.

Botulinum toxin for symptom control, pediatric VADs, and helping the unbefriended are all unique topics covered Friday afternoon, so don't think about playing hooky just yet. The one that catches my eye is the Prognostication, Relatedness and Hospice Formulary talk by Crook, Harrold, Lund Person, and Sears. Even though I am not a current hospice medical director (HMD), this topic is really important to sustainability of hospice organizations, and the threat of audits when rules are not clear or unequally followed in the community.

Later that day, the session by Kaye, Mahoney, Lyman and Cunningham on Face-To-Face Interdisciplinary Postmortem Review as a Tool to Mitigate Complicated Bereavement and Promote Legacy Building is intriguing because the title is one of the longest, and it sounds like a unique way to still care for patients and families even after death.

This day also has a few opioid safety sessions, which honestly you didn't see much at this conference in the past. Will a Better Mousetrap Help When You Work In A Lion's Den? What is the Role of Abuse-Deterrent Pharmaceuticals in Hospice and Palliative Care? by Barclay, Ray, Klempter, Capobianco and Why Are You So Scared? Managing Risk and Safe Prescribing of Opioids in Hospice and Palliative Medicine by Esch and Goldberg both highlight the difficulties of balancing access top pain medications and protecting the larger public health concern over opioid overdoses.

On Friday evening, many of us may be going out to sample the fine food in Chicago, but consider going to the Service of Remembrance and Celebration from 6-7pm before dinner. A solemn but meaningful opportunity to honor those in our field and those close to home.

Don't forget Friday is also the last day to see the exhibits and posters!

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by Christian Sinclair

This is the Thursday March 10, 2016 preview for the AAHPM and HPNA Annual Assembly. To learn more about this conference check out our overview, or see the previews for Wednesday, Friday and Saturday.

Christian Sinclair, MD, FAAHPM is editor of Pallimed, president-elect of AAHPM, and a palliative care doctor at the University of Kansas.

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by Christian Sinclair

This is the Wednesday, March 9, 2016 preview for the AAHPM and HPNA Annual Assembly. To learn more about this conference check out our overview, or see the previews for Thursday, Friday and Saturday.

Looking at a full day of pre-conferences, there are some real gems here. If you have not been to the pre-cons before, maybe because of time or cost, I would encourage you to take a closer look. The Vital Talk faculty will be there, which would be a good preview if you have ever considered going for more communication training. (Yes, even palliative care clinicians can benefit from more communication training!) Another popular one will be Mary Lynn McPherson's Medication Management workshop from 8-5pm. She packs in so much good information into her 60 minute presentations, this will be like taking a 1-year fellowship in one day! You have 19 to chose from, and I bet a few are already at capacity if you have not registered by now.

After the workshops, I'm excited to attend the AAHPM New Member and First-Timer reception and the AAHPM Physicians-in-Training reception. I remember being a fresh fellow in 2004 in Arizona at my first AAHPM conference like it was yesterday! If you fit into either of these groups, especially you fellows, get there!

After the receptions, the posters and exhibit hall open, which is where you will find me geeking out on all the studies, taking pictures of the posters, and seeing old friends. This

Looking at the printed materials, you'll see the plenary speaker listed as Ezekiel Emanuel. You may have missed the email and other communications, but the Wednesday speaker is now ZDoggMD. A big change in tone and background between the two, but given the reach that ZDoggMD has with his medical parody music videos, I am very excited to hear what he has to say (and sing?) Oh, you have not heard of ZDoggMD? Watch his "Ain't the Way to Die" video and then check out this interview Dr. Michael Fratkin did with Dr. Zubina Damania (his alter ego) for Pallimed.

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by Christian Sinclair

In the early days of Pallimed, we would commonly run a preview over several posts in anticipation of the Annual Assembly meeting since it is the key conference for the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice and Palliative Nurse Association (HPNA). We stopped doing it for unclear reasons, but last year two different people asked me about it at the meeting, so let's bring it back!

The 2016 meeting is this week in Chicago (home to AAHPM) and runs from Wednesday pre-conferences to Saturday afternoon. Check out the full brochure and listings here.

If you are going and a fan of Pallimed, it would be good to do three things first:

1. Tell us you are going to Chicago on our Facebook Event page, and share what you are learning. 
2. Brush off your Twitter account so you can follow the conference, share what you learn and spread the good news of palliative care. (This one is good even if you won't be in Chicago!)
3. And finally come to the 10th Pallimed / GeriPal Party on Thursday night!

And now on to the general preview!




If you have not figured it out already, the hotel and the Assembly are in the exact same building. I think this is pretty neat, and will give lots of opportunities to run into each other. It also means your phone chargers will never be far. Chicago is a great city to explore so if you are feeling a little penned in, then you have a few places that can reinvigorate you not far away.

The education is great, I always bring back new ideas to share with my peers. I am most excited about the chance to see old friends, meet online friends (IRL!), and discover new people who have many wonderful things to add to this community. So if you see me, come say hello and do not be shy.

I do not recall if this is the first year, but early-riser concurrent sessions are here. I'm more of a night owl myself but for the lineups they have Friday and Saturday for these 7-8a sessions. You'll want to get up early too. With titles like Don't Be a Boiling Frog: Take Action to Prevent Burnout and speakers like Ira Byock, Mellar Davis, Janet Bull, and Jeri Miller, I'm sure you'll be there.

End-of-Life Conversations at Dinner returns this year. The slots are all booked, but you may want to check with conference staff if there is a wait list. I heard really good things about this last year. Plus you'll still get done in time to meet us for the Pallimed / GeriPal party. Have I told you about that yet?

It may be too late to read the whole book, but The Good Doctor: A Father, a Son and the Evolution of Medical Ethics is the book club selection this year. We don't have a review up on Pallimed for this book, but if you read it for the book club and would like to write something up, we'd love to see it.

And in the super cool but probably totally booked department, Hatha Yoga on Thursday and Friday morning for getting your mind and body ready for a full day of palliative care learning. And unique to the Chicago location to museum tours at The Art Institute of Chicago. If you can't get in on these tours, you can always stop by on your own free time, but wow, what a neat excursion. You probably missed out on staying the night in Van Gogh's bedroom too. The museum is open 10:30-5:00 each day, except for Thursday when it stays open until 8pm.

Another general highlight which is often an undiscovered gem are the paper sessions and the case sessions. Check your program when you get there as the descriptions for these are not in the overall brochure and you don't want to miss papers or cases which resonate with you.

You may not think it is interesting, but the business meetings for both organizations (Friday) are critically important. If you have never been, grab a friend and go. You'll learn where your membership dues go, and understand just how much is being done in the field.

Get to a Special Interest Group (SIG) meeting if you have not been to one. There are over 25 now for AAHPM, and several for HPNA. If some unique part of our field really interests you, then find like-minded souls and make something great together. It always surprises me how many attendees who have been to this meeting numerous times, have never been to a SIG meeting.

And please come to the Pallimed / GeriPal Party on Thursday night. 10 years we've doing this! It's fun!

Don't forget to check out the Wednesday, Thursday, Friday and Saturday previews which will be published Tuesday!

Christian Sinclair, MD, FAAHPM is editor of Pallimed, president-elect of AAHPM, and a palliative care doctor at the University of Kansas.

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Plot Summary: Ferris Bueller (a nice palliative care clinician) has an uncanny skill at prioritizing quality of life. Intending to make one last night-out before the end of assembly, Ferris calls his friends, "borrows" a Ferrari, and embarks on a one-night journey through the streets of Chicago.

Details: If this is your first time or your 10th time, we invite you to come out to the annual Pallimed / GeriPal party that is a tradition at each Annual Assembly of AAHPM, HPNA and SWHPN. We had a great turnout for the progressive party last year in Philadelphia and will be hitting some great Chicago establishments Thursday Night.

Who: All are welcome. You don't have to read Pallimed or GeriPal, subscribe, to us, use social media, pay an admission, or anything. Meet some of the contributors to both Pallimed and GeriPal all evening.

When: Thursday March 10th, Start time 9pm, End time: TBD

Where: New this year is ACP (Advance Celebration Planning). Social media will help you know where we are, but we wanted to at least communicate our goals for our quality of life that evening. These are rough guides. Follow our Twitter and Facebook feeds or search for #hpmparty to find exactly where we are.

• 9pm Cindy's Athletic Club - Top of the Chicago Athletic Association Hotel, 12 S. Michigan Ave
• 10pm Plymouth Rooftop Bar - 327 S. Plymouth Ct
• 11pm Kasey's Tavern - 701 Dearborn St

Ways to follow on social media:
Pallimed Twitter Feed - Pallimed Facebook Page
GeriPal Twitter Feed - GeriPal Facebook Page
#hpmparty Twitter Feed

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by Christian Sinclair

2015 was a pretty exciting year in palliative care, but 2016 has a lot happening as well. Here are some of the things to put on your calendar right now, so you do not miss them!

To access these dates via Google Calendar (HTML), click here.
To import a .ics file of all current dates to your calendar software, click here.

Spring

• National POLST Paradigm Conference - February 3-5 - Chicago, IL
• Cambia Sojourns Scholars applications due - February 26
• HPM Board Certification Registration - March 1-May 16
• SWHPN General Assembly - March 6-8, 2016 - Chicago, IL
• AAHPM/HPNA Annual Assembly - March 9-12 - Chicago, IL
• Pallimed/GeriPal 10th Annual Gathering - March 10, Location TBD in Chicago, IL
• Caring for the Human Spirit Conference (HealthCare Chaplaincy Network) - April 11-13 - San Diego, CA
• National HealthCare Decisions Day - April 16 - Nationwide
• NHPCO 31st Management and Leadership Conference - April 19-23 - National Harbor, MD
• HMDCB Application Deadline - April 25
• Beginning of the HMDCB Certifcation testing window - May 19 - June 6

Summer

• Canadian Hospice Palliative Care Conference - June 3-5 - Banff, AB, Canada
• New Hospice and Palliative Medicine Fellows begin! - July 1
• #hpm chat 6th Anniversary - July 14
• Hospice Action Network Advocacy Intensive - July 18-19 - Washington, DC
• AAHPM Summer Institute - July 24-27 - Pittsburgh, PA
• NHCPO/AAHPM/HPNA Virtual Conference - August 9-11 - Online

Fall

• Palliative Care in Oncology Symposium - September 9-10 - San Francisco, CA
• 21st International Congress on Palliative Care - October 18-21 - Montreal, QC, Canada
• CAPC National Seminar - October 26-29 - Orlando, FL
• NHPCO 17th Clinical Team Conference and Pediatric Intensive - October 31-November 4 - Hollywood, FL
• HPM Board Exam - November 7, 2016
• NHPCO releases Annual Facts and Figures

Recurring

• #hpm chat (Twitter) - Wednesday nights 9p ET

If you know of any other major events, please add them in the comments below and we may add them to this growing list.

If you would like to help maintain this list and the Google Calendar, it is pretty easy, and can be taught in less than 30 minutes, please email editor - at- pallimed.org.

If you are interested in writing up a report for a major conference listed above, we are always looking for traveling correspondents. Please read this overview of writing conference reports and submit the form on that page.

If you are interested in educational events in Asian countries, please see this Google Calendar maintained by APHN.

Christian Sinclair, MD, FAAHPM is the editor of Pallimed, and always loves a good conference. 

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by Kristina Newport

Year 2 of the Palliative in Oncology Conference was a repeat success, with an attendance of over 650 practitioners, more sessions and a new format. A significant difference was the addition of patient advocates who gave their perspective on the topics discussed. Below are some pearls in three main areas, Communication, Symptom Management and Integration of Palliative Care. Check out the Symposium Program for a detailed schedule of the meeting.

COMMUNICATION

The meeting opened with discussion of novel communication aids that incorporate technology to improve communication and shared decision making. James Tulsky MD, known for his work in the area of physician-patient communication, shared a computer based training program that helps oncologists to better respond to negative emotions, a program that will soon be available for all US oncology trainees. He pointed out that “See one, Do one, Teach one” only works if you have somewhere to look, and effective communication education includes observation, practice and goal-directed feedback.

Dr. Vicki Jackson's slide on integration

Areej El-Jawahri MD presented her impressive work showing seriously ill patients who viewed a video about CPR and intubation were more likely not to want these treatments, be better informed about their options, have orders to forgo CPR/ intubation, and discuss preferences with providers.

Angelo Volandes MD MPH further emphasized the benefit of visual aids, introducing the ACP Decisions video library, including an informative (and free) video to introduce palliative care that made me want to receive palliative care immediately, despite being healthy! Joanna Paladino MD described her work on the Serious Illness Conversation guide. The work demonstrates that a tool to prompt conversations reduces patient anxiety while facilitating discussions in the setting of serious illness.

Paula Rauch, MD and Kathi Mooney PhD, RN discussed the effect of illness on children and the need to intentionally communicate and care for them in these instances. We were reminded “Just be honest” is not quite enough guidance for parents and children want to know when a parent’s death is approaching. I also loved hearing of the “Living Legacy” where friends and family plan ahead to be a part of special moments in the child’s life, ensuring a piece of the lost loved one lives on.

SYMPTOM MANAGEMENT

Howard McLeod, PharmD gave an informative talk that, if not already convinced, left me certain that Palliative Clinicians need to be well-versed in the role of bio-markers in patient care. He discussed the tailoring of treatments for effectiveness and side effects, and translating the science into something that is meaningful to the patient. I’m convinced we will all need to review our immunology textbooks so we can keep up with appropriate treatments!

Multiple presentations were given on cachexia, discussing mechanisms and potential treatments. The most promising was Jennifer Temel MD’s work on the ROMANA I and II trials, showing significant increases in lean body mass and body weight in patients with advanced non–small cell lung cancer (NSCLC) and cachexia who used anamorelin (not yet available in US) compared with placebo. Susan McClement, RN, PhD and Charles Loprinzi, MD addressed the patient side of cachexia, reminding us nutrition and hydration carry significant meaning to patients and families. For now, appetite stimulants don’t improve quality or quantity of life, so our role should include a focus on managing expectations.

Another medication we may hear more about is aprepitant, an expensive enti-emetic that helped to decrease cough frequency in lung cancer patients, as shown by Amelie Harle, MD who used their Manchester Cough in Lung Cancer scale for objective measurements in the study.

Brian Schmidt MD discussed mechanisms of cancer pain, noting destruction of tissue and compression of nerves is not the full explanation of cancer related pain. He notes nerve recruitment and increased pain is prognostic, serving as bellwethers and sensors embedded within the cancer. Talks on the use of radiotherapy for malignancy symptoms emphasized the Choosing Wisely initiative elements, with an emphasis on fewer fractions for palliative patients. This sometimes results in the need for retreatment, but does not increase symptoms as some might believe. Alternative treatments were also discussed this year, in a breakout session, with discussion of massage, acupuncture and music therapy.

INTEGRATION OF PALLIATIVE CARE

Marie Bakitas DNSc, APRN, NP-C, AOCN, ACHPN presented the third ENABLE trial showing early, phone based palliative care interventions decreased depression in caregivers and improved survival of advanced cancer patients when instituted early. This adds to the increasing literature that early, integrated palliative care can increase life expectancy, and caregiver stress when initiated in the appropriate patients at the appropriate time.

Kathleen Foley MD took a wider view at integration of palliative care with a look at the worldwide stage, discussing her passion of bringing symptom management to low resource areas, believing “pain control is a human right”.

Dr. Campbell's slide on palliative Care in the ICU  (Apologies to the man sitting in front of me!)

Margaret Campbell, PhD, RN, FPCN discussed appropriate identification of patients in need of palliative care, opening with a story of a patient for whom she was consulted so late that she asked “Are you consulting me to come and pronounce this patient?!” She advises us to identify patients based on their unmet needs, not based on their risk of dying. She emphasized the role of primary palliative care in the ICU, outlining the necessary elements in Table 3 of their paper, emphasizing advance care planning discussions early in the hospitalization.

Spirituality was touched upon by Michael Balboni and Jonathon Marron, demonstrating the need for the medical team, including the interdisciplinary palliative team, to have direct conversations, since community clergy interactions and hope for miracles tend to increased aggressive care.

A highlight on the second day was Vicki Jackson’s keynote presentation on effective care integration and the co-management model. She emphasized the need for Palliative and Oncology clinicians to understand (and respect!) each other and develop prognostic awareness. She notes that dedicated palliative clinicians may not be available, but other members of the oncology team may play the role of a palliative provider. She asks palliative clinicians not to “vilify the oncologist” (here, here!) and identifies “Prognostic awareness” as a key area for Palliative and Oncology collaboration, emphasizing that is not a one-and-done event, it must develop over time.

As the collaboration of Palliative Care and Oncology increases across the country and the globe, I’m excited to be a part of the conversation by attending and participating in meetings like this one. I hope to see increased participation at next year’s symposium, in San Francisco September 9-10, particularly from members of the interdisciplinary team. Thank you, AAHPM, ASCO, ASTRO and MASCC for another great opportunity to learn and share with our colleagues.

Kristina Newport MD (@kbnewport) practices Hospice and Palliative Medicine in Lancaster, PA where she also spends time running after her children, 4 and 6.