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In what has been an on-again off-again story of 5+ years that was beginning to seem like an unattainable holy grail, the Joint Commission has finally issued a press release stating in Fall 2011 they will be recognizing hospitals with exceptional palliative care programs with an emphasis on:

• A formal, organized palliative care program led by an interdisciplinary team whose members possess the requisite expertise in palliative care,
• Leadership endorsement and support of the program’s goals for providing care, treatment and services,
• A special focus on patient and family engagement,
• Processes which support the coordination of care and communication among all care settings and providers, and
• The use of evidence-based national guidelines or expert consensus to guide patient care.

This is really important for many reasons.  Many hospitals may claim to have palliative care teams but the members of the team, internal support and integration into hospital culture can vary widely as many who have worked with palliative care programs have seen.  No doubt we have seen large increase in the percentage of hospitals with palliative care with support from organizations like the Center to Advance Palliative Care, but The Joint Commission is the 600lb gorilla and more importantly is a non-palliative care organization to help support quality palliative care programs.

I do like the emphasis on the whole hospital program and not just the team. This may set some higher standards than all teams will be able to accomplish, but then I think that makes all of us strive to do better.  Or we can be like Lake Wobegon where everyone is above average.  I just wonder what percentage of teams will be able to achieve this certification for the hospital as a whole.  This cutoff point will be interesting to watch.

When The Joint Commission comes to your hospital, your palliative care team can get excited because now you may be the people that help the hospital achieve more recognition.  The suits in the C-Suite might find a new interest in what your program is doing and hopefully (fingers crossed) you might get the resources and staffing to achieve it!

One slight irony is the Advanced Certification for Palliative Care is housed in The Joint Commissions "Disease-Specific Programs."  Palliative care is about people, I guess we have to keep on educating.

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Quick media round-up from this week:

• Hospitals increasingly offer palliative care - Washington Post
• Critical (Re)thinking: How ICU's are getting a much-needed makeover - Wall Street Journal
• Special needs, Special care (Pediatric Palliative Care) - Boston Globe
• Many doctors still focus more on cure than managing pain - NPR
• Hit by the reality of cancer treatment - NYT Well Blog

All of these were making the rounds on Twitter today with lots of clicks and shares from people not in our field which is always nice to see. I am not going to go into detail on any of these articles tonight, but please share them with your team.  I particularly liked the WSJ and Boston Globe one.  The NYT blog deserves its own blog post to discuss the importance of language.

If any Pallimed Reader wants to write up a guest post on the WSJ, Boston Globe or NYT articles, email me your 250-500 word write up christian@pallimed.org. (Yes we are open to guest posts, more details to come! See your name in lights, or at least the faint glow of some strangers laptop.)

The NPR and WaPo articles were covering the basics.  Obviously important but not sure you will gain a lot from reading those.  And interestingly those were both written by the same person Michelle Andrews from the Kaiser Health Network.  Not sure why they are covering palliative care issues so much, but keep it up if it gets published.

This convergence doesn't quite rival the 2010 St. Patrick's Day journal smorgasbord of palliative care but is still a pretty impressive grouping of media outlets in just a span of a few days.

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Pallimed has finally undergone the design redux I have been wanting to do since 2010.  Some of you may have noticed the new look on the Arts and Humanites blog or the Case Conference blog.  With the new design rollout I am focusing on the overall blog functionality, so there may be a few broken links and bugs as I work them out over the next week.

If you do find any please feel free to report them to me at christian@pallimed.org. 

Here is a listing of the changes made so far across all the Pallimed blogs:


Comments

• Added Disqus plug-in feature for commenting
• Allows for multiple one click sign-in
• Still allows for subscribing to comments from individual posts
• Still allows for anonymous commenting
• Eliminates Word Captcha Spam protection (the quiggly words)
• Allows for nested replies (so you can reply to one comment right after that comment)
• Allows for ‘Likes’ to comments, increasing the validity/importance of your comments

Posts

• Added Print Friendly button to the end of each post
• Allows for removing images
• Can select which text to print
• Can save post as a PDF
• Can email post 
• Added automatic text cut off for quick summaries from front page to allow for quick scanning of most recent topics
• Added related posts at the end of each post to help you find other articles of interest.

Social

• Added Facebook share and like buttons with counters on each post
• Added Twitter buttons with counters for each post

Mobile

• Enabled Mobile versions of all three websites.
• Links to Apple and Android Palilmed Apps on top right column

General

• Added #HPM Daily - Daily digest of posts on Twitter about Hospice and Palliative Medicine
• Added 'posts by contributors'
• Updated disclaimer and privacy visibility
• Added Popular posts feature highlighting most clicked posts in last 30 days
• Added widget to see traffic in last 30 days (right column in footer

Navigation

• Added clearer navigation to other Pallimed blogs and Palliative Care Grand Rounds

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Hello all, today we have implemented a new commenting plug-in for the main Pallimed blog.  Some of you may have already noticed this at the Arts and Humanities blog or the Case Conference blog.  The new commenting system is called DISQUS, and if that looks confusing just say it out loud and you'll get it.

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Vancouver 2011

We don't usually comment on stuff from the main palliative care journals, but the Journal of Palliative Medicine published a study that supplements the NEJM trial on early palliative care in metastatic non-small lung cancer.  (See our initial reactions to the NEJM study here, here, and here.)  The present study examines the content and length of time spent during the initial outpatient consultation that took place during the trial. 

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Figuring out how much any patient or family member wants to know about the future chances of cure, disability or death is a delicate dance.  Lyle blogged about prognosis disclosure earlier this week and we have covered some of the research articles here before.  But in analyzing the research it is always good to have a narrative to help humanize the story.  The NYT Well Blog is following Dr. Peter Bach, a cancer researcher, as he navigates the medical system with his wife who was recently diagnosed with breast cancer.  The series can be found under the title "The Doctor's Wife."  This week he writes a great piece about his frustration in getting probability and prediction information from his wife's cancer doctor.

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One of my favorite bloggers and a great online supporter of palliative medicine is the Arkansas surgeon RL Bates (@rlbates) who writes at "Suture for a Living." This week she posted her Five Wishes for care near the end of her life on her blog.  Why? Partially as a response to reading about the recent Annals of Internal Medicine on the effect of surrogate decision making on the surrogate,  partially because her husband has difficulty talking about it, and partially because she wants to avoid conflict between any family members over decisions about her care as she discusses in her post.

Please go read her post and offer any comments.  This makes for an interesting ethics case...what would you do if a family member presented you with a blog post like this documenting a patients wishes? It may have already happened to one of you.


PS If I have not convinced you to check out her blog yet, she loves to quilt and posts her creations along with her medical musings for any fans of Americana!)

PPS Do you know it i s less than one month to National Health Care Decisions Day on April 16th?  Is your organization doing anything for it this year? (Disclaimer: I am helping NHDD organize social media efforts this year)

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A reporter for the New York Times recently made this statement (see video below):

"I think the Japanese tend to try to maintain a veneer of calm and not breech topics that might be alarming or insulting (emphasis added).  For example, until recently, it was the norm for families not to tell a family member who had cancer (about the cancer) just to save suffering on the part of the family member and we see some of that mentality at play in some of the communications we have seen from Japanese officials who have refused to confirm what turns out now to be a very serious situation at the Fukushima Daiichi plant.  They were very slow in acknowledging some of the dangers."

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We have covered the role of palliative care in emergencies and in post-disaster medical care before here at Pallimed (Hurricane Ike in Houston 2008, Iowa Floods in 2008, Earthquake in Haiti in 2010) . We are looking for any one in Japan or with connections to health care professionals in Japan to help inform the hospice and palliative medicine communities worldwide about some of the issues faced since the earthquake and tsunami struck.

If you have any stories please email christian@pallimed.org and we will arrange for an interview by email or Skype.

Photo courtesy of Boston.com The Big Picture

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I’m not sure how it got there, but an article from the Milwaukee Journal Sentinel landed in my inbox last week. It described the foundations of a new documentary, Consider the Conversation, by two friends who had recently experienced losses; one of them is also affiliated with a hospice. The video examines contemporary dying in America from both personal and cultural/health systems perspectives. The personal approach is achieved through “person on the street” interviews and interviews with people dying of progressive diseases. There are also interviews with well-know palliative care experts such as Ira Byock and James Cleary and journalist/author Stephen Kiernan.