Robert Crook, MD FACP – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Robert Crook, MD FACP, was selected based on his involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired him over the course of his career. We are sharing some of his answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
I especially want to recognize my wife, Annette, for her seemingly infinite love, support and sacrifices during this journey.
I am grateful to have worked with many skilled physicians, nurses, social workers, and chaplains who have taught me much and shared their passion for palliative care. I thank the Dominican Sisters of Hawthorne who introduced me to the field and for the privilege to work alongside them as an aide at Holy Family Cancer Home while in college. I appreciate Paul Mihacevich, Sister Luke, and all the nurses sharing with me their skilled care for dying patients and their families. I am grateful to the Hospice of Northwest Ohio for teaching inquisitive medical students and allowing me to learn from a master in compassion, Dr. Marsha Paul. It was an honor to learn under Dr. Michael Harrington during residency at Case/MetroHealth and I am appreciative for all the extra time he spent mentoring me. I give special thanks to the Hospice of the Western Reserve and Dr. Chuck Wellman for always being a resource over the years. My former partners Dr. Ann Moore and Dr. David Tribble have forever positively influenced practice. I appreciate the time, active mentoring, and friendship of Dr. Dan Masion, who taught me many things including some of the soft skills which were seemingly quite hard. Lastly, I am thankful for my current partners and the incredibly skilled and supportive team at Mount Carmel, especially Lori Yosick, Dr. Phil Santa-Emma and Dr. Walt Ferris.

Where do you see yourself in 5 years?
I hope to serve where called and where my gifts best match the world’s need.

What is the best advice you have ever received?
“Watch your thoughts, they become words. Watch your words, they become actions. Watch your actions, they become habits. Watch your habits, they become your character. Watch your character, for it becomes your destiny.” -Frank Outlaw

Highlights of the May Issue of the Journal of Pain and Symptom Management

Highlights of the April Issue of the Journal of Pain and Symptom Management
Listed below are a few articles from the most recent issue of the journal:

Promoting Evidence in Practice

Octreotide for Malignant Bowel Obstruction: Commentary on Currow et al.
Sebastiano Mercadante

Original Articles

Double-Blind, Placebo-Controlled, Randomized Trial of Octreotide in Malignant Bowel Obstruction
David C. Currow, Stephen Quinn, Meera Agar, Belinda Fazekas, Janet Hardy, Nikki McCaffrey, Smon Eckermann, Amy P. Abernethy, and Katherine Clark

Measuring End-of-Life Care and Outcomes in Residential Care/Assisted Living and Nursing Homes
Sheryl Zimmerman, Lauren Cohen, Jenny van der Steen, David Reed, Mirjam C. van Soest-Poortvliet, Laura C. Hanson, and Philip D. Sloane

Quality of Life and Cost of Care at the End of Life: The Role of Advance Directives
Melissa M. Garrido, Tracy A. Balboni, Paul K. Maciejewski, Yuhua Bao, and Holly G. Prigerson

Review Article

Measuring Experience with End-of-Life Care: A Systematic Literature Review
Jessica Penn Lendon, Sangeeta C. Ahluwalia, Anne M. Walling, Karl A. Lorenz, Oluwatobi A. Oluwatola, Rebecca Anhang Price, Denise Quigley, and Joan M. Teno

To access the articles, you must subscribe to JPSM or be a member of the American Academy of Hospice and Palliative Medicine (AAHPM). For further information on the Academy, call 847.375.4712 or visit aahpm.org.

Submitted by: David J. Casarett, MD, MA, Senior Associate Editor, JPSM

Laura Gelfman, MD, MPH – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Laura Gelfman, MD, MPH, was selected based on her involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired her over the course of her career. We are sharing some of her answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
My experience caring for Ms. R, an older woman with metastatic breast cancer and severe post-herpetic neuralgia, continues to shape my approach to palliative medicine. I cared for Ms. R throughout my clinical fellowship, through multiple hospitalizations and ultimately, I cared for her at home until she died.

These experiences taught me the importance of finding ways to ensure Ms. R’s voice was heard throughout her illness, which slowly diminished Ms. R’s closely guarded and highly valued independence. When her oncologist offered her more chemotherapy, Ms. R could not say “yes” because she suffered from her previous chemo and she could not say “no” because she was afraid of what the future might look like. Her sons and her doctors all agreed that her decision to not decide was a decision that we would support, all the while working to control her symptoms.

Our symptom management focused on the ebbs and flows of her somatic and neuropathic pain, opioid-induced constipation and acute delirium, each critical to her care. This required effective communication and care coordination among her care team, including her oncologist, homeopathic doctors, family and home care team. I witnessed firsthand the devastating effects and unmatchable joys of caregiving. Through my continued relationship with her family, I have come to appreciate the waves of bereavement and the meaning of sharing memories. When I look back at my fellowship, I realize that Ms. R taught me the fundamental tenets of palliative medicine, and the intense satisfaction and privilege of providing our care to patients with serious illness and their families.

Where do you see yourself in 5 years?
In 5 years, I plan to transition from a mentored K23 funded investigator to an R01 funded independent investigator whose research improves the care of older adults with advanced heart failure. Under future NIH career development funding, along with my Hartford Centers of Excellence Collaborative Pilot Award, I will design and pilot test an intervention to improve the communication skills among heart failure clinicians. With future R01 support, I will conduct a randomized controlled trial to test the intervention. Improving communication skills of heart failure clinicians has the potential to better outcomes of patients living with heart failure by aligning treatments with their goals of care. I will continue to leverage national funds to build a coalition of both funders and key stakeholders within HPM as well as outside of HPM to be able to move the field forward. I will use these awards to ensure that I improve the quality of care for patients living with serious illness and their families, and advance the field of HPM.

What is the best advice you have ever received?
Throughout my childhood, when I faced a challenging decision or problem, my parents encouraged me to take a step back with the simple phase that my father learned in the Navy “KISS: Keep it simple stupid.” To this day, I remind myself of this advice as I sit down to write a grant or a manuscript, to break bad news to a patient or a family member, teach medical students the fundamentals of pain management, or encourage a fellow to practice a new communication skill. By breaking down a complex problem into smaller pieces, I have come to realize that these challenges become more surmountable, not only for me as a clinician, educator or researcher, but for patients, families, learners, trainees and mentees.

Hunter Groninger, MD FAAHPM – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Hunter Groninger, MD FAAHPM, was selected based on his involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired him over the course of his career. We are sharing some of his answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
One of my favorite aspects of our field is the diversity of the professional base: people don’t come to HPM because they love a particular organ system; they come because of their own personal and professional stories. Because of this, so many rich experiences inform folks moving into the field. I can think of a dozen individuals who have significantly impacted my work and it would be difficult to choose the one who has influenced me the most.
But here is one of those rich experiences that stands out: as a fourth year medical student, I did a rotation in palliative care with Dr. Daniel Fischberg. One day, we were rounding on a patient, an elderly woman dying in an intensive care unit. Her large family was gathered around the bed, trying to accept the inevitable decline of this matriarch. Understandably, they were so incredibly sad. It was palpable in the room. I remember feeling paralyzed, like there was nothing more to be done that might help them through this time. Then, in the middle of talking with some of her children, Dan gently moved the conversation to life before this hospitalization. What did she like to do for fun? What gave her joy or excitement? Within a few seconds, the room filled with laughter and storytelling. The gathering suddenly seemed like a celebration. I was stunned to witness this simple magic, and I knew I wanted to be able to help patients and families just like this.

Where do you see yourself in 5 years?
I see myself exactly where I am now: serving the community of the Washington, DC, metro area. When I arrived here in 2006, the city of Washington, DC, had one of the lowest hospice utilization rates in the nation and one of the highest rates of in-hospital death. Patients and families were just beginning to learn of the supportive benefits that palliative care can provide. Since then, many HPM clinicians have worked hard to change this for the better, but there is much more to do. I aim to see palliative care deeply implemented into the inpatient and outpatient fabrics of my hospital; our current project to integrate palliative care upstream with advanced heart therapies is one part of that. I also want to create strong partnerships with community-based HPM providers to make this care truly seamless. And we need to study what we implement so we can always improve and extend these benefits.

What is the best advice you have ever received?
Founder of the Zen Hospice Project Frank Ostaseski has developed five precepts that he uses to teach caregivers of the dying. They are all important to me, but one in particular I find myself practicing many times a day: find a place of rest in the middle of things. Working with seriously patients and their families could not be more rewarding. It can also be very challenging work. Then put this hard work in the context of the rest of life – family, friends, financial responsibilities, hobbies, spiritual life – and it can be tricky not to feel pulled in too many directions. I remember talking with Frank about this specific precept. His suggestions were simple: pause and breathe before entering a patient’s room; enjoy a red light instead of being frustrated by the commute; when you wash your hands dozens of times on hospital rounds, just focus on washing them, and let your mind relax rather than race from thought to thought. When I follow this advice, I feel focused, energized, and present to these special moments with our patients. I can bring more to my work, but I also take away more from these rich experiences and look forward to the next encounter.

Jessica Merlin, MD MBA – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Jessica Merlin, MD MBA, was selected based on her involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired her over the course of her career. We are sharing some of her answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
I am fortunate to have had one of the giants in our field, Dr. Christine Ritchie, as my steadfast mentor. Christine has guided me through every aspect of my work, from study design to helping me with the often challenging transition from fellow to faculty. Whenever I find myself in a difficult situation, I always try to channel Christine’s compassionate but always practical and level-headed advice.

What is the best advice you have ever received
The best piece of advice I’ve ever received was actually from a TED talk, but is something that Christine and I have also often discussed, and something that I have personally experienced many times: “Chance favors the connected mind.” In other words, if you are engaged in your surroundings, passionate about what you do, work well with those around you, and open to new possibilities, amazing opportunities will come your way.

Where do you see yourself in 5 years?
One of my biggest opportunities has been to work in a very understudied area within palliative care – chronic pain, particularly in individuals with HIV. Approaches to chronic pain are often different than approaches to pain in serious illness disease, and include a focus on improving long-term pain and function through treating mood disorders and addiction when present, and optimizing person-centered self-management strategies. Over the next five years, I hope that my work will allow me to bring these approaches to community-based palliative care, and put chronic pain more on the “palliative care map” as a key area of importance within our field.

Jason A. Webb, MD – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Jason A. Webb, MD, was selected based on his involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired him over the course of his career. We are sharing some of his answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
I am fortunate at Duke University to have many clinicians who have influenced my work and trajectory into hospice and palliative medicine, and two clinicians and educators stand out: Dr. Anthony “Tony” Galanos and Dr. Harold “Harry” Goforth. During my training, I had the great fortune of rotating with Dr. Tony Galanos, or Dr. “G”, as all of his residents and colleagues refer to him. Dr. G is a master communicator, and through his tutelage, he has helped me develop a strong foundation in the skills needed to be a proficient and compassionate communicator. Dr. Goforth, who mentored me for two years during my combined internal medicine & psychiatry training, showed me how a clinician with a focus on psychosomatic medicine could be an invaluable resource for patients with a palliative care need and co-morbid mental illness. I learned nearly everything I know about pain and symptom management from a biopsychosocial perspective from Dr. Goforth.

Where do you see yourself in 5 years?
I am currently developing a career that has three primary elements: clinical work, medical education, and global health. In the next five years it is my hope to continue to cultivate my development as a strong HPM clinician, with a growing focus on developing an integrated psycho-oncology and palliative care clinic. In my educational role, it is my hope in the next 5 years to transition into further leadership roles in medical education, with a goal of becoming a HPM fellowship training program director. Finally, I have been fortunate enough to travel to Kenya for two global health expeditions focused on providing palliative care. I sincerely hope to further develop clinical and educational programs in Sub-Saharan Africa to advance the care of cancer patients with severely unmet pain and symptom management needs.

What is the best advice you have ever received?
The best advice I have ever received came from one of my global health mentors Dr. G. Ralph Corey, and it had nothing to do with medicine, but rather was advice in fatherhood. During my chief residency my wife and I were expecting our first child and during a mentorship meeting Dr. Corey said, “Just remember, being a father takes patience, and that there is no such thing as a bad child, only impatient parents.” His advice has helped me through long nights of fatherhood, and I have used this advice more than I know as a palliative care clinician. It has helped me better understand as well, that “there is no such thing as a bad patient, only impatient doctors.”

Gordon Wood, MD MSCI FAAHPM – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Gordon Wood, MD MSCI FAAHPM, was selected based on his involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired him over the course of his career. We are sharing some of his answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
My career has been shaped so significantly by mentors that it is impossible to name just one. My interest in palliative care grew out of the opportunity to work with Dr. Stephen McPhee while doing my medicine residency at University of California, San Francisco. I had the good fortune of doing an elective rotation in palliative care with him and got to see him read poetry during family meetings to capture the emotion at hand. It was a profound experience that changed the direction of my career. I then went to Northwestern for my Palliative Medicine fellowship where I worked with Dr. Joshua Hauser and Dr. Michael Preodor in the Education in Palliative and End-of-Life Care (EPEC) Project, first as an attendee then as a teacher. These experiences and relationships led to a decision to change my focus from research to medical education. At Northwestern, I also worked with Korey Eckley, LCSW who taught me the power and joy of working in an interdisciplinary team. During my fellowship, I attended OncoTalk where I met Dr. Bob Arnold. The experience there and my relationship with Bob, with whom I would later work as faculty, developed my interest in communication skills training which continues to be the focus of my academic work. Finally, my relationship with Dr. Martha Twaddle has brought me to my current position where I am able to continue my work in communication skills training in both the academic setting of Northwestern and at Midwest CareCenter, a community hospice.

Where do you see yourself in 5 years?
I anticipate many changes and developments within the next five years. First of all, the palliative care program I direct at Northwestern Medicine Lake Forest Hospital will have moved to the new replacement hospital, which is scheduled to complete construction in 2017. This will come with new trainees, including a family medicine residency. I am fortunate to have the support of Midwest CareCenter and the Martha L. Twaddle Chair in Palliative Medicine, which will allow me the opportunity to develop educational programs for the learners at this new hospital as well as for Midwest staff and our community. In five years, we should also be wrapping up the “Preference-Aligned Communication and Treatment (PACT)” Project, a 4.5 year project scheduled to begin in the Spring of 2015 which will implement and analyze an advance care planning intervention at more than 20 Illinois hospitals and their post-acute partners. I anticipate this project will inform future proposals centered on team communication training. In five years, I also hope to be continuing to work with VitalTalk as we come to the end of our 5-year goal of providing communication skills training to 11,500 clinicians. By that time, we at the Education in Palliative and End-of-Life Care (EPEC) project anticipate having an updated core curriculum as well as new specialist and international curricula. Finally, I hope to be planning a wonderful celebration for my 10-year anniversary with my wife along with my two daughters, who will be 8 and 5 by that time.

What is the best advice you have ever received?
The best advice I ever received was my fellowship program director, Jamie von Roenn, suggesting I attend OncoTalk. I was thrilled about the opportunity for an all-expenses-paid week in Aspen, however, I became considerably less excited when I found out that the week would be spent doing role-play. What I experienced at OncoTalk, however, was fundamentally different from any role-play I had done before. It felt real and safe, yet challenging, and, to my amazement, actually became fun. I learned how to be a better observer of communication, breaking conversations into discrete elements, connecting causes and effects. It started to feel more like working in a lab, bouncing ideas off of really smart and insightful colleagues and trying out new things. It was exciting and became the focus of my academic career. Now, through a program known as VitalTalk, I am now fortunate to teach alongside the people who were my teachers during that first trip to Aspen.

In reflecting on the advice to attend OncoTalk, I think it was not only the concrete experience of attending the conference that made the advice powerful. It was also the suggestion that pushing yourself outside of your comfort zone to try something new can help you grow in significant and sometimes surprising ways. I have since tried to remember this when confronted with opportunities that seem different or daunting and it has moved my career in exciting directions I never would have anticipated.

Lindy Landzaat, DO – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Lindy Landzaat, DO, was selected based on her involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. This honoree was then asked who inspired her over the course of her career. We are sharing some of her answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
I believe in having multiple mentors for different things. I’m fortunately to have benefitted from the wisdom of many mentors starting from my internship. Two individuals stand out for having most influenced my work. First, Dr. Christian Sinclair who allowed me to rotate as a visiting resident and encouraged my involvement with AAHPM, has been a critical mentor. Dr. Sinclair helped mentor me in developing presentation skills, broaden my use of resources, and continues to help mentor my career development. Dr. Karin Porter-Williamson has been a crucial mentor in these first 5 years as junior faculty helping me grow both as a clinician and as an educator. She is skilled in bedside patient care, understanding palliative care systems development, and overall a great advisor and support. Dr. Porter-Williamson was able to help steer me down the path of medical education even before I could see that path for myself. It’s been fulfilling and I remain thankful for her guidance. Both of these visionary individuals founded and served as the previous fellowship program directors for the KU fellowship that I’m fortunate to now direct. To Dr. Sinclair and Dr. Porter-Williamson, as well as the many influential mentors I’ve had, I remain exceptionally grateful.

Where do you see yourself in 5 years?
I see myself as an associate professor at KU, continuing to grow and enhance our fellowship program. I enjoy interacting with a variety of learners at different levels and will continue to teach. I strive to make meaningful contributions to palliative care medical education, and a variety of clinical areas of interest including palliative pulmonary hypertension, palliative wound care, legacy work. Five years from now, my children will be 7 and 9, and my motherhood mission statement will remain, to be “loving and effective.”

What is the best advice you have ever received?
During my fellowship, I was always impressed by one of my psychosocial faculty member’s ability to analyze and make sense of chaotic situations-ones that could draw you in and quickly become all consuming. My faculty had an ability to step back, take the big picture, reflect on it dispassionately and from all angles, and in such a way that could yield productive outcomes. When I asked, “how do you do THAT?” The faculty member shared with me a resource called the Landmark Education Forum. It was a 3 day course that I eventually attended and it helped me understand my patients and families better, be a more effective clinician, and it offered me insight into personal areas that were limiting me; insight that I never would have gained otherwise. This remains some of the most life changing advice I’ve ever received and I’m thankful each day for it.

Patrick White, MD – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Patrick White, MD, was selected based on his involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. Each honoree was then asked who inspired him over the course of his career. We are sharing some of his answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?

The two most important influences in my career in hospice and palliative are Bob Arnold and Rudolph Navari. Dr. Navari introduced me to hospice and demonstrated the importance of incorporating palliative care techniques into his own oncology practice to provide his patients with the best quality of life possible. As an expert in antiemetic therapy, he taught me the importance of evidence-based symptom management and fostered my interest in academic medicine. Bob Arnold has been invaluable to my growth in the hospice field. He has been an amazing role-model and mentor who has provided me with many unique opportunities including participation in an NIH training grant, state-of-the-art training in communications, and the opportunity to help lead one of the best academic hospices in the country. This paragraph cannot do justice to how much I have learned from Bob during the hundreds of hours we have spent in mentoring meetings. I also think that one of the aspects of hospice and palliative care that differentiates us from other fields, is that our most distinguished leaders are so altruistic with their time. In addition to Drs. Rudolph and Navari, I have been very grateful to have received help from many other experts, including Drs. Janet Bull and Jean Kutner. Finally, I must acknowledge much of my clinical expertise has benefitted from the experience of hundreds of extremely patient and dedicated nurses at each of the centers where I have trained.

Where do you see yourself in 5 years?

I hope to be the Chief Medical Officer at an academic hospice that is a leader in integrating hospice and palliative medicine throughout an entire health system. The current delivery of end-of-life care can be so fragmented that patients and caregivers lack the support they deserve. I hope to be a leader in a system that embraces the need to build a seamless continuum of care, where providers work collaboratively further upstream to provide patients and caregivers with the knowledge, support, and resources they need. I hope my research background will enable me to demonstrate with data, the outcomes that a health system leadership team will value in promoting better integration of hospice and palliative care. I would love to find creative ways to better support caregivers and work with the Academy to change the way we view dying in America.

What is the best advice you have ever received?

I think the best advice came from my colleague and friend, Dr. Christopher Hughes. While I was trying to learn more about management, he paraphrased Paul O’Neil, who said “An organization with the potential for greatness must have each employee answer three questions: 1) Did they get treated with dignity and respect by every employee they encountered; 2) Were they given the knowledge, tools, and support they needed to make a meaningful contribution at work; and 3) Did somebody notice their contribution.” In hospice, it can be easy to forget what a huge contribution each nurse, certified nursing assistant, chaplain, and social worker makes to the organization and clients, daily. Our goal and challenge is to create an organization where the majority of our team can answer “yes” to these questions every day.

Highlights of the April Issue of the Journal of Pain and Symptom Management

Listed below are a few articles from the most recent issue of the journal:

Special Article

Measuring What Matters: Top-Ranked Quality Indicators for Hospice and Palliative Care from the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association
Sydney Morss Dy, Kasey Kiley, Katherine Ast, Dale Lupu, Sally A. Norton, Susan C. McMillan, Keela Herr, Joseph D. Rotella, and David J. Casarett

Original Articles

Apoyo con Cariño: A Pilot Randomized Controlled Trial of a Patient Navigator Intervention to Improve Palliative Care Outcomes for Latinos With Serious Illness
Stacy Fischer, Lilia Cervantes, Regina M. Fink, and Jean S. Kutner

Measuring End-of-Life Care and Outcomes in Residential Care/Assisted Living and Nursing Homes
Sheryl Zimmerman, Lauren Cohen, Jenny van der Steen, David Reed, Mirjam C. van Soest-Poortvliet, Laura C. Hanson, and Philip D. Sloane

Patient Characteristics Associated With Prognostic Awareness: A Study of a Canadian Palliative Care Population Using the InterRAI Palliative Care Instrument
Kathryn Fisher, Hsien Seow, Joachim Cohen, Anja Declercq, Shannon Freeman, and Dawn M. Guthrie

To access the articles, you must subscribe to JPSM or be a member of the American Academy of Hospice and Palliative Medicine (AAHPM). For further information on the Academy, call 847.375.4712 or visit aahpm.org.

Submitted by: David J. Casarett, MD, MA, Senior Associate Editor, JPSM