In the interest of archiving the Education SIG’s “Education Resource Email” collection and making it more widely available, we have decided to post past emails. The email below was originally sent to the Education SIG listserve on November 21, 2012.
Capitol Hill Days and advocating for education funding
Dear Education SIG colleagues,
In the midst of your travel and/or preparation for the Thanksgiving holiday, I hope you can find time to read the following resource describing my experience at AAHPM’s Capitol Hill Days. I hope that it will offer some additional perspective on how both our SIG and the individuals therein might advocate for eduation funding. Most importantly, there is action that you can take today to help move this effort forward, so keep reading (or at least flag for follow-up when you return to work)!
I attended AAHPM’s Capitol Hill Days on behalf of our Education SIG this past July 16-18. I thought it might be useful to provide you with some information about what I learned during that experience and what it was like as a way of encouraging some of you to participate in Capitol Hill Days in future years.
Over the last few years, AAHPM has worked to craft a bill, entitled the Palliative Care and Hospice Education and Training Act (PCHETA), aimed at expanding opportunities for interdisciplinary education and training in palliative care and to secure support for its introduction in Congress. Specifically, PCHETA has 5 major aims:
1. Establishes Palliative Care and Hospice Education Centers to improve the training of interdisciplinary health professionals; develop and disseminate palliative care curricula; support training and retraining of faculty; provide students with clinical training in appropriate sites of care; and provide traineeships for advanced practice nurses.
2. Provides for physician training by authorizing grants to schools of medicine, teaching hospitals, and GME programs to train physicians (including residents, trainees, and fellows) who plan to teach palliative medicine.
3. Establishes Academic Career Awards to promote the career development of BC/BE junior faculty physicians in HPM. Eligible individuals must provide assurance of a full-time faculty appointment in a health professions institution and commit to spend a majority of their funded time teaching and developing skills in interdisciplinary education in palliative care.
4. Emphasizes workforce development by authorizing funding for up to 24 Palliative Care and Hospice Education Centers to establish fellowship programs that provide short-term intensive courses focused on palliative care. These fellowship programs will target current faculty who do not have formal training in palliative care and will provide formal re-training of these mid-career physicians in palliative medicine.
5. Provides career incentive awards for eligible health professionals who agree to teach or practice in the field of palliative care for at least 5 years. Eligible individuals include: advanced practice nurses, clinical social workers, pharmacists, and psychologists who are pursuing a doctorate or other advanced degrees in palliative care or related fields.
Sounds pretty great, right? Our visit to the Hill was timed to coincide with the week of this bill’s introduction on both the House and Senate floors. We began on Monday evening, July 16, with a working dinner where we were briefed on the bill and its potential impact on our field. We were lucky enough to have Senator Ron Wyden (D-OR), the primary sponsor of the bill, come to speak with us about his personal interest in this bill and about how we could be helpful to the cause in our upcoming meetings with other senators, representatives, and their staff members.
Tuesday morning, we learned about the legislative process and heard from various groups who are present throughout the year on the Hill working to advance issues related to hospice and palliative care. This was followed on Tuesday afternoon by highly coordinated visits with our local senators and representatives and/or members of their staff. In my case, I met with Legislative Assistants (LAs) for both of my state senators from North Carolina and with my own local representative, Rep. David Price (D-NC).
These experiences on Tuesday afternoon were clearly the highlight of the trip. We were understandably somewhat nervous as we entered the Senate and House office buildings, going through metal detectors and finding our way to the appropriate office replete with the state flag positioned outside the door. Luckily, we were accompanied by one of the staff members from the lobbying organization which supports AAHPM. They were there to ensure that we knew what to say (and what not to say) and also to debrief with us after our meetings. When meeting with legislative assistants, the staff member’s knowledge of the bill could vary from none to a modest amount. We often found ourselves explaining the difference between hospice and palliative care and highlighting the workforce issues in our field, especially as the population ages and becomes ever sicker. All in all, much of the interaction was not that different from talking with a patient or family member in our clinical setting. And who better to communicate about our field than one of us?! That, of course, is the impetus for these Capitol Hill Days.
The day after our visit, on July 19, 2012, AAHPM’s efforts came to fruition when the Palliative Care and Hospice Education and Training Act (PCHETA) was introduced in the United States Congress. PCHETA was introduced as S.3407 in the Senate by Sen. Ron Wyden (D-OR) and as H.R.6155 in the House by Representative Eliot Engel (D-NY17). As a result of our group’s collective efforts that week as well as ongoing efforts by AAHPM members and our lobbying group, the bill now has 38 co-sponsors in the House and 6 co-sponsors in the Senate.
As we learned during our time on the Hill, the introduction of PCHETA and gaining the above co-sponsors does not indicate that our work is done. In fact, just this week, those of us who attended Capitol Hill Days are following up with the staffers with whom we met in July. Any additional co-sponsors that we can gain during this lame duck session are very important as this support is very likely to carry over when the bill is re-introduced next year.
So, what can you do? If PCHETA sounds great to you, please visit the AAHPM Legislative Action Center at http://www.capwiz.com/aahpm/home/ and take the time to contact your senators and representative. It doesn’t take long but it will go a long way towards this bill gaining traction leading in to the next Congress. Think of it as your way of giving thanks for the work that AAHPM elected leaders and staff members do on our behalf year-round for our field and its practitioners.
Overall, I found Capitol Hill Days to be a great opportunity to learn more about AAHPM’s policy agenda and advocacy efforts and to network with other AAHPM members interested in advocacy on the part of AAHPM and our field. If you have any questions about ths experience, I’d be more than happy to speak with any of you about it.
Best wishes to you all for a Thanksgiving spent with family or friends or doing good work for patients and families,
Lynn O’Neill, MD
Duke Palliative Care
Assistant Professor, Division of Geriatrics
Duke University School of Medicine
DUMC Box 2706, Durham, NC 27710
Telephone 919-668-7215 ~ Fax 919-684-0572
In the interest of archiving the Education SIG’s “Education Resource Email” collection and making it more widely available, we have decided to post past emails. The email below was originally sent to the Education SIG listserve on July 13, 2012.
Two of your fellow EdSig members, Jennifer Reidy and Holly Yang, have taken the time to describe their experience at the Harvard Macy Institute faculty development course. Please keep reading as this is an amazing resource!
Education SIG Vice-Chair
Dear Education SIG members,
This year we’ve attended courses at the Harvard Macy Institute in Boston, which we want to highly recommend as an outstanding resource for faculty development. The Program for Educators in Healthcare Professions is designed for physicians, basic scientists and other healthcare professionals to stretch their skills in teaching, curriculum development, evaluation, leadership and information technology. The program consists of two sessions in residence at Harvard: an 11-day winter session and a 6-day spring session. Throughout the program and between the sessions, participants conduct an educational project of their own design at their home institution with support from peer and faculty mentors at Harvard Macy.
We had a class of about 80 people from 13 countries, and made invaluable friendships and professional relationships. The course director, Dr. Liz Armstrong, designed the course to foster a strong sense of community. The experience is very rigorous and intense, and you feel bonded to your classmates – likely for the rest of your careers. It is a great opportunity to network outside of palliative medicine and introduce our field to influential peers in medical education.
All of us have been to innumerable conferences during our education and careers, but Harvard Macy is truly a transformative, life-altering experience! The faculty are among the best we’ve ever seen, and they come from Harvard’s schools of medicine, business and graduate education. As a result, the curriculum is a fascinating mix of educational theory, adult developmental psychology, literature on organizational change and quality improvement, among other themes. One of the highlights of the course is the “peer consultation group,” which consists of 4-5 participants and a faculty facilitator who brainstorm ideas, give advice and provide support for each individual’s educational project throughout the course and beyond. We intend to keep in touch with our groups and will likely seek feedback from them for years to come.
For more details, you can check out their website at harvardmacy.org. The program is expensive and requires a significant time commitment, so getting support from your own institution is paramount. There are a growing number of alumni who are palliative care physicians, so we are creating our own community as well! Please feel free to contact us if you have questions or want more information.
Jennifer Reidy, MD
University of Massachusetts
Holly Yang, MD
San Diego Hospice & Palliative Care
Health care has become a world of dizzying change as more and more people realize that the current system is not working for anyone. There are new regulatory models, new care delivery models, and new funding models, but no one has the silver bullet. Along with the increasing pace of change comes a flood of new concepts and terms to describe them, many of which are ill defined and themselves evolving.
Nowhere is health care changing more fundamentally than in how it regards the role of the patient in the process of care. Patient satisfaction has long been a standard metric for many health care institutions, but for many never rose above a “nice to have” next to the “must haves” of clinical effectiveness and financial viability. In fact, many thought patient satisfaction often got in the way of the other two goals because giving patients what will satisfy them was thought to cost money and slow down or even subvert the clinical process.
Then HCAHPS drove a change to “patient experience” – related to patient satisfaction but not the same. Experience is about how reliably a given process like pain control happens and satisfaction is about how happy the patient is with that process. And finally we have arrived at “patient engagement”- a subset of “patient experience” perhaps but maybe the biggest change of all. Fundamentally, patient engagement requires that we who provide care involve the patient as a full partner in the planning and carrying out of that care. This change would seem to mark the official death of medical paternalism. But, it certainly feels like “selling the farm” to many. How can good care result when we let those without training in the field have at least a vote in the treatment decisions and maybe even a veto? Certainly lots of people will make “bad” decisions.
To those of us who are familiar with the history of how authority has operated in western religion, this debate has to sound familiar. Arguably, the most far reaching change Martin Luther and other reformers brought about in western Christianity in the 16th century is the idea that every Christian can have their personal relationship with God and can independently decide what they believe. This change was implemented in part by translating the sacred text of Christianity into a language that each believer could read or at least understand. For the most part, the authority of the ordained religious leader remained as the expert on belief and practice but that role became much more advisory than prescriptive. The religious leader now had to convince the faithful that a certain belief or behavior was “right” rather than having the belief or practice followed just because the leader said so.
Modern professional health care chaplains have long been trained to operate in this advisory model. It has been for years against the codes of ethics and best practice in professional chaplaincy to tell someone what to believe or practice unless specifically asked for that advice. Patient engagement has been the standard of care. Those of us who have worked in this way for a long time are very comfortable letting the patient lead the conversation and reach their own conclusions about what their own religious or spiritual belief and practice should be even when they differ from our own and how that belief and practice can help them cope with their illness. In fact, this model of care seems to work better than dictating to the patient beliefs and behaviors which they then mostly don’t follow.
That experience of chaplaincy practice leads me to feel confident that true patient engagement of the kind professional chaplains have long practiced will in fact improve, not only the process, but the outcomes of health care. Many will resist as many have and still do resist this model of chaplaincy. However, I am convinced that professional chaplaincy can be a major facilitator of this necessary change and can help our patients and our health care colleagues embrace this new and strange but ultimately very beneficial model.
George Handzo, BCC, CSSBB
President, Handzo Consulting
Senior Consultant, HealthCare Chaplaincy
by Amjad Riar, MD
Nearly a decade ago, during my training as a third-year medical resident, one of my rotations in oncology was at Johns Hopkins. One of the responsibilities was to admit patients with advanced cancers, and I saw oncological emergencies for seriously ill cancer patients. This ignited the thought in my mind that — even in this state-of-the-art, world-class hospital providing excellent, disease-focused medical care — we are missing something relating to patient and family needs. Soon after my training was over, I began practicing as an internist but kept on exploring until I found the answer to my question, and that was a palliative care fellowship. I was excited that the answer meant patients in need would benefit from good pain control, effective symptom management, and an approach driven by their goals of care. But I realized that it is more complicated than I thought, when I found myself explaining to patients — and most commonly to other physicians — that palliative care is not about dying and is not only hospice, but is focused on all the things that can come before hospice. There wasn’t — and still is not — a single day in my practice that I don’t find myself explaining and trying to educate other docs about palliative care.
I have seen myself struggling with patients in so much pain and suffering from various symptoms in hospitals, and yet the attending physician is not interested in a palliative care consultation due to a lack of understanding about the focus and expertise of palliative care teams. This motivated me further. In hoping that one day I would see palliative care available to all patients and families and more education made available for all the stakeholders in health care, I realized the need for public policy advocacy and thought to approach the legislators in my home state of Maryland. I started calling their offices and writing letters with facts about palliative care … how it can lower health care spending while improving quality of life as well as quality of care. For two years, I tried to make the case to a few lawmakers. Most of them quickly concluded the conversation by saying that we already have hospice-related legislation, and they didn’t think a palliative care bill would get through that easily. Eventually, my persistence paid off, and I was able get through to one lawmaker who agreed to consider introducing a bill to mandate palliative care services in hospitals statewide. By this time New York’s palliative care legislation was already in place, so I had more real scenario to present.
The problem that I really wanted to address through legislation was patient and family access in acute care settings, along with provider — and general public — education. This required me to learn many new tactics and skills on how to lobby effectively. I had no idea how the legislative process works. I was asked by our state delegate to review the bill he drafted. After many meetings and fine tuning the language, we had crafted a measure we thought would be effective yet not controversial. It was ready for presentation to the House committee.
Now the real work started. This taught me even more, including an appreciation for how hard it can be to achieve something so right in your heart and mind but which may not make much sense to others. I called the office of each member of the committee and asked for an appointment, eventually meeting with all 23 delegates one on one. My goal was to educate each and every member of the committee in person before the bill came up for a hearing, to explain why this bill is needed and how the subject matter is different from what they may think. I created a “one pager” speaking to the issue and need. The bill could only move forward if there was a favorable report from the committee.
This certainly was a strenuous learning process. While the committee members came to have a good understanding of what the palliative care legislation was intended to achieve, we hit a stumbling block when a few members decided to postpone consideration of the bill. But, with continued advocacy and support from other organizations, the committee chair decided to create a workgroup to further discuss the measure. We met on regular basis and, eventually, my advocacy efforts all paid off: in this year’s session, a palliative care bill was passed in both the Maryland House and Senate. It is awaiting the governor’s signature.
The bill requires the establishment of at least five palliative care pilot programs in hospitals with at least 50 beds across the state. The programs are required to collaborate with palliative care or community providers to deliver care; to gather data on costs and savings to hospitals and providers, access to care, and patient choice; and to report to the Maryland Health Care Commission on best practices.
Of course, this is just a first step on the road in right direction… but at least we are on the road! Next steps are really focused on continued education and involvement of stakeholders. I am focused on building coalitions, continuing collaborations, and expanding palliative care services in long-term care and non-acute settings. I will keep you posted!
In the meantime, my message is this: One palliative care provider can make a difference!!
We know the number of patients with serious illnesses is only increasing. In today’s highly specialized and fragmented health care system, these patients walk a fine line from being the beneficiary of modern medicine to becoming its victim. Informed decision making, along with early involvement of palliative care, can potentially help these patients and their families to avoid the latter. Consider advocating for palliative care in your state. Get active in promoting better health care for our future generations. I will be very happy to share more about my experience so you don’t have to go through unnecessary steps that I may have. And if you decide to take action, you might just uncover personal stories where palliative care has impacted the lives of key policymakers and, in doing so, find a champion for your cause. The hard part is first taking the initiative. Once you do, however, remain persistent! You will be surprised to learn that persistence will pave the way to success. If you believe in something right, just go for it — and keep marching until you reach your destination!
This past Tuesday was the annual National Healthcare Decisions Day when patients are encouraged “to express their wishes regarding healthcare and for providers and facilities to respect those wishes, whatever they may be.” To be clear, this is not about getting people to agree to a Do Not Resuscitate order or agreeing to limit their treatment options if that is not what they want. It is presumably an opportunity for patients to take control of their care at a time when they otherwise would not be able to do so. For those of us for whom religious beliefs and values inform and undergird these decisions, it is about taking advantage of an open invitation from a health care system which so often seems oblivious to those beliefs to make them known and document them in relationship to care decisions.
In observing this day, Dr. Eric Widera offers a very provocative post on GeriPal. He cites a recent editorial by Theresa Allison and Rebecca Sudore in JAMA Internal Medicine and a related study by Heyland and colleagues investigating documentation of treatment preferences by a sample of elderly patients in Canada. One of the most dramatic and disturbing findings of the study was that, for those who had stated preferences, over two-thirds of those preferences were either not documented at all or documented incorrectly in the medical record. This finding calls into serious question the basic premise of advance directives. If one’s stated preferences are likely not to be observed, why even bother?
But Allison and Sudore up the ante even further when they state:
“Discussions about goals of care and code status constitute a medical procedure every bit as important to patient safety as a central line placement or a surgical procedure. Much as we have developed systems to improve patient safety in surgical procedures, we need to develop systematic approaches to discussing patient values and goals of care.”
Dr. Widera then raises the obvious question, “Should failure to follow preferences be a medical error?”
For those of us who are not physicians, this could be an invitation for doctor bashing. However, we need to all take seriously that patient safety is everyone’s responsibility. So if this is about patient safety, we are all culpable. But, even if this is not a patient safety issue, I would expect that all of us believe that patient’s wishes should be respected and every effort should be made to make that happen.
The newly released 3rd edition of the NCP Clinical Practice Guidelines contains the following criterion under Guideline 8.1. This criterion applies equally to all members of the treatment team.
“All expressed wishes, preferences, values, goals, plan of care, surrogate decision makers and advance care plans are routinely documented, including the completion of clinical orders such as inpatient resuscitation status, out of hospital do not resuscitate orders, and health care surrogate declaration documents for adult patients.”
So it seems to me the bottom line here is that all members of the treatment team are obliged, individually and as a group, to make sure that all stated treatment preferences and advance directives are well documented, well understood by the team, and observed. If the finding of this study turns out to be true more widely, all of us bear responsibility. Dr. Widera along with the authors of the editorial raise an interesting and provocative question. However, no matter whether consensus ever develops around the answer to that question or not, the findings of this study should galvanize us all to action. The findings point out that while getting patients to fill out their advance directives is a necessary first step, there is another necessary part to the process which may be seriously broken. Each of us needs to be committed to point out that brokenness each and every time we see it.
George Handzo, BCC, CSSBB
President, Handzo Consulting
Senior Consultant, HealthCare Chaplaincy
The Annual Assembly is over. The boxes have returned from New Orleans and we have put all the items back on the shelves. Today, we had our “Post Con” meeting and talked about the specifics: what went right and where we can make improvements for next year’s Assembly. The staff shared some interesting facts:
• 2419 attendees from 15 different countries and every state in the union were in New Orleans.
• 509 gallons of coffee were consumed at the Convention Center.
• 51 companies exhibited in the exhibit hall and 27 companies were present at the Job Fair.
• 3486 sleeping nights were reserved for attendees.
• 439 Twitterers tweeted 6716 tweets – totaling 6.1 million impressions. There was lots to talk about!
• Attendees participated in 135 educational sessions and purchased 286 of recordings of those they couldn’t attend.
• 13 past presidents were present to celebrate the Academy’s 25th anniversary, including Drs. Carla Alexander, Bob Arnold, Andrew Billings, Ira Byock, Gail Cooney, Ron Crossno, Laurel Herbst, Michael Levy, Dave McGrew, Sean Morrison, Cameron Muir, Ron Schonwetter and Martha Twaddle.
For the staff, the Annual Assembly is a culmination of a year’s worth of planning, meetings and conference calls. We are excited each year to come to the meeting and come away re-energized by the passion our members bring with them. Although we are still in “recovery mode” from the 2013 meeting (going through notes from on-site meetings and following-up with attendees), the planning for 2014 has already begun.
The 2014 AAHPM & HPNA Annual Assembly in San Diego will be here in just 345 days – mark your calendars for March 12-15!
Director, Marketing & Membership
“I’m sitting on a prop plane that smells like ranch dressing.” I texted my brother on the way home from #hpm13. His reply? “Hold your nose and hope for the best.”
Little did I know that I was the kind soul who provided the fifty seater with the odiferous presence of ranch dressing. The bottle of “Bayou Butt Burner Hot Sauce” that I snagged in New Orleans as a souvenir for my husband apparently could not withstand the pressure of my several journals worth of CME. That bag, saturated with seven dollars worth of ranchy, bayou goodness, still sits in the garage waiting for me to clean it up, a memory of a wonderful trip to New Orleans with an equally wonderful group of people.
On reporting on my trip, my boss said, “Yeah, it’s nice to go to those things. They’re energizing, but nothing ever comes of them in practice.” I agree in part; it IS nice to attend AAHPM’s annual conference. My goal for this year’s post-conference blues is to pick three areas of my home hospice practice in need of attention, and improve on them based on what I learned this year at AAHPM’s national conference.
So where to begin? First off, in trying to rehash tidbits for colleagues, I found myself searching my brain for tips, quips, or pearls handed to me this week. But where were they? As I sat, pondering, twirling my achy thumbs, it came to me.
As a TweetPro for this year’s conference, my tidbits are all on my twitter profile. I tweeted everything I heard that stood out to me, favorited others’ tweets, and retweeted the gems from the seminars I couldn’t attend. Now, they’re all there for me to savor. Pearls of wisdom, line by line, in 140 characters or less.
In all honestly, I took a lot of grief for being a TweetPro. A lot of people just don’t get it. Friends of mine from other sectors of life took offense to my overhaul of their twitter feed. My own family members texted me messages of hospice and palliative medicine exhaustion! But there were far more who did get it, who learned a thing or two, and who thanked me for the record-keeping. The TweetPro title encouraged us to spread the twitter-love to all those wishing to try, which allowed for fast information sharing and extensive networking. Within sessions, the role focused my mind on the topic being discussed, allowed me to engage quickly (and quietly) with others in other rooms and other states, answer questions, ask questions, and solidify the knowledge I was recording. Live tweeting the conference amplified my experience within the assembly, not only academically but socially as well.
Here comes the hard part. Now that I have the knowledge recorded permanently for the world to see, I have to figure out how to make it useful closer to home. I could just rest, knowing I’m a bit smarter now and that my CME hours are climbing, but that does nobody but me any good. I figure I can best benefit my patients by sharing the HPM love with my team of nurses, social workers, and chaplains.
Perhaps the best thing to come of my time in New Orleans was the time away from work to reflect on my patients and my experiences, both personal and professional, and how they affect me as a person and as a physician. In an attempt to share some of what I learned, I aim to be more supportive of my team and more accountable to my families. This is the type of goal that is fueled by the energy provided by both the AAHPM members and assembly.
Thank you to everyone who attended the AAHPM Annual Assembly in New Orleans this year. Each person in attendance helped me recognize that there are thousands of us who share in the same passion, and that it’s a passion worth fighting for.
Now, if you’ll excuse me, my practice, like my bag, waits patiently to be cleaned.
Bethany C. Calkins, MD
In opening the Easter service in my church yesterday, the pastor reminded the congregation that Easter is centrally about turning from death to new life. He pointed out that this is not only about what we, as Christians, believe God did for us through the death and resurrection of Jesus in overcoming death, but a lesson we can use elsewhere in our lives. He reminded us that many in Newtown, our cross-county neighbor, have been able to turn the horror of the death that was visited on them into a focus on new life. They are certainly not in any kind of denial about the pain and suffering they continue to feel, but many have been able to focus on the blessings and gifts that they still have in their lives.
And this example is seen lots of other places in our lives. For those of us who work in health care, we almost daily see patients and their loved ones who are confronted with tremendous suffering. Some become bitter and angry, but others genuinely acquire a greater appreciation for parts of life they had previously taken for granted. What is still unknown is what causes individuals to turn one way or the other. For those of us who are chaplains, we look for what parts of spirituality or religious belief support this kind of resilience and what parts impede it.
In this search, case studies are important. They are each unique of course but they each give us powerful insights into the ways some people live life to the fullest in the face of suffering and death and others give up on life almost completely.
Those of us who attended the recent AAHPM annual assembly were treated to a plenary by David and Deborah Oliver which I, and I know many others, felt was not only highly educational, but awe-inspiring. David has been living with stage 4 cancer. He and Deborah have “gone public” with virtually all aspects of their journey- both the struggles and the triumphs. But what impressed me more than anything else is their determination to live their lives in all the fullness they can muster including family, friends, travel, and each other. They are determined to find joy and fulfillment in their lives and, because they keep looking, they find it in abundance. There have certainly been trials along the way mostly with the medical system which are also instructive and well documented. David is determined to keep control of both his life and his death. His “HOPE” for dying is:
(H) to die in my own home
(O) surrounded by others
(P) pain free
(E) and excited about living
Many of you may already be familiar with David Oliver from his series of YouTube videos. He also has an ebook out called, Exit Strategy: Depriving Death of its Strangeness that is available on Smashwords. Whether you are a veteran in the field who can always learn more, someone just entering health care, or a patient or caregiver yourself, both David’s videos and book are must sees.
George Handzo, BCC, CSSBB
The Annual Assembly, like baseball season, comes and goes quickly. However, the planning is ongoing and takes a year. Prior to the Annual Assembly, there is much discussion past assemblies – the good, the bad, and the mediocre. The opening day of the Annual Assembly for AAHPM and HPNA – is always exciting. Okay, perhaps not as exciting as Opening Day at Fenway Park for the Red Sox, or opening day for the baseball season in general. But still exciting and rewarding. We have the previous stats from other annual assemblies – winning sessions, home run session and speakers, fouls of language and lack of inclusion, and outs of people who promoted something other than palliative care principles. We have a variety of list of players, and a back-up plan for most last minute changes and pinch hitters. It is the time to see everything unfold.
The strategy behinds the conference is a fluid process, a sort of quality assessment improvement process. Discussions include an overview of the assembly, scheduling, team building, and yes, the process. These are ongoing issues but each assembly has a special focus with a theme and the attention to new leaders and new research in the field. Indeed, the plan behind the “The Game” or the Annual Assembly is much like the delivery of palliative care. There is a “general template for evaluation” – the blueprint of the conference. It outlines everything that needs to be done keeping the group in track with tasks and dates. The evaluation also includes review of the abstract submissions; a competitive process. It is important to understand that the level of conference sophistication continues to rise. All accepted abstracts have an average score of 4.5 or above in a rating of 1—5. This has risen significantly even from two years ago when it was around 4.0.
The amount of “advanced care planning” for the Annual Assembly is extensive – with the “goals of care” established in the overall objectives of the meeting: networking, education, and renewal. The “surrogate decision makers” are comprised of the members of Planning Committee. It consists of the Co-Chairs representing HPNA and AAHPM as well as the planning committee members reflecting the diversity of both organizations, the Research Sub-Committee Co-Chairs and their research committee, and the staffs at AAHPM and HPNA. There are constant “family meetings” to provide information of the state of abstracts, plenary planning, conflict of interest, continuing education credits, and the like. There are “decision points” in terms of abstract review and acceptance, content review, and the implementation of new technology into sessions. Above all, there is a “collaborative process” which helps when there are bumps. These include the inevitable technology glitches, communication with abstracts not being accepted, and keeping everyone in the communication loop around decision-making. Thus, there is the philosophy “hope for the best, and plan for the worst” and “promoting excellence.”
Being Co-Chair at the meeting is like being a Baseball Manager. You are in the background working on the process. Then you are in the public domain when it all begins. You are responsible for what occurs at the conference. Since people know who you are, you hear the good and the bad as well as everything in between. People assume you know all the intimate details of the conference, from the telephone numbers of the AV people, to Room Numbers, to session scheduling. To assure confidence in offering up-to-date information and assistance, I carry a notebook with all the conference details. My notebook has an hour by hour, day by day review of the schedule, from the schedule with Title of Presentations, to Presenters, to Room numbers for my reference. I also have my own personal schedule with the events which includes dropping in on preconferences, new speakers, or new technologies. Yes, this may be old school, but I can tell you it is often easier and quicker than getting online access to the conference sessions.
On Wednesday, the pre-conferences are the warm-up or “pre-season” for the Annual Assembly. You get to see your co-collaborators- the national staff from AAHPM and HPNA – whom you have spent many telephone and e-mail hours working with, to check in to make sure everything is ready.The Opening Reception sets the tone; the personal connection. Relationships are renewed with the delight of seeing friends and colleagues. New relationships are established as one puts names to faces of people you have worked with. On Thursday as the Opening Plenary begins, there is a feeling of “Game on-Here we go!” There are a variety of expectations for the day – to be inspired, to explore new areas, and to reconnect. The “season” has begun. On Friday, the “game” is in full swing the conference seems to be full swing, people are in a groove. Difficult choices must be made in terms of which sessions to attend arise, but that is a good thing. We want people to have conflicting choices they want to go to; rather than having a choice by elimination. On Saturday, the tenor is quieter. People have been in full swing for 2 days. They are aware it will end soon and they must say goodbye. An eerie silence begins to descend as participants begin to leave. By the afternoon, “The Game” is over with the sense of “Well played.” There is a bittersweet feeling; one is the sadness of it all ending and the other is a feeling of accomplishment of having achieved education, networking, and renewal. Just like a baseball season, the highs and lows will be discussed and reviewed in detail. Some predictions for the future will occur. But as in all baseball seasons, the hope is that next year, it will be a winner with same energy and enthusiasm.
Constance Dahlin, APRN-BC ACHPN FPCN FAAN
Northshore Medical Center
Palliative Care Services
Much is properly made these days of the role of spiritual care in palliative and hospice care and the lead role that professional chaplains need to play in that domain of care. Many palliative care teams and professional chaplains have risen to this challenge. The newly released version of the NCP Guidelines makes that standard even clearer. However, I would maintain that, for this integration to fully mature, chaplains need to become more involved in the greater palliative care community just as they need to be involved in the professional chaplaincy community. Put another way, for chaplains to grow their identity as members of palliative care teams, they need to live in the palliative care culture nationally as well as locally.
While there are several options for how to do this, one that has been highly worthwhile for me over the past four years is the American Academy of Hospice and Palliative Medicine (AAHPM) which just concluded its yearly conference. I would immediately acknowledge that there are several barriers to chaplains being involved here- mostly involving money and time. Dues and attendance at the conference are expensive by chaplaincy standards although I do run into chaplains attending AAHPM whose way is being paid by their teams. And the time to go, especially if one is also attending one’s professional chaplaincy association meeting, often winds up cutting into vacation time. Thus, I’m not claiming that this integration will be easy to accomplish. I am claiming that unless we find ways over these barriers, the continuing integration of spiritual care and chaplaincy care into palliative care will be seriously impeded.
Some of what chaplains might imagine as barriers are not. Two “barriers” I know some chaplains presume are “This is an organization mainly for doctors so I won’t be welcome there” and “There will be no content at the meeting relevant to my work”. Both of those assumptions are decidedly false. Remember- these are palliative care and hospice people. By and large, they appreciate and welcome the inclusion of the spiritual dimension of care. And this is a very large organization so the range of offerings in any one time slot at the conference is very wide and deep. My problem in most time slots is picking between the several offerings I want to go to.
The number presentations involving chaplains is still small but increasing. I’ve been part of a team that has presented a very popular pre-conference seminar for the past four years. Tim Ford (VCU), Edie Meyerson (Mt. Sinai-NYC), and this year Terry Irish (City of Hope) and Denise Hess (Providence Health, Torrance, CA) have all made excellent contributions. One of the interesting parts of AAHPM culture is that it is almost impossible to get a workshop accepted unless there are presenters from more than one discipline. This supports the value placed on team work in palliative care. For chaplains, this means that the place to start if you want to present is to talk to your team and be part of a team presentation or a presentation with at least one other member of your team. This year Terry presented with a social worker and Denise with a physician from their respective teams. Note- the deadline for workshop submissions for next year’s conference in San Diego is April 19th. Now is the time! You don’t have to be a member to submit.
Another feature of AAHPM is that it heavily promotes social media. Even if you are not an AAHPM or NHPCO member you can follow various palliative care and hospice blogs and tweets. Pallimed and GeriPal are two of my favorites along with following AAHPM itself and palliative care luminaries like Diane Meier on Twitter. These will give you a good sense of the conversation and hopefully incent you to respond or comment occasionally. This is a major way the voice of chaplaincy and spiritual care is more often heard in the conversation. And it only costs a little time! I recently signed up to contribute to the AAHPM blog itself again to get the chaplaincy voice into the conversation.
For me the highlight of this AAHPM conference was the official release of the 3rd edition of the Clinical Practice Guidelines for Quality Palliative Care from the National Consensus Project which is a consortium of the major palliative care and hospice groups in the US. The guidelines can be downloaded free at www.nationalconsensusproject.org. Notably, Domain 5 (Spiritual, Religious, and Existential Aspects of Care) is tremendously expanded with significant chaplaincy input. The guidelines present powerful evidence for the necessity of professional chaplaincy on these teams. This set of guidelines is now the standard for palliative care and hospice teams and will hopefully become incorporated into the advanced certification standards for the Joint Commission as the 2nd edition was.
So, talking to each other as chaplains is essential. But if those are the only conversations we have, we are in danger of remaining pretty insular as a profession and worse, spiritual care will not be fully present in palliative care. We have to find a way!
George Handzo, BCC, CSSBB
President, Handzo Consulting