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

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

Morphine or Oxycodone for Cancer-Related Pain? A Randomized, Open-Label, Controlled Trial
Julia Riley, Ruth Branford, Joanne Droney, Sophy Gretton, Hiroe Sato, Alison Kennett, Christina Oyebode, Michael Thick, Athol Wells, John Williams, Ken Welsh, and Joy Ross

The Role of Central and Peripheral Muscle Fatigue in Postcancer Fatigue: A Randomized Controlled Trial
Hetty Prinsen, Johannes P. van Dijk, Machiel J. Zwarts, Jan Willem H. Leer, Gijs Bleijenberg, and Hanneke W. van Laarhoven

Symptom Prevalence in Lung and Colorectal Cancer Patients
Anne M. Walling, Jane C. Weeks, Katherine L. Kahn, Diana Tisnado, Nancy L. Keating, Sydney M. Dy, Neeraj K. Arora, Jennifer W. Mack, Philip M. Pantoja, and Jennifer L. Malin

Grief After Patient Death: Direct Care Staff in Nursing Homes and Homecare
Kathrin Boerner, Orah R. Burack, Daniela S. Jopp, and Steven E. Mock

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

Philly in February? You bet!

Will you be attending the AAHPM & HPNA Annual Assembly next month? Are you wondering what there is to do in Philadelphia? Lucky for you even in February there is no shortage of great food or things to do!

Philadelphia is set apart from other cities by the variety of things to see and do around the Convention Center! Historic, family–oriented or recreational – Philadelphia has something for everyone! Covering fine arts, history, science and culture, the city often hosts unique visiting exhibits that can be found at some of the most popular attractions in the region. Discover all you need to know about Philadelphia’s Arts & Attractions and create your own list of must–sees for your visit!

The New York Times recently released a list of 52 Places to Go in 2015. Philadelphia was ranked number 3! According to the NYT Philadelphia has become a hive of outdoor urban activity.

After a long day of captivating sessions why not treat yourself to one of the many great restaurants the city has to offer? Recommendations from members include:
Cuba Libre, Zahav, Vernick, Little Fish, Nomad Pizza, Vedge, MeltKraft, Starr Restaurants including: Jones, Buddakhan, The Continental, and El Vez. Garces Restaurants including: Garces Trading Company, Amada, and Village Whiskey. Amis, Little Nona’s, Pennsylvania 6, and Barbuzzo. Capogiro Gelato was named the best place to eat ice cream in the country by National Geographic. Parc, Sbraga, Alla Spina, Fette Sau, Tallulah’s Garden, Mercato, and Stateside. Walk over to the Reading Terminal Market for lunch. There are local food vendors, Amish crafts and candy. Visit the Italian market. Craving a cheesesteak? Looking for a knock out burger? Check out other restaurants in Market East.

Where to get a drink:
Tria
Franklin Mortgage
Hop Sing Laundromat
Stratus Lounge

Great attractions:
Attend the Philadelphia 76ers basketball game against the Washington Wizards on Friday, February 27th. Use promo code AAHPM to get discounted tickets.
Liberty Bell & Independence National Historical Park and Independence Hall
Constitution Center
Betsy Ross House
US Mint
Barnes Museum
Rodin Museum
National Museum of American Jewish History
Institute of Contemporary Art
Philadelphia Museum of Art, home to the famous stairs from Rocky. Check out these other places for Rocky fans.
Eastern State Penitentiary tour.
Walk or bike along Schuylkill River trail in Fairmount Park or hike on the Wissahickon trail.
View the top free attractions in the city and a listing of additional museums and attractions.

Family activities:
North Bowl (great for adults and kids)
Smith Playground
Please Touch Museum
The Franklin Institute
Philadelphia Zoo
Adventure Aquarium which is just across the river in Camden.
Looking for more kid friendly activities? Check out the top ten family friendly activities.

Still can’t decide? Check out the official visitor and travel site VisitPhilly.com for more ideas!

Applying and Preparing for Hospice Medical Director Certification through HMDCB

HMDCB is currently accepting applications to become Hospice Medical Director Certified™ (HMDC™) in 2015. HMDCB’s certification exam is for hospice physicians seeking to demonstrate an essential skill set that comprises the administrative, regulatory, legal, and clinical skill necessary in hospice medicine. Early applications are due February 9, 2015 and late applications will be accepted until March 9, 2015 with an assessed $250 late fee. Apply early and save!

So you’re thinking about taking the exam, but are not sure how to prepare. AAHPM provides a number of products to help with your exam preparation.

  • HMD Prep – great for self-assessment or HMDC exam preparation, this 75-item multiple-choice practice test assesses your knowledge in hospice practice. Content is based on the HMDC exam blueprint.
  • Hospice Medical Director Manual – this book defines best practices; offers tools and sample documents; and provides answers about physician roles in hospice, employment in or contracting with a hospice and the medical director’s responsibilities on the hospice team and within the organization.
  • Recordings of the 2013 HMD Conference – these recordings are great practice resources that highlight the clinical, administrative, and regulatory aspects of your work; they include audio and synchronized PowerPoint content and separate audio files.

Visit HMDCB.org for information regarding the examination or browse the AAHPM store to order your preparatory materials!

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

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

EMPOWER: An Intervention to Address Barriers to Pain Management in Hospice
John G. Cagle, Sheryl Zimmerman, Lauren W. Cohen, Laura S. Porter, Laura C. Hanson, and David Reed

Feasibility of Using Algorithm-Based Clinical Decision Support for Symptom Assessment and Management in Lung Cancer
Mary E. Cooley, Traci M. Blonquist, Paul J. Catalano, David F. Lobach, Barbara Halpenny, Ruth McCorkle, Ellis B. Johns, Ilana M. Braun, Michael S. Rabin, Fatma Zohra Mataoui, Kathleen Finn, Donna L. Berry, and Janet L. Abrahm

Patterns of Community-Based Opioid Prescriptions in People Dying of Cancer
Bruno Gagnon, Susan Scott, Lyne Nadeau, and Peter G. Lawlor

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

Call for Action: The IOM Report

Larry Beresford, freelance medical journalist in Alameda, CA (Twitter: @larryberesford)

The Institute of Medicine’s landmark new report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, developed with the active participation of several AAHPM leaders in an exhaustive, 2-year process of evidence-based deliberation, was released on September 17. It contains a number of key findings about the delivery of person-centered care, clinician-patient communication, professional education and development, and public education and engagement—many of which harmonize well with the Academy’s aims and activities.

In an article I wrote for the latest AAHPM Quarterly, board member Christian Sinclair, MD FAAHPM, states that every Academy committee, task force, and work group could use the IOM report as the basis for pursuing long-term goals in advocacy for the delivery of palliative care in America. Individual palliative care professionals, he hopes, won’t let this serious document “gather dust on the digital shelf,” but instead will use it to get the word out in their communities.

Read it, if not all 458 pages at least the six page summary of key findings and recommendations. Then, let us know how you find ways to use it as a tool for spreading the message of palliative care in the comments below.

AAHPM Unveils List of Inspiring HPM Leaders Under 40

Congratulations to These Inspiring Hospice and Palliative Medicine Leaders Under 40

In fall 2014, AAHPM called upon members to nominate accomplished hospice and palliative medicine professionals under the age of 40. More than 75 nominations were submitted highlighting exceptional work contributions by the next generation of hospice and palliative medicine leaders. Eligible candidates were evaluated on the following criteria: involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, mentoring of students or residents, and any special circumstances or professional accomplishments that set them apart. Congratulations to the following 44 Inspiring Hospice and Palliative Medicine Leaders Under 40 who will be recognized at the 2015 AAHPM & HPNA Annual Assembly:

Rebecca Aslakson, MD PhD
Justin Baker, MD FAAHPM
Ankur Bharija, MD
Bethany Calkins, MD MS
Darren Cargill, MD CCFP
Robert Crook, MD FACP
Kimberly Curseen, MD
Lori Earnshaw, MD
Esme Finlay, MD
Amy Frieman, MD
Laura Gelfman, MD MPH
Hunter Groninger, MD FAAHPM
Sarah Elizabeth Harrington, MD FAAHPM
Jennifer Hwang, MD MHS
Christopher Jones, MD
Jessica Kalender-Rich, MD
Arif Kamal, MD
Amy Kelley, MD MSHS
Anne Kinderman, MD
Jeff Klick, MD
Kate Lally, MD FACP
Lindy Landzaat, DO
Thomas LeBlanc, MD MA
Ashlie Lowery, MD
Jessica Merlin, MD MBA
Joseph Milano, MD
Kathleen Neuendorf, MD
Kristina Newport, MD FAAHPM
Lynn O’Neill, MD MS FAAHPM
Rupali Rajpathak, MD
Thomas Reid, MD MA
Eric Roeland, MD FAAHPM
Sandra Sanchez-Reilly, MD MSci FAAHPM AGSF
Randall Schisler, MD
Ruchir Shah, MD
Rashmi Sharma, MD MHS
Cardinale Smith, MD MSCR
Keith Swetz, MD MA FACP FAAHPM
Jason Webb, MD
Patrick White, MD
Eric Widera, MD FAAHPM
Gordon Wood, MD MSCI FAAHPM
Holly Yang, MD HMDC FAAHPM
Mina Zeini, MD CMD

Visit aahpmBlog.org throughout the next year where posts from these inspiring leaders will discuss who has most influenced their work, where they see themselves in 5 years, and the best advice they ever received.

Organizational Advocacy Key to Promoting Advance Care Planning… Now it’s Time for Individuals to Make Their Voices Heard!

By Gregg VandeKieft, MD MA FAAFP FAAHPM
Co-chair, AAHPM Public Policy Committee

The following is part of a three-post progressive blog about advance care planning, prompted by the Centers for Medicare & Medicaid (CMS) decision not to pay for the new “complex” advance care planning codes in this year’s Medicare Physician Fee Schedule. Now is the time to tell CMS why you support reimbursement for these important services! The agency is accepting public comments through Dec. 30 —it’s easy to submit comments online!

Please also see AAHPM Public Policy Committee co-chair Phil Rodgers’ Pallimed post for detailed background on efforts to advance the new codes via the AMA RUC and with CMS, and read AAHPM State Policy Issues Working Group Chair Paul Tatum’s GeriPal post where he makes the case that it’s time for advance care planning to become routine for patients with serious illness.

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A common complaint in emergency departments and ICUs goes something like: “Why didn’t anyone ever talk with this patient about how serious their illness is? Is this really what they would have wanted?” Primary care providers and subspecialists who commonly deal with serious illness cite time constraints or fear that frank discussion of prognosis will “take away hope” as barriers. The unfortunate result is that things take a turn for the worse before the patient and their family have seriously considered or prepared for that possibility, and physicians with whom they have no prior relationship end up having “the talk” in the ED or after admission to the hospital.

Efforts to promote effective advance care planning (ACP) range from coordinated community-focused efforts, like the Gunderson Clinic’s Respecting Choices program to grassroots efforts like The Conversation Project. But what have medical specialty societies done to promote ACP? I’m proud to say that our Academy has been a leader on this front, particularly in terms of public policy advocacy.

For years, AAHPM has worked to advance federal legislation that would promote ACP. After his proposal to reimburse physicians for time spent in conversation about goals of care was cut from the draft health care reform bill amid cries of “death panels,” U.S. Rep. Earl Blumenauer (D-OR-3) invited key stakeholders – including AAHPM − to the table to develop comprehensive legislation on the matter. The result is the Personalize Your Care Act.

This legislation would provide coverage under Medicare and Medicaid for voluntary advance care planning consultations, make grants available for communities to develop programs to support “physician orders for life-sustaining treatment” to promote patient autonomy across the care continuum, require advance care planning standards for electronic health records, and allow portability of advance directives across states. The bill, which is cosponsored by U.S. Rep. Phil Roe, MD (R-TN-1), had bipartisan support in the House this past Congress, but it will need to be reintroduced next year. (Congressmen Blumenauer and Roe have met with Academy leaders for small-group dialogues during our annual Capitol Hill Days.)

At the same time, AAHPM has engaged in regulatory advocacy on the matter. The Academy joined with other medical society stakeholders to advocate for new CPT codes (included as 99497 & 99498 for 2015) for more complex advance care planning. AAHPM surveyed its members to contribute to findings presented to the AMA/Specialty Society Relative Value Scale Update Committee (RUC) which then developed and relayed relative value recommendations for the codes to CMS. (AAHPM was invited to survey under the American Geriatrics Society (AGS), which has a permanent seat on the RUC.) The Academy’s RUC advisor, Phil Rodgers, MD FAAHPM, has worked with representatives from AGS and other medical societies to strategize about how best to influence CMS staff and officials, and he participated in a meeting with CMS staff that stakeholder societies requested to explain why ACP is good medicine and urge CMS to reimburse these important services.

It’s been great to see other organizations also work to promote ACP. The American Medical Association’s (AMA) Code of Medical Ethics includes a section devoted to advance care planning, adapted from a more comprehensive report on ACP by the AMA’s Council on Ethical and Judicial Affairs. The American Society of Clinical Oncology (ASCO) has published a booklet on ACP, accessible in English and Spanish along with other materials, from a page dedicated to ACP on ASCO’s Cancer.Net web site. The American Geriatrics Society provides links to Prepare for Your Care, an on-line ACP tool for patients and families with excellent educational videos. A Spanish language version was recently added.

The American Academy of Family Physicians (AAFP) passed a resolution at its 2014 Congress of Delegates promoting the implementation of centralized registries for advance directives, durable power of attorney for health care, physician orders for scope of treatment (POLST), and do not resuscitate orders. The AAFP also has a position statement on “Ethics and Advance Planning for End-of-Life Care” that strongly encourages ACP and the completion of advance directives “as a part of routine outpatient health maintenance.”

But, if all these societies’ extensive efforts have yet to bring about the desired level of change, are further initiatives likely to be productive? Data from the “Respecting Choices” project confirm that communities can be positively affected by well-designed collaborative programs. Moreover, those of us practicing as palliative care specialists have an opportunity and responsibility to promote generalist palliative care skills among our colleagues.

Of course, with comments now being accepted on the 2015 Medicare Physician Fee Schedule Interim Final Rule – where CMS indicated it would not pay for the new CPT codes for advance care planning at this time (CMS states other codes can already be used for reporting and payment) – we, as individuals, have a unique and very valuable opportunity to weigh in with policymakers to explain why ACP is a vital medical service and how Medicare reimbursement not only serves to promote these important services for beneficiaries but, without separate codes, we are unable to track them to look at utilization, outcomes, and which specialties are performing ACP services and where.

I urge all my Academy colleagues – and everyone who cares about sound health policy – to take just a few minutes to submit comments to CMS by Dec. 30.

Phil Rodgers, who co-chairs the Academy’s Public Policy Committee with me, provides these tips for doing so:

  • Explain why you think it’s important to pay for ACP services through a specific mechanism. CMS has suggested that it believes Medicare already pays for ACP services through the Evaluation and Management (E/M) and extended service codes. Tell them about the unique value of advance care planning, and how it is ‘separately and identifiably’ necessary in addition to all other services (medical therapy, symptom management, etc.).
  • Be specific, be yourself, and write about what you know. It’s OK to reference the literature about ACP services and palliative care, the IOM report, the importance of tracking the frequency ACP is performed, the needs of an older and sicker society etc., but it’s more powerful to speak from personal experience. Tell patient stories that illuminate a connection between high quality advance care planning and better care for your patients. Every HPM professional I know has dozens if not hundreds such stories. Now is the time to tell them.

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

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

Original Articles

Strategies to Support Recruitment of Patients With Life-Limiting Illness for Research: The Palliative Care Research Cooperative Group
Laura C. Hanson, Janet Bull, Kathryn Wessell, Lisa Massie, Rachael E. Bennett, Jean S. Kutner, Noreen M. Aziz, and Amy Abernethy

Symptom Incongruence Trajectories in Lung Cancer Dyads
Karen S. Lyons, Christopher S. Lee, Jill A. Bennett, Lillian M. Nail, Erik Fromme, Shirin O. Hiatt, and Aline G. Sayer

Repeated Assessments of Symptom Severity Improve Predictions for Risk of Death Among Patients With Cancer
Rinku Sutradhar, Clare Atzema, Hsien Seow, Craig Earle, Joan Porter, and Lisa Barbera

Palliative Radiation Before Hospice: The Long and the Short of It
Heidi N. Yeung, William M. Mitchell, Eric J. Roeland, Beibei Xu, Loren K. Mell, Quynh-Thu Le, and James D. Murphy

Mindfulness-Oriented Recovery Enhancement Ameliorates the Impact of Pain on Self-Reported Psychological and Physical Function Among Opioid-Using Chronic Pain Patients
Eric L. Garland, Elizabeth Thomas, and Matthew O. Howard

Special Series on Research Methodology

Ethical Conduct of Palliative Care Research: Enhancing Communication Between Investigators and Institutional Review Boards
Amy P. Abernethy, Warren H. Capell, Noreen M. Aziz, Christine Ritchie, Maryjo Prince-Paul, Rachael E. Bennett, and Jean S. Kutner

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

Integrating with Palliative Care- Opportunities and Challenges

Recently, I attended the yearly National Seminar given by the Center to Advance Palliative Care. I was honored to be a member of the faculty and on the planning committee. The attendance was over 900- up over 50% from a year ago- a tribute both to the growth of palliative care as a discipline and the respect with which CAPC is held in the palliative care space. This is the place palliative care nurses, doctors and administrators come to find out about best practice in the field from medical issues, to business models, to integration of palliative care into virtually every possible setting on the health care continuum. As Dr. Diane Meier, head of CAPC pointed out in her opening talk, palliative care has now gone from being an innovative practice to standard practice- at least in hospitals. It will soon be unusual for a hospital not to offer palliative care.

Maybe most importantly, palliative care is about caring for the whole person in all dimensions- including the spiritual. Every palliative model includes the mandate to attend to spiritual suffering. The Joint Commission’s advanced certification process in palliative care mandates a chaplain on the palliative team and will likely soon mandate that the chaplain have suitable training. Everywhere I went at this seminar, I heard spiritual care mentioned and included. This was a rare event in health care where no one looked quizzically when you said you were a chaplain, as if to ask “why are you here?”

Given this environment and context, the lack of chaplains was glaring. One of the Tweets from this event, posted by a physician, said simply “Where are the chaplains?” The attendance roles put the number of chaplains at 1% of the total attendance (i.e. about 10). Now, to be fair, the number of social workers wasn’t much greater, but this is still a problem. We as chaplains have rightly complained for years that we are not included- to the detriment of patient care. Now we have a setting that represents maybe the fastest growing discipline in health care and loves to have us, and we are not showing up. On top of that, this event is a phenomenal place for chaplains to learn about how we might add more value to the palliative care enterprise. So this is not just about giving. It is about getting at least as much as we give.

The barriers are mostly pretty obvious. This seminar is not cheap and going likely means not going to something else like the meeting of the chaplaincy body that certifies us. Many chaplains who cover palliative care do not do it full time so there are other responsibilities. Chaplaincy staffing is generally so tight that being aware for 3-4 days puts a burden on our colleagues and on the institution. We all know all of these barriers.

But there are opportunities. Several of the chaplains I did meet at CAPC came at the behest of and at the expense of their institutions who now highly value palliative care and understand how central spiritual care is to that endeavor. My guess is that more chaplains could make the case to their administrations that they should be funded for CAPC. My guess is that many administrations (and many palliative care chaplains) don’t appreciate the opportunities the CAPC National Seminar provides to further integrate spiritual care into palliative care. However, more and more hospitals are seeking Joint Commission accreditation in palliative care and are then trying to figure out how to get chaplaincy included in a way that will pass this process.

So I don’t have any magic answers. My only plea to chaplains involved in palliative care is when the CAPC notice comes around next year; don’t just reflexively press the “delete” button. And, by the way, I could have written this exact post with reference to the convention of the American Academy of Hospice & Palliative Medicine that will be in Philadelphia in February. Hope to see lots of my chaplain colleagues there.

The Rev. George Handzo, BCC, CSSBB
President
Handzo Consulting, LLC

Highlights of the November 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

Methylprednisolone for the Prophylaxis of Pain Flare: Commentary on Yousef and El-mashad
Susannah Ellsworth

Challenges to Pain Medicine Management at Home: Commentary on the Schumacher et al. Papers
Jane B. Hopkinson

Original Articles

Pre-Emptive Value of Methylprednisolone Intravenous Infusion in Patients With Vertebral Metastasis. A Double-Blind Randomized Study
Ayman Abd Al-maksoud Yousef and Nehal Mohamed El-mashad

Pain Medication Management Processes Used by Oncology Outpatients and Family Caregivers Part I: Health Systems Contexts
Karen L. Schumacher, Vicki L. Plano Clark, Claudia M. West, Marylin J. Dodd, Michael W. Rabow, and Christine Miaskowski

Pain Medication Management Processes Used by Oncology Outpatients and Family Caregivers Part II: Home and Lifestyle Contexts
Karen L. Schumacher, Vicki L. Plano Clark, Claudia M. West, Marylin J. Dodd, Michael W. Rabow, and Christine Miaskowski

A Randomized Trial of the Effectiveness of Topical “ABH Gel” (Ativan®, Benadryl®, Haldol®) Versus Placebo in Cancer Patients With Nausea
Devon S. Fletcher, Patrick J. Coyne, Patricia W. Dodson, Gwendolyn G. Parker, Wen Wan, and Thomas J. Smith

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