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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

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

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

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

Avoidable and Unavoidable Visits to the Emergency Department Among Patients With Advanced Cancer Receiving Outpatient Palliative Care
Marvin Omar Delgado-Guay, Yu Jung Kim, Seong Hoon Shin, Gary Chisholm, Janet Williams, Julio Allo, and Eduardo Bruera

What’s Different About Patients With Hematologic Malignancies? A Retrospective Cohort Study of Cancer Patients Referred to a Hospice Research Network
Thomas W. LeBlanc, Amy P. Abernethy, and David J. Casarett

Hospital End-of-Life Treatment Intensity Among Cancer and Non-Cancer Cohorts
Amber E. Barnato, Elan D. Cohen, Keili A. Mistovich, and Chung-Chou H. Chang

Predictors of Thirst in Intensive Care Unit Patients
Nancy A. Stotts, Shoshana R. Arai, Bruce A. Cooper, Judith E. Nelson, and Kathleen A. Puntillo

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

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

Why am I taking the HMDCB certification exam?

I have completed my application, paid my fee, scheduled my exam, and now I am beginning to study! So why am I doing this?

I have been in Hospice and Palliative Medicine for almost 30 years. I am a fellow and past president of the AAHPM. I am a founding member of the Academy, and I have my own palliative care company employing over 25 physicians, with two new contracts. How could I possibly benefit from getting this certification? I have talked with many people over the last two years who may have different credentials but do have the same question.

Hospice and Palliative Medicine is a very young field. Its entire existence fits within my career, and I am nowhere near ready to retire. In its short history, HPM has become a subspecialty of medicine and has a seat with the big boys of medicine. One of the consequences of this is that the board certification now requires a fellowship. There are only about 250 training positions in the country, and as a general rule, the only people that do fellowships are young physicians fresh out of training. Many of us who do hospice medicine are neither young nor fresh out of training, and are unlikely to stop our current activities to do a fellowship even if there were adequate physicians.

As of last count, there are over 5800 hospice programs in the country, and I believe a similar number of declared palliative medicine programs. Many physicians don’t consider this, but there are more board certified HPM physicians now than there are likely to ever be in the future. This is due to the fact that the large majority of physicians who are board certified, qualified for that certification based on practice experience, not fellowship training.

In addition to these workforce considerations, the regulatory and administrative demands on hospice physicians are constantly growing. Gone are the days where hospices could have their medical directors “sit down, shut up, and sign”. The hospices need physicians that are competent not only in good palliative medicine, but that also know how to provide for these regulatory and administrative needs.

Here enters the need for a certification that a physician can deliver these goods. This certification never intends to be an ABMS/AOA board specialty, and therefore will never require a fellowship. A physician can qualify to take the exam if they have had a fellowship, but they can also qualify now and forever, by practice experience. This certification also focuses very heavily on hospice and not the broader world of non-hospice palliative medicine. We fully anticipate that this will be the credential of value to the hospice industry as we go forward.

I don’t believe that getting this certification will change or enhance my professional life at this point in my career. I do believe that this certification is very important to the world of hospice medicine. This young profession needs all of us to step up to provide this very important credentialing foundation to the work that we do. If you, like me, see what you do as something more than a job, then I would like to extend a personal challenge for you to look beyond the personal gains, and assist in getting the momentum behind this certification.

Submitted by: David M. McGrew, MD FAAHPM

HMDCB Certification Discount at Assembly

If you missed the early application deadline to sit for the HMDCB exam, don’t worry! Attendees of AAHPM’s Assembly and virtual assembly will receive a discount code to waive the $250 late fee. Simply stop by the HMDCB booth, #418, and ask for the code.

Hospice medical directors are a diverse group of professionals, many of whom have followed varied career paths leading to their affiliation with hospice programs. Thus, some may be unable or choose not to undertake full hospice and palliative medicine subspecialty board certification through ABMS or AOA. These same physicians, however, do desire a formal recognition process that will validate their commitment and provide a solid foundation for their work as hospice medical directors.

By applying to become Hospice Medical Director Certified® (HMDC®), physicians can achieve profession recognition and credibility, increase your professional marketability, and enhance the team approach that is essential to successful hospice care.


    To earn the HMDC credential, licensed physicians from the United States and Canada must

  • Demonstrate 400 hours of broad hospice-related activities during the past 5 years
  • Conform to HMDCB Code of Professional Conduct
  • Meeting ONE of the follow 3 eligibility pathways:
    • Practice Pathway: 2 years of work experience in a hospice setting:
    • Certification Pathway: Current certification in hospice and palliative medicine (HPM) through ABMS, AOA, or ABHPM:
    • Training Pathway: Successful completion of an HPM-accredited fellowship training program:
  • Pass a certification exam.

Learn more about HMDCB at Be sure to visit HMDCB in booth #418 at Assembly to receive your discount card!

Thomas LeBlanc, MD MA – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Thomas LeBlanc, MD MA 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?
I’ve been incredibly fortunate to work with a remarkable team of palliative care researchers and clinicians here at Duke over the last decade. There are too many amazing people to mention, but among the most influential are Amy Abernethy, James Tulsky, Karen Steinhauser, and Tony Galanos. Amy is busier and more productive than anyone I know, yet she’s always incredibly generous with her time, resources, and mentorship; we’ve been working together since I was a medical student in 2005, and so many of the opportunities and success I’ve had are because of her. I worked in James’ clinic when I was a 3rd year medical student, and that’s when I first came to understand the incredible power of good communication. Seeing his masterful communication skills in action motivated me to cultivate some of those skills too, and it has made me a better doctor in the end. Plus, without his guidance in all things about life, who knows where I’d be! And without Karen’s help, I doubt I would have gotten my first grant. She met with me at a coffee shop during a day off, and very gently helped me realize how many mistakes I had made in my writing. With that useful feedback, the grant was markedly improved and it got funded, and this success has really helped launch my research in palliative care for patients with blood cancers! Last but certainly not least, I’ve been fortunate to work with Tony Galanos several times in recent years, especially during my HPM fellowship. His passion for helping patients and families is truly remarkable, and his prowess doing so is inspirational. He has shown me first-hand what it means to truly palliate.

Where do you see yourself in 5 years?
In 5 years I hope I’m still doing what I do now: caring for patients with blood cancers, and doing research that seeks to improve their quality of life, even in cases where we cannot cure. When I look back in 5 years, I hope to be able to say that I’ve made a difference in the lives of the patients and families I’ve cared for, and that the research I’ve done has helped move us towards a place where we can better serve their needs. I also hope I can say that we’re more sophisticated in how we deliver palliative care to patients with blood cancers such that we’re doing it better, and much more often, even alongside active cancer treatment.

What is the best advice you have ever received?
One of my favorite teachers used to post inspirational quotes on the walls of the classroom. The one that always stuck with me was this: “You are what you take time to become.” It seemed true back then, and it continues to ring true in my lived experiences since. Sometimes we’re fortunate in life to be in the right place at the right time, but mostly we end up where we are because of each step we’ve taken along the way. I strive to make each step count, and to ensure it’s a firm-footed one that heads in the right direction.

Help Spread a Unified & Positive Hospice & Palliative Care Message

Want to introduce palliative care and hospice as a positive kind of healthcare to patients and other healthcare providers? By Rebecca Goett MD

American Academy of Hospice and Palliative Medicine (AAHPM) is highlighting our strength with our palliative power and hospice hero campaign. As palliative and hospice providers, promoting our field as a harmonized discipline filled with growing resources is important. AAHPM wants to emphasize how palliative care and/or hospice empowers patients in caring for their life-limiting illness.

In order to promote our strength, we want you to share pictures, poems, video, audio, or quotes exemplifying hospice and palliative medicine. Submit an image, poem, or song that best portrays the power of palliative care or describe your hospice hero using the Twitter hashtags #pallpower or #hospicehero. Tweet at @AAHPM to communicate your story! Participants may also use AAHPM’s Facebook page to post your #pallpower or #hospicehero moment. No Twitter of Facebook? No problem. You can share by stopping by the AAHPM Resource Center at the assembly to convey a story, poem, photo, or video describing your moment.

The two submissions with the most impact selected by the AAHPM external awareness committee will receive a signed book by Dr. Atul Gawaude or Chester Elton. Only tweets, Facebook posts and AAHPM Resource Center submissions received during the AAHPM &HPNA Annual Assembly (Wednesday, February 25th starting at 7am through Saturday, February 28th ending at 2pm) will be eligible for the contest. We encourage everyone to continue tweeting their personal expressions of #pallpower and #hospicehero throughout the year. With this contest, we begin the campaign to reinforce palliative care and hospice as an affirmative empowering type of healthcare.

To assist in enhancing our solidarity, AAHPM is selling palliative power and hospice hero socks at the AAHPM Resource Center for $15 to help spread awareness. Check out our photos. Wear your #pallpower or #hospicehero socks Saturday for #hpmsox at the annual assembly.

Tweet, Facebook, or stop by our booth at the AAHPM & HPNA Annual Assembly and share what #pallpower or #hospicehero means to you!

Buy and wear your socks for on Saturday for #hpmsox!

Fine print: Those participants who include @AAHPM in the tweet are giving permission to AAHPM to display their tweet/ media (picture, audio, video, poem etc). Only current AAHPM members will be eligible for the prizes.

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

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:
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 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 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

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