Archive for January, 2014

Hospice and Palliative Medicine Visionary Eduardo Bruera Shares His Insights on the Field

In celebration of 25 years serving the profession, the American Academy of Hospice and Palliative Medicine (AAHPM) asked its 5,000 members to nominate who they think are the leaders – or Visionaries – in the field. They then asked members to vote for the top 10 among the 111 nominated.

“This program recognizes key individuals who have been critical in building and shaping our field over the past 25 years,” noted Steve R. Smith, AAHPM executive director and CEO. “These individuals represent thousands of other healthcare professionals in this country that provide quality medical care and support for those living with serious illness — each and every day.”

The Visionaries – 14 women and 16 men – are physicians, nurses and hospice pioneers such as British physician, nurse and social worker Cicely Saunders, credited with starting the modern hospice movement, and Elisabeth Kübler Ross, author of numerous books including the groundbreaking “On Death and Dying.” Five elected officials were nominated and one of them, former President Ronald Reagan, was named a Visionary for signing into law the Medicare hospice benefit in 1982.

Many of the visionaries will be sharing their thoughts about the field and who inspired their work. We’ll be posting them over the next several months. Today’s post is from Eduardo Bruera, MD FAAHPM, Professor of Medicine, The University of Texas MD Anderson Cancer Center in Houston, TX.

Who has most influenced your work and what impact has he or she had?
I was very fortunate to learn the principals and practices of whole person medicine from my father. He was a cardiologist who made home visits on a regular basis and I was able to learn a lot from his example. Dr. Neil McDonald mentored me during my early years as a fellow and junior faculty and taught me unforgettable lessons about medicine, academic and administrative issues, and demonstrated by his behavior and guidance how it is possible to be at same time an academic and administrative leader and to be a highly ethical person. Dr. Vittorio Ventafridda over the years taught me great lessons about what palliative care should be and he always insisted on the importance of taking our discipline to academic centers in the United States.

What does it mean to you to be named a “Visionary” in Hospice and Palliative Medicine?
There is no greater honor than being recognized by my peers. Over the years I have followed the teachings of our pioneers and tried to contribute to our field with research and education on how to assessment and manage common clinical problems in the delivery of palliative care. I have enormous respect for everyone working in this difficult field. In my view, palliative medicine specialists represent the essence of what medical care should be. This recognition is for me a challenge to do more and better work on their behalf.

What is your vision for the future of hospice and Palliative Medicine?
Every academic hospital and medical school will have a fully established palliative medicine department with full time palliative medicine specialists and an inpatient palliative care unit. Every hospice in the United States will have full time palliative medicine specialist medical directors and medical staff. Palliative medicine will be one of the main components of medical care, education, and research.

More information on the Visionaries project, including the list of 30 Visionaries is on the Academy’s website www.aahpm.org.

Hospice and Palliative Medicine Visionary Betty Ferrell Shares Her Insights on the Field

In celebration of 25 years serving the profession, the American Academy of Hospice and Palliative Medicine (AAHPM) asked its 5,000 members to nominate who they think are the leaders – or Visionaries – in the field. They then asked members to vote for the top 10 among the 111 nominated.

“This program recognizes key individuals who have been critical in building and shaping our field over the past 25 years,” noted Steve R. Smith, AAHPM executive director and CEO. “These individuals represent thousands of other healthcare professionals in this country that provide quality medical care and support for those living with serious illness — each and every day.”

The Visionaries – 14 women and 16 men – are physicians, nurses and hospice pioneers such as British physician, nurse and social worker Cicely Saunders, credited with starting the modern hospice movement, and Elisabeth Kübler Ross, author of numerous books including the groundbreaking “On Death and Dying.” Five elected officials were nominated and one of them, former President Ronald Reagan, was named a Visionary for signing into law the Medicare hospice benefit in 1982.

Many of the visionaries will be sharing their thoughts about the field and who inspired their work. We’ll be posting them over the next several months. Today’s post is from Betty Ferrell, PhD MA RN CHPN FAAN FPCN, Research Scientist, City of Hope National Medical Center in Duarte, CA.

Who has most influenced your work and what impact has he or she had?
My professional life has been rich with the influence of many colleagues across disciplines, some present in my daily work at City of Hope National Medical Center, and many across the globe who struggle to advance palliative care in circumstances far more challenging than my own. Over the past 14 years of our ELNEC project (End of Life Nursing Education Consortium), I have been strongly supported by many; chief among them are Rose Virani, Pam Malloy, Judy Paice, Patrick Coyne, and Kathy Foley.

My mentors have come from every discipline and I am humbled by my colleagues in medicine, nursing, chaplaincy and social work. I am confident that quality palliative care exists only when we all work together with a shared vision.

If I were to select one person who has most influenced my career it would be Nessa Coyle. I met Nessa about 25 years ago and we became cross-country colleagues and now close friends. Nessa is the embodiment of palliative care. She has the vast knowledge of pain and symptom management, the art of psychosocial support, a deep connection with both existential concerns and an intense passion and clear vision for what is right. From Nessa I have learned to remain focused on what matters, to be silent at times and to rage at others, and to remain in awe of humans facing the end of life.

What does it mean to you to be named a “Visionary” in Hospice and Palliative Medicine?
I began my career in 1977 when there were less than 10 hospices in the country, there were none in my state, the words “palliative care” didn’t exist in our vocabulary, and when Kübler-Ross work was only beginning to be known.

I count my life as one of enormous opportunity and blessing to have been a part of dedicated and passionate colleagues who have changed the culture of care and created hospice and palliative care as an essential component of health care and who have advocated for such care as a human right. I recall working closely with Diane Meier creating the National Consensus Project Guidelines, fully aware of what a tremendous gift it is to be able to do important work in the company of those you admire the most.

To be recognized as a “visionary” is a very special honor, especially having been nominated by colleagues in AAHPM. When I think “visionary” I think of those who were bold enough to see that there was a better way. I consider myself as one lone voice in a very large chorus. Advances in our field have only been possible through the generous spirit of many with a common vision that the end of life is not a medical failure, but a sacred time of life.

What is your vision for the future of hospice and Palliative Medicine?
My vision for the future is that all people facing serious illness and the end of life will have access to high quality palliative care. I hope that palliative care will be so well integrated that it would be shocking for a patient and family to not receive this care. I have heard many of my colleagues say that we who have been so privileged to be a part of this early history are building the care system we want for ourselves.

I envision a time when our society fully expects to receive “compassionate and competent palliative care” which are the words of Dame Cicely Saunders and that we have indeed built a system of care that responds to that expectation. I am confident that vision can be a reality.

More information on the Visionaries project, including the list of 30 Visionaries is on the Academy’s website www.aahpm.org.

Highlights of the January Issue of the Journal of Pain and Symptom Management (JPSM)

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

Impact of Advance Directives and a Health Care Proxy on Doctors’ Decisions: A Randomized Trial
Monica Escher, Thomas V. Perneger, Sandrine Rudaz, Pierre Dayer, and Arnaud Perrier

Use and Perceived Benefits of Complementary Therapies By Cancer Patients Receiving Conventional Treatment in Italy
Andrea Bonacchi, Lorenzo Fazzi, Alessandro Toccafondi, Maurizio Cantore, Maria Grazia Muraca, Grazia Banchelli, Mauro Panella, Francesca Focardi, Roberto Calosi, Francesco Di Costanzo, Massimo Rosselli, and Guido Miccinesi

The Effects of Cognitive Behavioral Therapy for Postcancer Fatigue on Perceived Cognitive Disabilities and Neuropsychological Test Performance
Martine M. Goedendorp, Hans Knoop, Marieke F.M. Gielissen, Constans A.H.H.V.M. Verhagen, and Gijs Bleijenberg

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

Hospice and Palliative Medicine Visionary Patrick Coyne Shares His Insights on the Field

In celebration of 25 years serving the profession, the American Academy of Hospice and Palliative Medicine (AAHPM) asked its 5,000 members to nominate who they think are the leaders – or Visionaries – in the field. They then asked members to vote for the top 10 among the 111 nominated.

“This program recognizes key individuals who have been critical in building and shaping our field over the past 25 years,” noted Steve R. Smith, AAHPM executive director and CEO. “These individuals represent thousands of other healthcare professionals in this country that provide quality medical care and support for those living with serious illness — each and every day.”

The Visionaries – 14 women and 16 men – are physicians, nurses and hospice pioneers such as British physician, nurse and social worker Cicely Saunders, credited with starting the modern hospice movement, and Elisabeth Kübler Ross, author of numerous books including the groundbreaking “On Death and Dying.” Five elected officials were nominated and one of them, former President Ronald Reagan, was named a Visionary for signing into law the Medicare hospice benefit in 1982.

Many of the visionaries will be sharing their thoughts about the field and who inspired their work. We’ll be posting them over the next several months. Today’s post is from Patrick Coyne, MSN APRN ACHPN FAAN, Clinical Director, Thomas Palliative Care Service, Virginia Commonwealth University Medical Center in Richmond, VA.

Who has most influenced your work and what impact has he or she had?I have been blessed in my life and career. I had wonderful parents who instilled the ability to question everything and ask “why not?” My wife Ellie and daughter Erin have been constantly supporting my love for palliative care and keeping me grounded and energized. Judy Paice has been and remains my go-to person with challenges in pain management, symptom issues and other crises. Betty Ferrell clearly took a risk on me by giving me many unique opportunities which allowed me to grow professionally and encouraged me unconditionally. Tom Smith, really to be forever known as my partner in crime, was/is a constant supporter, advocate and friend. Tom was willing to take risks with me that I believe ultimately helped us make a positive impact on countless individuals’ lives and an entire healthcare system. I have been fortunate through the years to have been surrounded by countless exceptional nurses, physicians, administrators, social workers, volunteers, researchers as well as other disciplines. Some who deserve particular attention, Bart Bobb, Clareen Wiencek, Laurie Lyckholm, Dani Noreika, Connie Dahlin , Mary Ann Hager and Ken White. All their dedication made this work easier, constantly encouraged and challenged me, and thus supported my professional development. The entire palliative care team at Virginia Commonwealth University is without a doubt the greatest group I could ever have the opportunity to work with; in a word they are” unrelenting”. Finally, our patients and their families teach and tolerate me daily, always pushing me to improve and question the status quo.

What does it mean to you to be named a “Visionary” in Hospice and Palliative Medicine? I am overwhelmed, shocked and honored. Clearly there are individuals more deserving of this honor. I believe this is a validation of the work of the teams with whom I have served, specifically Virginia Commonwealth University/Massey Cancer Palliative Care Program, the ELNEC team and the APRN palliative externship program at Virginia Commonwealth University.

What is your vision for the future of hospice and Palliative Medicine?I believe palliative care will experience extremely rapid growth and eventually acceptance within our society. This growth will be challenging as our numbers are few and the need is great. I hope programs such as our pilot APRN palliative externship program at Virginia Commonwealth University will ease this problem and promote solutions.

More information on the Visionaries project, including the list of 30 Visionaries is on the Academy’s website www.aahpm.org.