Archive for June, 2014

Highlights of the July 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

Family Needs Regarding Death Rattle: Commentary on Shimizu et al.
Johannes Bükki

Original Articles

Strategy for Death Rattle of Terminally Ill Cancer Patients and Their Family Members: Recommendations from a Cross-Sectional Nationwide Survey of Bereaved Family Members’ Perceptions
Yoichi Shimizu, Mitsunori Miyashita, Tatsuya Morita, Kazuki Sato, Satoru Tsuneto, and Yasuo Shima

Patterns of Hospice Care Among Military Veterans and Non-Veterans
Melissa W. Wachterman, Stuart R. Lipsitz, Steven R. Simon, Karl A. Lorenz, and Nancy L. Keating

Review Article

Recommendations for Bowel Obstruction With Peritoneal Carcinomatosis
Guillemette Laval, Blandine Marcelin-Benazech, Frédéric Guirimand, Laure Chauvenet, Laure Copel, Aurélie Durand, Eric Francois, Martine Gabolde, Pascale Mariani, Christine Rebischung, Vincent Servois, Eric Terrebonne, and Catherine Arvieux, on behalf of the French Society for Palliative Care, with the French Society for Digestive Surgery, the French Society for Gastroenterology, the French Society for Digestive Cancer, and the French Association for Supportive Care in Oncology

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

Leveraging Technology to Improve Patient Monitoring

Submitted by Rebecca Collins RN, BSN, OCN, CHPN

Hospice has long been seen as a way to provide comfort through effective symptom management for terminally ill patients. Controlling a patient’s symptoms allows hospice patients to experience a better quality of life with the added benefits of decreasing emergency room visits and avoiding hospital stays. Now that hospitals face penalties for readmission of patients with certain chronic conditions, Hospice of Dayton’s Focused Care program not only benefits the patients from a quality of life standpoint, but also the hospitals with readmission avoidance.

Focused Care is a specialized program of treatment that is tailored to address disease specific issues of hospice eligible patients with cancer, cardiac or pulmonary diseases. The Focused Care model uses concepts such as critical thinking algorithms, assessment guidelines, contingency orders, along with promoting collaboration between the community and hospice medical teams. After putting all the above processes in place, we recognized that we needed a way to monitor those cardiac and pulmonary patients in our program that were deemed to be the most fragile. Thus the next step was to add a tele-monitoring component to Focused Care.

Hospice of Dayton is currently the only hospice program in the area that uses tele-monitoring in the care plan for their patients. We have 20 of these user friendly devices that prompt the patients daily to complete their vital signs along with answering a set of disease specific questions. The data is transmitted each day for review by the two Focused Care Nurses during the week and triage nurses on the weekends. Admittedly, the word “micro-management” can have a negative connotation, but not in the case of monitoring our Focused Care patients! If a patient’s report shows adverse vital signs or increased disease specific complaints, the Focused Care Nurse will phone the patient real-time to further assess their needs. If necessary, patients can be instructed to use PRN medication as outlined in their contingency orders or an on-call nurse visit can be arranged for further assessment. These trends can then be reported to the hospice and attending physicians to further guide the plan of care.

Daily monitoring also provides a connection to the patient, addressing the potential isolation or anxiety that patients can experience with end-stage CHF and/or COPD. Patients learn to trust that if they have adverse signs or symptoms, they won’t be directed to go to the hospital, but can stay in their home setting and have their issues addressed quickly and efficiently. The total Focused Care approach serves to further highlight how the hospice approach to symptom management for terminally ill patients can provide positive outcomes and prevent unnecessary hospital readmissions.

Do you currently use tele-monitoring in your practice? What has your organization found to be effective in symptom management for those patients suffering from chronic conditions in the outpatient setting? Has your organization made any adaptations when providing care those patients with end-stage cardiac or pulmonary diseases?

Further information on the Hospice of Dayton Focused Care Program can be obtained at: http://www.hospiceofdayton.org/main/services/care-services.

Disparities, Diversity, and Palliative Care

Larry Beresford

We would like to think that hospice and palliative medicine are extremely patient-centered and individualized to the holistic needs and beliefs of each patient and family. But there can be widely differing perspectives across cultural groups about what individuals need in order to feel that their individuality was honored and what will be experienced as supportive and respectful care under the highly stressful circumstances of serious, advanced, or life-threatening illness.

Can the field of hospice and palliative medicine be more inclusive and more respectful of cultural and other differences than it already is? You can read more about the Academy’s efforts to advance these issues in the latest issue of the AAHPM Quarterly. AAHPM has empaneled a Diversity Advisory Group, which convened a “World Cafe” at the most recent AAHPM & HPNA Annual Assembly for attendees to discuss and prioritize these issues. The Academy has also developed an LGBT Special Interest Group.

What do you think? You can share your perspectives and suggestions on these vitally important issues below.

Ignite: Engaging Others and Building High Performance Teams

Cory Ingram, MD, MS, FAAHPM
Mayo Clinic

I had the good fortune of participating in Dr. Stephen Beeson’s Ignite workshop at this years annual assembly meeting. The first of a series of leadership workshops offered in sequence from AAHPM. Dr. Beeson shared that the foundation to leadership is an ability to create a common ground. A well understood common ground. This is achieved through leadership skill that include listening, conflict resolution, relationship building, effective communication, giving and receiving or better yet inviting feedback. Lastly, it is about having the right mindset.

The right mindset is one of two cognitive stances. Either a fixed mindset or a growth mindset. The fixed mindset responds to a challenge with and inability to see a solution. The person with a growth mindset sees opportunity in a challenge. In creating and achieving common ground it is important to foster a growth mindset and a commitment to the common ground and not necessarily anyone person, but rather the team and the common ground. The common ground is best conveyed through story. A patient story that allows the common ground to be felt. Common ground building flows from a common vision of what is hoped to be achieved. In building a common ground culture change will happen slowly 4-6 people at a time.

Dr. Beeson suggested the use of huddles, debriefs, and rules of engagement to foster effective communication and overcome challenges. The huddles and debriefs must include the common ground. Ascribing to the motto: “All of us is better than one of us” allows for talent to be tapped from all the team members. Fostering curiosity from the team members allows for group reflection to ensure nothing is being missed and that the group is on the right track. Trust among team members is paramount. Keep in mind it takes two to create trust and one to break that trust. Elite teams have a clear mission and identity and mission trumps identity. Their roles are clear and communication effective. Coaching and training are both available on the team and members receive recognition of great work.

How do you recognize success? Contagion is likely the sign of success and is defined at the lateral movement of the common ground. It will spread on it’s own.

I wish I could attend the next leadership forum this fall and would encourage attendance of this leadership workshop series from AAHPM. Thanks AAHPM for offering such a valuable resource for professional development.

AAHPM Leadership Forum: Ascend
AAHPM Ascend is a new intensive two-day program included in AAHPM’s comprehensive new Leadership Forum
premiering September 14–16, 2014, in Oak Brook, IL. This program has limited capacity and will be offered in
subsequent years.

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

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

A Randomized Trial of Weekly Symptom Telemonitoring in Advanced Lung Cancer
Susan E. Yount, Nan Rothrock, Michael Bass, Jennifer L. Beaumont, Deborah Pach, Thomas Lad, Jyoti Patel, Maria Corona, Rebecca Weiland, Katherine Del Ciello, and David Cella

A Randomized, Placebo-Controlled Study of Fentanyl Buccal Tablets for Breakthrough Pain in Cancer Patients: Efficacy and Safety in Japanese Patients Receiving Opioid Treatment of 30 mg/day or More (Oral Morphine Equivalents)
Toshifumi Kosugi, Sasagu Hamada, Chizuko Takigawa, Katsunori Shinozaki, Hiroshi Kunikane, Fumio Goto, Shigeru Tanda, Yasuo Shima, Kinomi Yomiya, Motohiro Matoba, Isamu Adachi, Tetsusuke Yoshimoto, and Kenji Eguchi

Current State of Psychiatric Involvement on Palliative Care Consult Services: Results of a National Survey
Kevin R. Patterson, Andrea R. Croom, Esther G. Teverovsky, and Robert Arnold

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

AAHPM Mentorship Blog: My Year-Long Mentorship Journey

The AAHPM annual meeting has been known to be one of “the best support groups from all around the world.” It provides an opportunity to meet with dedicated, visionary, like-minded colleagues and reignite our shared passion. Sometimes though, we need a little bit more focused attention on our own career development.

This is where my AAHPM mentorship story starts. Career development as a junior faculty member committed to palliative medicine can be very challenging. It’s even harder when you try to combine another field, like I did in geriatric medicine. I wanted a mentor who understood key issues in both geriatrics and palliative medicine. I also wanted several qualities in a mentor: someone who excelled at scientific endeavors and at caring for patients, a good sense of humor, enthusiasm, and the ability to think critically yet speak kindly was a must-have. This is where Eric Widera came in, well, almost.

My personal needs assessment was done. I knew I needed mentorship, identified the qualities that I wanted in a mentor, the only problem was “the ask.” Approaching someone to be your mentor can be very awkward. Wondering around the annual assembly asking people who inspire you to be your mentor doesn’t work (I know — I tried). Fortunately I was redirected by Arif Kamal and Thomas LeBlanc who shared information about their successful experiences with the AAHPM year-long mentorship program with me. In addition to identifying mentors who had the qualities they wanted, Arif and Thomas had created an action plan for collaboration that demonstrated mutual interest and investment from both mentor and mentee.

I revisited my mentorship needs assessment and added an action plan with objectives that I wanted to accomplish at the end of the year. Then I thought: “who would be excited to do this as well?” and this is actually where Eric came in.

Since I already knew Eric, I did not need someone to help with introductions. What I needed was an “ask” that would get his buy-in. Eric is a social media guru who knows almost every pop culture reference, so my mentorship collaboration proposal was a Top-Ten List in PowerPoint format. As you likely deduced, it worked.

Over the course of the year-long AAHPM mentorship program, I was able to do the following:
• Visit UCSF where I received advice from the faculty on several projects that I was working on and on my own career development plan
• Organize an amazing group of faculty to present at the Reynolds, AGS, and AAHPM annual meetings
• Publish curricula on conducting code status discussions on the MedEd Portal
• Co-author a “Curbside Consultation” article published in the American Family Physician about how to discuss hospice care with patients (and was invited to write another one on Advance Directives)
• Work with a task force to successfully disseminate the AGS Geriatrics Evaluation and Management Tools to VA health care providers

The AAHPM mentorship year has been an enormously positive experience. I still can’t believe that AAHPM essentially paid me $1500 and provided free conference registration for me to receive career advice, networking connections, editorial expertise, and life coaching. I also hope they don’t start charging for this now that I pointed it out (oops-sorry future applicants). I am truly grateful and indebted to AAHPM and Eric for this wonderful mentorship opportunity. My mentorship advice to everyone who is thinking of applying: do it while it is still free!

Written by Shaida Talebreza (with mentorship from Eric Widera)