Archive for November, 2016

Reflecting on the Palliative Care Research Retreat

As I landed in Quebec for the Annual Kathleen M. Foley Palliative Care Retreat and Research Symposium, I had little idea what was in store for me at this fantastic professional networking opportunity. As a junior investigator in the field of palliative and end-of-life care research, I was certainly looking forward to this opportunity. But I did not expect the open doors it would provide for me. I came to this research retreat expecting it to be another conference, but what I got instead was an invaluable networking and learning opportunity. The phenomenal networking opportunity alone made this retreat prove to be one of the most valuable professional development activities I have undertaken so far. The opportunity to interact with both senior and junior investigators leading the charge in this field allowed me to expand my thinking and approach to my own lines of research. The knowledge and practical skills gained were merely icing on the cake!

For me, one of the most prized and valuable component of this research retreat was the opportunity to network with both senior and junior investigators in the field of palliative care research. Upon arriving, I quickly noticed when looking around the room that nearly all of the leading researchers whom I cite regularly in my own work were there! Due to the intimacy of this setting, I had the opportunity to have meaningful interactions with them throughout my time at the conference. It was truly a rare opportunity as a researcher. Equally as valuable, I was able to connect with many other fellow junior investigators in the field. We not only shared our own experiences of trying to secure funding and apply for career awards, but we were able to give one another critical and insightful feedback on projects we were undertaking as well as begin to form collaborations. Due to the structure of this conference, a lot of these opportune moments to get feedback on my own work occurred over breakfast or dinner. The casual, intimate, and warm environment really lent itself to these fantastic collaborative opportunities!

Another key enriching experience of this research retreat for me was getting to see the “state of the science” from leaders in the field. For instance, one of the plenary talks discussed the growing challenge we face as researchers in learning how to balance the need to run rigorous experiments with the need to disseminate and implement findings in an increasingly fast-paced clinical world. This talk sparked a really fruitful and rich conversation amongst research retreat attendees on the state of our field and how we balance this need for rigorous study design and dissemination and implementation efforts. As a junior investigator, I find myself consistently faced with this growing challenge of a world influenced by faced-paced technology and industry efforts and the slower process inherent in rigorous research design. Hearing my fellow colleagues wrestle with this same dilemma and propose creative solutions directly informed some of the research I am currently working on.

In terms of the knowledge gained, this research retreat offered many. First, there was the poster session which was run unlike any poster session I had ever attended. I headed downstairs expecting a typical poster session but instead was pleasantly surprised by formal presentations in cohort groups that allowed for meaningful conversations and presentations around each poster topic. I found this allowed the opportunity to not only ask the researchers questions about their research but to learn from my colleagues as they posed critical questions about the research projects, design, and conclusions. Second, the breakout group I attended was focused on how to engage in non-academic writing. The session leader focused on how to write op-eds, fiction, and non-fiction and spoke from his extensive and quite impressive experiences writing in these various outlets. It really opened my eyes to the possibilities of how to communicate the important work myself and others do in the world of palliative care research to a larger audience through these alternative avenues. Finally, the last session I attended before the closing plenary was focused on submitting a revision for a grant mechanism and responding to reviewer comments. I am actually in the midst of resubmitting an NIH grant, and this session served to outline key tactics to consider when resubmitting a grant. The two investigators who so generously shared examples of their own PCORI and NIH grant revisions helped bring light to how to respond to reviewer comments and increase your odds of funding. I found this to be a very valuable experience in the midst of my own grant resubmissions.

The most fantastic and enjoyable aspect of this entire conference that connected all of the poster sessions, breakout sessions, and trainings combined was the networking built into the research retreat. I loved that the research retreat built in the opportunity to meet with colleagues over fantastic dinners to engage one another on the key dilemmas and questions we face as palliative care researchers. Some of my most meaningful conversations around career and professional development as well as study design and measurement considerations all took place around the dinner table. The most special of these dinners was the opportunity dine with other fellow AAHPM Research Scholars. These bright future leaders of the field brought a lot of knowledge and wisdom to the table as well as their own experiences in carving out a career as a palliative care researcher. I enjoyed the opportunity to learn from them, network with them, and start new collaborative relationships with them to be one of the most rewarding experiences. Having leaders in the field at the table, such as Sean Morrison, only served to enrich these conversations and shed key wisdom on our own careers.

This research retreat served to orient me better to the world of palliative care research. Certainly, I have focused on this area of research within my own professional setting, but I have not yet had the opportunity to come together in a room full of diverse professionals including (but certainly not limited to!) oncologists, geriatricians, social workers, registered nurses, and a host of PhDs coming from a variety of backgrounds all centered on the area of palliative care research. The breadth and diversity of this group of individuals reflected the diversity of palliative care as a specialty. It was such an enriching experience that not only exposed me to the field of research but to the work that the National Palliative Care Research Center (NPCRC) and the American Academy of Hospice and Palliative Medicine (AAHPM) undertake. I had the opportunity to meet the leaders of these institutions first hand and was also able to learn about potential professional and funding opportunities. In fact, due solely to attending this conference, I was able to submit an LOI for receiving a pilot grant through the NPCRC. In short, this high level of exposure really made me more aware of the opportunities that exist to pursue this work.

In closing, this research retreat was perhaps the best way to “fast track” me into the world of palliative care research as I enter that world myself as a junior investigator. I walked away with a lot of knowledge, a better sense of the state of our field, formation of new collaborations (I’ve already started a peer writing group!), and key insights into how to get this work funded. I look forward to continuing my professional journey alongside these fantastic researchers. And I am very grateful for the opportunity to have attended as a Research Scholar for AAHPM!

Megan Shen, PhD
AAHPM Research Scholars Participant

AAHPM and Partners Receive Grant to Fund National Registries Project

Clinical data registries (CDRs) have the potential to demonstrate value and drive measure development within the specialty of hospice and palliative medicine. They also advance Maintenance of Certification and research endeavors and promote national quality improvement. The increasing requirement for quality reporting within value-based payment programs has elevated the need for organized data systems.

Physicians that submit data to a qualified CDR can satisfy some of the Center for Medicare and Medicaid Services (CMS) Merit-Based Incentive Performance System (MIPS) program requirements. With the emergence of MACRA, several organizations have expressed an interest in coming together to discuss a coordinated approach to developing or connecting CDRs for hospice and palliative medicine.

“To improve the care of patients with serious illness, we need to develop, test and implement quality measures that matter for them and provide reporting platforms that empower clinicians to engage in quality improvement,” states AAHPM Chief Medical Officer Joe Rotella, MD MBA HMDC FAAHPM. He notes that existing registries supply important pieces for solving the quality puzzle, but a complete solution will require deeper collaboration and integration.

With this goal in mind, AAHPM and its partner organizations, the Center to Advance Palliative Care (CAPC), the National Palliative Care Research Center (NPCRC), the Global Palliative Care Quality Alliance (GPCQA), and the Palliative Care Quality Network (PCQN), recently developed a proposal and were awarded a $487,000 grant from the Gordon and Betty Moore Foundation to explore the feasibility for integrating existing registries or creating a new one to advance the quality of care for patients with serious illness. AAHPM will serve as the lead organization to guide and organize this project in recognition of its mission and role as a national medical specialty society. Quality Committee chairs Christine Ritchie and Laura Hanson will serve in the Project Co-Lead roles. The activities funded by the grant will occur over a 12 month period (November 2016 – November 2017).

Over the past year, the Academy has convened groups of registry developers and other stakeholders from hospice and palliative care. “AAHPM is helping to bring key stakeholders together to identify a quality infrastructure and resources needed for hospice and palliative care clinicians and their patients,” Christian Sinclair, MD FAAHPM, Academy president adds. “This support from the Moore Foundation will help us move forward together.”

The Gordon and Betty Moore Foundation fosters path-breaking scientific discovery, environmental conservation, patient care improvements and preservation of the special character of the Bay Area. Visit Moore.org and follow @MooreFound.

Fore more information about this work and registries in general, visit our website.

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:

Original Articles

EffenDys – Fentanyl Buccal Tablet for the Relief of Episodic Breathlessness in Patients with Advanced Cancer: A Multicenter, Open-Label, Randomized, Morphine-Controlled, Crossover, Phase II Trial

Steffen T. Simon, Marianne Kloke, Bernd Alt-Epping, Jan Gärtner, Martin Hellmich, Rebecca Hein, Maren Piel, Oliver A. Cornely, Friedemann Nauck, and Raymond Voltz

Efficacy and Safety of Two Methadone Titration Methods for the Treatment of Cancer-Related Pain: The EQUIMETH2 Trial (Methadone for Cancer-Related Pain)


Philippe Poulain, Marie-Pierre Berleur, Shimsi Lefki, Danièle Lefebvre, Gisèle Chvetzoff, Eric Serra, Fibra Tremellat, Alain Derniaux, and Marilène Filbet, for the EQUIMETH2 Study Group

Nationwide Japanese Survey About Deathbed Visions: “My Deceased Mother Took Me to Heaven”

Tatsuya Morita, Akemi Shirado Naito, Maho Aoyama, Asao Ogawa, Izuru Aizawa, Ryosuke Morooka, Masanori Kawahara, Yoshiyuki Kizawa, Yasuo Shima, Satoru Tsuneto, and Mitsunori Miyashita

Pain Assessment, Management, and Control Among Patients 65 Years or Older Receiving Hospice Care in the U.S.

Meagan Cea, M. C. Reid, Charles Inturrisi, Lisa R. Witkin, Holly G. Prigerson, and Yuhua Bao

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 Casarett, MD MA, Senior Associate Editor, JPSM

Meet Our 5,000th Member!

It is with great excitement that we share that AAHPM membership has exceeded 5,000 members! This is the largest our membership has ever been and we couldn’t be where we are today without each member’s hard work and dedication to the field. To celebrate this milestone, we reached out to our 5,000th member, Kelsey Terland, MD.

Dr. Terland is currently a hospice and palliative medicine fellow at Providence Alaska Medical Center in Anchorage, AK. She isn’t native to Alaska though. She was raised in Oregon, but moved to Alaska after college. Dr. Terland attended the University of Washington School of Medicine WWAMI program which allowed her to stay in Alaska for most of her medical training. She then completed her residency at the Family Medicine Residency of Idaho in Boise.

When we asked Dr. Terland how she became interested in hospice and palliative medicine, she shared her story.

“Looking back I feel like I knew my heart was in hospice and palliative medicine even before I went to medical school”, said Terland. “Prior to medical school I worked as a case manager for patients with Alzheimer’s and related dementias. I volunteered for my local hospital’s No One Dies Alone program where I would sit with patients who were at the end of their life if they did not have family or friends to be with them. Throughout my medical training I maintained my interest in the field by participating in preceptorships with providers in the field. During my family medicine residency, I continued to find myself drawn to working with patients facing serious illness and those at the end of their lives. I spent a month during my residency working with the HPM fellowship in Anchorage and this solidified my desire to commit to the field by entering fellowship. I’m so excited for what the future may hold!”

Being a hospice and palliative medicine fellow in Alaska can be a challenge, as the state is “geographically enormous with an incredibly diverse population”, Terland says. “There are inspiring people here thinking very creatively about how to reach patients across our vast state to bring hospice and palliative medicine into very rural villages”.

Terland joined AAHPM as a way to connect with other professionals in the field and gain access to educational materials, as well as to stay up to date with the latest research.

When she isn’t dedicating her days to hospice and palliative medicine, Terland is spending time with her supportive husband and two energetic little boys, exploring the beautiful wilds of Alaska.

Kelsey Terland, MD with her two little boys

Research & Retreats: An Inside Look from AAHPM President Christian Sinclair

Each year, AAHPM awards a number of scholarships to deserving individuals to attend the Annual Kathleen M. Foley Palliative Care Retreat & Research Symposium through the Research Scholars Program. Congratulations to our 2016 recipients! Gain an insider’s view of the retreat from current AAHPM President Christian Sinclair.

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During this year as president of the American Academy of Hospice and Palliative Medicine (AAHPM), I am privileged to hear about many of the great things happening in our field. This past week I attended the Kathleen Foley Palliative Care Retreat and Research Symposium in Quebec City where junior and senior researchers gathered for education, networking and mentorship.  Dr. Sean Morrison and the National Palliative Care Research Center (NPCRC) were responsible for convening this grand meeting as they had done for the past nine years.  This year’s co-sponsors included the American Cancer Society (ACS), AAHPM, the Hospice and Palliative Nurses Association (HPNA), Gordon and Betty Moore Foundation, and Emily David and Joseph S. Kornfeld Foundation.

Like many of you, I am not a researcher, but I do consider myself quite a big fan of research, as it helps establish the foundations for our interventions and ability as a field to change systems of care. The researchers invited were a diverse group of nurses, psychologists, social workers and physicians holding grants supported by the NPCRC and ACS, research scholarships from AAHPM and HPNA, and other leaders, investors, and supporters of the field of palliative care.

During the two days of content, the approaches to learning were varied, from classic didactics from Vincent Mor, Ab Brody, Susan Mitchell and others, to the poster presentations and work-in-progress sessions from many of the junior investigators. Names that you recognize from articles like Tulsky, Arnold, Temel, Ritchie, Kutner, Teno, Ferrell, Mor, Mitchell, Wolfe and others were there to give feedback to early- and mid-career researchers as they presented their work. The camaraderie and mutual admiration was evident from the many conversations I observed and participated in.

One of the big themes at this 10th Foley Retreat, was looking to the future. The NPCRC had already accomplished many of the early goals of creating a stronger research pipeline through support of early-career scientist-clinicians, yet open discussions were held to best plan for the future in an ever-shifting funding landscape. Many felt that the support from the NPCRC and aligned organizations (like AAHPM and others) was critical to maintaining the momentum by helping palliative care researchers get started wherever they are, especially when there are only a handful of institutions able to crank out the studies we need as a young field.

Like the opportunity to visit with those preparing for the boards and hospice medical directors at this year’s Summer Institute, I am very appreciative to see the diversity of professional focus in hospice and palliative care. At the heart of these experiences is fellow hospice and palliative care clinicians supporting each other, which is one of the reasons I love this field and support the Academy.