Posts tagged annual meeting

A Developing Countries Scholar’s Perspective on the 2011 Assembly

Attending the 2011 AAHPM &HPNA Annual Assembly in Vancouver February 16-19, 2011 was a wonderful experience for me. It would have been impossible without the support from AAHPM for physicians like me who are working in developing countries. I got the opportunity learn new clinical and scientific knowledge of palliative care by attending different sessions on different days including the preconference workshops. It was a good platform to know and to develop personal relationships with palliative care workers from Canada, USA and other parts of the world. I am already benefitting from this new relationship to improve palliative care in Nepal.

I am going to conduct a one-day Palliative Care Workshop for fellows of different departments March 25, 2011. I got the chance to meet Steven M. Radwany during Annual Assembly who is helping to conduct the palliative care workshop by supplying 60 copies of the Primer of Palliative Care 5th Edition with the help of different friends from AAHPM. I met Fraser Black & Robin Love from INCTR who are also helping me. I have already received “INCTR Palliative Care Handbook” from INCTR Head Office, Brussels, Belgium for the participants of this workshop. Frank Ferris from San Diego has shown different opportunities to improve my personal career and to develop palliative care in Nepal. The educational flash drive provided by Laura Davis is very useful to conduct my daily palliative care activities.

Besides I could see the beauty and development of Vancouver and feel the warm hospitality of the Canadian people.

Bishnudutta Paudel, MD

Peds SIG Offers New Avenues for Involvement in the Field

Although it was painful to get up so early on the final day of the AAHPM Assembly in Vancouver, it was completely worthwhile to attend the meeting of the Pediatrics Special Interest Group (SIG). Over the years that I’ve attended this meeting, it’s been amazing to watch the evolution of interest and attendance in our SIG, and the parallel explosion of pediatric education, research and advocacy opportunities.

In 2007, our statewide pediatric palliative care (PPC) network OPPEN (Ohio Pediatric Palliative and End-of-life care Network) organized a national conference as a follow-up to the National Hospice and Palliative Care Organization’s (NHPCO) pediatric conference in Dearborn, Michigan in 2004. These efforts were organized precisely because there was no place for PPC providers to go to find educational and research information and to network with colleagues; most national conferences had only occasional, if any, pediatric content. Fortunately, that has certainly changed!

For the past few years, the AAHPM has offered greatly increased pediatric content at the Assembly, with pediatric sessions in almost every concurrent slot, as well as large numbers of pediatric paper presentations (which are often award winners). Pediatric representation exists throughout the organization, from workgroups and committees through the Board of Directors.

Similarly, NHPCO has been offering a pediatric track at its Clinical Team Conference for several years now, and its advisory group ChiPPS (Children’s Project on Palliative and Hospice Services) has expanded, undergone strategic planning, and taken on a leadership role in equipping hospice and palliative care organizations to care for children and in working closely with NHPCO in its advocacy and policy activities (www.nhpco.org/pediatrics).

The American Academy of Pediatrics (AAP) has also jumped on the PPC bandwagon, with the establishment of the Section on Hospice and Palliative Medicine. This group is focusing primarily on policy and educational activities, including opportunities for scholarly activity through the AAP’s main meeting, the National Conference Exhibition. The Section maintains 2 listservs that boast healthy discussion about many aspects of our field, 1 for members and 1 for any interested parties; Affiliate Membership is possible for non-physicians as well (www.aap.org; check out the web page soon for a more expanded discussion of each of these national opportunities for PPC involvement and commitment).

The Center to Advance Palliative Care has recently increased its pediatric focus too. Last fall, the annual conference included a pediatric track for the first time, and that will continue this year. Palliative Care Leadership Center tools and training for programs interested in starting or growing a PPC or hospice program have been available through a number of different sites for years; in 2008, 2 pediatric-specific sites were added (Akron Children’s Hospital and Children’s Hospitals and Clinics of Minneapolis) and a new pediatric curriculum was developed (www.capc.org).

And there are other groups involved with PPC as well. A few more highlights include:

  • PEPPERCORN, the Pediatric Palliative Care Research Network, a dedicated group of researchers from a number of sites across North America who are working individually and collaboratively to advance the science of PPC
  • The Hospice and Palliative Nurses Association (www.hpna.org), which has successfully developed a pediatric nursing certification examination in hospice and palliative care, and is also developing accompanying educational material
  • The National Networks for Pediatric Palliative Care (www.network4pedspallcare.org), a grassroots effort focused on developing a web-based clearinghouse of programs and information for families and providers.
  • The Pediatric Hospice and Palliative Medicine Competencies Project, a group of PPC leaders who have been working with the original HPM competencies document and authors to create a companion resource for pediatrics; importantly, the AAHPM’s Board of Directors approved support for this project at this year’s board meeting.

During this time, the Academy’s SIG has continued to meet and grow. In the last few years, we’ve become more organized, along with all SIGs in the Academy which are receiving more support through the new and expanded Communities model. We’ve developed an elections process, allowing a rotation of leadership and the opportunity for younger or newer folks in the field to become involved. This year’s Assembly featured a Pediatric SIG-sponsored session which was very well received. And there were a tremendous number of great suggestions for next year’s Assembly that were generated at the SIG meeting. Our next big push will be for a pediatric plenary!

In short, it’s a great time to be in pediatric hospice and palliative care. Seeing colleagues, learning about many new avenues to become involved in the field, talking about challenging and uplifting situations, sharing wisdom and lessons learned, and literally catching the contagious excitement among us were just a few of the reasons to get out of bed on Saturday morning for the SIG meeting. Hope to see you there next year in Denver!

Dancing with Broken Bones (Feb. 16th)

“Where there is love of humanity, there is love of the art.”

This quote from Dr. Moller’s talk really resonated with me as a relatively recent graduate of medical school.

In a thought-provoking exploration of impoverished patients struggles in the healthcare system at the end of life, an underlying theme was the importance of exposing training physicians to life as a poor and terminally ill patient. Nowadays, every medical school has managed to carve into an ever expanding curriculum a course on the “human side” of being a doctor; how to assemble body parts and physiologic processes into caring for a real live human being. Despite many strong programs, I suspect the vast majority of medical students leave school without the tools needed to truly care for the patients they will encounter in residency.

Exposing medical students and residents to palliative care in all settings and across all socioeconomic lines will only help to strengthen patient care.

Feeling Our Fire

Earthy, dynamic, funny, rich in the wisdom of connection, reflection, and rejuvination…This describes this morning’s plenary by Dr. Sherry Showalter. Her words and movements celebrated this work we do. She reminded us that that which is to provide light, must endure burning, and that we who strive to heal, must, each day, heal ourselves.

Her message invigorated us with renewed purpose, inspiring us to go forward with fresh eyes and weightless spirit, to bear witness and share strength, to open the door with an open heart and open mind, to achieve comfort, to offer hope, to create healing.

Wado Dr. Sherry “Charles” Showalter. Wado!

Karen Whitley Bell, RN, CHPN

After the Bad News… When Patients Hear Something Different than What Was Said

How many times have you begun a conversation with a patient or family, only to discover their understanding of the situation is far different from what the referring physician has shared with you?

All too often, it seems, judging from the large attendance at this informative, lively session that led attendees through the labyrinth of difficult, high stakes conversations. The role-play exercise—a PC consult with a determined mother of teens who believes she’s discharging to rehab to “get stronger for chemo” — stimulated a discussion that identified techniques, pitfalls, and ethical boundaries.

The take-away of techniques included three communication approaches: offering a hypothetical situation (have you thought about what you’d want if the chemo isn’t effective?), offering hope/worry language (I’m hoping you’ll feel better and be able to go home to spend time with your family, but I’m worried that your body is very sick, and this might not be possible) and naming the dilemma.

Some techniques to avoid common pitfalls included communication with the team after to conversation to ensure a common message and reduce team distress, and avoiding splitting, even bringing the referring physician to the meeting, if possible.

The concept of planting a seed—taking the conversation only as far as the patient appears able—emerged as we explored the ethical boundaries of sharing unwanted news, weighed with our duties to the patient and family to provide accurate information to empower informed decision making.

While we recognize that some patients and families may stay “stuck,” the goal of these conversations, and indeed all care, is to maximize the chances for better outcomes. Thank you Drs Jacobson, Thomas & Jackson for an enlightening session.

Karen Whitley Bell, RN, CHPN

NEUROTOXICANTS: Unmasking Uncommon Syndromes (333)

This lecture was very informative and was well attended.

To summarize the meeting and the clinical pearls:

Definition:

Pharmaceutical neurotoxicant

drug or drug-like entities due to its own properties or in combination with other drug or drug-like entities illicit an untoward response to its host’s nervous system

  • Many drugs used in hospice/palliative care have potential side effects. Often we are using polypharmacy and the sum of the parts can lead to neurologic syndromes. Minimize drugs used. Ask yourself: is this drug needed? is it likely to cause side effects? Is there something that we can stop if we start this drug?
  • The symptoms of Serotonin syndrome, Anticholinergic syndrome and Neuroleptic syndrome can be vague, and the clinical syndrome is usually missed. Only in the extreme cases is the diagnosis obvious. Clinicians are not well versed in the neurologic syndromes so they are often missed. There is overlap between the three syndromes.
  • Symptoms of restlessness or agitation are treated with medications such as haldol that are meant to reduce these symptoms. Often increasing or adding new medications worsen symptoms which usually leads to increasing medications. This lecture helped to point out that some of the worsening symptoms are medication related and tapering off the medication is the appropriate next step.
  • Elevated temperature is not always infection. In both NMS and Serotonin syndrome it can be side effect of drugs
  • Myoclonus is not always related to opioid toxicity
  • Careful examination to include pupillary size and reflex response can help differentiate between syndromes

Summary of the syndromes in the table below (hope it opens – I’m new at this)

table for neurotoxicants

Overall it was a good lecture that made the participants aware that these syndromes exist, that the medications we use in hospice and palliative care are often the culprits and without high level of suspicion the syndromes are missed.

A Whirlwind Tour of Pharmacology for Symptom Mangement in Pediatric Patients

Today at the AAHPM Assembly, I had the opportunity to attend a much-needed session on pharmacology for symptom management in pediatric patients. Sponsored by the Pediatric Special Interest Group, this “whirlwind tour” covered pharmacologic approaches to depression, anxiety, delirium and insomnia in children. The three presenters from San Diego Hospice – a palliative care physician, a child psychiatrist and a pharmacist – effectively used video and powerpoint to get a lot of important points across quickly. While a bit more attention could have been paid to time management, this was an important session that could easily have been 2 hours in length, and the presenters definitely conveyed the main points in a clear and easy-to-follow fashion.

In pediatrics, we suffer from a practice gap in that there remains such a dearth in evidence-based research for much of our clinical practice. So we rely on anecdotal evidence, or fly by the seat of our pants. It’s very helpful to have guidance and wisdom from a long-established program who have amassed a significant clinical history with pediatric patients. What was particularly informative was the data table that they put together and freely shared, listing all of their recommended pharmacologic choices for each symptom, along with mechanism of action, dosing guidelines, absorption/metabolism/excretion information, common adverse events, and specific clinical pearls about their use. The table also included an algorithm specifying first and second-line choices for each symptom.

One of the many great things about the pediatric palliative care community is the unselfish sharing that we do – as exemplified by the resources offered at today’s presentation. At a national level, we’re currently working on ways to store and share important and widespread information that would benefit everyone, including clinical pathways/protocols, seminal presentations, program development tools, policies/guidelines, and bibliographies. Stay tuned to the AAHPM SIG webpage for updates as to how this information will be made available!

Eating Out and Activities in Vancouver

AAHPM and HPNA members and staff are getting excited for the 2011 Annual Assembly in beautiful Vancouver. As you may remember, last year, we posted our favorite dining out spots in Boston. Now we would like to know, those of you from or who have visited Vancouver, what do you recommend? Leave a comment and share some tips.

Thanks, and we look forward to seeing you there!

HPNA/AAHPM Collaboration for Annual Assembly

For the past 6 years, AAHPM and HPNA have collaborated to provide an annual conference for members of the interdisciplinary team. As we would expect, the outcomes have improved annually. Last year’s conference in Boston, recorded the highest attendance, the most satisfied attendees and highest rating for presenters.

Is it possible to improve? With any process, there are always opportunities to improve. This year’s conference committee co-chairs and more than 60 volunteer committee members have been committed to raise the bar even higher. HPNA will be kicking off a year-long celebration of their 25th Anniversary with many specialty events so we encourage you to come see, enjoy, network and grow professionally. While there, ask about the Hospice and Palliative Nurses Foundation walk-a-thon. It is a great way to exercise and support grants, scholarships and awards in research and education. See you in Vancouver, B.C. – remember your passport!!

The unsung work of AAHPM committees

Blog #2 from AAHPM consultant Dale Lupu

So there were 26 AAHPM committees, task forces, and Strategic Coordinating Committees (SCC) working in 2009. Because so much of the work is “behind the scenes,” it may be mysterious to many Academy members. I’m going to try to pull back the curtain just a bit to give you a glimpse.

You probably can envision the work of the committee charged with developing the program for the Annual Assembly. Like other committees, this group works both at a big picture level and a level that is “in the weeds.” At the weeds level, they have to decide how many sessions and select those sessions (with apologies to the many wonderful submissions that just couldn’t fit into the program). At the big picture level they map the big learning goals for the conference: what are the learning gaps for the field? What do people need in their different work setting (hospices big and small, hospital based palliative care, long-term care, rural, pediatric, etc.). What do different experience levels need? This year that big picture thinking led to a decision to integrate more pediatric content into the program and to conduct our first-ever forum for medical and nursing students.

But what about committees like Business Practices and Workforce? What do they do? Let me give you just two examples. In the Workforce area, the Board charged the Workforce Task Force with monitoring workforce trends and coming up with a strategy to enhance workforce capacity. This is a big charge, and the task force initially took some time to study and educate themselves about the issues. Last year the task force met for a half day with a national expert on physician workforce issues (Ed Salsberg of the AAMC). This helped us understand how the physician workforce issues in HPM relate to the overall shortage of primary care physicians and the looming shortages in certain specialties such as oncology. When we went around the table, almost all participants reported positions staying open for a year or more, despite intensive recruitment. Many programs were giving up on recruiting from the outside and were turning to a “grow your own” strategy. The task force decided that an important first step was to describe just how bad the workforce shortage really was. The task force developed a Workforce Trends paper – which was approved by the Board yesterday. (Look for the paper to come out in JPSM some time this summer. It shows we need between 4,400 and 10,800 FTE’s in the field, but currently have only 1,700 to 3,300 FTE’s in practice.) Of course, knowing how big the problem is only the beginning. Now we need to develop a range of solutions to this big problem.

Now turning to the Business Practices Task Force. They started with a member needs assessment. The survey results spoke loudly and clearly. Members are hungry for salary and compensation information. The committee considered how to get good information to fill that need and recommended to the board that AAHPM invest in a professional compensation survey to be conducted by an outside firm with deep experience in salary survey and reporting. The board approved that imitative, RFP’s were sent out, proposals were vetted, and a vendor (Mercer) was selected. The committee is now working with Mercer to design a survey tool that will be simple to fill out, yet capture the complexity and diversity of compensation in our field. Look for the compensation survey in your inbox this spring.

That’s just a glimpse of the work that went into two projects this year. There were many more (the Business Meeting gave an overview of all of the biggies.) Meanwhile – I need to run to two more committee meetings. Wish I can spend more time in sessions. Maybe next year.