Geriatric Fast Facts

PCNOW has added a new section, Geriatric Fast Facts, to the Fast Fact home page. Geriatric Fast Facts are accessible, concise, and clinically actionable 1-2 page reports on Geriatric topics applicable across medical specialties. Fast Facts are interdisciplinary, spanning the progression of medical education. These are coordinated by faculty from the Geriatric Division at the Medical College of Wisconsin using the Palliative Care Fast Fact format, but they have their own distinct editorial process and numbering system.

New Fast Fact Released: #345 Intimate Partner Violence

FF #345 has been released: Intimate Partner Violence. Thank you to Priya Pinto MD, Carolyn Genereux LCSW, and Elizabeth Chuang MD for this new addition to the Fast Fact library.

Have you ever cared for a terminally ill patient whom you had concerns for intimate partner violence? Such case are often associated with significant clinician distress. Some of the distress may stem from the lack of published guidelines on how to screen and respond to concerns for intimate partner violence for patients who are seriously ill. This Fast Fact offers clinical pearls and best practices on how to screen for intimate partner violence, mandatory reporting laws, and how to respond if intimate partner violence is suspected. For further information about psych-social challenges in caring for patients who are seriously ill, see our Psych-Social core curriculum heading within Fast Facts and our educational resource guide for palliative care social workers.

Redefining Hope: A Medical Student’s Perspective

“Doctor,” the woman hesitated, as she struggled to accept what she had been dreading during the many weeks that her father had been in the hospital. “How exactly, you know, does the deed happen? Will he suffer?” As I watched our patient’s daughter struggle with the realization that her elderly father may never recover or be able to return home, I imagined the questions racing in her head, trying to grasp what her father’s final days may look like. Even acknowledging the reality by using the word “dying” or “death” was overwhelming for her, and speaking in euphemisms like “deed” seemed more comfortable. The doctor calmly explained to her what she could expect, what the team of doctors and nurses could do to ensure her father’s comfort, and what support was available to the daughter during this difficult time. While there was little that could be offered from a curative perspective, there was still hope that her father’s final days would be meaningful, memorable, and comfortable.

As a medical student, I only spent two weeks rotating with the palliative care service, yet I was astounded by the many conversations like these which I had the privilege of observing and sometimes partaking in — conversations between doctors, patients, family members, nurses, and social workers. I was touched to see that palliative care truly restores meaning, hope, and beauty to patients and families, and even to healthcare providers, during times that otherwise appear hopeless. For patients suffering with chronic illness and their families, often times each day brings new aches and pains, worsening prognoses, and limitations on what one was previously able to do. In each of these moments, accepting this new reality can be a process of loss and grief. Palliative care providers have the power to carry patients and families through these difficult transitions and transform these moments by redefining hope. These are opportunities to discuss what the patient values and is aiming for, how these goals can best be achieved, and what is most important in the remaining time. These are also opportunities to explore uncertainty in an authentic way, acknowledging that there is much about medicine and illness which we (as healthcare professionals, as patients, as family members) cannot control; however, the things that we can control can be optimized to respect each patient’s goals and values.

In his book Being Mortal, Atul Gawande states, “You may not control life’s circumstances, but getting to be the author of your life means getting to control what you do with them.” Perhaps the most important lesson I learned during my palliative care rotation is that as health care providers, we have the privilege of empowering patients to reclaim authorship of their lives when they feel their reality, their purpose, and their hope has been stripped away. We can assure them that they will not be alone during life’s difficult transitions. In the midst of uncertainty, we can return the pen to our patients and remind them that they still get to write the final chapters.

Palliative Care Nurse Externship Program

Four national palliative care externship sites have been selected as part of the newly created Palliative Care APRN Externship. These locations and faculty are listed below, and all expect to begin offering courses in 2018. The Medical University of South Carolina will serve as the clinical leadership site.

The Palliative Care APRN Externship is a week-long mentored immersion course for APRNs, and is intended to provide primary palliative care education to APRNs from any setting. These sites were selected based on maturity, depth, collaborative partnership, and commitment to palliative advanced practice nursing education.

• Duke University Hospital and Health System Palliative Care (Durham, NC) Jennifer Gentry, MSN, ANP-BC, ACHPN, FPCN Elizabeth Zechinati, MSN, AGNP-C, ACHPN

• Johns Hopkins Hospital Palliative Care Service (Baltimore, MD) Michelle Churchill, MSN, ANP-BC, ACHPN Catherine Saiki, MSN, AGNP-C, ACHPN

• MJHS Institute for Innovation in Palliative Care (New York, NY) Colleen Fleming-Damon, PhD(c), ANP-BC, ACHPN, FT Elsbet Servay, MSN, FNP-BC, ACHPN

• University of Minnesota Palliative Care Service (Minneapolis, MN) Lyn Ceronsky, DNP, MSN, GNP-BC, CHPCA, FPCN Michael Finch, MSN, ANP-BC, ACHPN

• Medical University of South Carolina (Charleston, SC) – Clinical Leadership Site Patrick Coyne, MSN, ACNS-BC, FPCN, FAAN Mary Adler, MSN, ANP-C, ACHPN Joan Cain, MSN, FNP-BC, ACHPN

This program has been created with the financial support of the Cambia Health Foundation’s Sojourns Scholars Leadership Program, and with administrative support from the Hospice and Palliative Nurses Association.

For more information and to obtain an application, contact:

Constance Dahlin, MSN, ANP-BC, ACHPN, FPCN, FAAN
Palliative Care APRN Externship Director
Cambia Sojourns Scholar 2016
Director of Professional Practice, Hospice and Palliative Nurses Association
E-mail: aprneducation@gmail.com

New Fast Fact Released: #344 Opioids for Serious Illness During Pregnancy

Fast Fast #344 has been released: Opioids for Serious Illness in Pregnancy. Thank you to Kasey L Malotte, PharmD, Rosemarie Hirsch, MD, and Hunter Groninger, MD for this new addition to the Fast Fact library.

How safe are opioids during pregnancy? How safe are they for newborns of breastfeeding mothers on opioids? What if a pregnant or breastfeeding patient is on maintenance opioid therapy for addiction, which opioid would be safest? This new Fast Fact synthesizes the best medical evidence on this topic to offer safe opioid prescribing considerations for pregnant patients or patients who are breastfeeding.

New Fast Fact Released: #343 Chronic Critical Illness in Adults

Fast Fact #343 has been released: Chronic Critical Illness in Adults. Thank you to Amanda Hinrichs DO and Drew Rosielle MD for the new addition to the Fast Fact library.

Keller, Kimberly – Outlook Web App
Many patients in ICU settings or long term acute care hospitals remain dependent on life support for a protracted period of time beyond their initial ICU presentation. This disease state is referred to as “chronic critical illness.”. Palliative care clinicians are often ask to help chronically critically ill patients and their families decide whether to pursue a tracheostomy or withdraw life support in favor of a more natural death. This Fast Fact reviews the definition and clinical outcomes of chronic critical illness and offers pearls for leading complex medical decision for chronically critically ill patients. For more ICU resources for palliative care teams, check out the Resources/tools for your Palliative Care Program link on the PCNOW webpage.

“FACTS AND FIGURES HOSPICE CARE IN AMERICA 2016 Edition”

In the September 21st New York Times article by Dr. Danielle Ofri “One last visit to see my patient” she describes how a family went from thinking of hospice about giving up to extolling its virtues. Many unfortunately still see hospice in the same way as this patient’s family and the recent 10 page document released by the National Hospice and Palliative Care Organization (NHPCO) highlights this. It provides a synopsis about hospice, who is receiving hospice in the US, how much care was received, how Medicare pays for hospice and who is providing hospice.

Some key facts and figures for 2015.

  • > 1.3 million Medicare beneficiaries were enrolled in hospice care for 1 day or more
  • 46% of all Medicare decedents received one day or more of hospice care with variation across states from 24% to 57%. (WI was in the 50-55% range)
  • Most recipients were elderly (>84), white females, with cancer being the principal diagnosis (28%).
  • 69.5 days and 23 days the average and median length of service for Medicare patients enrolled in hospice, respectively
  • About 98% of days of care was at the Routine Home Care level with 56% of care being provided at home.
  • $15.9 billion paid by Medicare
  • $11,510.00, the average spending per Medicare hospice patient.

As a physician who takes care of patients with serious illness I have found out so far that the best ambassadors for hospice are usually those who describe their experience as ‘great’ with their loved one’s care on hospice. The opposite is also true, there are families that have had bad experiences with hospice which they hold on to and unfortunately prevents them from having their loved one experience what could be a peaceful and wonderful time on hospice. The numbers in this document can be used by Palliative care teams to guide discussions with patients with serious illness and their families who will benefit from hospice (See Fast Facts #82, 87 & 90 for more information about the Medicare Hospice benefit). Hopefully just as Dr. Ofri did, we can think of death also as a “moment of joy” when our patients and families enjoy and embrace the benefits they could derive from hospice care.

https://www.nhpco.org/sites/default/files/public/Statistics_Research/2016_Facts_Figures.pdf

New Fast Fact Released: Chemotherapy Related Cognitive Impairment

Fast Fact #342 has been released: Chemotherapy Related Cognitive Impairment. Thank you to Katharine Brewster MD, Daniel Shalev MC, and Jon Levenson MD for this new addition to the Fast Fact library.

Many cancer patients develop cognitive changes which can significantly impact quality of life. Distinguishing the cause of these cognitive changes can be clinically challenging. There is emerging evidence that chemotherapy can contribute to forgetfulness and “fogginess in thinking.” Colloquially this has been referred to as “chemobrain.” This Fast Fact explores the potential impact chemotherapy can have on cognition.

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