Journal of the Advanced Practitioner in Oncology Podcast

Jibran Majeed, DNP, ACNP-BC, CCRN, of Memorial Sloan Kettering Cancer Center, details how his team created a clinical decision tool to help with decision making for patients who present with new venous thromboembolism. Related Content Implementing a Clinical Decision Tool to Improve Oncologic Venous Thromboembolism ManagementCancer-Associated Venous Thromboembolic Disease, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology

Many communication skills that advanced practice providers (APP) develop are similar to those of other providers. However, a survey reveals unique communication challenges for APPs that stem from public lack of understanding of this unique role on the multidisciplinary care team. Related Content: General and Unique Communication Skills Challenges for Advanced Practice Providers: A Mixed-Methods Study. https://doi.org/10.6004/jadpro.2022.13.1.3Episode 41: The Never-Ending Need to Explain Yourself: Defining Your AP Role. https://www.advancedpractitioner.com/episode-41-the-never-ending-need-to-explain-yourself-defining-your-ap-role.aspxComskil: Communication Skills Training Program & Research Laboratory. https://www.mskcc.org/hcp-education-training/communication-skills-research

Feeling like your tank is empty? You may be coping with change fatigue. Katherine Albert, DNP, FNP-BC, AOCNP, of University of Colorado at Colorado Springs, speaks to host Wendy Vogel, MSN, FNP, AOCNP, about how the pandemic has depleted our reserves and left us unprepared to deal with rapid changes in health care. Katherine and Wendy discuss strategies to refuel your tank, including early communication, team cohesion, and taking time to rest, reflect, and recover. Related Content:Change ManagementLeading change: Why transformation efforts fail https://hbr.org/1995/05/leading-change-why-transformation-efforts-fail-2Healthcare Leadership Lab https://healthcareleadershiplab.com/Change FatigueThe relationship among change fatigue, resilience, and job satisfaction of hospital staff nurses https://doi.org/10.1111/jnu.12373Change fatigue in health care professionals—an issue of workload or human factors engineering? https://doi.org/10.1016/j.jopan.2014.02.007Change fatigue, job satisfaction, and organizational commitment among nurses https://www.proquest.com/openview/09167b00934b43fc5a829fc9efb2d8b2/1?pq-origsite=gscholar&cbl=18750&diss=yPractice Adaptive ReserveChange implementation: The association of adaptive reserve and burnout among inpatient medicine physicians and nurses. https://doi.org/10.1080/13561820.2018.1451307 Burnout among primary care providers and staff: Evaluating the association with practice adaptive reserve and individual behaviors. https://doi.org/10.1007/s11606-020-06367-zSurge CapacityExploring the concept of surge capacity https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No2May09/Articles-Previous-Topics/Surge-Capacity.htmlThe pandemic has depleted people's surge capacity. Here are ways to recharge.https://www.cbc.ca/news/canada/kitchener-waterloo/jennifer-moss-happiness-column-surge-capacity-1.6202050

Teams do their best work when they feel connected. Ginger Johnson, speaker and author, talks with host Wendy Vogel, MSN, FNP, AOCNP®, on the power of connection to align values and encourage new ideas and growth within health-care teams.Related Content:Connectivity Canon by Ginger JohnsonUse code CANON5 for $5 offArt of Gathering by Priya Parker

Health-care disparities create barriers to disease prevention, early detection, and treatments. These disparities are found across all cancer types. In this episode, Rose DiMarco, PharmD, BCPS, BCOP, Thomas Jefferson University Hospitals, and Joseen Chundamala, PharmD, University of Pennsylvania Health System, discuss actionable steps oncology advanced practitioners can incorporate into their everyday practice to consistently provide high-quality care to all patients. Related Content:Social Determinants of Health and Cancer Disparities: What Can APs Do to Improve Patient Care? (APSHO members only) Single Item Literacy Screener (SILS)Harvard Implicit Association Test (IAT)Social Determinants of Health

Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood. Having multiple ACEs is a major risk factor for many health conditions, including cancer. Host Wendy H. Vogel, MSN, FNP, AOCNP®, talks with Sharon Moore, DPh, Regional Coordinator for ONE Tennessee and Public Health Academic Detailer for Metro Drug Coalition, on how being cognizant of potential ACEs a patient with cancer may have can help inform and improve the care and education advanced practitioners provide. Related Content: ONE TennesseeMetro Drug CoalitionThe Origins of Addiction: Evidence From the Adverse Childhood Experiences Study by Vincent Felitti, MD PACEs ConnectionCDC: Adverse Childhood Experiences (ACEs)The Effect of Multiple Adverse Childhood Experiences on Health: A Systematic Review and Meta-Analysis by Hughes et al. Adverse Childhood Experiences and the Presence of Cancer Risk Factors in Adulthood: A Scoping Review of the Literature From 2005 to 2015 by Ports et al. Adverse Childhood Experiences (ACEs), Cell-Mediated Immunity, and Survival in the Context of Cancer by Steel et al. The Association Between Adverse Childhood Experiences and Risk of Cancer in Adulthood: A Systematic Review of the Literature by Holman et al.

In late 2021, R. Donald Harvey, PharmD, BCOP, FCCP, FHOPA, of the Winship Cancer Institute of Emory University, traveled to Nigeria for 2 weeks as a visiting Fulbright Specialist to train pharmacists on best practices in chemotherapy for cancer treatment. He recounts unforgettable experiences and lasting impressions his counterparts left on him, as well as plans for continuing to help strengthen the capacity of cancer treatment and care in Nigeria.Related Content:Project Bink BlueFulbright Specialist Program

Gretchen McNally, PhD, ANP-BC, AOCNP, of The Ohio State University James Cancer Hospital, talks about the language of addiction, recognizing signs of an opioid or substance use disorder, and universal precautions to take through the lens of a case study. Related Content: Addiction in Patients With Cancer: Challenges and OpportunitiesJL811: Opioid Use Disorders: Experience, Knowledge and Interest Among Oncology Advanced Practice Providers and PharmacistsJL725: Oncology Advanced Practice Providers: Opportunities to Positively Impact the Opioid Epidemic

Seeing an increase in interventional radiology (IR) referrals and patient wait times, in 2019, an advanced practitioner mobile IR team was started to perform paracentesis and thoracentesis at a major cancer center. Hear from Caitlin Treacy, MS, AGACNP, of Memorial Sloan Kettering Cancer Center, on this advanced practitioner–led team, including hiring, training, and outcomes. This poster received the Outstanding Poster Award at JADPRO Live 2021. Related Content:(JL910) Implementation and Impact of an Advanced Practice Provider-Led Bedside Procedural Team at a Major Cancer Institution

The ninth annual JADPRO Live conference wrapped up in October, and Wendy Vogel, MSN, FNP, AOCNP®, Executive Director of APSHO, and Annie Yueh, Editor of JADPRO, take a look back at their favorite moments, interesting statistics, and attendee feedback. Related Content:Episode 46: Your True Self: A New Take on How to Combat BurnoutThe Mary Pazdur Award for Excellence in Advanced Practice in Oncology

Cancer-related fatigue (CRF) is one of the most prevalent, debilitating symptoms for patients with cancer. It is also a multifactorial problem for which there is no one solution. Emily A. Lemke, DNP, AGPCNP-BC, AOCNP, of the Medical College of Wisconsin, summarizes data on one potential option: 2,000 mg of American ginseng daily. She reviews the safety and efficacy, where to source it, and tools to measure fatigue in patients.Related Content:Ginseng for the Management of Cancer-Related Fatigue: An Integrative Review. J Adv Pract Oncol 2021;12(4):406–414Ginseng (American) in About HerbsGinseng Board of WisconsinEvaluation of the psychometric properties of the PROMIS Cancer Fatigue Short Form with cancer patients. J Psychosom Res. 2016 Feb;81:9-13MFSI (Multidimensional Fatigue Symptoms Inventory)ESAS (Edmonton Symptom Assessment System)

This week, we're sharing an episode from Cancer Buzz, the podcast of the Association of Community Cancer Centers (ACCC). While most cancer programs in the United States report that they employ advanced practitioners (APs), they are often not utilized to the full scope of their abilities in clinical research.In this episode, Beth Faiman, PhD, MSN, APRN-BC, AOCN, FAAN, shares the evolution of the advanced practitioner role at her institution, where APs have a larger voice in the research process and clinical trial protocols, serve as champions to advocate for patients and research staff, and collaborate with their team to promote best practices in clinical trial delivery.

Margaret Leddy, PA-C, of Duke University Health System, wants to turn the idea of self-care on its head. She starts by asking: Who are you really? By identifying your core values and what you enjoy doing, you can start taking small steps to focus on yourself and thrive even in a setting with high rates of burnout. Related Content: The Way of Integrity by Martha Beck Brené Brown's List of Values

Donald C. Moore, PharmD, BCPS, BCOP, DPLA, of Atrium Health, Levine Cancer Institute, in Concord, North Carolina, talks with host Wendy Vogel, MSN, FNP, AOCNP®, on recent data and strategies for managing adverse events of ibrutinib, acalabrutinib, and zanubrutinib in the treatment of B-cell malignancies. Related Content:A Review of the Bruton Tyrosine Kinase Inhibitors in B-Cell Malignancies. J Adv Pract Oncol 2021;12(4):439–447. https://doi.org/10.6004/jadpro.2021.12.4.8

This week, we're sharing an episode from Cancer Buzz, the podcast of the Association of Community Cancer Centers (ACCC). Listen about how oncology advanced practitioners (APs) can play a greater role in clinical research and, according to a recent national study, have a strong interest in doing so. Hear how APs can leverage their deep role in the day-to-day cancer care decisions to improve diversity in clinical trials by bringing their experience to trial design and the accrual process.In spring 2021, ACCC and Harborside hosted a Virtual Summit to Define on the Role Oncology Advanced Practitioners in Equitable Cancer Care Delivery. Each summit session focused on one specific domain of care delivery—Care Coordination and Communication; Clinical Trials; and Acknowledging and Mitigating Implicit Bias. Look for more on the Summit findings coming soon to the ACCC website.Related Content: Understanding Attitudes and Roles of Oncology Advanced Practitioners in the Setting of Cancer Clinical Trials: A Pilot Study. J Adv Pract Oncol 2021;12(5):465–476.

This week, we're sharing an episode from Cancer Buzz, the podcast of the Association of Community Cancer Centers (ACCC). Increasing diversity and equity in clinical trials will require buy-in and commitment from all stakeholders in the research enterprise. In this episode, Colleen Lewis, MSN, ANP-BC, AOCNP, talks about the critical role oncology advanced practitioners can play in moving the needle on equity and inclusion in cancer clinical trials.In spring 2021, ACCC and Harborside hosted a Virtual Summit to Define on the Role Oncology Advanced Practitioners in Equitable Cancer Care Delivery. Each summit session focused on one specific domain of care delivery—Care Coordination and Communication; Clinical Trials; and Acknowledging and Mitigating Implicit Bias. Look for more on the Summit findings coming soon to the ACCC website.

As the need for oncology services increases and the predicted shortage of oncologists draws near, the number of locum tenens positions is expected to increase. How can advanced practitioners help with the hiring and onboarding of locum tenens physicians while supporting patients and ensuring their continuity of care? In this episode, we address checklists for locum tenens, how to explain the AP role to physicians, and keeping an open line of communication with patients and the entire health-care team.Resources:Association Between Treatment by Locum Tenens Internal Medicine Physicians and 30-Day Mortality Among Hospitalized Medicare Beneficiaries. JAMA. 2017 Dec 5; 318(21): 2119–2129. The Quality and Safety of Locum Doctors: A Narrative Review. J R Soc Med. 2019 Nov; 112(11): 462–471. Use of Locum Tenens Physicians in Oncology Practice. J Oncol Pract. 2010 May; 6(3): 161–163. Checklist for Hiring a Great Locum. Can Vet J. 2011 Apr; 52(4): 439–441. General Practice Locum Improvement Tool. BMJ Qual Improv Rep. 2014; 3(1): u202980.w1397.

Andrew S. Guinigundo, MSN, RN, CNP, ANP-BC, Lead APP at Oncology Hematology Care in Cincinnati, Ohio, talks with host Wendy H. Vogel, MSN, FNP, AOCNP®, about how to explain the advanced practice role to patients, colleagues, and the general public using the rules of personal branding. Resources: Understanding the Role of Advanced Practice Providers in Oncology in the United States. J Adv Pract Oncol 2018;9(6):585-598 The Elevator Pitch: Communicating Your Expertise, Experience, and Value to Patients, Co-Workers, and Prospective Employers in an Instant. J Adv Pract Oncol 2021;12(3):250–252 #APCareSafeCare

Jessica Zucker, RN, MSN, AGNP-BC, describes the development and implementation of a new role called the “Inpatient Consult Advanced Practice Provider” (ICAPP) on an inpatient bone marrow transplant unit, and how it led to fewer interruptions to patient care, decreased job stress, and improved job satisfaction for the entire team.A Role to Alleviate Burnout and Maintain Quality of Care. J Adv Pract Oncol 2021;12(2):203–208

Genomic or biomarker testing? Germline or genetic testing? The various terms that providers use about testing can cause confusion and lead to suboptimal testing and care.Nikki Martin, MA, Director of Precision Medicine Initiatives at LUNGevity Foundation, talks about the work of the Consistent Testing Terminology Working Group to encourage the use of consistent, plain language terms for biomarker and genetic testing that are applicable across cancer types. Allyson Price, MPAS, PA-C, a member of the working group, describes the important role of the advanced practitioner in explaining testing results to patients. The official recommendations are: “Biomarker testing” is the preferred term for tests that identify characteristics, targetable findings, or other test results originating from malignant tissue. “Genetic testing for an inherited mutation” or “genetic testing for inherited cancer risk” are recommended to describe tests to identify germline mutation. Resources: Working Group White PaperASCO abstractCancer.Net article

Amy Pierre, MSN, ANP-BC, of Flatiron Health and Memorial Sloan Kettering Cancer Center, describes how career ladders for advanced practitioners can increase job satisfaction, encourage career growth and development, and ultimately, improve patient care. Related articles from JADPRO:Applying Metrics to Outpatient Oncology Advanced Practice ProvidersDevelopment of a Professional Practice Model for Neuro-oncology Advanced Practitioners at an Academic Medical Center: A Quality Improvement ProjectThe Development of an Oncology Clinical Nurse Specialist Fellowship Program

Constance Visovsky, PhD, RN, ACNP-BC, Director of the College of Nursing at University of South Florida, gives tips for advanced practitioners on how to develop your topic based on clinical practice, structure your abstract, and tailor it to the conference you're submitting to. Consider submitting a poster abstract for JADPRO Live, October 7-10 and 14-17! Abstract submission opens in the spring.

TaCharra Y. D. Woodard, MSN, APRN, ACNP-BC, AOCNP®, and Carla M. Patel, MSN, APRN, ACNP-BC, of The University of Texas MD Anderson Cancer Center, describe the successful implementation of an enhanced recovery approach in thoracic surgery at their center. Woodard and Patel also provide clinical pearls for improving postoperative outcomes, such as strategies for eliminating lines and tubes, controlling pain, and managing nausea and vomiting.Read TaCharra and Carla's article, Roadmap to the Enhanced Thoracic Surgical Journey, from the Jan/Feb 2021 issue of JADPRO.

Wendy Vogel, MSN, FNP, AOCNP®, talks about all the factors that should go into determining fair pay for an oncology advanced practitioner, including salary benchmarks, non-billable work, and the need for oncology providers in the area. Read Wendy's article on fair market value in JADPRO. Read the national survey on advanced practice providers in the US.

David Johnson, PA-C, Director of Advanced Practice Professional Services at Moffitt Cancer Center, talks about knowing your worth as an oncology advanced practitioner and how to strategize for salary negotiations with current or potential employers. Read the JADPRO article on determining your fair market value as an oncology advanced practitioner. Review survey data on average compensation for oncology advanced practitioners in the US. Read David's blog post on APSHO.org.

How can nurse practitioners, physician assistants, and pharmacists contribute to clinical research, and how can they enhance the accrual and conduct of clinical trials in the future? Christa Braun-Inglis, MS, APRN-Rx, FNP-BC, AOCNP, of the University of Hawaii Cancer Center, talks about her search to answer these questions and what she discovered through her research. View Christa's poster from the 2020 ASCO Quality Care Symposium. Access the APSHO Empowered and APSHO Educator Modules that Christa mentions.

Hear about how Fedricker D. Barber, PhD, ANP-BC, AOCNP®, of The University of Texas MD Anderson Cancer Center, and her team developed the project that was presented with JADPRO Live 2020's Outstanding Poster Award: Impact of Advanced Practice Providers on Early Recognition and Management of Adverse Events in Patients Enrolled in Early Clinical Trials in the Ambulatory Setting (JL806).View Dr. Barber's poster.

In an era of video meetings, Deborah Rust, MSN, CRNP, AOCN®, Chair of the APSHO Communications Committee, shares tips for leading a successful and productive call, including how to foster team spirit, engage every participant, and encourage collaboration. Plus, Deborah addresses how to deal with the technical side, like the use of the mute button, asking people to turn on their videos, and dealing with both overtalkers and dead air.

Suzanne McGettigan, MSN, CRNP, AOCN®, of Abramson Cancer Center, talks about the mutually beneficial nature of peer review and gives tips on what to expect from the process and how to get started.

The first Editor-in-Chief of JADPRO, Pamela Hallquist Viale, RN, MS, CNS, ANP, along with Kelley Moore, Acquisitions Editor, Claudine Kiffer, Editorial Director, and Annie Yueh, Editor, talk about the history of the journal, its roots in supporting advanced practitioners in oncology, and ways to get involved with the journal.

Beth Warnick, MSN, CRNP, ACNP-C, of Allegheny Health Network in Pennsylvania, shares her experience diagnosing anemia in her 23 years as an oncology advanced practitioner.

Tajuana Bradley, MSN, APRN-BC, of Georgia Cancer Specialists, delves into what drives her every day in her practice of caring for patients with cancer.

Michael Bonsaver, FNP-C, remembers the one patient who taught him the lesson that has been the foundation of his career—that there is always something you can do for your patient, even if it seems there is nothing that can be done.

Mary Peterson, MS, APRN, AOCNP, recounts the patient interactions that have stayed with her throughout her career as a nurse practitioner in stem cell transplant.

Gary Shelton, DNP, NP, ANP-BC, AOCNP, ACHPN, an Advanced Practice Hospice and Palliative Care Nurse, tells his story about how his professional and personal lives intersected while caring for his mother.

Kristin M. Daly, MSN, ANP-BC, AOCNP, of Siteman Cancer Center at Washington University in St. Louis School of Medicine, was the moderator for our storytelling session at JADPRO Live 2019. In the coming weeks, we'll be playing for you stories from that session, starting off with one of Kristin's anecdotes about a surprising secret one of her patients was keeping from her and her colleagues.

Lorraine Drapek, DNP, FNP-BC, AOCNP, describes how she started the Massachusetts General Cancer Center sexual health clinic and how clinicians can get the conversation started about sexual health. Resources mentioned by Dr. Drapek:WilltoLoveInternational Society for the Study of Women's Sexual Health

Kristin M. Daly, MSN, ANP-BC, AOCNP, of Siteman Cancer Center at Washington University in St. Louis School of Medicine, shares why she thinks clinicians have the best stories, her own experience participating in The Moth StorySLAM, and her advice for telling your own story.

Shelton Lacy Harrell, MSN, ACNP-BC, from the Division of Hematology and Oncology at Vanderbilt-Ingram Cancer Center, describes her experience managing patients after her attending physicians left the practice. Harrell talks organization, communicating with stakeholders, and making sure patients don't fall through the cracks, all during the COVID-19 pandemic.

Jason Astrin, PA-C, MBA, DFAAPA, answers frequently asked questions about various telemedicine topics, such as billing and reimbursement, scheduling, and the future of telehealth.Watch a recording of our telemedicine webinar.Please be aware that CMS has issued updated guidance on billing for telemedicine since this episode.

When a physician assistant does everything she can to fulfill the wishes of a dying patient, things start getting complicated quickly as the patient's highest priority—the well-being of his dog, Shadow—as well as an intruder to the house and an unexpected business come into play. This is the story of how Paige Goforth, MMS, PA-C, did everything she could, including recruiting the support of her family and community, to help her patient find peace. Please note that this episode was recorded before COVID-19.News story: https://wcyb.com/news/local/pepins-pet-projectsFriends for the Fight: https://www.facebook.com/CommunityAgainstCancer

The NP/PA Hematology Fellowship Program at Mayo Clinic has reorganized its training curriculum to keep fellows learning and, most importantly, safe. We talk with Lisa Hwa, APRN, CNP, DNP, APP Hematology Fellowship Program Director, andDrew Gastin, PA-C, a Fellow in the program, about changing expectations and adapting to social distancing by participating in online learning, telehealth, and remote research initiatives.

We asked Allan Cameron, EdD, CFP, AIF, a certified financial planner with Strategic Financial Partners in Tennessee and a registered investment advisor throughout the Southeast, about his tips for keeping financial investments and retirement accounts safe.

People who are immunocompromised, such as those undergoing bone marrow transplant (BMT), are at an increased risk of experiencing severe effects from the virus. And in addition to taking extreme precautions against COVID-19 exposure, BMT patients and their providers are navigating myriad other changes and hurdles in order to ensure continued safe care during the pandemic. We spoke with Cathy Featherstone, FNP, Advanced Practice Provider Manager for Adult BMT and Lymphoma and Myeloma Services at Memorial Sloan Kettering Cancer Center about how she and her team have adapted to this new challenge.

As more and more clinical trials begin analyzing the novel SARS-CoV-2 virus and the efficacy and safety of potential treatment options, many of us are left wondering about how this shift in focus will affect ongoing and future clinical trials for other diseases, especially cancer. Nataya Francis, ARNP, nurse practitioner in the Clinical Research Unit at Moffitt Cancer Center, is seeing the impact on the oncology clinical trials management process firsthand.

As the COVID-19 pandemic brings nonessential travel to a near standstill, health-care systems are innovating ways to use technology to continue to provide high-quality care. We talk to Kathy Deanda, Senior Director of Virtual Health for the UCHealth System and Senior Director of Neurosciences for University of Colorado Hospital, and Keri Halsema, a nurse practitioner at the Blood Disorder Center for the University of Colorado about their rapid expansion of telehealth services at UCHealth.

Gabrielle Zecha, PA-C, MHA, Director of Advanced Practice Providers at Seattle Cancer Care Alliance, talks about her team's preparations for COVID-19.

The COVID-19 outbreak has necessitated cancer centers to rapidly develop screening protocols and explore telemedicine strategies to prevent infections. Advanced practitioners have been on the front lines of patient care and education, and we talk with two of them to see what their processes are and what other health-care providers can learn from their experiences.Robert Hall, MSN, is an oncology/hematology nurse practitioner with a focus on myeloid malignancies and clinical research at Vanderbilt University, Nashville, Tennessee.Sandra Kurtin, PhD, ANP-C, AOCN®, is an oncology/hematology nurse practitioner at the University of Arizona Cancer Center, and Assistant Professor of Clinical Medicine and Adjunct Clinical Assistant Professor of Nursing at the University of Arizona.The Advanced Practitioner Society for Hematology and Oncology (APSHO) has compiled resources on COVID-19.

Victoria Reiser, RN, BSN, BMTCN, OCN, author of the JADPRO article "Beyond CAR T-Cell Therapy: Continued Monitoring and Management of Complications" speaks with co-host Wendy Vogel, MSN, FNP, AOCNP, on caring for patients who have received CAR T-cell therapy.2:07 Introductions3:42 If you had a billboard about your article, what would the headline be?4:25 Why is this topic important for APs?5:27 How would you explain CAR T-cell therapy to family members?6:35 Infusion process7:52 Monitoring for cytokine release syndrome8:26 Immune effector cell-associated neurotoxicity syndrome (ICANS)11:05 Inpatient vs. outpatient11:35 Caregiver involvement14:02 Hemophagocytic lymphohistiocytosis (HLH)15:48 Recovery period16:28 Long-term toxicities17:34 Assessing response18:18 Prophylaxis after therapy19:30 COVID-19 advice for patients20:52 Geriatric patients22:15 Myths23:42 What's the hardest thing about CAR T-cell therapy?

What’s the quickest way to ruin a dinner party? Talking about death might be one, but Debra Jarvis, former chaplain with Seattle Cancer Care Alliance, TEDMED speaker, podcaster, author, and writer-in-residence at University Congregational United Church of Christ doesn’t shy from talking about taboo topics. After her keynote at JADPRO Live, Debra sat down with freelance medical writer and editor, Kate MacDougall, on her journey on the Camino de Santiago, similarities she recognized between her hike and the practice of oncology, and fine-tuning attitudes and perspectives on death.

In early 2020, the Trump administration rolled out a Medicaid block grant program, where states apply to received capped federal funding and have new flexibility to dictate coverage and benefits. Tennessee's application is a telling example of how health benefits for the most vulnerable populations have the potential to change drastically. Subscribe to JADPRO: https://advancedpractitioner.com/subscribe/References: Kaiser Family Foundation estimates based on 2017 National Health Expenditure Accounts data from CMS, Office of the Actuary; The Kaiser Family Foundation, Medicaid in the United States Fact Sheet, October 2019. http://files.kff.org/attachment/fact-sheet-medicaid-state-US. The Facts on Medicare Spending and Financinghttps://www.kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/ Trump Administration Announces Transformative Medicaid Healthy Adult Opportunity https://www.cms.gov/newsroom/press-releases/trump-administration-announces-transformative-medicaid-healthy-adult-opportunity Trump Administration Clears The Way For Medicaid Block Grantshttps://www.npr.org/sections/health-shots/2020/01/30/800841612/trump-administration-offers-states-a-way-to-block-grant-medicaid