Podcasts about human caring

When working with patients, it is essential for palliative care providers to have goal-oriented conversations. Without them, caregivers may not efficiently and collaboratively meet the patients' needs and goals for their own care. How can new technologies enhance these conversations, both from a productivity and a human relationship standpoint?Matthew Gonzales, MD, of the Institute for Human Caring at Providence, joins the conversation to discuss IHC, the center's successes, and its use of generative artificial intelligence. Gonzales lays out how “EmpathyAI” can enhance caregiver-to-patient interactions and lead to better outcomes for patients in a goal-aligned care model.ResourcesVisit the IHC's official website to learn more about its work

On episode 483 of The Nurse Keith Show nursing and healthcare career podcast, Keith interviews Dr. Janette Moreno, an author, coach, poet, and nurse leader whose first book, "Human Caring through Healing Haiku: Mindful Journaling for Healthcare Providers", was created out of her passion and commitment to the nursing profession. In the course of their conversation, Keith and Dr. Moreno discuss her journey with the poetic form of expression known as Haiku, her training as a Caritas Coach under the tutelage of Dr. Jean Watson, and her vision of how nurses can reclaim joy and wellness through thoughtful self-reflection. Dr Janette Moreno completed her Doctorate in Nursing Practice, Executive Leadership from the University of San Francisco, California in 2016. She was the Director of Nursing Education, Practice, and Professional Development at the Brawerman Nursing Institute, Cedars-Sinai from 2020 - 2024. She also served as the Director of Professional Development and Education at Stanford Children's Hospital from 2017 – 2020. She worked at Stanford Healthcare from 2004-2017 with a clinical background as a critical care nurse focused on cardiovascular surgery prior to becoming a director, educator, clinical practice coordinator, and program manager. With more than 20 years of clinical and leadership experience, she has extensive experience with clinical and academic teaching, mentoring, coaching, consulting, curriculum development, and professional development. Dr. Moreno has presented nationally and internationally and shared best practices of clinical excellence outcomes on professional/shared governance, professional practice, leadership development, mentoring and succession planning. She is well published in peer-reviewed journals on professional governance, Caring Science, professional practice excellence, and diversity, equity, inclusion, and justice. She is faculty for the Association of California Nurse Leaders (ACNL) Foundations for Leadership Excellence and a Practice Transition Accreditation Program (PTAP) team lead appraiser for the American Nurses Credentialing Center (ANCC). She is a Caritas Coach and has integrated mindfulness and resilience as a transformational caring leader. She has led several organizations' strategic integration of the Theory of Caring Science and Model of the Professional Role into practice environments that led to clinical excellence outcomes. Connect with Dr. Janette Moreno JanetteMoreno.com Human Caring Through Healing Haiku on Amazon Facebook Instagram LinkedIn

Charlene talks with Janette Moreno, DNP, RN, NEA-BC, NPD- BC, author of the new book Human Caring Through Healing Haiku. Janette has served in some of the top nursing leadership roles at hospitals like Cedars-Sinai and Stanford Children's Health, in addition to serving on ACNL's Board of Directors representing our South region. Her new book combines the gentle power of haiku with concepts found in Jean Watson's Caring Science and Caritas Processes. Charlene and Janette talk about the Caritas Processes and why mindfulness is so important for nurse leaders. Host: Charlene Platon, MS, RN, FNP-BC (@charleneplaton) Guest: Janette Moreno, DNP, RN, NEA-BC, NPD- BC (janettemoreno.com) About the show: ACNL in Action is a production of the Association of California Nurse Leaders, the professional organization for nurse leaders. New episodes come out on the first Friday of every month. Want to support ACNL? Consider making a donation: http://bit.ly/cog-podcast . Learn more about ACNL, including how to become a member, at acnl.org.  Follow us on Facebook, Instagram, and LinkedIn at @acnlnurse.

Welcome to another enlightening episode of "When the Moment Chooses You." In this special episode, we are joined by Janette Moreno and Jan Anderson, co-authors of the book "Human Caring, Healing Haiku." They share their journey and insights on how poetry and Caring Science come together to create a transformative experience in nursing. Janette and Jan discuss the profound impact of their book on promoting healing and caring practices. Tune in for an insightful conversation that celebrates the fusion of art and science in healthcare. Don't miss this episode that highlights the beauty and power of haiku poetry in nursing. --- Send in a voice message: https://podcasters.spotify.com/pod/show/charlene-johnson68/message

Today's disagreement is on medical aid in dying. In the United States, this term refers to the right for a terminally ill, adult patient to end their own life by taking a medication prescribed by a doctor. Medical aid in dying is currently legal in ten states and Washington, D.C.We've brought together an activist and a doctor to dive into the topic:Dr. Ira Byock is a physician, author, and advocate for palliative care — the medical practice of treating people with serious, complex, and terminal illnesses. Ira is the founder of the Providence St. Joseph Health Institute for Human Caring and is an emeritus professor of medicine and professor of community health and family medicine at the Geisel School of Medicine at Dartmouth College.Kim Callinan is an end-of-life leader and advocate in the field of medical aid in dying. She is President and Chief Executive Officer of Compassion & Choices, an organization that aims to “improve care, expand options and empower everyone to chart their end-of-life journey.”Today we ask a wide range of important questions on medical aid in dying.How broken is end-of-life care in America? And how should we fix it?What are the potential risks and benefits of implementing medical aid in dying?How should we be thinking about death, dying, and the end-of-life for our loved ones?And one more very exciting note: today's disagreement is facilitated by Catherine Cushenberry, one of our producers and someone who has been helping to bring the idea for this podcast to life from the very beginning. Catherine is also a healthcare industry veteran and the perfect facilitator for this topic.And as you'll hear, she's awesome at it.Show NotesCurrent state of end-of-life care [03:25]Palliative care [07:45]Question of unintended consequences [12:56]Defining medical aid in dying [16:47]Effect of medical aid in dying on end-of-life care [22:36]Medical aid in dying outside the U.S. [28:02]Process of medical aid in dying [33:56]Is there a slippery slope? [37:30]Reasons why people choose medical aid in dying [43:21]Financial incentives [47:08]Steelmanning [51:05]

Physician Dr. Ira Byock is a voice for change in the hospice industry, and an advocate for quality end of life care. His many years of experience in hospice medicine, coupled with the compassion he has for people dealing with serious illness, have made him an industry leader in the U.S. According to his website (irabyock.org), he is “Founder of the Institute for Human Caring at Providence St. Joseph Health. Dr. Byock is Active Professor Emeritus of Medicine and Community & Family Medicine at the Geisel School of Medicine at Dartmouth. He served as Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire from 2003 through July 2013. Dr. Byock has been involved in hospice and palliative care since 1978. His research has contributed to conceptual frameworks for the lived experience of illness that encompasses a continuum from suffering to wellbeing; related measures for subjective quality of life during illness; and effective life-completion counseling methods. From 1996 to 2006 he directed Promoting Excellence in End-of-Life Care, a national Robert Wood Johnson Foundation program that developed prototypes for concurrent palliative care of people with life-threatening conditions. He is a past president of the Academy of Hospice and Palliative Medicine.”   What Dr. Byock's bio doesn't describe is his caring heart. It drives his dedication to identifying the issues we face in the hospice industry and offering evidence-based, practical solutions. He wants the hospice silo of healthcare to correct its own path. Dr. Byock believes hospice can heal its own dysfunction by holding providers and clinicians responsible for the care we provide and how we provide it. His articles in STAT magazine and the Journal of Palliative Medicine describe actionable, practical solutions. Hospice practitioners of every discipline can learn from Dr. Byock.   Connect with Dr. Byock at irabyock.org. Find and purchase Dr. Byock's books, including The Four Things That Matter Most, by clicking here.  Read Dr. Byock's STAT article Hospice Care Needs Saving here.  Read Dr. Byock's article Core Roles and Responsibilities of Physicians in Hospice Care: A Statement by and for U.S. Hospice and Palliative Care Physicians by clicking here.                                                                                      28 Apr 2023https://doi.org/10.1089/jpm.2023.0194   Book podcast host Helen Bauer to speak at your event or conference by sending an email to helen@theheartofhospice.com.  Follow The Heart of Hospice on Facebook, Instagram, and LinkedIn.  Connect with The Heart of Hospice podcast on The Whole Care Network and other caregiving podcasts by clicking here.  Find more podcast episodes from The Heart of Hospice at The Heart of Hospice Podcast (theheartofhospice.com)

Physician Dr. Ira Byock is a voice for change in the hospice industry and an advocate for quality end of life care. His many years of experience in hospice medicine, coupled with the compassion he has for people dealing with serious illness, have made him an industry leader in the U.S.  According to his website (irabyock.org), he is “Founder of the Institute for Human Caring at Providence St. Joseph Health. Dr. Byock is Active Professor Emeritus of Medicine and Community & Family Medicine at the Geisel School of Medicine at Dartmouth. He served as Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire from 2003 through July 2013. Dr. Byock has been involved in hospice and palliative care since 1978. His research has contributed to conceptual frameworks for the lived experience of illness that encompasses a continuum from suffering to wellbeing; related measures for subjective quality of life during illness; and effective life-completion counseling methods. From 1996 to 2006 he directed Promoting Excellence in End-of-Life Care, a national Robert Wood Johnson Foundation program that developed prototypes for concurrent palliative care of people with life-threatening conditions. He is a past president of the Academy of Hospice and Palliative Medicine.”   What Dr. Byock's bio doesn't describe is his caring heart.  It drives his dedication to identifying the issues we face in the hospice industry and offering evidence-based, practical solutions.  He wants the hospice silo of healthcare to correct its own path.  Dr. Byock believes hospice can heal its own dysfunction by holding providers and clinicians responsible for the care we provide and how we provide it.  His articles in STAT magazine and the Journal of Palliative Medicine describe actionable, practical solutions.  Hospice practitioners of every discipline can learn from Dr. Byock.   Connect with Dr. Byock at irabyock.org. Find and purchase Dr. Byock's books, including The Four Things That Matter Most, by clicking here.  Read Dr. Byock's STAT article Hospice Care Needs Saving here.  Read Dr. Byock's article Core Roles and Responsibilities of Physicians in Hospice Care: A Statement by and for U.S. Hospice and Palliative Care Physicians by clicking here.                     28 Apr 2023https://doi.org/10.1089/jpm.2023.0194 Book podcast host Helen Bauer to speak at your event or conference by sending an email to helen@theheartofhospice.com.  Follow The Heart of Hospice on Facebook,  Instagram, and LinkedIn.  Connect with The Heart of Hospice podcast on The Whole Care Network and other caregiving podcasts by clicking here.  Find more podcast episodes from The Heart of Hospice at The Heart of Hospice Podcast (theheartofhospice.com)  

Physician Dr. Ira Byock is a voice for change in the hospice industry, and an advocate for quality end of life care. His many years of experience in hospice medicine, coupled with the compassion he has for people dealing with serious illness, have made him an industry leader in the U.S. According to his website (irabyock.org), he is “Founder of the Institute for Human Caring at Providence St. Joseph Health. Dr. Byock is Active Professor Emeritus of Medicine and Community & Family Medicine at the Geisel School of Medicine at Dartmouth. He served as Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire from 2003 through July 2013. Dr. Byock has been involved in hospice and palliative care since 1978. His research has contributed to conceptual frameworks for the lived experience of illness that encompasses a continuum from suffering to wellbeing; related measures for subjective quality of life during illness; and effective life-completion counseling methods. From 1996 to 2006 he directed Promoting Excellence in End-of-Life Care, a national Robert Wood Johnson Foundation program that developed prototypes for concurrent palliative care of people with life-threatening conditions. He is a past president of the Academy of Hospice and Palliative Medicine.”   What Dr. Byock's bio doesn't describe is his caring heart. It drives his dedication to identifying the issues we face in the hospice industry and offering evidence-based, practical solutions. He wants the hospice silo of healthcare to correct its own path. Dr. Byock believes hospice can heal its own dysfunction by holding providers and clinicians responsible for the care we provide and how we provide it. His articles in STAT magazine and the Journal of Palliative Medicine describe actionable, practical solutions. Hospice practitioners of every discipline can learn from Dr. Byock.   Connect with Dr. Byock at irabyock.org. Find and purchase Dr. Byock's books, including The Four Things That Matter Most, by clicking here.  Read Dr. Byock's STAT article Hospice Care Needs Saving here.  Read Dr. Byock's article Core Roles and Responsibilities of Physicians in Hospice Care: A Statement by and for U.S. Hospice and Palliative Care Physicians by clicking here.                                                                                      28 Apr 2023https://doi.org/10.1089/jpm.2023.0194   Book podcast host Helen Bauer to speak at your event or conference by sending an email to helen@theheartofhospice.com.  Follow The Heart of Hospice on Facebook, Instagram, and LinkedIn.  Connect with The Heart of Hospice podcast on The Whole Care Network and other caregiving podcasts by clicking here.  Find more podcast episodes from The Heart of Hospice at The Heart of Hospice Podcast (theheartofhospice.com)

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Bob Beitcher is the President and CEO, Motion Picture and Television Fund ( MPTF - https://mptf.com ) a charitable organization that offers assistance and care to those in the motion picture and television industries and their families with limited or no resources, including services such as temporary financial assistance, case management, and residential living. Mr. Beitcher has been the chief executive officer and president at MPTF since July 2011 and serves on the organization's Board of Directors. Previously, Mr. Beitcher was president and chief executive officer of Panavision and vice-chairman of the MacAndrews and Forbes Media Group. He joined Consolidated Film Industries in 1997 as president and chief executive and served in that position until 2000 when the company was acquired by Technicolor. At Technicolor, he created the Creative Services group, which remains an industry leader in visual effects. Earlier in this career, Mr. Beitcher worked closely with George Lucas, Jim Henson, and Francis Coppola and their respective production companies. He has been a director of MPTF since 2007. He is on the board of directors of Vino Vault and Exokinetics, and serves on the advisory board of the Institute for Human Caring, the ARRI Rental Group, ProdPro, and the Jewish Graduate Student Initiative. In 2021, he accepted an Oscar statuette from the Academy of Motion Picture Arts and Sciences on behalf of MPTF.

In today's episode we have the Honor to interview Dr. Jean Watson. Dr. Jean Watson is Distinguished Professor and Dean Emerita, University of Colorado College of Nursing Anschutz Medical Center, USA; founder of the original Center for Human Caring in Colorado; a Fellow of the American Academy of Nursing (FAAN); Founder and Director of non-profit organization, Watson Caring Science Institute; past President of the National League for Nursing; founding member of International Association in Human Caring and International Caritas Consortium; She held the nation's first endowed chair in Caring Science for 16 years; holds Sixteen (16) Honorary Doctoral Degrees, including 13 International Honorary Doctorates; Her work is studied and implemented around the world. She is a widely published author and recipient of many awards and honors; authored and co-authored over 30 books on caring; In 2013, Dr. Watson was inducted as a Living Legend by the American Academy of Nursing, its highest honor. Primary Field: Philosophy -Theory of Human Caring Nursing; Transpersonal Caring; Unitary Caring Sacred Science. Join us today as Dr. Watson shared his journey with us and learned how she prepared for when the moment chooses her. ABOUT WHEN THE MOMENT CHOOSES YOU PODCAST Coach Charlene's purpose is to bring transformation by creating and inspiring destiny moments because every heartbeat matters... When the Moment chooses you will engage in compassionate courageous conversations with some of the most daring trailblazers and change agents in organizations, corporations and the world who dared to respond to those destiny moments. Listen to new episodes bi-weekly on Sundays anywhere you get your podcasts. You will move from thinking and talking about your dreams….to manifesting the desires of your heart….Be inspired to become the highest expression of yourself. What will you do when the moment chooses you? follow me on social media: whenthemomentchoosesyou Facebook: https://www.facebook.com/whenthemomentchoosesyou Instagram: https://www.instagram.com/whenthemomentchoosesyou/ Website: charlenejohnsonglobal.net (coming soon) --- Send in a voice message: https://anchor.fm/charlene-johnson68/message

Twenty percent of Americans live in a rural setting and full access to some medical care is limited: often requiring long drives or temporary relocations. That includes specialty palliative care -- the interdisciplinary services of physicians, nurses, social workers, and chaplains aimed at helping patients control symptoms of a serious illness.On today's podcast, we explore a demonstration project underway in rural Stevens County, Washington undertaken by the Palliative Practice Group at the Providence Institute for Human Caring.The in-person nursing and chaplaincy providers in two rural hospitals are being joined by physicians and social workers through a Tele-PC video connection or by phone, allowing patients to avoid 70-100 mile drives to seek consultations. And the Tele-PC connection allows far-flung family members to be involved in bedside conversations about the goals of care..JOIN US ONLINE ON JUNE 16thHUMANIZING HEALTHCARE EXPERT SERIESFor information on the June 16th online event, Remote Palliative Care: A telehealth roadmap to reaching rural communities, featuring a number of guests heard on this episode of the podcast, visit this link. Registration is now open. .Gregg VandeKieft, M.D., MA, FAAFP, FAAHPM Executive Medical Director, Palliative Practice Group and Tele-PCProvidence Institute for Human CaringOlympia, Wash..Kevin Murphy, M.D., MSW Executive Director, Palliative Practice GroupProvidence Institute for Human CaringSeattle, Wash..Adie Goldberg, Ph.D., LICSW Palliative Care Social WorkerSpokane, Wash..Amber Moody, RNPalliative Care NurseProvidence Mount Carmel HospitalColville, Wash.(LISTEN to extended conversation).Kelly CorcoranChief Mission OfficerProvidence Mount Carmel HospitalColville, Wash.(LISTEN to extended conversation).Matthew Gonzales, M.D., FAAHPM Associate Vice President, Chief Medical and Operations OfficerProvidence Institute for Human Caring.Ira Byock, M.D., FAAHPMFounder/Senior Vice President for Strategic InnovationProvidence Institute for Human Caring. .   

In this episode, moderated by Dr. Alissa Thomas (University of Vermont), patient caregiver Ms. Sandra Klima, hospice and palliative medicine physicians Dr. Gregg VandeKieft (Providence Institute for Human Caring) and Dr. Frank Ferris (Ohio Health), and medical oncologist Dr. Charles Blanke (Oregon Health and Science University) exchange perspectives on medical aid in dying, including legal, ethical and practical aspects. If you liked this episode, please subscribe. Learn more at https://education.asco.org, or email us at education@asco.org.   TRANSCRIPT Dr. Thomas: Hello, and welcome to the ASCO Education podcast series. My name is Dr. Thomas, and I'm a Neuro-oncologist at the University of Vermont Medical Center, and  Associate Professor in the College of Medicine in the Department of Neurological Sciences in Burlington, Vermont. As today's host, I will be moderating a discussion on medical aid in dying with four guest speakers, Dr. Gregg VandeKieft, who is a Palliative Care Physician, Clinical Ethicist and Executive Medical Director at Providence Institute for Human Caring in Olympia, Washington. Dr. Charles Blanke, a Medical Oncologist and Professor of Medicine at Oregon and Health Sciences University in Portland, Oregon. Sandra Klima, who is the partner and caregiver of a patient who passed away using medical aid in dying in Vermont. And Dr. Frank Ferris, who is a hospice and palliative medicine physician, as well as executive director of Palliative Medicine Research and Education at Ohio Health in Columbus, Ohio.     For consistency during this talk, we'll be using the term medical aid in dying or MAID to refer to death with dignity and physician-assisted dying. So, to begin the discussion, I'd love to hear from Sandra about your perspective as a caregiver. Can you share with us what it was like caring for your partner and what your reaction was when you learned about his wishes?  Sandra Klima: Yes. Thank you. I'm glad to participate. My partner had died of glioblastoma in April of 2018. When we found out, it was pretty shocking. The very first thing he brought up was Act 39. And initially I was very surprised and uncomfortable with it because I didn't want to think about death, I wanted to think about living. And he was very quick, Rob was very quick. We made an appointment at the funeral parlor. He wanted to get everything taken care of quickly. So I was shocked that he wanted to use Act 39. I did not feel that it was, as I said, appropriate to talk about, but he explained he had a friend who had glioblastoma and she did not take that action.  And she kept a diary and he said it was very difficult to read. And he did not want to go through that process that she went through. He didn't want to lose who he was. He wanted to die as himself instead of a short time later as a lesser person. And wanted the choice, and Act 39 gave that to him. And I respected and supported his decision once we talked about it. Cancer is a progressive disease and there comes a time when you will not be in control. Facing that and knowing it only goes downhill is scary. So having the option that looked out before the end phase is a blessing, and it is death with dignity, and that's how it feels to me.  Dr. Thomas: Thank you so much for sharing that experience. This has been a hot topic and I'd love to hear from our panel, what are some of the common misconceptions around medical aid in dying, and how is this different from concepts like euthanasia or assisted suicide?  Dr. VandeKieft: Well, for starters in the United States, all the states that allow aid in dying require the person to self administer the agent. So it's not euthanasia where somebody else administers the lethal agent. Our neighbors to the north in Canada actually do allow voluntary euthanasia and about 90% of their aid in dying individuals do it by voluntary euthanasia as opposed to self-administration. Another misconception is that it is heavily targeting the most vulnerable and disenfranchised, when in fact data from Oregon and Washington really indicate that it's mostly the well-educated, economically privileged who tend to utilize the aid and dying acts. And so there's actually been some questions in recent years about equity in rural areas and for other people who have difficulty accessing aid in dying,  Dr. Blanke: I'd love to reinforce that point. So, the Oregon data suggests that 74% of participants have at least some college, and almost 99% actually have medical insurance, although getting the insurance company to actually pay for the drugs is a different issue. I'd like to also suggest that opponents of death with dignity say that it violates the Hippocratic Oath, which I do not believe it does. Death with dignity deaths make up a tiny minority of overall deaths in any of the states where it is legal, and a good chunk of patients, somewhere between 30% and 60%, get the prescription and never even take it. So, I like to say that the act fights out of its weight class. A lot of people get the power and control of having that medication, but never actually need it.  Dr. Thomas: I understand there are a number of safeguards within the law to try to protect patients and help access and protect physicians. Would you be able to touch on the safeguards?  Dr. Blanke: I'll start there if okay, and most of the other states have modeled their law after Oregon's. So first the patient has to make multiple requests over time. They have to demonstrate a continued interest in death with dignity, and the law has built in cooling off periods. The patients have to clearly understand what will happen if they actually take these drugs, and what happens in 99.5% of cases is they will die as a result. The patients have to put in a witnessed written request for medications, and one of the witnesses cannot be related by blood or marriage, cannot be the patient's doctor, and most importantly can't be in a patient's will. They cannot have a financial interest in the death. So I think those are very reasonable patient safeguards.  Dr. VandeKieft: One exception I would call out is the state of Montana, which did not actually pass the legislation or a voter initiative to legalize aid in dying. But it was a state Supreme Court decision that said it was unconstitutional to prohibit it. So they actually don't have a regulatory framework in place, but they do offer protections to physicians. If they participate, they cannot be prosecuted. But all the other states in the US that have laws have a regulatory framework, much like Dr. Blanke just described.  Dr. Thomas: That's really helpful for the legal ramifications. What are the main ethical considerations around medical aid in dying?  Dr. VandeKieft: If you think of the classic ethical framework, autonomy tends to drive a lot of the conversation, that is the patient's right to self-determination. If they choose to pursue aid in dying, even if we morally disagree with the appropriateness of it, is it our position to prohibit them from following through with it? But then many others will also look at the concepts of beneficence, that is the obligation to do good for our patients, and non-maleficence, that is the obligation to not do harm for our patients. And people on both sides of the arguments will invoke those terms. People who oppose it would say the good is to prolong life. People who support it would say the good is to give people the right to choose the best quality of life and self-determination. People who oppose would say that the death, if it's self administered is actually a harm. The supporters would say the harm is making a person suffer, when in fact they have the potential to cut that suffering short on their own terms.  And so those ethics discussions tend to get into it fairly significantly, particularly around the public policy and social aspects. And then finally, at least within the health system I work, we've really shifted our focus away from a lot of the high-level legal and ethical debates and into what do you do for the patients who request it, and how do we make sure that there's non abandonment, accompaniment through the end of life, and that we seek out the reasons that they asked about aid in dying in the first place, and figure out how we can best serve the concerns that raised the question?  Dr. Blanke: I would love to actually strengthen that last point that Dr. V just brought up. A lot of patients use up three months of their expected six months survival barely finding me. Because what happens is they went to their primary provider, asked for death with dignity. Their physician says, "I don't do it. I don't know anybody who does. Good luck with it." This is a legal option in the state of Oregon, as well as about 11 other states. And the question as to whether or not providers have the obligation to at least refer, is a strong ethical point. A lot of the state's statutes say they can't hinder referral. They have to supply records if the patient asks for it, but I'm not aware that any of them have mandatory referral. And I think the physician is ethically obliged to offer that possibility, even if they don't want to write a prescription, which of course is totally okay.  Dr. Ferris: And if I might comment, I think the other obligation here is to, for the patient, particularly with cancer, but with anybody with any diagnosis who might be choosing this pathway is to ensure that they've had very early referral for palliative care services. That all their symptoms, any issues that are causing suffering are actually being addressed. And that as you have suggested, that they are clearly accompanied by somebody without bias, who understands how to unwrap and provide counseling in all the different realms psychological, social, spiritual counseling, to make sure that they and their families or their partners are in a really good place. Everybody's comfortable with the choice. The family lives on after a situation like this, and they need to have been comfortable with that. That the choice was the appropriate one for the person, and that what we're doing is we're respecting that person's choices and they're comfortable with it.  Dr. Blanke: I totally support that. The flip side of the coin is none of the states really say what to do if you are unable to offer death with dignity. They don't certainly mandate palliative care. I see a number of patients who really don't have terminal illnesses, or they have terminal illnesses that they are not expected to die within the mandatory six months. And I think we should ask ourselves, why are they seeking death with dignity? We have to ask ourselves, "Should we be referring these patients for psychiatric care?"  Dr. Ferris: Well, and if I could come back and emphasize that, I think oncology broadly has frequently had late referral patterns to palliative care services. I've got story after story, I'm a radiation oncologist by background, having done palliative care for the last 35 years. Even in the last couple of weeks, students learning with me have said, "We tried to get referrals and the oncologist wouldn't refer. Is there anything wrong with having a partnership?" So, the oncologist continues to do their wonderful work, at the same time we're managing the patient's experience and that people understand all their options, of which this is one of them, and they have a legal right to that in 11 states, so that we do the best possible care for people.  Dr. VandeKieft: I want to amplify your point. Dr. Ferris, if people choose aid in dying as the culmination of excellent palliative or end-of-life care, that's a very different scenario than if they're choosing it in lieu of palliative care because they don't have access. And so anybody who has access to aid in dying certainly should have access to the highest quality palliative care and hospice care and behavioral health, as Dr. Blanke pointed out, to make sure that they aren't despairing for something that could be treated more readily.  Dr. Ferris: And if I could add one more point, I think there's also a palliative care evangelist who says, "Well, if you just do this a little longer, everything's going to be wonderful." Except that we haven't made a difference. We as a community need to recognize when that's the case as well. So none of us are perfect, but it's the making sure we're a really comprehensive team and able to walk with people and honor and respect their choices.  Dr. Thomas: Thank you. We've spoken a lot about some of the logistics and legal and ethical aspects. I'd love to hear about what the experience is actually like. What are the barriers that patients face when they're trying to seek out medical aid in dying? We have a caregiver here who directly experienced this. How was it trying to access this and are their barriers either individually or systemically?  Sandra Klima: When Rob made his choice, we obviously had to go to the physicians and do the two interviews and get the approvals and wait the days in between and sign all the forms. But eventually we got to go pick up this medicine. But there was one pharmacy that had the medicine. We went, made a drive there. It was far from where we were. So we went over there. We had to plan it to be when there was a physician there who would give us the medicine. So that kind of struck me as strange. So you had to schedule everything and then you get there, and I don't know if it was my paranoia or what, but you feel like everyone's looking at you from behind the counter like, "Oh, you are the people coming to get that medicine?" And it was really just a little uncomfortable.  And you feel like you were almost doing something illegal. So that is the pressure I felt during that process about that. The only other piece is once you start this process in motion, we had the hospice people and the palliative care people contact us. We had several meetings with them. We talked about it with our cancer counselor, so I was very comfortable. And most importantly, Rob was comfortable to get the medicine that he would have to take and have it with him. It gave him peace of mind. It gave him freedom to enjoy his life.  Dr. Blanke: I'll add a few practical matters. The states that have death with dignity mandate that the patient takes it through their GI tract. That usually involves swallowing. We have a number of patients who are unable to swallow, or they have GI obstruction. They're allowed to take the medication through their rectum, although that eliminates a lot of the dignity from death with dignity. But we are not allowed to use intravenous formulations. Even if the patient self-administers. We also have patients and patients with Lou Gehrig's disease or amyotrophic lateral sclerosis make up about 11% of death with dignity users. Many of those patients do not have the use of their limbs. I had one young lady who was nearly completely paralyzed. She could move her head and she could move the pinky of one hand. And I spent somewhere north of four hours simply figuring out how she could fulfill the law by self administering a drug.  Finally we put in an NG and she was able to press a syringe plunger while I held a syringe, legal in Oregon, with that single pinky. I think the law is incredibly discriminatory against people with disabilities in the interest allegedly of protecting them. Next issue is we talked about the written request, which I do think offers safeguards, but sometimes it's hard. If patients want confidentiality, which the law allegedly is interested in, they may not want their neighbor to know that they're going to do this and they may not have somebody who is able to sign the form. Finally, we have talked a little bit about finding a participating provider. That continues to be an absolutely huge barrier, particularly because it's not just one provider, it's a prescribing physician and a consulting physician. They have to find two doctors, and if they're in say a Catholic health system or they're at the VA, sometimes it's nearly impossible for them.  Dr. VandeKieft: Loop back to Miss Klima's comment about the peace of mind that her partner experienced, and note that sometimes even just the conversation provides that. I've had numerous patients who brought the topic up, and they weren't actually asking for requests. They were just seeking information or in one instance, trying to let her family know how badly she was suffering and bringing this up was a way of demonstrating that to them. But I had a patient with ALS who brought the question up. The fact that I accepted it, spoke back to her in a respectful and supportive manner, provided her some relief.  But then when the doctors from End of Life Washington, the advocacy group who can help provide support to people in the home, came out and visited her, she responded that it alleviated her anxiety and her depression, didn't resolve them, but eased them. And that also she learned that she didn't have to act as early as she thought she would have on her own. And so I kind of jokingly said, "So meeting with doctors may have actually prolonged your life." And she laughed and said, "You know, doctor, it did, because I would've done it earlier if I hadn't met with them."  Dr. Ferris: If I can speak to what you just said back in the era of HIV and AIDS, when we had very little, I cared for more than 1,000 people out in the community. And I would say more than 60% of them asked me that question of when they got to a spot of intractable suffering, when I hastened their death. And of course that was illegal in those days. But what I was clearly able to do, is talk about palliative sedation for them, to be clear I would look after them, clear I would look after their families. And just as you have suggested, I think one of the huge issues is, "I have an option. I have an alternative here. Somebody is going to look after me. And if I've decided, if I'm going to go to medical aid in dying, if I'm going to go the palliative route, I don't have to experience the horrible part that I don't want to experience."  We need to talk about both of these openly with people, and be clear that they and their families will be accompanied in whatever the process and as you've suggested, without judgment, maintaining confidentiality. These are super important issues for people. I think about my own personal future, these things loom. I think it is people with lots of thoughts about what might happen, maybe a bit too much knowledge, who worry about the intractable nature of suffering, whatever it is, whether it's psychological, physical, spiritual. It's being able to accompany people appropriately and respect their choices.  Dr. Thomas: Right.  Dr. Blanke: So I'd like to add one more practical detail. We talked a little bit about finding providers and how difficult that is. And if you think about the challenge of finding two providers in Portland, you have to multiply that by about 100 to find any providers in Klamath Falls or Eastern Oregon. The good news is telemedicine has made our lives and the lives of our patients quite a bit easier.  Dr. Thomas: As I listen to the conversation, I'd be curious about your thoughts about health equity issues around this. You've alluded to the fact that somebody who has physical or neurologic disability may have challenges depending on where you live. It may be challenging to access. Are there other populations of patients where you worry about health equity and access to medical aid in dying?  Dr. Blanke: Well, I can comment that most of the patients find me or my colleagues who provide this through web searches. So, they have to have access to computers, which is not necessarily all that easy for all the rural residents of Oregon. Even though I told you that 99% of patients have insurance, we also mentioned that getting the insurance company to pay for the drug is very, very difficult. Hospice almost never wants to pay for it for the usual hospice- related reasons, and the drugs are about $700 in Oregon. That is a hindrance to a lot of my patients.  Dr. VandeKieft: I think being mindful of historic disenfranchised communities, people of color, Native Americans, that the healthcare system has not always treated fairly historically, and they have reasons to be suspect at times. Now this is something that usually they will seek us out as opposed to the healthcare system promoting it, but just being sensitive to the fact that we're doing something that could be perceived as problematic by communities who have historically been mistreated by the health system as well as other systems.  Dr. Thomas: I'd like to just have a better understanding of residency and the law. I think that there is written into most of these laws, you have to be a resident of the state where medical aid in dying is available. But what does that mean to be a resident, and how do states define that?  Dr. Blanke: So for us in Oregon, it's not like the classic situation where you have to demonstrate that you have a driver's license or you have to produce a gas bill in your name. The statute basically allows the prescriber to define residency in their own mind.  Dr. Thomas: What advice would you give to oncologists and other physicians who might have patients approach with questions about this? How do you talk with patients about this matter?  Dr. VandeKieft: The very first thing I respond to is... This is a very important question. I appreciate that you brought it up and that you have the [inaudible 00:20:35] and trust in me to raise the topic. But before I get into the details, I'd like to learn more about what led you to ask me about it. Would that be okay? And even that last phrase, would that be okay as intentional and that by asking permission, I'm making sure that they have agency, and demonstrating respect to them. But that approach has made a huge difference in that I have learned on many occasions, people have no intent of actually proceeding with it. As I mentioned earlier, they may simply be asking for information.  One gentleman, his response was, "Well, my buddies told me about it, and I didn't even know that was a law. And when I started to explain it, he said, oh, that sounds too much like suicide. I would never do that. And then the other woman, I referenced, she went through it and then looked at me and said, “Doctor, I would never do it.”, and looked at her daughter and son-in-law, “I just want my family to know how badly I'm suffering.” And so starting with that open-ended question is really crucial because if we make assumptions and if we start projecting our own biases onto them, we may completely miss what they're looking for and the opportunity to provide them the best services that we could.  Dr. Blanke: If I merely mention that this is an option, the patient is going to think that I'm recommending it, and I certainly don't see it that way. It's just one of many options. If we offer chemotherapy, we are not mandating that particular drug or even suggesting they get chemotherapy at all. Certainly, with the exception of palliative care, I recommend they seek that out, that I really want them to seek it out. But I think it's incumbent on the providers if they see a patient with a terminal illness to list this among the many options that are possible for the patient living in Oregon or those other 10 states. I know that's controversial.  Dr. Ferris: Well, I really want to highlight what you just said, Gregg, about the process of inquiry. To me, everybody practicing oncology, everybody practicing medicine needs to be able to model exactly the way you opened when asking any significant question, including prognosis, "When am I going to die? What about this therapy?" Because what we know, many of the times, patients aren't asking what the words specifically say, they're calling out their suffering and how can we help them? Or they've got a plan, they've got something they want to do. So that was beautiful modeling, Gregg.  Dr. VandeKieft: Dr. Blanke, he used that example of people not hearing. And one of the cases that I still struggle with a little bit, I work in a Catholic health system, so I'm not a participating physician. And we're really counseled that we shouldn't be the one to bring it up. And I had an elderly woman. I was doing a hospice home visit and she asked me how long I thought she had. And unfortunately, Dr. Ferris, I didn't think to ask her what led her to ask me the question on that occasion. And I probably should have, because I told her my prognosis and she looked at me with a profound look of disappointment and said, "I don't think I can suffer that much longer." And a couple of days later, she died very unexpectedly. She took an intentional overdose and the fact that I didn't inform her of the option of aid in dying still haunts me that I may have failed her.  Dr. Thomas: Thank you so much for sharing that. Ms. Klima, we've heard a lot from the experts. Is there advice you'd give patient to patient or caregiver to caregiver about what to ask your physicians?  Sandra Klima: You need to ask as many questions as you want and have the doctor answer you truthfully. I think when a patient is asking a doctor a question, they're asking the doctor, "What are my options?" I'm going to assume you're going to give me all the options. I'm not going to assume you're not going to tell me the options you don't like, because I want to know what are my options. I'm the one who's suffering. I'm the one who will have to make a choice. And I can tell you the choice Rob made, to use Act 39 in Vermont, was a blessing for us. It was a peaceful death that I cannot overemphasize. It was the right decision to make. It was for his decision, but it was the right decision to make.  And I think if a physician would not have told us of that option, I would be in the same situation that you felt, Gregg, where the lady took it upon herself. Because you thought through it, you had a plan, it was planned. It was a nice wind up to an ending. And I think that physicians owe it to their patients to tell them all of the options available and let the patient make a choice. I also think physicians owe it to the patient to be clear what the end phase of their life will be. Because it's not roses. If they don't do this, they have to live through that end phase, which sometimes it's horrific. And I think they need to have a clear understanding of what's to come and a clean list of all the options. And I think that should just be required, and personal choice of a physician is not on the table.  Dr. Ferris: So it's important that we explain all the options, I completely agree, that are available within the context of the law. And certainly in the Americas, in Europe, and I've been in many other countries where palliative sedation is one of those therapeutic options. Where the patients can have amnesia, the family can be well looked after. We need to describe all the available options that are within the law, in the jurisdiction in which we live. I completely agree.  Dr. Blanke: And I'll add that that actually also applies to some of the patients who want death with dignity, are suffering horribly but don't actually qualify because they have a chronic illness expected to live too long. I just saw a patient last week and we actually talked about VCED, the voluntary cessation of eating and drinking, which is something that many, many people fear, including providers, but if done properly is fantastic. She used VCED. She passed away. She died two days later and her family could not have been more thankful.  Sandra Klima: I'll chime in on that because the comparison between my father dying and Rob dying, it really just has an impression on my mind. My father did not have a diagnosis of X amount of months to live, but my father had chronic problems and he was suffering. And the death that I watched him go through and was with him for, was nothing like Rob's death. It wasn't peaceful. It haunts me today. It haunts me. My father should have been a candidate, but he wasn't. What was the point of living four more months in this miserable state?  Dr. Thomas: You know, it dawns on me that this is a very different kind of death. It is not suicide legally or medically. It's a different process than natural death from a terminal illness. And it's not even possible in every state or every country. And I imagine it is very different for the people who are left behind, for family members and caregivers to process this kind of death and bereavement after their loved one passes. Can you comment, Sandra, on how medical aid in dying affects the caregivers and affects the family and how you can prepare for bereavement and support in bereavement?  Sandra Klima: I felt that this death was anticipated, and my bereavement, the part that bothered me about Rob's end of life, was that I was unprepared for how quickly the decision was made. The decision was made quickly because he started getting paralyzed again on the side of his body. And he decided, "Today's the day." And it was three or four hours later, and it took me by surprise at how quickly the decision was going to be made. That's the only part I regret was I didn't have a strong enough plan about what was going to happen when that decision was made. That probably needs to be emphasized because you can plan all you want when it's not going to happen. But at the moment it happens, it's like a fire drill. You got to go through and get all those things lined up. And I can tell you, I felt worse for my father's death than I did for Rob's death. So even though it's a different kind of death, it was a peaceful death with dignity.  Dr. Blanke: In terms of the bereavement, I have seen all sorts of responses from patients' families initially, from those who could not be more supportive. Sometimes they even seem to want it more than the patient does, to those who actively oppose it. But in my experience, which now numbers about 205, the families are almost always on board at the end when they see how much the patient has been suffering and how much peace the actual control over the patient's life and death gives them. I always offer after the patient is gone to the family to contact me whether it's a week later or a month later, or a year later, if they have questions about the process, if they need any help in referrals. It's never happened a single time.  Dr. VandeKieft: I think back to the landmark article that Tim Quill published in the early 1990s about his patient, Diane, and how he highlighted that she ended up committing suicide. And there's kind of a shame, it's done in the shadows, and that when you have aid in dying as an option that can be brought out into a planned open manner in the way that Ms Klima is describing with her partner. And then also with the bereavement and the partners, I think we need to listen once again. I just had a case yesterday that somebody was telling me of a gentleman who got the prescription for aid in dying, but ended up not taking it and died of "natural causes."  His wife told the bereavement counselor afterwards, “That was such a relief because I was struggling terribly with the spiritual aspects of this. And I would've really had a hard time had he gone through with it.” She had not shared that with her husband or anyone else because she wanted to be so supportive of him. And it was only by the bereavement counselor, listening and opening up that she could really understand, "What are the true struggles that this family is going through and how can I meet their needs?"  Dr. Ferris: If I can comment, it doesn't matter whether people have chosen medical aid in dying. When people die, there's a loss for anybody who's a survivor. People can be comfortable with the process that occurred or not. They can perceive suffering or not. The loss leads to changes. And what we know is the transitions through the loss period that we call bereavement for different people are profound in different ways. And what we need to make sure is that people are connected with services. It's why with every patient I care for, whatever therapy provided, I do participate in ventilator withdrawal. I participate in palliative sedation. I've done this all my career. I make sure they're in the hospice system, in the United States, which provides people with 13 months bereavement support or more, because if a death occurs in a hospital without hospice care, then the patient gets a decedent phone call from the chaplain, if they're lucky, or they're lucky enough to have a physician like Dr. Blanke who says call me.  Most people don't make themselves available and you're out at sea. And we know that the suffering of a bereavement can lead to incapacitance, people depressed, not functional, people even get illnesses in the process. So there's a huge cost to society for not addressing this issue carefully. It's about the preparation, and what I try to do is get the bereavement conversation going before the person dies, so that we're talking about it and integrating it.  Sandra Klima: Right, I agree.  Dr. Thomas: Thank you all so much for this conversation. Thank you, Sandra Klima and Dr. VandeKieft and Dr. Blanke and Dr. Ferris. I think this was such an important conversation. Talking about death can be very difficult and I just appreciate the openness and sensitivity and your willingness to share these experiences. Thank you to all of our listeners. We appreciate you tuning into this episode of ASCO Education podcast.    Thank you for listening to the ASCO Education podcast. To stay up to date with the latest episodes, please click subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive education center at education.asco.org.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization activity or therapy should not be construed as an ASCO endorsement. 

Carmen, Meghan and Stephanie were honored to have some time with Dr. Watson. Dr. Jean Watson is Distinguished Professor and Dean Emerita, University of Colorado College of Nursing Anschutz Medical Center, USA; founder of the original Center for Human Caring in Colorado; a Fellow of the American Academy of Nursing (FAAN); Founder and Director of non-profit organization, Watson Caring Science Institute; past President of the National League for Nursing; founding member of International Association in Human Caring and International Caritas Consortium; She held the nation's first endowed chair in Caring Science for 16 years; holds fifteen (15) Honorary Doctoral Degrees, including 12 International Honorary Doctorates; Her work is studied and implemented around the world. She is a widely published author and recipient of many awards and honors; authored and co-authored over 30 books on caring; In October, 2013, Dr. Watson was inducted as a Living Legend by the American Academy of Nursing, its highest honor.

The medical use of marijuana poses interesting issues, including its legal status: It's illegal at the Federal level and its legal in close to 40 of the States. We'll weed through the confusion in a conversation on Medical Cannabis. For more information on the advanced care planning or the Institute of Human Caring of Providence, visit: https://www.instituteforhumancaring.org/

Daniela Lamas, M.D., is a critical care physician at Brigham and Women's Hospital in Boston and a faculty member at the Harvard Medical School. She's also a frequent opinion writer for The New York Times. The paper published her piece, "When Faced With Death, People Often Change Their Minds," earlier this year.    "We need to shift the focus from talking to healthy people about what would happen should they stop breathing during a routine procedure, and toward improving conversations with people who are already seriously ill," Dr. Lamas wrote. Her op-ed piece comes on the heels of an essay the Journal of the American Medical Association published a few months earlier, "What's Wrong With Advance Care Planning?" by Drs. Sean Morrison, Diane Meier, and Robert Arnold, which argues that advance care planning has failed to accomplish its goals of aligning care and improving communication at the bedside. Joining Dr. Lamas in conversation is Ira Byock, M.D., a palliative physician, author, longtime advocate for advance care planning, and the founder of the Providence Institute for Human Caring, where this podcast is produced.  Dr. Byock holds that while there's dire need to redesign advance directives, providers should talk with patients about who they trust to speak for them and their general healthcare goals — optimally long before onset of a medical crisis. .  *******************.The podcast producers are interested in hearing from providers with questions or suggestions for an upcoming webinar on BEST PRACTICES FOR SOCIAL MEDIA USE FOR HEALTHCARE PROFESSIONALS. Have a story to share with us? Have suggestions? Write to us at HearMeNowStories@providence.org or leave a voicemail message on +1 424-212-5436. And thanks! 

Does advance care planning work? There's controversy swirling around the question, and we try to shed some light on it with two leading physicians with different views. For more information on the advanced care planning or the Institute of Human Caring of Providence, visit: https://www.instituteforhumancaring.org/

Trained as physician, Dr. Gonzales serves as chief medical information officer for the Institute for Human Caring at Providence. He began his career in biology and created software.

Two-plus years into a global pandemic, U.S. nursing is in a state of 911. Three nurse leaders unpack the economic, social and psychological impacts of demoralized nurses leaving the field en masse. For more information about the Providence Institute for Human Caring, visit here: https://www.instituteforhumancaring.org/

An episode we planned to be about addiction and holiday stress turned into an episode about connection, community, and compassion. Listen for great strategies for us all as 2022 dawns. For more information about the Providence Institute for Human Caring visit here: https://www.instituteforhumancaring.org/

Entering the third year of the COVID-19 pandemic, we talk with three people about their view of COVID: a physician leading clinical care for a large healthcare system, a reporter in Washington, D.C., covering national health policy, and a frontline doc in a hospital in Los Angeles County. For more information about the Providence Institute for Human Caring, visit here: https://www.instituteforhumancaring.org/

This week Celine is joined by Andy Goodman, the co-founder and director of The Goodman Center. Along with Storytelling as Best Practice, he is author of Why Bad Ads Happen to Good Causes and Why Bad Presentations Happen to Good Causes. He also publishes a monthly journal, free-range thinking, to share best practices in the field of public interest communications.Andy is internationally known for his speeches and workshops on storytelling and has led over 500 trainings for clients including CARE, The Nature Conservancy, Boys and Girls Clubs of America, NOAA, the San Diego Zoo, MIT, Princeton, the Bill and Melinda Gates Foundation, the Robert Wood Johnson Foundation, GE, Bank of America, and many others.He has designed communications curriculum for the College for Social Innovation in Boston as well as for the African Leadership University in Mauritius. When not teaching, traveling, or recovering from teaching and traveling, Andy serves on the advisory board of the Institute for Human Caring.Storytelling with a Purpose is a MemoryFox Production. Learn more about MemoryFox on their website: https://www.memoryfox.io/Want to be featured on a future episode or have a question for us? Email us at storytellingwithapurposepod@gmail.com.

.PERSONALIZING CARE IN A TRANSACTIONAL WORLDexcerpts from the online conference held 1 November 2021and sponsored by the Providence Institute for Human Caring.You can watch the videos of each online session here..CONFERENCE AGENDA.KEYNOTE: Three Keys to Personalizing Healthcare Dr. Ira Byock, Institute for Human Caring.Why Serious Illness is a Serious Health-Equity Issue Dr. Tammie Quest, EmoryDr. Glen Komatsu, TrinityCare HospiceDr. Karen Boudreau,  ProvidenceMichael Drummond, Institute for Human Caring.Medicine Meets Ministry - Engaging Faith Communities to Fill Unmet Needs Seán Collins, Hear Me Now PodcastRev. Cynthia Carter Perrilliat, Alameda County Care AllianceJeannie Blaustein, ReImagine End of LifeJohnny Cox, Alliance of Catholic Health Care.Let's Get Digital, Digital - Humanizing the EHR Sara Veazy, ProvidenceDr. Matt Gonzales, Institute for Human CaringGregory Makoul, PatientWisdomMike Drummond, Institute for Human Caring.From Scratch - Discovering the Healing Powers of Food, Family and Community Tembi Locke & Dr. Ira Byock.Whole Person Care in the ICU Dr. Wes Ely, VanderbiltDr. Daniela Lamas, Brigham and Women's HospitalLiga Mezaraups, Providence.Age-Friendly Works at Providence and Beyond Amy Berman, John  A. Hartford FoundationYazmin Hehdi, Patient RepresentativeDr. Carrie Rubenstein, Swedish Family MedicineMike Drummond, Institute for Human Caring.Closing RemarksDrs. Ira Byock and Matt Gonzales, Institute for Human Caring  

“This book is a love letter to any fellow humans who have felt like they were the underdogs for deeply caring about people and their wellbeing at work.” – MaryBeth Hyland, Permission to Be Human: A Conscious Leader's Guide to Creating a Values-Driven Culture Wellbeing at work Just as we go to a doctor if we break an arm, we should treat ourselves with the same level of respect when it comes to our mental, emotional, and spiritual wellbeing – even at work. While we might not think of spirituality at work, I put it in the domain of wisdom and purpose, vision or values – important guiding pillars for showing up as your best self. It all plays a role. This is the groundwork for my conversation with MaryBeth Hyland. She's the founder of SparkVision, a firm committed to creating environments where people thrive. Especially in the past year and a half, our mental health may have taken a hit – and it's important to recognize it's likely the same with those we interact with each day. From our discussion, you'll learn: - What's included in the term “wellbeing”? - How do you approach someone if you notice they're having difficulty with their mental health? - How do you address the fact you were hurt by someone who's in a tough place mentally? Invest in your relationships at work [10:43] “So much of it has to do with your relationship … It's a short- and long-term relationship that involves a lot of investments in each other to feel like it's coming from a place of caring and wanting to help people in their wellbeing instead of maybe wanting to call them out, or stigmatize, or make them feel like something's even more wrong.” [15:48] “The more you're willing to share of yourself, the more willing other people are to share.” Establishing boundaries [20:05] “There's a big misconception with boundaries that boundaries are about controlling other people. But boundaries are actually about creating an environment that's good for you, that's going to take care of your wellbeing.” Taking ownership for your part [24:30] “To truly be sorry, you have to be willing to sit with what the other person experienced and hold space for that just like they did for you, when you were on the other side of it.”   Connect with Mary Beth Hyland on LinkedIn: https://www.linkedin.com/in/marybethhyland/ Learn More about Spark Vision: https://www.sparkvisionnow.com/ Work Life with Adam Grant https://podcasts.apple.com/us/podcast/we-should-allow-sad-days-not-just-sick-days/id1346314086?i=1000530163973 Be Well Lead Well Pulse  www.bewellleadwellpulse.com WellBeing at Work, from Gallup: https://www.gallup.com/workplace/336935/wellbeing-at-work.aspx   To discuss executive coaching, leadership development program design, and workshop facilitation, please visit: https://rise-leaders.com/contact-info/

Trained as an emergency physician, Dr. Byock has been involved with hospice and palliative care since the 1970s. He is a past president of the American Academy of Hospice and Palliative Medicine He led the Robert Wood Johnson Foundation Promoting Excellence in End of Life Care program and the Missoula Demonstration Project. He directs the Center for Human Caring. and served as director for Promoting Excellence in End-of-Life Care, a national grant program of the Robert Wood Johnson Foundation.

.PART ONEPERSONALIZING CARE IN A TRANSACTIONAL WORLD.Dr. Wes Ely is the author of the new book, Every Deep-Drawn Breath:  A Critical Care Doctor on Healing, Recovery, and Transforming Medicine in the ICU. He's also one of the participants in the upcoming online conference Personalizing Care in a Transactional World, presented by the Providence Institute for Human Caring. The conference is being held Monday, Nov. 1, from 8a-Noon PDT. Registration is now open. Dr. Matt Gonzales, Chief Medical Information Officer for the Institute, talks with host Seán Collins about some of the topics featured during the conference..Matthew Gonzales, M.D., FAAHPM,Palliative Care PhysicianAssociate Vice PresidentChief Medical Information OfficerProvidence Institute for Human CaringGardena, Calif...PART TWOEVERY DEEP-DRAWN BREATH.A conversation with Dr. Wes Ely about his new book. Wes Ely, M.D., MPHPulmonologist and Critical Care PhysicianProfessor of MedicineVanderbilt University School of MedicineNashville, Tenn.author: Every Deep-Drawn Breath: A Critical Care Doctor on Healing, Recovery, and Transforming Medicine in the ICU.Proceeds from sales of the book will benefit the Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center established to help ICU survivors and their families. Visit Dr. Ely's website: www.icudelirium.org for updates on the work at CIBS.. 

In this episode, Greg and Carey discuss what got Carey interested in learning about and utilizing cannabis therapeutically in her own practice and creating an entire program around it. They talk about the human endocannabinoid system and its effects on our health, including ways of modulating the endocannabinoid system without using cannabis. They talk about Carey's presentation on Cannabis Care 101 at the upcoming Pacific Symposium this Fall. You will hear Carey's thoughts on the recreational use and what the literature say about safety, long term effects, and age-related issues, for example, teen use. Finally, we learn about the Pacific College medical cannabis certificate program. - For more information about Pacific College's Medical Cannabis Certification Program visit https://www.pacificcollege.edu/medicalcannabis - Dr Carey Clark will also be speaking at the 2021 Pacific Symposium. Information and registration https://www.pacificcollege.edu/symposium/ About Carey Clark Carey S. Clark, PhD, RN, AHN-BC, FAAN, serves as Director of Nursing, chair of the Medical Cannabis Certificate Program, and faculty in the Medical Cannabis and Holistic Nursing programs. She is the immediate Past President of the American Cannabis Nurses Association, and has been a nurse since 1994, with a wide practice background including experience within the acute care setting, pediatrics, hospice care, and parish nursing. Her previous position was at the University of Maine at Augusta, where she developed an award winning holistic-integral nursing program for RN-BSN students. Dr. Clark has over 30 publications in journals such as Advances in Nursing Science, International Journal for Human Caring, Holistic Nursing Practice, and Creative Nursing. Dr. Clark has presented at many national and local conferences, particularly with oncology and holistic nurses, where she focuses on bringing basic knowledge about the endocannabinoid system and medicinal use of cannabis. She remains committed to including the endocannabinoid system in every nursing curriculum in the world, as she is the editor of the forthcoming Wolters-Kuhlwer Cannabis Handbook for Nurses (2020). Dr. Clark looks forward to sharing her knowledge with other like-minded nurses as we create change in healthcare systems and support the holistic healing of those we serve.

In this episode, Dr. John Nelson welcomes his colleague, Dr. Zane Wolf, Dean Emerita and Professor at La Salle University. Dr. Wolf was recently recognized in Stanford's ranking of worldwide academics as in the top 2% of over 7 million scientists around the world. Her work in caring science includes creating the Caring Behaviors Inventory and serving as the Editor in Chief of the International Journal for Human Caring. Zane and John discuss the importance of measuring frameworks of care, as well as other concerns related to caring, such as staff well-being and patient safety. They reveal the value of qualitative and quantitative data to understand the context of care, and how theory and research and predictive analytics are critical to improving patient experience, nurse engagement, and achieving the quadruple aim. You will enjoy this lively discussion between two passionate colleagues whose lifework has advanced the science of caring.

We explore the poetry of medicine by offering two conversations. In the first, Dr. Ira Byock talks with Dr. Patrick Clary about his poetry, why he writes it, how he uses it, and why it matters."I don't see it as a medical practice so much as a humane practice for us as we do medicine; to maintain our way of looking at our patients as people."    —Dr. Patrick Clary in conversation with Dr. Ira Byock..Then host Seán Collins talks with palliative care clinician Redwing Keysaar about the poetry workshops she's been hosting online during the pandemic. What began as a way for people to process their grief has become a way to get in touch with un-tapped creativity and strengths."We forget so many of the healing modalities that are with us all the time and that have been part of the various cultures that many of us come from. Dr. Rachel Remen says, "We may have lost faith in our ability to write poems just as we have lost faith in our ability to heal. Recovering the poet strengthens the healer and sets free the unique song that's at the heart of each life."   —Redwing Keysaar, RN in conversation with Seán Collins..Patrick L Clary, M.D.  has long used poetry as a tool in his effort to understand, practice, and teach medicine. His work has appeared in anthologies and in two collections, Notes for a Loveletter and Dying for Beginners. A conscientious objector on the basis of Quaker beliefs, he served as a medic with US Infantry Units in Vietnam 1969-70. He is past President of the New Hampshire Hospice and Palliative Care Organization and remains clinically active in end-of-life care as medical director of a community hospice house...Ira Byock, M.D., FAAHPM, is a leading medical authority and public advocate for improving care through the end of life. He is founder and serves as chief medical officer of the Providence Institute for Human Caring. The Institute drives transformation in clinical systems and culture to make caring for whole persons the new normal. The Institute for Human Caring's change strategies produce measurable and scalable improvements in healthcare quality and efficiency. Dr. Byock's books include The Best Care Possible  and The Four Things That Matter Most...Redwing Keysaar, RN is a palliative care clinician, author, poet, educator, national presenter, and frequent contributor to the public conversation about palliative and end-of-life care. Redwing is currently the director of Patient and Caregiver Education at the MERI Center for Education in Palliative Care (Making Education Relevant and Integrated) for Primary Palliative Care Education  at the Mt. Zion Campus of the University of California, San Francisco. She is the author of The Last Acts of Kindness. 

Host: Kate MacKay Producer: Madeline Goldberger Guest: Mercer Gary Transcript: Provided by Otter.ai Project: Gary, M. E. (2021). Care Robots, Crises of Capitalism, and the Limits of Human Caring. International Journal of Feminist Approaches to Bioethics, 14(1), 19–48. https://doi.org/10.3138/ijfab-2020-07-28 Music: 'The City Sleeps' by Death By Ginger

Karen White-Trevino explores how evidence-based, caring micro-practices can be integrated into the daily workflow of RNs working in the acute care setting. Caring micro-practices are actionable activities that operationalize the ethic of caring.

This podcast was recorded on 1/11/2021Ali Santore and Julie Rovner join us for a conversation about the opportunities and challenges members of the new Biden administration face as they work to mend the nation, deal with the nation's response to a deadly pandemic, and advance access to care for underserved populations in what is now a four trillion-dollar healthcare business in America. Nominally, the Democrats have an advantage in Congress, but it's only with a razor-thin margin in the Senate that will necessitate cooperation across both the aisle and within the party itself. That suggests we'll see a return to more deliberative processes on Capitol Hill and less drama.Confused by the difference between a Public Option and Medicare for All? Julie Rovner wrote in detail about these and other issues leading up to the 2020 election. Read her piece here. And be sure to check out this video that sorts through some of the political rhetoric. Executive Orders have become a common way for Presidents to accomplish short-term goals, but they can be undone with a stroke of the next guy's pen. Julie writes about the Great Undoing that's likely to be high on the Biden agenda.For the latest healthcare policy news, follow Julie on Twitter.  And check out her other stories at the Kaiser Health News website.  And be sure to  listen to What the Health?  (our second-favorite podcast!)Stay up-to-date on Ali Santore's advocacy work for Providence on the Community Partnership website.  Ali also contributes to the Providence leadership blog.  Julie Rovner is Chief Washington Correspondent for Kaiser Health News and host of the all-women panelist podcast, “What the Health?” Prior to joining KHN in 2014, she spent 15 years as health policy correspondent for NPR, specializing in the politics of health care. A noted expert on health policy issues, Rovner is the author of a critically-praised reference book Health Care Politics and Policy A-Z.Ali Santore is senior vice president of government affairs and social responsibility for Providence. Her national advocacy and engagement strategies have advanced federal priorities that preserve and expand access to care for the underserved, positioning Providence as a leading advocate for mental health, advance care planning, and strengthening the Medicaid program. Ali also oversees Providence's social responsibility programs, including the organization's initiative to become carbon-negative by 2030.Seán Collins is the host and a producer of the Hear Me Now Podcast, a production of the Providence Institute for Human Caring. He is a veteran public radio producer, having spent more than 20 years at NPR News where he led a team that produced the network's flagship newsmagazine, All Things Considered. Collins is a former Benedictine monk.

 MERRY CHRISTMAS!The Rev. Denise Hess of the Supportive Care Coalition  (now part of the Catholic Health Association) joins host Seán Collins in a reflection on the Christian doctrine of the Incarnation and the ways it has inspired centuries of healthcare. They talk about the example of Jesus-as-healer, the crucial role women have served in promoting healthcare ministries, and the place suffering plays in our understanding of caring for the whole person.They are accompanied throughout the hour by three musicians who perform original arrangements of traditional carols: Gabe Miller, violin and arranger; Elijah Cole, guitar; and Nathan Pence, bass.  "Good is the Flesh"by Brian Wren Good is the flesh that the Word has become,    good is the birthing, the milk in the breast,    good is the feeding, caressing and rest,    good is the body for knowing the world,Good is the flesh that the Word has become. Good is the body for knowing the world,    sensing the sunlight, the tug of the ground,    feeling, perceiving, within and around,    good is the body, from cradle to grave,Good is the flesh that the Word has become. Good is the body, from cradle to grave,    growing and aging, arousing, impaired,    happy in clothing, or lovingly bared,    good is the pleasure of God in our flesh,Good is the flesh that the Word has become. Good is the pleasure of God in our flesh,    longing in all, as in Jesus, to dwell,    glad of embracing, and tasting, and smell,    good is the body, for good and for God,Good is the flesh that the Word has become.  Samaritanus bonus (excerpt)by Pope Francis "At work here is a contemplative gaze that beholds in one's own existence and that of others a unique and unrepeatable wonder, received and welcomed as a gift. This is the gaze of the one who does not pretend to take possession of the reality of life but welcomes it as it is, with its difficulties and sufferings, and, guided by faith, finds in illness the readiness to abandon oneself to the Lord of life who is manifest therein."  "A Blessing for the New Baby"by Luci Shaw Lightly as a falling star, immense, may youdrop into the body of the pure young girl like a seedinto its furrow, entering your narrow home under the shadowof Gabriel's feathers. May your flesh shape itself within her,swelling her with shame and glory. May her belly growround as a small planet, a bowl of golden fruit. When you suck in your first breath, and your loud criesecho through the cave (blessings on you, little howler!),may Mary adorn you with tears and caresses like ribbons,her face glowing, a moon among stars. At her breasts,may you drink the milk of mortality that transforms you,even more, into one of your own creatures. And now, as the night of this world folds you inits brutal frost (the barnyard smell strong as sin),and as Joseph, weary with unwelcome and relief, his handsbloody from your birth, spreads his thin cloakaround you both, we doubly bless you, Baby,as you are acquainted, for the first time, with our grief.  "Journey of the Magi"by T.S. Eliot “A cold coming we had of it,Just the worst time of the yearFor a journey, and such a long journey:The ways deep and the weather sharp,The very dead of winter.”And the camels galled, sore-footed, refractory,Lying down in the melting snow.There were times we regrettedThe summer palaces on slopes, the terraces,And the silken girls bringing sherbet.Then the camel men cursing and grumblingAnd running away, and wanting their liquor and women,And the night-fires going out, and the lack of shelters,And the cities hostile and the towns unfriendlyAnd the villages dirty and charging high prices:A hard time we had of it.At the end we preferred to travel all night,Sleeping in snatches,With the voices singing in our ears, sayingThat this was all folly. Then at dawn we came down to a temperate valley,Wet, below the snow line, smelling of vegetation;With a running stream and a water-mill beating the darkness,And three trees on the low sky,And an old white horse galloped away in the meadow.Then we came to a tavern with vine-leaves over the lintel,Six hands at an open door dicing for pieces of silver,And feet kicking the empty wine-skins.But there was no information, and so we continuedAnd arrived at evening, not a moment too soonFinding the place; it was (you may say) satisfactory. All this was a long time ago, I remember,And I would do it again, but set downThis set downThis: were we led all that way forBirth or Death? There was a Birth, certainly,We had evidence and no doubt. I had seen birth and death,But had thought they were different; this Birth wasHard and bitter agony for us, like Death, our death.We returned to our places, these Kingdoms,But no longer at ease here, in the old dispensation,With an alien people clutching their gods.I should be glad of another death.   Rev. Denise Hess, MDiv, BCC-PCHACSupportive Care Coalition Catholic Health Association of the United States for further reading:Incarnate Grace: Perspectives on the Ministry of Catholic Health Careed. Fr. Charles Bouchard, OP, STD Listen to the playlist from today's episode on SoundCloud.    Seán Collins is the host and a producer of the Hear Me Now Podcast, a production of the Providence Institute for Human Caring. He is a veteran public radio producer, having spent more than 20 years at NPR where he led a team that produced the network's flagship newsmagazine, All Things Considered. Collins is a former Benedictine monk. Contact us at HumanCaring@providence.org

Dr. Ira Byock, Founder and Chief Medical Officer of the Providence Institute for Human Caring, discusses a new vision for advance care planning that simply asks individuals to name a trusted decision- maker to speak for them in the event they're not able to speak for themselves. This choice is then entered into the electronic health record by a care provider. Joining Dr. Byock are Edo Banach, President and CEO of the National Hospice & Palliative Care Organization, and Nathan Kottkamp, founder of the National Healthcare decisions Day.

COVID-19 has changed the way we live and the way we die. The pandemic has changed interactions at the bedside, our rituals of mourning, and how we process loss. Hear Me Now Podcast presents “Grief in the time of COVID,” featuring Dr. Ira Byock, founder and chief medical officer at Providence's Institute for Human Caring, and Rev. Denise Hess, executive director of the Supportive Care Coalition.

If you or someone you know is struggling with depression or other mental health issues and would like to seek help, please check out the Work@BeWell website for a list of qualified organizations. Send us an email and share your COVID Winter strategies with us to help us plan our next episode.  Read Dr. Ira Byock's article Heroism and Hypocrisy: Seeing Our Reflection with 2020 Vision in The Journal of Palliative Medicine.   GuestsRobin Henderson, Psy. D. is a clinical psychologist in Portland, OR, and the Chief Executive for Behavioral Health for Providence Oregon and the Clinical Liaison to the Well Being Trust.Ira Byock, M.D., is a leading palliative care physician and the Founder and Chief Medical Officer of the Providence Institute for Human Caring in Gardena, CA.  About UsAt the Institute for Human Caring, we believe that whole-person care is essential to helping patients, families, and caregivers experience the best care possible. This requires attending to the body, mind, and spirit.  Learn more about our Hear Me Now storytelling and listing initiative. Contact us at HumanCaring@providence.org

About UsAt the Institute for Human Caring, we believe that whole person care is essential to helping patients, families, and caregivers experience the best care possible. This requires attending to the body, mind and spirit.  To learn more about whole person care and the Institute for Human Caring go to: instituteforhumancaring.orgTo learn more about the Hear Me Now storytelling and listing initiative please go to: https://www.instituteforhumancaring.org/Hear-Me-Now.aspx 

About UsAt the Institute for Human Caring, we believe that whole person care is essential to helping patients, families, and caregivers experience the best care possible. This requires attending to the body, mind and spirit.  To learn more about whole person care and the Institute for Human Caring go to: instituteforhumancaring.orgTo learn more about the Hear Me Now storytelling and listing initiative please go to: https://www.instituteforhumancaring.org/Hear-Me-Now.aspx

For additional information about the Transgender educational programs by Erika Laurentz or Bennett Pendleton please reach out to them directly at:Erika Laurentz: Erika.anne.Laurentz@gmail.com or Erika.Laurentz@providence.orgBennett Pendleton: Bennett.Pendleton@gmail.com About UsAt the Institute for Human Caring, we believe that whole person care is essential to helping patients, families, and caregivers experience the best care possible. This requires attending to the body, mind and spirit.  To learn more about whole person care and the Institute for Human Caring go to: instituteforhumancaring.orgTo learn more about the Hear Me Now storytelling and listing initiative please go to: https://www.instituteforhumancaring.org/Hear-Me-Now.aspx

About UsAt the Institute for Human Caring, we believe that whole person care is essential to helping patients, families, and caregivers experience the best care possible. This requires attending to the body, mind and spirit.  To learn more about whole person care and the Institute for Human Caring go to: instituteforhumancaring.orgTo learn more about the Hear Me Now storytelling and listing initiative please go to: https://www.instituteforhumancaring.org/Hear-Me-Now.aspx

About UsAt the Institute for Human Caring, we believe that whole person care is essential to helping patients, families, and caregivers experience the best care possible. This requires attending to the body, mind and spirit.  To learn more about whole person care and the Institute for Human Caring go to: instituteforhumancaring.orgTo learn more about the Hear Me Now storytelling and listing initiative please go to: https://www.instituteforhumancaring.org/Hear-Me-Now.aspx Contact us at HumanCaring@providence.org

To continue this new series, Edo sits down with Ira Byock, MD, FAAHPM, Founder and Chief Medical Officer of the Institute for Human Caring. They discuss why service in leadership is so important and qualities to look for in new hires. Hear their thoughts on why historically hospice hasn't always gotten an equal seat at the table.

#009 - Join host Dr. Red Hoffman as she interviews Dr. Ira Byock, nationally known author and speaker and the founder and chief medical officer of the Institute for Human Caring at Providence St. Joseph in Southern California.  Ira served as the president of the American Association of Hospice and Palliative Medicine as well as the Director of the Robert Wood Johnson Foundation's Promoting Excellence in End of Life Care, under which the Surgeons Palliative Care task force (now the Committee on Surgical Palliative Care) was created within the American College of Surgeons.  For those interested in the history of surgical palliative care, Ira is also known as the man who introduced surgeons Dr. Robert Milch to Dr. Geoffrey Dunn (both men went on to become leaders in the field of surgical palliative care).  Ira shares that seeing how poorly patients at the end of life were treated in his training hospital led him to develop a hospice program while still a resident physician.  He discusses that illness is fundamentally a personal issue (rather than a medical issue) and that by acknowledging this, surgeons can do their part in making certain that patients get the best care possible.  He is thoughtful, inspiring, generous with both his time and his experience, and a pure joy to talk to!Learn more about Ira here.Ira's books include:The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life Dying Well: Peace and Possibilities at the End of LifeThe Four Things that Matter MostLearn more about the Surgeons Palliative Care Workgroup here (includes PDFs of over two dozen articles written about surgical palliative care and published in the Journal of the American College of Surgeons.)To learn more about the surgical palliative care community, visit us on twitter @surgpallcare

Join us today as we speak with Dr. Ira Byock, CMO for the Institute for Human Caring at Providence St. Joseph Health, about care advocacy innovation.