Podcasts about palliative

If your parent has cancer, dementia, serious illness, or is just declining because they're getting older, you may feel the urge to help them as they get weaker. Perhaps you make space in your busy life, juggle responsibilities with both your parents and your kids, research the best care, and just try your best to show up for your parents. When you do all that it can be shocking and frustrating if your parents rebuff your efforts to help.This week on The Integrative Palliative Podcast I share 20 things that you can do if your parents won't accept your help.Thanks for all that you do!Dr. DeliaDelia Chiaramonte, MDwww.integrativepalliative.comCoping Courageously: A Heart-Centered Guide for Navigating a Loved One's Illness Without Losing Yourself is available here: www.copingcourageously.com Please review this podcast wherever you listen and forward your favorite episode to a friend! And be sure to subscribe!Sign up to stay connected and learn about upcoming programs:https://trainings.integrativepalliative.com/IPI-stay-in-touchI'm thrilled to be listed in Feedspot's top 15 palliative podcasts!https://blog.feedspot.com/palliative_care_podcasts/

Dr. Joseph McCollom and Dr. Ramy Sedhom discuss precision palliative care, a new strategy that aims to align palliative care delivery with patient and caregiver needs instead of diagnosis alone. TRANSCRIPT ADN Podcast Episode 8-22 Transcript: What Is Precision Palliative Care? Rethinking a Care Delivery Problem Dr. Joseph McCollom: Hello and welcome to the ASCO Daily News Podcast. I'm your guest host, Dr. Joseph McCollom. I'm a GI medical oncologist and palliative oncologist at the Parkview Packnett Family Cancer Institute here in Fort Wayne, Indiana. So, the early benefits of palliative care for patients with cancer have been well documented, but there are challenges in terms of bandwidth to how do we provide this care, given the workforce shortages in the oncology field. So today, we'll be exploring a new opportunity known as precision palliative care, a strategy that aims to align care delivery with patient and caregiver needs and not just diagnosis alone. Joining me for this discussion is Dr. Ramy Sedhom. He is the medical director of oncology and palliative care at Penn Medicine Princeton Health and a clinical assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine. Our full disclosures are available in the transcript of this episode.  Dr. Sedhom, it's great to have you on the podcast today. Thank you so much for being here. Dr. Ramy Sedhom: Thank you, Joe. It's a pleasure to be here and lucky me to be in conversation with a colleague and friend. Yes, many of us have heard about the benefits of early palliative care. Trials have shown better quality of life, reduced symptoms, and potentially even improved survival. But as we know, the reality is translating that evidence into practice, which is really, really challenging. So Joe, both you and I know that not every patient can see palliative care, or I'd even argue should see palliative care, but that also means there are still many people with real needs who still fall through the cracks. That's why I'm really excited about today's topic, which we'll be discussing, which is precision palliative care. It's a growing shift in mindset from what's this patient's diagnosis or what's this patient's prognosis, to what matters most for this person in front of me right now and what are their individual care needs. I think, Joe, it's very exciting because the field is moving from a blanket approach to one tailored to meet people where they actually are. Dr. Joseph McCollom: Absolutely, Ramy. And I think from the early days when palliative care was kind of being introduced and trying to distinguish itself, I think one of the first models that came to clinicians' eyes was Jennifer Temel's paper in The New England Journal of Medicine in 2010. And her colleagues had really looked at early palliative care integration for patients with advanced non–small cell lung cancer. And in that era – this is a pre-immunotherapy era, very early targeted therapy era – the overall prognosis for those patients are similar to the population I serve as a GI medical oncologist, pancreatic cancer today. Typically, median overall survival of a year or less. And so, a lot of her colleagues really wanted her to track overall survival alongside quality of life and depression scores as a result of that. And it really was a landmark publication because not only did it show an improvement of quality of life, but it actually showed an improvement of overall survival. And that was really, I think, revolutionary at the time. You know, a lot of folks had talked about if this was a drug, the FDA would approve it. We all in GI oncology laugh about erlotinib, which got an FDA approval for a 2-week overall survival advantage. And so, it really kind of set the stage for a lot of us in early career who had a passion in the integration of palliative care and oncology. And I think a lot of the subsequent ASCO, NCCN, COC, Commission on Cancer, guidelines followed through with that. But I think what we realized is now we're kind of sitting center stage, there's still a lot of resource issues that if we sent a referral to palliative care for every single patient diagnosed with even an advanced cancer, we would have a significant workforce shortage issue. And so, Ramy, I was wondering if you could talk a little bit about how do we help center in on who are the right patients that are going to have the greatest benefit from a palliative care specialist intervention? Dr. Ramy Sedhom: Thanks, Joe. Great question. So you mentioned Dr. Temel's landmark 2010 trial published in the New England Journal of Medicine. And it is still a game changer in our field. The results of her work showed not only improved quality of life and mood, but I think very surprisingly at the time, a survival benefit for patients with lung cancer who had received early palliative care. That work, of course, has helped shape national guidelines, as you've shared, and it also helped define early, as within 8 weeks of diagnosis. But unfortunately, there remains a disconnect. So in clinical practice, using diagnosis or stage as the only referral trigger doesn't really match the needs that we see show up. And I think unfortunately, the other part is that approach creates a supply demand mismatch. We end up either referring more patients than palliative care teams can handle, or at the opposite extreme, we end up referring no one at all. So, I actually just wanted to quickly give, for example, two real world contrasts. So one center that I actually have friends who work in, tried as a very good quality improvement incentive, auto-refer all patients with stage IV pancreas cancer to palliative care teams. And while very well intentioned, they saw very quickly that in a two-month period, they had 30 new referrals. And on the palliative care side, there were only 15 available new patient slots. On the other hand, something that I often see in practice, is a situation where, for example, consider the case of a 90-year-old with a low-grade B-cell lymphoma. On paper, low-risk disease, but unfortunately, when you look under the microscope, this gentleman is isolated, has symptoms from his bulky adenopathy, and feels very overwhelmed by many competing illnesses. This is someone who, of course, may benefit from palliative care, but probably doesn't check the box. And I think this is where the model of precision palliative care steps in. It's not really about when was someone diagnosed or what is the prognosis or time-based criteria of their cancer, but it's really fundamentally asking the question of who needs help, what kind of help do they need, and how urgently do we need to provide this help? And I think precision palliative care really mirrors the logic and the philosophy of precision oncology. So just like we've made strides trying to match therapies to tumor biology, we also need to have the same attention and the same precision to match support to symptoms, to context of a patient situation and their caregiver, and also to their personal goals. So I think instead of a blanket referral, we really need to tailor care, the right support at the right moment for the right person to the right care teams. And I think to be more precise, there's really four core elements to allow us to do this well. So first, we really need to implement systematic screening. Let's use what we already have. Many of our centers have patient reported outcomes. The Commission on Cancer motivates us to use distress screening tools. And the EHR is there, but we do very little to flag and to surface unmet care needs. We have seen amazing work from people like Dr. Ethan Bash, who is the pioneer on patient-reported outcomes, and Dr. Ravi Parikh, who used to be my colleague at Penn, now at Emory, who show that you could use structured data and machine learning to identify some of these patient needs in real time. The second piece is after a systematic screening, we really need to build very clear referral pathways. One very good example is what the supportive care team at MD Anderson has done, of course, led by Dr. Eduardo Brera and Dr. David Huey, where they have, for example, designed condition-specific triggers. Urgent referrals, for example, to palliative care for severe symptoms, where they talk about it like a rapid response team. They will see them within 72 hours of the flag. But at the same time, if the unmet need is a caregiver distress, perhaps the social work referral is the first part of the palliative care intervention that needs to be placed. And I think this helps create both clarity and consistency but also it pays attention to that provider and availability demand mismatch. Third, I really think we need to triage smartly. As mentioned in the prior example, not every patient needs every team member of the palliative care team. Some benefit most from the behavioral health intervention. Others might benefit from chaplaincy or the clinician for symptom management. And I think aligning intensity with complexity helps us use our teams wisely. Unfortunately, the greatest barrier in all of our health care systems is time and time availability. And I think this is one strategic approach that I have not yet seen used very wisely. And fourth, I really think we need to embrace interdisciplinary care and change our healthcare systems to focus more on value. So this isn't about more consults or RVUs. I think it's really about leveraging our team strengths. Palliative care teams or supportive care teams usually are multidisciplinary in their core. They often have psychologists, social workers, sometimes they have nurse navigators. And I think all of these are really part of that engine of whole person care. But unfortunately, we still are not set up in care delivery systems that unfortunately to this day still model fee for service where the clinician or the physician visit is the only quote unquote real value add. Hopefully as our healthcare systems focus more on delivery and on value, this might help really embrace the structure to bring through the precision palliative care approach. Dr. Joseph McCollom: No, I love those points. You know, we talk frequently in the interdisciplinary team about how a social worker can spend 5 minutes doing something that I could not as a physician spend an hour doing. But does every patient need every member every time? And how do we work as a unified body to deliver that dose of palliative care, specialized palliative care to those right patients and match them? And I think that perfect analogy is in oncology as a medical oncologist, frequently I'm running complex next-generation sequencing paneling on patients' tumors, trying to find out is there a genetic weakness? Is there a susceptibility to a targeted therapy or an immunotherapy so that I can match and do that precision oncology, right patient to the right drug? Similarly, we need to continue to analyze and find these innovative ways like you've talked about, PROs, EHR flags, machine learning tools, to find those right patients and match them to the right palliative care interdisciplinary team members for them. I know we both get to work in oncology spaces and palliative and supportive spaces in our clinical practice. Share a little bit, if you could, Ramy, about what that looks like for your practice. How do you find those right patients? And how do you then intervene with that right palliative oncology dose? Dr. Ramy Sedhom: So Joe, when I first started in this space as a junior faculty, one thing became immediately clear. I think if we rely solely on physicians to identify the patients for palliative care, we're unfortunately going to be very limited by what we individually, personally observe. And I think that's what reflects the reality that many patients have real needs that go unseen. So over the past few years, I've really worked with a lot of my colleagues to really work the health system to change that. The greatest partnership I've personally had has been working with our informatics team to build a real time EHR integrated dashboard that I think helps us give us a broader view of patient needs. What we really think of as the population health perspective. Our dashboard at Penn, for example, pulls in structured data like geriatric assessment results, PHQ-4 screens, patient reported outcomes, whether or not they've been hospitalized, whether or not these hospitalizations are frequent and recurrent. And I think it's allowed us to really move from a reactive approach to one that's more proactive. So let me give you a practical example. So we have embedded in our cancer care team, psycho-oncologists. They share the same clinic space, they're right down the hall. And we actually use this shared dashboard to review weekly trends in distress scores and patient reported outcomes. And oftentimes, if they see a spike in anxiety or worsening symptoms like depression, they'll reach out to me and say, “Hey, I noticed Mrs. Smith reported feeling very anxious today. Do you think it'd be helpful if I joined you for her visit?” And I think that's how we could really use data and teamwork to offer and maximize the right support at the right time. Like many of our other healthcare systems, we also have real-time alerts for hospitalizations. And I think like Dr. Temel's most recent trial, which we'll discuss at some point, I'm sure, it's another key trigger for vulnerability. I think whenever someone's admitted or discharged, we try to coordinate with our palliative care colleagues to assess do they need follow-up and in what timeline. And we know that these are common triggers, progression of disease, hospitalizations, drops in quality-of-life. And it's actually surprisingly simple to implement once you set up the right care structures. And I think these systems don't just help patients, which is what I quickly learned. They also help us as clinicians too. Before we expanded our team, I often felt this weight, especially as someone dual trained in oncology and palliative medicine, as trying to be everything to everyone. I remember one patient in particular, a young woman with metastatic breast cancer who was scheduled for a routine pre-chemo visit with me. Unfortunately, on that day, she had a very dramatic change in function. We whisked her down to x-ray and it revealed a pretty large pathologic fracture in her femur. And suddenly what was scheduled as a 30-minute visit became a very complex conversation around prognosis, urgent need for surgery and many, many life changes. And when I looked at my Epic list, I had a full waiting room. And thankfully, because we have embedded palliative care in our team, I was able to bring in Dr. Collins, the physician who I work with closely, immediately. She spent the full hour with the patient while I was able to continue seeing other patients that morning. And I think that's what team-based care makes possible. It's not just more hands on deck but really optimizing the support the patient needs on each individual day. And I think last, we're also learning a lot from behavioral science. So many institutions like Penn, Stanford, Massachusetts General, they've experimented with a lot of really interesting prompts in the EHR. One of them, for example, is the concept of nodes or the concept of prompt questions. Like, do you think this patient would benefit from a supportive care referral? And I think these low-level nudges, in a sense, can actually really dramatically increase the uptake of palliative care because it makes what's relevant immediately salient and visible to the practicing physician. So I think the key, if I had to maybe finish off with a simple message: It's not flashy tech, it's not massive change against staffing, but it's having a local champion and it's working smarter. It's asking the questions of how can we do this better and setting up the systems to make them more sustainable. Dr. Joseph McCollom: I appreciate you talking about this because I think a lot of folks want to put the wheels on in some way and they don't know where to get started. And so I think some of the models that you've been able to create, being able to track patients, screen your population, find the right individuals, and then work within that team to be able to extend, I think when you have an embedded palliative care specialist in your clinic, they expand your practice as a medical oncologist. And so you can make that warm handoff. And that patient and that caregiver, when they view the experience, they don't view you as a medical oncologist, someone else as a palliative care specialist, they view that team approach. And they said, "The team, my cancer team took care of me." And I think we can really harness a lot of the innovative technological advancements in our EHR to be able to prompt us in this work. I know that Dr. Temel had kind of set the stage for early palliative care intervention, and you did mention her stepped palliative care trial. Where do you see some of the future opportunities as we continue to push the needle forward as oncologists and palliative care specialists? What do you see as being the next step? Dr. Ramy Sedhom: So for those who are not familiar with the stepped palliative care trial, again, work by Dr. Temel, I think it's really important to explain not just the study itself, but I think more importantly, what it's representing for the future of our field. First, I really want to acknowledge Dr. Temel, who is a trailblazer in palliative oncology. Her work has not only shaped how we think about timing and delivery, but really about the value of supportive care. And more importantly, I think for all the young trainees listening, she had shown that rigorous randomized trials in palliative care are possible and meaningful. And I think for me, one quick learning point is that you could be an oncologist and lead this impactful research. And she's inspired many and many of us. Now let's quickly transition to her study. So in this trial, the stepped palliative care trial, patients with advanced lung cancer were randomized into two groups. One group followed the model from her landmark 2010 New England Journal of Medicine paper, which was structured monthly palliative care visits, again, within eight weeks of diagnosis. The second group, which is in this study, the intervention or the stepped palliative care group, received a single early palliative care visit. Think of this as a meet and greet. And then care was actually stepped up. If one of three clinical triggers happened. One, a decline in patient reported quality of life as measured by PROs. Two, disease progression, or three, hospitalization. And the findings which were presented at ASCO 2024 were striking. Clinical outcomes, very similar between the two groups. And this included quality-of-life, end-of-life communication, and resource use. But I think the take-home point is that the number of palliative care visits in the stepped group was significantly lower. So in other words, same impact and fewer visits. This was a very elegant example of how we can model precision palliative care, right sizing patient care based on patient need. So where do we go from here? I think if we want this model to take root nationally, we really need to pull on three key levers: healthcare systems, healthcare payment, and healthcare culture. So from a system alignment, unfortunately, as mentioned too often, the solution to gaps in palliative care is we need more clinicians. And while yes, that's partly true, it's actually not the full picture. I think what we first need to do and what's more likely to be achieved is to develop systems that focus on building the infrastructure that maximizes the reach of our existing care teams. So this means investing in nurse navigation, real-time dashboards with patient-reported outcomes and EHR flags, and again, matching triage protocols where intensity matches complexity. And the goal, as mentioned, isn't to maximize consults, but to really maximize deployment of expertise based on need. The second piece is, of course, we need payment reform. So the stepped palliative care model only works when it allows continuous patient engagement. But unfortunately, current pay models don't reward or incentivize that. In fact, electronic PROs require a very high upfront financial investment and ongoing clinician time with little to no reimbursement. Imagine if we offered bundled payments or value-based incentives for teams that integrated PROs. Or imagine if we reimbursed palliative care based on impact or infrastructure instead of just fee-for-service volume. There is a lot of clear evidence that tele-palliative care is effective. In fact, it was the Plenary at ASCO 2024. Yet we're still battling these conversations around inconsistent reimbursement, and we're always waiting on whether or not telehealth waivers are gonna continue. So I think most importantly is we really need to recognize the broader scope of what palliative care offers, which is caregiver support, improving navigation, coordinating very complex transitions. To me, and what I've always prioritized as a champion at Penn, is that palliative care is not a nice to have, and neither are all of these infrastructures, but they're really essential to whole person care, and they need to be financially supported. And last, we really need a culture shift. We need to change from how palliative care is perceived, and it can't be something other. It can't be something outside of oncology, but it really needs to be embraced as this is part of cancer care itself. I often see hesitancy from many oncologists about introducing palliative care early. But it doesn't need to be a dramatic shift. I think small changes in language, how we introduce the palliative care team, and co-management models can really go a very long way in normalizing this part of patient care. And I'm particularly encouraged, Joe, by one particular innovation in this space, which is really the growth of many startups. And one startup, for example, is Thyme Care, where I've seen them working with many, many private practices across the country, alongside partnerships with payers to really build tech-enabled navigation that tries to basically maximize triage support with electronic PROs. And to me, I really think these models can help scale access without overwhelming current care teams. So precision palliative care, Joe, in summary, I think should be flexible, scalable, and really needs to align based on what patients need. Dr. Joseph McCollom: No, I really appreciate, Ramy, you talking about that it really takes a village to get oncology care in both a competent and a compassionate way. And we need buy-in champions at all levels: the system level, the administrative level, the policy level, the tech level. And we need to change culture. I kind of want to just get your final impressions and also make sure that we make our listeners aware of our article. We should be able to have this in the show notes here as well to find additional tools and resources, all the studies that were discussed in today's episode. But, Ramy, what are some of your kind of final takeaways and conclusions? Dr. Ramy Sedhom: Before we wrap up, I just want to make sure we highlight a very exciting opportunity for residents considering a future in oncology and palliative medicine. Thanks to the leadership of Dr. Jamie Von Roen, who truly championed this cause, ASCO and the ABIM (American Board of Internal Medicine) have partnered to create the first truly integrated palliative care oncology fellowship. Trainees can now double board in just two years or triple board in three with palliative care, oncology, and hematology. And I think, Joe, as you and I both know, it's incredibly rewarding and meaningful to work at this intersection. To close our message, if there's one message I think listeners should carry with them, it's that palliative care is about helping people live as well as possible for as long as possible. And precision palliative care simply helps us do that better. We need to really develop systems that tailor support to individual need, value, and individual goals. Just like our colleagues in precision oncology mentioned, getting the right care to the right patient at the right time, and I would add in the right way. For those who want to learn more, I encourage you to read our full article in JCO, which is “Precision Palliative Care As a Pragmatic Solution for a Care Delivery Problem.” Joe, thank you so, so much for this thoughtful conversation and for your leadership in our field. And thank you to everyone for listening. Thank you all for being champions of this essential part of cancer care. If you haven't yet joined the ASCO Palliative Care Communities of Practice, membership is free, and we'd love to have you. Dr. Joseph McCollom: Thank you, Ramy, not only for sharing your insights today, but the pioneering work that you have done in our field. You are truly an inspiration to me in clinical practice, and it is an honor to call you both a colleague and friend.  And thank you for our listeners for joining us today. If you value the insights that you've heard on the ASCO Daily News Podcast, please subscribe, rate, and review wherever you get your podcasts. Thanks again. Disclaimer: 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. Follow today's speakers:   Dr. Joseph McCollom @realbowtiedoc Dr. Ramy Sedhom @ramsedhom Follow ASCO on social media:   @ASCO on X (formerly Twitter) ASCO on Bluesky  ASCO on Facebook   ASCO on LinkedIn   Disclaimer: Dr. Joseph McCollom: No relationships to disclose Dr. Ramy Sedhom: No relationships to disclose

The conversation delves into the complexities of end of life care in combat settings, emphasizing the need for palliative care discussions among military medical personnel. It highlights the challenges faced in recognizing non-survivable injuries, the decision-making process in resuscitation efforts, and the importance of compassionate care for both patients and their loved ones. The discussion also touches on the role of opioids in managing pain and anxiety during end of life care, advocating for a shift in focus from aggressive treatment to comfort and dignity for the patient.TakeawaysEnd of life care is a critical conversation in military medicine.Palliative care is often overlooked in combat settings.Recognizing non-survivable injuries is essential for effective care.Decision-making in resuscitation requires courage and leadership.Compassionate care benefits both the patient and their loved ones.Opioids play a significant role in managing pain in palliative care.Transitioning to palliative care is a necessary step in certain cases.Medical providers must educate themselves on end of life care.Patient autonomy should be respected in decision-making.Compassionate care can alleviate the emotional burden on medical providers.Chapters00:00 Introduction to End of Life Care in Combat02:34 The Challenges of Palliative Care in Military Settings09:57 Recognizing Non-Survivable Injuries19:08 Decision-Making in Resuscitation Efforts35:49 Transitioning to Palliative Care43:03 The Role of Opioids in Palliative Care53:18 Compassionate Care and Patient AutonomyThank you to Delta Development Team for in part, sponsoring this podcast.⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠deltadevteam.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠For more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

In Part 3 of The Dying Patient: Palliative and End of Life Care, we delve into the complexities ambulance clinicians face when supporting patients in their final days and hours. Often the first to recognise when someone is dying, paramedics work within a system where community engagement may be limited, making their role crucial in identifying signs such as terminal agitation, unconsciousness, and other common symptoms. The episode discusses the importance of anticipatory medications and proactive advance care planning , especially in situations involving carer breakdown or when patients change their minds about where they wish to die.We explore why ambulance services are frequently called during end-of-life stages, whether due to uncontrolled symptoms, sudden deterioration, or emotional distress within families. Paramedics not only offer symptom relief, both pharmacological and non-pharmacological, but also provide vital emotional support to those navigating grief, denial, or fear. Challenges include differentiating between reversible conditions and active dying, managing care when anticipatory medications are unavailable, and coordinating with wider healthcare teams.Breaking bad news is another critical area discussed, with a focus on using frameworks such as Ask-Tell-Ask and adapting communication to the emotional needs of the moment. Lastly, the episode reflects on cultural considerations in a city as diverse as London. From language barriers and different expressions of grief to religious rituals and care after death, ambulance clinicians must remain adaptable and compassionate, ensuring that care is respectful, inclusive, and sensitive to the needs of every individual and their family. Some of the links to information mentioned in the episode can be found here: These are some of the resources mentioned in the episode:Breaking Bad News: ⁠⁠https://www.sth.nhs.uk/clientfiles/File/Breaking%20bad%20news%20Reflection%20on%20the%20process.pdf⁠⁠Good Grief - understanding the grief journey in more detail: ⁠⁠https://good-grief.org/resources/⁠⁠Hospice UK, an excellent place for further resources: ⁠⁠https://www.hospiceuk.org/our-campaigns/dying-matters/dying-matters-awareness-weekUK National Guidelines on Diabetes and End of Life Care: https://www.diabetes.org.uk/sites/default/files/2025-03/EoL_TREND_2024_v11-1.pdfThis episode is sponsored by PAX: The gold standard in emergency response bags.When you're working under pressure, your kit needs to be dependable, tough, and intuitive. That's exactly what you get with PAX. Every bag is handcrafted by expert tailors who understand the demands of pre-hospital care. From the high-tech, skin-friendly, and environmentally responsible materials to the cutting-edge welding process that reduces seams and makes cleaning easier, PAX puts performance first. They've partnered with 3M to perfect reflective surfaces for better visibility, and the bright grey interior makes finding gear fast and effortless, even in low light. With over 200 designs, PAX bags are made to suit your role, needs, and environment. And thanks to their modular system, many bags work seamlessly together, no matter the setup.PAX doesn't chase trends. Their designs stay consistent, so once you know one, you know them all. And if your bag ever takes a beating? Their in-house repair team will bring it back to life.PAX – built to perform, made to last.Learn more at pax-bags.com

Caring for an aging parent is hard in the best of circumstances. Whether your parent has cancer, Alzheimer's disease, another form of dementia, or an end of life condition, it can be overwhelming, exhausting, and stressful to support them as their health declines.Add in challenging relationships with your siblings, and the whole mess can feel unmanageable. This week on The Integrative Palliative Podcast we'll talk about what you can do when you're caring for an aging parent with siblings who are adding to your stress.Let's keep talking!Dr. Deliawww.integrativepalliative.comCoping Courageously: A Heart-Centered Guide for Navigating a Loved One's Illness Without Losing Yourself is available here: www.copingcourageously.com A free guide for physicians to help reclaim your joy at work and in life https://trainings.integrativepalliative.com/pl/2148540010Please review this podcast wherever you listen and forward your favorite episode to a friend! And be sure to subscribe!Sign up to stay connected and learn about upcoming programs:https://trainings.integrativepalliative.com/IPI-stay-in-touchI'm thrilled to be listed in Feedspot's top 15 palliative podcasts!https://blog.feedspot.com/palliative_care_podcasts/

Ospite della 166° puntata di Illuminismo Psichedelico è l'avvocata Claudia Moretti, tra gli autori del documento "Le Terapie Psichedeliche nel Fine Vita", con cui l'Associazione Luca Coscioni comunica ai ministeri che secondo le norme che regolano le cure palliative e l'uso del farmaco sperimentale  è già possibile utilizzare, in assenza di alternativa terapeutica, composti che si siano dimostrati efficaci, tra cui la psilocibina. Durante la puntata insieme a Claudia abbiamo anche parlato della libertà di modulazione del nostro stato di coscienza, delle differenze tra la tabellazione italiana e quella internazionale, ricordando anche la Comunicazione che è stata presentata all'ONU dal Prof. Cesare Romano, docente di diritto internazionale alla Loyola Law School di Los Angeles e dal Prof Andrea Boggio, docente di diritto presso la Bryant University del Rhode Island, sul caso Ayahuasca, di cui potete scoprire qualcosa in più guardando questo webinar sul canale YouTube di Illuminismo Psichedelico. Qui potete firmare l'appello dell'Associazione Luca Coscioni affinché l'Italia apra alle terapie psichedeliche. 

What role can psychedelics play in helping terminally ill patients face death with peace, clarity, and meaning?  In this episode, we welcome Hannah Whitmore, PhD, RN, CHPN®, a Registered Nurse and PhD researcher whose work—The Pragmatism of Palliative Care—explores the clinical potential of Psychedelic-Assisted Therapy (PAT) to support death acceptance in patients at the end of life. Dr. Whitmore brings a compassionate and evidence-based lens to a topic that challenges long-standing models of care, offering insight into how PAT could be thoughtfully integrated into palliative and hospice settings.  Together, we explore:  The latest research on PAT for existential distress and death anxiety  Clinical and ethical considerations when working with terminally ill populations  Barriers to implementation and the future possibilities for PAT in end-of-life care  How nursing science is shaping new approaches to healing at the end of life  This episode is a grounded, deeply human conversation at the intersection of medicine, mortality, and meaning—guided by a nurse scientist dedicated to easing suffering when it matters most.      Hannah Whitmore, PhD, RN, CHPN Certified hospice and palliative care nurse and clinician scientist, Dr. Whitmore supports individuals, families, and healthcare teams navigating serious illness and end-of-life transitions. Currently a post-doctoral fellow at the University of California, San Francisco (UCSF), she combines hands-on experience with a holistic approach informed by the latest research, mindfulness practices, and symptom management expertise. Her research focuses on symptom science and the integration of psychedelic-assisted therapy to address existential distress, depression, and promote death acceptance in seriously ill individuals. A member of Sigma Global Nursing Excellence, Dr. Whitmore guides healthcare teams and provides culturally sensitive care to diverse populations. She collaborates with healthcare organizations to enhance palliative care services and empowers individuals and teams to find resilience and dignity in complex end-of-life situations.    Brett Snodgrass, DNP, FNP-C, ACHPN®, FAANP Dr. Brett Snodgrass has been a registered nurse for 28 years and a Family Nurse Practitioner for 18 years, practicing in multiple settings, including family practice, urgent care, emergency departments, administration, chronic pain and palliative medicine. She is currently the Operations Director for Palliative Medicine at Baptist Health Systems in Memphis, TN. She is board certified with the American Academy of Nurse Practitioners. She is also a Fellow of the American Association of Nurse Practitioners and an Advanced Certified Hospice and Palliative Nurse. She completed a Doctorate of Nursing Practice at the University of Alabama – Huntsville. She is a nationally recognized nurse practitioner speaker and teacher. Brett is a chronic pain expert, working for more than 20 years with chronic pain and palliative patients in a variety of settings. She is honored to be the HPNA 2025 podcast host. She is married with two daughters, two son in laws, one grandson, and now an empty nest cat. She and her family are actively involved in their church and she is an avid reader.

When is someone really dead? What does it mean to survive? Is mind-uploading really a possible future way of surviving? These are some of the questions we are discussing with Dr Ariel Zeleznikow-Johnston.Dr Ariel Zeleznikow‑Johnston is a neuroscientist and Research Fellow at Monash University in Melbourne, Australia, whose work delves into the neural basis of consciousness - from understanding how genetics and environment shape cognition to exploring the subtle qualities of perceptual experience such as color qualia. A 2019 PhD graduate from The University of Melbourne, he has published extensively on how cognitive function changes across the lifespan. He is the author of The Future Loves You: How and Why We Should Abolish Death, which advocates for brain preservation technology as a means to suspend death and revive individuals in the future.Check out Peter's review of the book here: https://reachlevity.com/p/a-clear-case-for-cryonics-a-review-of-the-future-loves-youHis multidisciplinary approach combines rigorous neuroscience with philosophy and ethics, positioning him at the forefront of contemporary debates about identity, mortality, and the future of human life.

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

- Overview of Cancer & the LGBTQI+ Community, Including HIV & HPV - The LGBTQI+ Community's Disproportionate Cancer Burden - Addressing the LGBTQI+ Health Disparities Gap, Including Mistrust of Health Care Providers - Barriers to Health Care Access, Including Discrimination - Health Care, Cancer Screening, Palliative & Supportive Care, Affordable Housing, Gay Men & Lesbian Cancer Issues - Transgender/Gender-Nonconforming People's Cancer Concerns - Challenges for LGBTQI+ Caregivers - Social Security Disability Benefits for LGBTQI+ People Living with Cancer - Military Service & the LGBTQI+ Community - Practical, Financial, Emotional & Social Concerns - Cancer Resources for the LGBTQI+ Community - Questions to Ask Our Panel of Experts

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter BJ Miller, a hospice and palliative care physician, and Bridget Sumser, a licensed social worker specializing in serious illness and end-of-life care, join Peter to share insights from their decades of work supporting people at the end of life. In this episode, they explore the emotional and physiological processes of dying, the cultural barriers that prevent meaningful conversations about death, and how early engagement with mortality can lead to greater clarity and connection. The conversation highlights the distinctions between hospice and palliative care, the nature of suffering beyond physical pain, and the transformative role of honesty, forgiveness, and relational awareness in the dying process. Through stories and reflections, BJ and Bridget reveal what truly matters in the end—and how the dying can teach the living not only how to face death but how to live more fully. We discuss: The personal journeys of BJ and Bridget into end-of-life care, and the connection between living and dying [3:30]; What dying looks like: the physical, cognitive, and emotional realities at the end of life [13:15]; How historical perspectives on death contrast with modern experiences of dying [25:30]; The difference between palliative care and hospice care [30:45]; The systemic challenges surrounding hospice care: why patients often enter it too late to receive its full benefits [35:30]; How delayed hospice referrals and unspoken preferences often prevent patients from dying where and how they truly want [39:30]; The realities of home hospice: challenges, costs, and burdens placed of families [43:45]; How proactively engaging with the reality of death can avoid unnecessary suffering and promote a more peaceful ending [53:30]; How palliative care is misunderstood and underutilized—especially in cancer care [1:02:45]; Palliative care in the case of Alzheimer's disease: emotional support, future planning, and family involvement [1:12:15]; The importance of having an advance directive: defining what matters most before it's too late [1:23:00]; The differences between how young and old individuals experience dying from cancer [1:30:15]; The difference between pain and suffering, role of medicine in pain relief, and why emotional healing is essential at the end of life [1:35:45]; Dying well: the power of self-honesty and human connection at the end of life [1:47:00]; How psychedelics like psilocybin can unlock emotional breakthroughs and deepen connection for patients near the end of life [1:55:15]; Lessons from the dying on how to live well [1:57:30]; The physical process of active dying, and the emotional and practical considerations for loved ones [2:09:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

In our previous episode, we explored the meaning and importance of end-of-life care, particularly during the final 12 months of life. We discovered how difficult it is to predict this timeline, especially for ambulance clinicians who often see patients at critical points without a full picture of their medical history.In this episode, we take a closer look at what that final year can involve, focusing on the pre-hospital setting. We'll explore the unique challenges ambulance clinicians face in making rapid, high-stakes decisions, and how existing documentation—such as care plans or advance directives—can provide valuable guidance in those moments.We'll also discuss the role of shared decision-making and how ambulance services can help balance specialist and generalist palliative care needs. Alongside this, we'll highlight how the NHS Long Term Plan and other key initiatives aim to improve care coordination and ensure more consistent, compassionate care.Lastly, we'll examine the barriers to effective advance care planning. These range from cultural sensitivities to systemic and logistical obstacles. Throughout, we'll consider how we can better support ambulance clinicians to deliver thoughtful, person-centred care during some of life's most vulnerable and uncertain moments. Please find links to the SPICT Tool that is mentioned in the episode: https://www.spict.org.uk/#:~:text=Supportive%20%26%20Palliative%20Care%20Indicators%20Tool,is%20a%20plain%20language%20version.

keywords assisted dying, suicide, palliative care, mental health, grief, legislation, death, cultural attitudes, pandemic, healthcare summary In this conversation, Dr. Rachel Gibbons, David Jones and Dr Naomi Murphy discuss the complexities surrounding assisted dying, its implications, and the cultural shifts in attitudes towards death. The dialogue explores the differences between assisted dying and suicide, the role of palliative care, and the emotional landscape of dying, particularly in light of the pandemic. Dr Gibbons emphasizes the need for thoughtful discourse and safeguards in the legislation surrounding assisted dying, while also reflecting on personal experiences with grief and the societal attitudes towards death. takeaways Assisted dying is a global movement gaining traction. Terminology around assisted dying varies by country. Cultural attitudes towards death are shifting post-pandemic. There is a significant difference between assisted dying and suicide. Quality of end-of-life care is crucial. Palliative care needs to be improved for better outcomes. The emotional landscape of dying is complex and charged. Societal biases can impact decisions around assisted dying. Grief can manifest differently based on relationships. Legislation around assisted dying requires careful consideration and safeguards.   Website with links to papers, book. https://www.drrachelgibbons.co.uk/ titles  

keywords assisted dying, suicide, palliative care, mental health, grief, legislation, death, cultural attitudes, pandemic, healthcare summary In this conversation, Dr. Rachel Gibbons, David Jones and Dr Naomi Murphy discuss the complexities surrounding assisted dying, its implications, and the cultural shifts in attitudes towards death. The dialogue explores the differences between assisted dying and suicide, the role of palliative care, and the emotional landscape of dying, particularly in light of the pandemic. Dr Gibbons emphasizes the need for thoughtful discourse and safeguards in the legislation surrounding assisted dying, while also reflecting on personal experiences with grief and the societal attitudes towards death. takeaways Assisted dying is a global movement gaining traction. Terminology around assisted dying varies by country. Cultural attitudes towards death are shifting post-pandemic. There is a significant difference between assisted dying and suicide. Quality of end-of-life care is crucial. Palliative care needs to be improved for better outcomes. The emotional landscape of dying is complex and charged. Societal biases can impact decisions around assisted dying. Grief can manifest differently based on relationships. Legislation around assisted dying requires careful consideration and safeguards.   Website with links to papers, book. https://www.drrachelgibbons.co.uk/ titles  

The need for better palliative care in nursing homes is significant. Consider this: the majority of the 1.4 million adults residing in U.S. nursing homes grapple with serious illnesses, and roughly half experience dementia. Many also suffer from distressing symptoms like pain. In addition, about 25% of all deaths in the United States occur within these facilities. Despite these substantial needs, specialized palliative care beyond hospice is rare in nursing homes. Furthermore, only about half of nursing home residents nearing the end of life receive hospice care. So, how can we improve palliative care for individuals in nursing homes? Today's podcast explores this crucial question with three leading experts: Connie Cole, Kathleen Unroe, and Cari Levy. Our discussion delves into: The specific palliative care needs of nursing home residents. How to think about primary and specialized palliative care in this setting. The obstacles hindering referrals to palliative care services. Practical strategies to overcome these barriers and enhance care. We also take a dive into these 2 articles that Connie first authored: Palliative care in nursing homes: A qualitative study on referral criteria and implications for research and practice. JAGS 2024 Nursing Home Palliative Care Referral Process, Barriers, and Proposed Solutions: A Qualitative Study. 2024 If you are interested in learning more, check out some of our other palliative care in nursing home podcasts including: Discussion of a primary palliative care multinational trial with Lieve Van den Block Understanding the variability in nursing home care A podcast on Palliative Rehab?!? with Ann Henshaw, Tamra Keeney, and Sarguni Singh  

In this episode of the Pre-Hospital Care Podcast, we explore the evolving role of ambulance clinicians in palliative and end-of-life care. We're joined by a dedicated team working to improve how prehospital services support patients in their final months, ensuring care is compassionate, coordinated, and patient-centred.We introduce the team and their roles before breaking down the key concepts of palliative and end-of-life care. We discuss the differences between generalist and specialist palliative care, the challenges of identifying patients in the last year of life, and the critical role ambulance services play in this journey.The conversation then moves to the service gaps and educational challenges identified within prehospital care. We examine referral pathways, tools like SPICT for early identification, and how technology shapes advanced care planning (ACP) to help inform decision-making. The team also highlights the importance of education in building clinician confidence when navigating these complex cases.Looking ahead, we discuss the future of prehospital palliative care, including the role of simulation training, national collaboration, and addressing healthcare inequalities. We also explore opportunities for joint learning, debriefs, and improved care pathways to strengthen the connection between ambulance services and specialist palliative care teams.The SPICT tool can be found here: https://www.spict.org.uk/the-spict/This podcast is sponsored by PAX.⁠Whatever kind of challenge you have to face - with PAX backpacks you are well-prepared. Whether on water, on land or in the air - PAX's versatile, flexible backpacks are perfectly suitable for your requirements and can be used in the most demanding of environments. Equally, PAX bags are built for comfort and rapid access to deliver the right gear at the right time to the right patient. To see more of their innovatively designed product range, please click here:⁠https://www.pax-bags.com/en/⁠

Palliative physician B.J. Miller asks: Is there a better way to think about dying? And can death be beautiful? SOURCES:B.J. Miller, palliative-care physician and President at Mettle Health. RESOURCES:A Beginner's Guide to the End: Practical Advice for Living Life and Facing Death, by Shoshana Berger and B.J. Miller and (2019).“After A Freak Accident, A Doctor Finds Insight Into ‘Living Life And Facing Death,'” by Fresh Air (W.Y.P.R., 2019).“Dying In A Hospital Means More Procedures, Tests And Costs,” by Alison Kodjak (W.Y.P.R., 2016).“The Final Year: Visualizing End Of Life,” by Arcadia (2016).“What Really Matters at the End of Life,” by B.J. Miller (TED, 2015).“The Flexner Report ― 100 Years Later,” by Thomas P. Duffy (Yale Journal of Biology and Medicine, 2011).“My Near Death Panel Experience,” by Earl Blumenauer (The New York Times, 2009).The Center for Dying and Living. EXTRAS:“Max Tegmark on Why Superhuman Artificial Intelligence Won't be Our Slave (Part 2),” by People I (Mostly) Admire (2021).“Max Tegmark on Why Treating Humanity Like a Child Will Save Us All,” by People I (Mostly) Admire (2021).“Amanda & Lily Levitt Share What It's Like to be Steve's Daughters,” by People I (Mostly) Admire (2021).“Edward Glaeser Explains Why Some Cities Thrive While Others Fade Away,” by People I (Mostly) Admire (2021).“Sendhil Mullainathan Explains How to Generate an Idea a Minute (Part 2),” by People I (Mostly) Admire (2021).“Sendhil Mullainathan Thinks Messing Around Is the Best Use of Your Time,” by People I (Mostly) Admire (2021).“How Does Facing Death Change Your Life?” by No Stupid Questions (2021).“How to Be Better at Death,” by Freakonomics Radio (2021).

Palliative and hospice care can both have a huge impact on one's quality of life  during serious illness. How do these types of care differ and when are they important? In this episode, Dr. Chan sits down with Diana Franchitto and Dr. Jennifer Ritzau of HopeHealth, a nonprofit palliative and hospice care organization in Rhode Island, to answer these questions and more. 

  In this episode, we are joined by Dr. Amelia Breyre, the lead author of Multidisciplinary Lessons from Palliative Extubations at Home, to discuss the complexities and collaborative efforts involved in facilitating palliative extubations at home. Dr. Breyre shares insights from two remarkable cases, highlighting how multidisciplinary coordination between critical care, palliative care, EMS, and hospice teams made it possible for patients to return home for end-of-life care. This conversation offers important lessons for EMS clinicians and physicians committed to improving patient-centered care at the end of life. Featured Article Breyre, A. M., Grammatico, M., Policastro, A., Ingram, C. J., Prsic, E., Sussman, L. S., & Couturier, K. (2024). Multidisciplinary Lessons from Palliative Extubations at Home. *Prehospital Emergency Care*, 1-4.

When someone you love is is ill or had died, life feels hard. Yet sometimes we add to our distress by judging how we are feeling or behaving. We feel sad and then we feel critical that we're still sad. We feel angry and then feel guilty that we feel angry.It is the "shoulds" that cause us distress - it doesn't have to be that way.This week I'll share the 3 words that can help reduce your suffering.I'm glad you're here!Deliawww.integrativepalliative.comCoping Courageously: A Heart-Centered Guide for Navigating a Loved One's Illness Without Losing Yourself is available here: www.copingcourageously.com A free guide for physicians to help reclaim your joy at work and in life https://trainings.integrativepalliative.com/pl/2148540010Please review this podcast wherever you listen and forward your favorite episode to a friend! And be sure to subscribe!Sign up to stay connected and learn about upcoming programs:https://trainings.integrativepalliative.com/IPI-stay-in-touchI'm thrilled to be listed in Feedspot's top 15 palliative podcasts!https://blog.feedspot.com/palliative_care_podcasts/

MAID: Why the Government Wants You to Kill Yourself - Kelsi Sheren Watch this video at- https://youtu.be/gBgh-yxZtzY?si=MN9ITRLcCj4nG8v8 Triggernometry 1.3M subscribers 1,015,492 views Jan 15, 2025 TRIGGERnometry - NEW episodes every Sunday and Wednesday 2 pm ET/7 pm UK Kelsi Sheren is a former Canadian Artillery Gunner, coach, author, host of The Kelsi Sheren Perspective and a TEDx Speaker. | Follow Kelsi on X: https://x.com/KelsiBurns SPONSOR: Our partners Augusta Precious Metals are the best Gold dealer provider in the business. Protect your 401K: https://bit.ly/Triggernometry_Augusta... SPONSOR: Shopify! Sign up for a £1 per month trial at https://www.shopify.co.uk/trigger/ SPONSOR: MUDWTR. Start your new morning ritual & get up to 43% off your ‪@MUDWTR with code TRIG at - https://mudwtr.com/TRIG. Join our exclusive TRIGGERnometry community on Substack! https://triggernometry.substack.com/ OR Support TRIGGERnometry Here: Bitcoin: bc1qm6vvhduc6s3rvy8u76sllmrfpynfv94qw8p8d5 Shop Merch here - https://www.triggerpod.co.uk/shop/ Advertise on TRIGGERnometry: marketing@triggerpod.co.uk Find TRIGGERnometry on Social Media:   / triggerpod     / triggerpod     / triggerpod   About TRIGGERnometry: Stand-up comedians Konstantin Kisin (@konstantinkisin) and Francis Foster (@francisjfoster) make sense of politics, economics, free speech, AI, drug policy and WW3 with the help of presidential advisors, renowned economists, award-winning journalists, controversial writers, leading scientists and notorious comedians. 00:00 Introduction 01:06 What is M.A.I.D? 14:23 How do they justify euthanising children? 16:40 Augusta Precious Metals advert 18:15 How can you euthanise people for just being depressed? 21:31 What do we do with people who are genuinely seriously mentally unwell? 26:10 Electro-shock therapy 29:21 M.A.I.D is a self reporting system with no safeguards 33:57 Palliative care 37:02 Shopify advert 38:20 Is cost saving the reason this is being pushed? 46:12 Government overspending 49:44 How much of this is to do with ideology? 51:15 MUD/WTR advert 52:44 What are people doing to push back? 58:11 They're trying to kill as many people as possible 01:03:57 What's the thing we're not talking about that we should be?

In this profound episode of Health Confidential, we are joined by Dr. Emma Jones, a compassionate palliative care physician and spiritual healer, as we navigate the emotional terrain of grief, burnout, and the healing power found in life's most difficult transitions. Drawing from her extensive work in hospitals and hospices, Dr. Jones shares the tender truths that emerge at the edge of life and death—and how these lessons can transform our health, perspective, and inner peace.Dr. Jones invites us to explore how listening, presence, and spiritual openness play vital roles in caring for those in pain. She explains how burnout, often seen as weakness, is a sacred signal calling us back to our humanity and inner wisdom. Through her stories and insights, we discover that healing isn't always about curing—it's about connection, authenticity, and love.KEY TAKEAWAYS:Grief is a portal to deeper self-understanding and healing.Burnout is a message, not a failure—it invites us to realign with our values.Palliative care is not just end-of-life care, but whole-person healing.Holding space and presence is more powerful than “fixing.”True healing is rooted in empathy, intuition, and spiritual connection.BEST MOMENTS:“Burnout is not about being weak—it's about being too strong for too long.” – Dr. Emma Jones“People want to be heard, not cured. Healing begins when we listen.”“The dying often teach us how to live.”GUEST INFORMATIONDr. Emma JonesPalliative Care Physician & Spiritual HealerInstagram: @dremmajones Website: https://www.emmajonesmd.com/ VALUABLE RESOURCEShttps://www.SimoneGisondi.comHOST BIOMeet the remarkable Simone, a seasoned coach, published author, and the dynamic host of Health Confidential. With a life story that includes surviving a brutally communist regime, enduring a tumultuous family life, and even facing a stroke amidst a divorce, Simone embodies the true essence of strength and resilience.As the driving force behind Health Confidential and an honorary graduate of the school of hard knocks, Simone offers a powerful blend of personal experience and professional coaching insights. Each episode is a source of empowerment, enlightenment, and encouragement, designed to inspire listeners to overcome life's hurdles.#GriefHealing #PalliativeCare #BurnoutRecovery #HealthConfidential #DrEmmaJones #SpiritualHealing #InnerPeace #ListeningHeals Hosted on Acast. See acast.com/privacy for more information.

We are joined by Molly Carlile AM, Manager of PEPA & IPEPA Victoria (Program of Experience in the Palliative Approach), free Australia wide program that offers workshops and placements in the palliative approach to care. PEPA works closely with Barwon Health providing opportunities throughout the Barwon South West for workers in aged care and disability services.Molly shares her extensive knowledge and experience as the manager of the PEPA program from 20+ years working in palliative care, the importance of death literacy and the value of expanding our conversations and education in the palliative approach.For more information about the PEPA and IPEPA programs follow this link.Please take the opportunity to listen and share through your networks, families and friends to keep these conversations happening.

Feelings of burnout and boredom have become prevalent in modern life. To understand the roots of and solutions to these issues, we can turn to both ancient philosophers and contemporary thinkers. Among the latter is Korean-German philosopher Byung-Chul Han, whose thought-provoking analyses are gaining increasing recognition.If you're not yet familiar with Han's philosophy, Steven Knepper, a professor at the Virginia Military Institute and the co-author of a new critical introduction to this modern philosopher's work, will take us on a tour of some of Han's key ideas. In the first part of our conversation, Steven unpacks Han's concept of the “burnout society” and why so many of us feel tired from participating in what he calls “auto-exploitation” and “positive violence.” We then discuss how our burnout society is also a “palliative society” that tries to avoid suffering at all costs and how our obsession with health has turned us into a modern version of Nietzsche's “last man.” We end our discussion with some of Han's ideas for resisting the pitfalls of modernity, including embracing ritual, contemplation, and an openness to the mystery of others.Resources Related to the PodcastByung-Chul Han's books, including The Burnout Society and The Palliative SocietyShop Class as Soulcraft and The World Beyond Your Head by Matthew B. CrawfordNew Verse ReviewSteven's work at The LampDying Breed Article: Resonance as an Antidote to Social AccelerationDying Breed Article: What Nietzsche's Typewriter Brain Can Tell Us About Twitter BrainSunday Firesides: Protect the Sanctum Sanctorum of SelfhoodSunday Firesides: We Need as Much Meaning Extension as Life ExtensionConnect With Steven KnepperSteven at VMI

Palliative care physician and author Alen Voskanian discusses his article, "Discover the secrets to regaining joy in medicine," based on an excerpt from his book. Drawing from his personal experience with burnout where he felt isolated and like a failure within the demanding medical industry, Alen strongly emphasizes that burnout is a common result of a broken health care system, not an individual failing. He offers key advice points for physicians and health care workers: recognize burnout isn't your fault, engage in fixing the system, always prioritize patients ethically, let go of harmful comparison and competition, seek help without shame, make time for loved ones and important life events, prioritize personal health and wellbeing through nutrition, sleep, exercise, and mindfulness, practice gratitude, curb perfectionism, and continually reconnect with your core purpose for entering the field. Alen urges colleagues to understand that joy is their right and to actively reclaim it for themselves, their families, and their patients. Our presenting sponsor is Microsoft Dragon Copilot. Want to streamline your clinical documentation and take advantage of customizations that put you in control? What about the ability to surface information right at the point of care or automate tasks with just a click? Now, you can. Microsoft Dragon Copilot, your AI assistant for clinical workflow, is transforming how clinicians work. Offering an extensible AI workspace and a single, integrated platform, Dragon Copilot can help you unlock new levels of efficiency. Plus, it's backed by a proven track record and decades of clinical expertise and it's part of Microsoft Cloud for Healthcare–and it's built on a foundation of trust. Ease your administrative burdens and stay focused on what matters most with Dragon Copilot, your AI assistant for clinical workflow. VISIT SPONSOR → https://aka.ms/kevinmd SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

Palliative care, or treatment focused on symptom management and quality of life, is an important and often overlooked aspect of care for people with kidney disease. Similarly, conservative treatment of advanced kidney disease, or medical management without dialysis or transplantation, is not well understood by patients and care providers alike. In this episode of the Kidney Commute, our interprofessional team discusses these two important aspects of kidney disease care. This episode offers CME/CE credit to eligible listeners. If you'd like to claim credit, please go to kidney.org/podcast-CE to register for this episode and complete requirements.

Dr. Lorrie Hale was raised in the Chicago area as well as Kentucky. She earned her veterinary degree from the University of Illinois in 1995. Afterwards, she worked in two practices in the Chicago area.She then worked for twelve years in general practice in Louisiana before returning to teach clinical veterinary skills at the University of Illinois. She started her holistic education by completing her acupuncture training at Chi University in 2012.In 2016 she joined the faculty at Louisiana State University, starting a clinical skills program and expanding the Integrative Medicine and Rehabilitation Service in the Teaching Hospital. She completed her Master's in TCVM from Chi University in 2020, and also has certifications in Chinese Herbal Medicine, Food Therapy, Tui-Na, and Palliative and End of Life Care from Chi.In 2019, she became Service Chief at LSU. Dr. Hale is also a Charter Fellow of the American College of Veterinary Botanical Medicine and serves on the Board of Directors.Please enjoy this conversation with Dr. Lorrie Hale as we discuss her education, holistic training, and work as an Academic Integrative Educator and Practitioner.

I was very proud to use the word “apotheosis” on today's podcast.  See if you can pick out the moment.  I say something like, “Palliative care for people experiencing homelessness is, in many ways, the apotheosis of great palliative care.”  And I believe that to be true.  When you think about the early concepts that shaped the field, you can see how palliative care for persons experiencing homelessness fits like a hand in a glove: total pain envisioned by Cicely Saunders, which even its earliest sketches included social suffering like loneliness; or Balfour Mount, who coined the term “palliative care,” lamenting the cruel irony of our care for the dying, and the desperate need to create programs to reach more people experiencing suffering. Today we talk with Naheed Dosani, a palliative care physician at St. Michael's Hospital in Toronto, and health justice activist. His story, which he shares on today's podcast, is remarkable.  Just out of fellowship, Naheed built a palliative care program for homeless persons  called the Palliative Education and Care for the Homeless (PEACH) Program.  This podcast is a complement to our prior podcast on aging and homelessness with Margot Kushel. Today we discuss: What is the best terminology? Homeless? Homelessness? Houseless? Marginally housed? What makes palliative care for people experiencing homelessness challenging? What makes it rewarding?  What is unique about the practice of palliative care for people experiencing homelessness? We discuss the principles of harm reduction, social determinants of health, and trauma informed care.  Major overlap with substance use disorder issues, which we have covered recently (and frequently) on this podcast. How are the health systems designed or not designed to meet the needs of people experiencing homelessness?  What are the equity issues at stake, and at risk of being cut, both in Canada and the US?   Many more links below.  And I had a blast playing Blinding Lights by that Toronto band The Weekend. Enjoy! -Alex   End Well Talk https://www.youtube.com/watch?v=eG4QE-hfPQU Resources on the PEACH Program Program Review Paper – A recent publication in Longwoods Healthcare Quarterly reviewing the PEACH model. https://pubmed.ncbi.nlm.nih.gov/37144698/ Promising Practice Recognition – PEACH was named a Promising Practice in equity-oriented palliative care as part of a national initiative funded by Health Canada, operated by Healthcare Excellence Canada & the Canadian Partnership Against Cancer. https://www.healthcareexcellence.ca/media/z3jifqqd/pp-peach-en-2024-v2.pdf Toronto Star Feature https://www.thestar.com/life/together/people/dr-naheed-dosani-started-peach-to-provide-palliative-care-for-homeless-and-vulnerably-housed-populations/article_c56d8f45-cbe9-522e-9554-46778bf50407.html CityNews Toronto Feature https://toronto.citynews.ca/2022/08/08/peach-team-palliative-health-care-homelessness/ Psychosocial Interventions at PEACH In addition to medical care, PEACH also runs two key psychosocial interventions for our clients: PEACH Grief Circles – Structured spaces for workers in the homelessness sector to process grief. CBC covered this a few years ago, including a radio segment feature on CBC White Coat, Black Art (which you can access at the below link). https://www.cbc.ca/radio/whitecoat/palliative-care-team-helps-the-homeless-die-with-dignity-a-healing-circle-helps-them-grieve-1.5048409 PEACH Good Wishes Program – A program that provides meaningful gifts for unhoused individuals who are terminally ill. https://www.cbc.ca/news/canada/toronto/toronto-homeless-palliative-holidays-1.5407360 Kensington Hospice & 'Radical Love' Equity-Oriented Hospice Palliative Care Naheed Dosani also serves as the Medical Director of Kensington Hospice, Toronto's largest hospice. There, he helps run an innovative program called 'Radical Love' Equity-Oriented Hospice Palliative Care, which provides low-threshold, low-barrier access to hospice care for structurally vulnerable individuals (e.g., those experiencing homelessness). The program also operates via a partnership with the PEACH Program. As a result of the 'Radical Love' program at Kensington Hospice: At any given time, Kensington Hospice has evolved from caring for structurally vulnerable individuals

#572: At age 7, Dr. Jordan Grumet lost his father. This early loss shaped his career path — he became a physician, following in his dad's footsteps. But by 2010, feeling burned out from internal medicine, he took an unexpected turn: he became a hospice doctor. In this episode, Dr. Grumet joins us to discuss what he's learned from thousands of conversations with people in their final days.  These discussions have revealed a pattern: people don't typically regret their bank balance on their deathbed. Instead, they regret not pursuing the activities and dreams that truly lit them up. Dr. Grumet explains the difference between what he calls "Big P Purpose" versus "little p purpose." Big P Purpose involves major life goals like becoming president or curing cancer. Little p purpose, by contrast, focuses on the process — finding activities you enjoy regardless of the outcome.  He shares the story of a young professional who loved competitive cycling. While working a demanding nonprofit job, this person started fixing bikes at races on weekends. This side project combined his skills and passion, eventually creating enough income for him to reduce his full-time hours. Dr. Grumet introduces three key concepts for building more purpose into your life: - Joy of Addition: Add activities that excite you, even if just for 15 minutes daily - Art of Subtraction: Remove activities that drain you - Substitution: When you can't add or subtract, swap one activity for another He emphasizes that money isn't the only tool for creating change. Youth, energy, relationships, skills and community can be equally valuable resources. A 22-year-old might lack funds but has the advantage of time and stamina that a 51-year-old doesn't possess. Dr. Grumet references the Harvard Adult Developmental Health Study, which found that strong relationships — not achievements or money — most strongly correlate with happiness. He suggests that pursuing activities you enjoy naturally leads to building these vital connections. The episode closes with a powerful story about his grandfather, who loved math and became an accountant in the 1950s.  This passion influenced Dr. Grumet's mother to become a CPA, which in turn helped young Jordan develop confidence in math, despite his reading challenges. Years later, this mathematical thinking helped him diagnose a rabbi's rare condition — proving how small actions can create ripple effects across generations. Timestamps: Note: Timestamps will vary on individual listening devices based on dynamic advertising run times. The provided timestamps are approximate and may be several minutes off due to changing ad lengths. 0:00 Introduction to Dr. Grumet, hospice doctor discussing end-of-life insights 1:06 Transition from medicine to hospice as side hustle 2:21 Hospice shifts from medical to emotional care 4:12 Palliative care vs hospice care explained 5:05 Age range of hospice patients 6:55 Life priorities and deathbed regrets 13:46 Harvard Adult Developmental Health Study on happiness 20:00 Purpose, happiness and flow states 26:35 Joy of Addition and Art of Subtraction explained 33:30 Using youth when lacking money 41:18 Calendar evaluation strategies 48:45 Managing family disappointment 56:08 Regrets as purpose anchors 1:03:26 Common end-of-life regrets 1:09:06 Small actions, big legacy For more information, visit the show notes at https://affordanything.com/episode572 Learn more about your ad choices. Visit podcastchoices.com/adchoices