Podcasts about palliative

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.

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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  

Recorded on 5 June 2025 for ICMDA Webinars.Dr Peter Saunders chairs a webinar with Dr Nicholas HerodotouPalliative Medicine is the symptom management of any patient who has an irreversible, progressive, life-limiting condition and is not solely cancer patients. It aims to enhance quality of life, utilizing a holistic, multidisciplinary approach. Good symptom management of palliative patients is what every clinician should be able to deliver. This short webinar addresses the practical management of how to commence strong opioids, palliative surgical interventions, palliative emergencies and lastly, when do you stop treating a patient who is clinically deteriorating.Nicholas studied medicine at St Andrew's University, Scotland, earning a BSc in medical sciences, then trained at St Bartholomew's Hospital Medical College, London, qualifying in 1994. After GP training, he worked as a locum in General Practice and Psychiatry before choosing palliative medicine. He completed specialist training in Warwickshire (CCT 2007) and became an NHS consultant in Luton in 2009, focusing on holistic care in acute hospitals.His passion is to make a difference to palliative patients so that they die with dignity and respect.He is the former president of the Motor Neurone Disease Association local branch and a UCL lecturer.He is married to a former Dentist and they have four children. He enjoys playing squash player and running marathons.⁠To listen live to future ICMDA webinars visit⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://icmda.net/resources/webinars/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

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.

Rebecca and Sarah are joined by Professor Mark Saunders, Consultant Oncologist at The Christie, to explore the evolving landscape of colorectal cancer treatment. They discuss how advancements in surgery, chemotherapy, and radiotherapy have improved survival rates, the critical role of multidisciplinary teams (MDTs) and the importance of patient choice and support. The episode also addresses newer therapies, managing side effects and the increasing focus on cancer as a chronic disease, offering practical insights for primary care.If you loved this episode and would like to hear more like this, please send your review to the-christie.gatewayc@nhs.net and share the series with a colleague.GPs Talk Cancer is the podcast series from GatewayC. GatewayC is the free early cancer diagnosis resource funded by the NHS and is part of The Christie NHS Foundation Trust. View the full shownotes for this episode at Podcast - GatewayCProduced by Louise Harbord from GatewayC and Listening Dog Media.DISCLAIMER: We know this podcast might be of interest to anybody, however it is aimed at primary care health professionals. All patient cases are based on real stories from our clinical practice as GPs. They are fully anonymised with no identifiable patient data. All featured statistics are accurate at the time of recording. All views expressed by guest speakers are their own. Hosted on Acast. See acast.com/privacy for more information.

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/

Ein Thema das oft viele Fragen aufwirft. In der aktuellen Folge erklären wir anhand eines Patientenbeispiels was Palliative Sedierung ist, worauf geachtet werden sollte und wann diese eingesetzt werden kann. Wir besprechen die aktuellen Leitlinien und wie wir es in der Praxis handhaben. Wie so oft ist gute Kommunikation einer der wichtigsten Aspekte.

Welche Herausforderungen gibt es eigentlich in der palliativen Wundversorgung? Und wie kann man sich auf betroffene Patienten und Patientinnen sowie ihre Familien einstellen?Diese und weitere Fragen besprechen wir in dieser Folge, in der es um die palliative Wundversorgung geht - live vom Bremer Pflegekongress! Zusammen mit Gabi Weigold (Krankenschwester, Fachtherapeutin Wunde, Palliativ-Fachkraft, Geschäftsleitung Wundmanagement Gabi Weigold) sprechen wir über dieses Thema, was es genau bedeutet und wie man damit umgehen kann bzw. welche Produkte sich dafür auch eignen könnten, um die Patienten und Patientinnen bestmöglich zu begleiten. Aufgepasst: Du bist medizinische Fachkraft und möchtest Dich selbst durch ein kostenfreies Muster von unseren Produkten überzeugen?Dann bestelle hier gleich Dein Musterpaket in unserem Produktkatalog!PS: Kennst Du schon unseren Newsletter? Melde Dich jetzt an und wir halten Dich auf dem Laufenden mit Wissenswertem rund um das Thema Wundversorgung.Jetzt anmelden!

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.

Am Lebensende ist manchmal eher palliative Begleitung statt Blaulicht gefragt. Trotzdem wählen Angehörige oder Pflegekräfte manchmal reflexhaft 112. In dieser Folge erklärt Notärztin und Palliativmedizinerin Dr. Alexandra Scherg, über welche palliativen Kenntnisse Notärztinnen und Notärzte verfügen sollten. Außerdem geht es um eine Reform, die lange überfällig ist. Was steckt hinter der Idee eines Notfallausweises? Welche Rolle kann die Telemedizin spielen? Und warum geraten gerade Pflegekräfte und Angehörige so schnell in ein Dilemma? Antworten und Denkanstöße gibt's im Gespräch. Zur Folgen-Übersicht: https://bit.ly/3NFotcj

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. Bridget Fahey, Section Editor of the Palliative Oncology Editorial Board section of Surgical Oncology Insight, discusses with Dr. Kim Kopecky the results of a scoping review of language used by researchers evaluating palliative general surgical interventions for adult patients. Dr. Kopecky is author of "The language of palliative surgery: A scoping review," published in the June 2024 issue of the journal.  

In questa puntata di Start, un modo inedito per ottenere la cittadinanza statunitense; alcune preoccupazioni rispetto a Meta AI; una sfida enorme per la nostra sanità; infine, la storia di Luca. Se vuoi raccontarmi le difficoltà e le sfide che, come giovane, incontri nella tua vita quotidiana o, semplicemente, dirmi la tua opinione sulle notizie che hai ascoltato oggi, puoi mandare un'email a angelica.migliorisi@ilsole24ore.com

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.

Bernadette and Marie are thrilled to have Koshin Paley Ellison join us on the show. He is an author, Zen teacher, Jungian psychotherapist, leader in contemplative care, and co-founder of an educational non-profit called the New York Zen Center for Contemplative Care. Through its numerous educational programs, contemplative retreats, and Soto Zen Buddhist practices, the New York Zen Center touches thousands of lives every year.  Koshin has appeared on dozens of podcasts and his work has been featured in the New York Times, PBS, CBS Sunday Morning and other media outlets.  His books grounded in Buddhist wisdom and practice have all gained national attention including “Whole-hearted: Slow Down, Help Out, Wake Up”, “Untangled: Walking the Eightfold Path to Clarity, Courage and Compassion,” and “Awake at the Bedside: Contemplative Teachings on Palliative and End-of-Life Care”. You find all of Koshin's books on amazon.com.Learn more about Koshin at ZenCare.org and follow him on Instagram @KoshinPaleyEllison.Here are some other resources to learn more about Koshin and his work: Koshin's Books Foundations in Contemplative Care Contemplative Medicine Fellowship An Introduction to Zen Meditation (video series)  

Listen to ASCO's Journal of Clinical Oncology Art of Oncology article, "I Hope So Too” by Dr. Richard Leiter from Dana-Farber Cancer Institute. The article is followed by an interview with Leiter and host Dr. Mikkael Sekeres. Leiter shares that even in the most difficult moments, clinicians can find space to hope with patients and their families. TRANSCRIPT  Narrator: I Hope So Too, by Richard E. Leiter, MD, MA  “You're always the negative one,” Carlos' mother said through our hospital's Spanish interpreter. “You want him to die.” Carlos was 21 years old. A few years earlier he had been diagnosed with AML and had undergone an allogeneic bone marrow transplant. He was cured. But now, he lay in our hospital's bone marrow transplant (BMT) unit, his body attacked by the very treatment that had given him a new life. He had disseminated graft-versus-host disease (GVHD) in his liver, his lungs, his gut, and, most markedly, his skin. The BMT team had consulted us to help with Carlos' pain. GVHD skin lesions covered his body. They were raw and weeping. Although the consult was ostensibly for pain, the subtext could not have been clearer. Carlos was dying, and the primary team needed help navigating the situation. As his liver and kidney function declined, the need to address goals of care with Carlos' mother felt like it was growing more urgent by the hour. Difficult cases, like a young person dying, transform an inpatient unit. Rather than the usual hum of nurses, patient care associates, pharmacy technicians, and unit managers going about their daily work, the floor becomes enveloped in tension. Daily rhythms jump a half step ahead of the beat; conversations among close colleagues fall out of tune. “Thank goodness you're here,” nurse after nurse told my attending and me, the weight of Carlos' case hanging from their shoulders and tugging at the already puffy skin below their eyes. I was a newly minted palliative care fellow, just over a month into my training. I was developing quickly, but as can happen with too many of us, my confidence sat a few steps beyond my skills. I thought I had a firm grasp of palliative care communication skills and was eager to use them. I asked for feedback from my attendings and genuinely worked to incorporate it into my practice. At the same time, I silently bristled when they took charge of a conversation in a patient's room. Over the ensuing week, my attending and I leaned in. We spent hours at Carlos' bedside. If I squinted, I could have convinced myself that Carlos' pain was better. Every day, however, felt worse. We were not making any progress with Carlos' mother, who mostly sat silently in a corner of his room. Aside from occasionally moaning, Carlos did not speak. We learned little, if anything, about him as a person, what he enjoyed, what he feared. We treated him, and we barely knew him. Each morning, I would dutifully update my attending about the overnight events. “Creatinine is up. Bili is up.” She would shake her head in sadness. “Doesn't she get that he's dying?” one of the nurses asked us. “I feel like I'm torturing him. He's jaundiced and going into renal failure. I'm worried we're going to need to send him to the ICU. But even that won't help him. Doesn't she understand?”  We convened a family meeting. It was a gorgeous August afternoon, but the old BMT unit had no windows. We sat in a cramped, dark gray family meeting room. Huddled beside Carlos' mother was everyone on the care team including the BMT attending, nurse, social worker, chaplain, and Spanish interpreter. We explained that his kidneys and liver were failing and that we worried time was short. Carlos' mother had heard it all before, from his clinicians on rounds every day, from the nursing staff tenderly caring for him at his bedside, and from us. “He's going to get better,” she told us. “I don't understand why this is happening to him. He's going to recover. He was cured of his leukemia. I have hope that his kidneys and liver are going to get better.” “I hope they get better,” I told her. I should have stopped there. Instead, in my eagerness to show my attending, and myself, I could navigate the conversation on my own, I mistakenly kept going. “But none of us think they will.” It was after this comment that she looked me right in the eyes and told me I wanted Carlos to die. I knew, even then, that she was right. In that moment, I did want Carlos to die. I could not sit with all the suffering—his, his mother's, and his care team's. I needed her to adopt our narrative—that we had done all we could to help Carlos live, and now, we would do all we could to help him die comfortably. I needed his mother to tell me she understood, to accept what was going on. I failed to recognize what now seems so clear. Of course, his mother understood what was happening. She saw it. But how could we have asked her to accept what is fundamentally unacceptable? To comprehend the incomprehensible?  At its best, serious illness communication not only empathetically shares news, be it good or bad, but also allows patients and families adequate time to adjust to it. For some, this adjustment happens quickly, and in a single conversation, they can digest difficult news and move to planning the next steps in care for themselves or their loved ones. For most, they need more time to process, and we are able to advance the discussion over the course of multiple visits. My attending led the conversations from then on. She worked with the BMT attending, and they compassionately kept Carlos out of the intensive care unit. He died a few days later, late in the evening. I never saw his mother again. I could not have prevented Carlos' death. None of us could have. None of us could have spared his mother from the grief that will stay with her for the rest of her life. Over those days, though, I could have made things just a little bit less difficult for her. I could have protected her from the overcommunication that plagues our inpatient units when patients and families make decisions different from those we would make for ourselves and our loved ones. I could have acted as her guide rather than as her cross-examiner. I could have hoped that Carlos stopped suffering and, genuinely, hoped he got better although I knew it was next to impossible. Because hope is a generous collaborator, it can coexist with rising creatinines, failing livers, and fears about intubation. Even in our most difficult moments as clinicians, we can find space to hope with our patients, if we look for it. Now—years later, when I talk to a terrified, grieving family member, I recall Carlos' mother's eyes piercing mine. When they tell me they hope their loved one gets better, I know how to respond. “I hope so too.” And I do. Dr. Mikkael Sekeres: Hello and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the oncology field. I'm your host, Mikkael Sekeres. I'm professor of Medicine and Chief of the Division of Hematology at the Sylvester Comprehensive Cancer Center at University of Miami. Today I am thrilled to be joined by Dr. Ricky Leiter from the Dana-Farber Cancer Institute. In this episode, we will be discussing his Art of Oncology article, “I Hope So, Too.” Our guest's disclosures will be linked in the transcript. Ricky, welcome to our podcast and thank you so much for joining us. Dr. Ricky Leiter: Thanks so much for having me. I'm really excited to be here. Dr. Mikkael Sekeres: Ricky, I absolutely adored your essay. It really explored, I think, a combination of the vulnerability we have when we're trying to take care of a patient who's dying and the interesting badlands we're placed in when we're also a trainee and aren't quite sure of our own skills and how to approach difficult situations. But before we dive into the meat of this, can you tell us a little bit about yourself? Where are you from and where did you do your training? Dr. Ricky Leiter: Sure, yeah. Thanks so much. So I grew up in Toronto, Canada, and then moved down to the States for college. I was actually a history major, so I never thought I was going to go into medicine. And long story short, here I am. I did a Post-Bac, did a year of research, and ended up at Northwestern Feinberg School of Medicine for med school, where I did a joint degree in medical humanities and bioethics. And that really shaped my path towards palliative care because I found this field where I said, “You know, wow, I can use these skills I'm learning in my Master's at the bedside with patients thinking about life and death and serious illness and what does that all mean in the broader context of society.” So, moved from Chicago to New York for residency, where I did residency and chief residency in internal medicine at New York Presbyterian Cornell, and then came up to the Harvard Interprofessional Palliative Care Program, where I did a clinical fellowship, then a research fellowship with Dana-Farber, and have been on faculty here since. Dr. Mikkael Sekeres: Fantastic. Any thoughts about moving back to Canada? Dr. Ricky Leiter: We talk about it every now and then. I'm really happy here. My family's really happy here. We love life in Boston, so we're certainly here for the time being. Definitely. Dr. Mikkael Sekeres: And the weather's so similar. Dr. Ricky Leiter: Yeah, I'm used to the cold. Dr. Mikkael Sekeres: I apparently did not move to Miami. I'm curious, this may be an unfair question, as you have a really broad background in humanities and ethics. Are there one or two books that you read where you think, “Gee, I'm still applying these principles,” or, “This really still resonates with me in my day to day care of patients who have cancer diagnosis”? Dr. Ricky Leiter: Oh, wow, that is a great question. There are probably too many to list. I think one is When Breath Becomes Air by Paul Kalanithi, which I didn't read in my training, I read afterwards. And I think he's such a beautiful writer. The story is so poignant, and I just think Paul Kalanithi's insights into what it means to be living with a serious illness and then ultimately dying from cancer as a young man, as someone in medicine, has really left an imprint on me. Also, Arthur Kleinman. The Illness Narratives, I think, is such a big one, too. And similarly, Arthur Frank's work. I mean, just thinking about narrative and patient stories and how that impacts our clinical care, and also us as clinicians. Dr. Mikkael Sekeres: And I suspect us as writers also. Dr. Ricky Leiter: Absolutely. Dr. Mikkael Sekeres: We imprint on the books that were influential to us. Dr. Ricky Leiter: Certainly. Dr. Mikkael Sekeres: So how about your story as a writer? How long have you been writing narrative pieces? Is this something you came to later in your career, or did you catch the bug early as an undergrad or even younger? Dr. Ricky Leiter: So I caught it early, and then it went dormant for a little while and came back. As a history major, as someone who is humanities minded, I loved writing my papers in college. Like, I was one of those nerds who got, like, really, really excited about the history term paper I was writing. You know, it was difficult, but I was doing it, particularly at the last minute. But I really loved the writing process. Going through my medical training, I didn't have as much time as I wanted, and so writing was sort of on the back burner. And then actually in my research fellowship, we had a writing seminar, our department, and one of the sessions was on writing Op-eds and perspective pieces. And we had a free write session and I wrote something sort of related to my research at the time I was thinking about, and Joanne Wolfe, who was helping to lead the session, pediatric palliative care physician, she said, “You know, this is really great. Like, where are you going to publish this?” And I said, “Joanne, what do you mean? I just wrote this in this session as an exercise.” She said, “No, you should publish this.” And I did. And then the bug came right back and I thought, “Wow, this is something that I really enjoy and I can actually make a difference with it. You know, getting a message out, allowing people to think a little bit differently or more deeply about clinical cases, both in the lay press and in medical publications.: So I've essentially been doing it since and it's become a larger and larger part of my career. Dr. Mikkael Sekeres: That's absolutely wonderful, Ricky. Where is it that you publish then, outside of Art of Oncology? Dr. Ricky Leiter: So I've had a couple of pieces in the New York Times, which was really exciting. Some in STAT News on their opinion section called First Opinion, and had a few pieces in the New England Journal as well, and in the Palliative Care Literature, the Journal of Palliative Medicine. Dr. Mikkael Sekeres: Outstanding. And about palliative care issues and end of life issues, I assume? Dr. Ricky Leiter: Sort of all of the above. Palliative care, serious illness, being in medical training, I wrote a fair bit about what it was like to be on the front lines of the pandemic. Dr. Mikkael Sekeres: Yeah, that was a traumatic period of time, I think, for a lot of us. Dr. Ricky Leiter: Absolutely. Dr. Mikkael Sekeres: I'm curious about your writing process. What triggers a story and how do you face the dreaded blank page? Dr. Ricky Leiter: So it's hard to pin down exactly what triggers a story for me. I think sometimes I'm in a room and for whatever reason, there's a moment in the room and I say, “You know what? There's a story here. There's something about what's going on right now that I want to write.” And oftentimes I don't know what it is until I start writing. Maybe it's a moment or a scene and I start writing like, “What am I trying to say here? What's the message? And sometimes there isn't a deeper message. The story itself is so poignant or beautiful that I want to tell that story. Other times it's using that story. And the way I think about my writing is using small moments to ask bigger questions in medicine. So, like, what does it mean to have a good death? You know, one piece I wrote was I was thinking about that as I struggled to give someone what I hoped would be a good death, that I was thinking more broadly, what does this mean as we're thinking about the concept of a good death? Another piece I wrote was about a patient I cared for doing kidney palliative care. And she was such a character. We adored her so much and she was challenging and she would admit that. This was someone I wanted to write about. And I talked to her about it and she was honored to have her story told. Unfortunately, it came out shortly after her death. But she was such a vibrant personality. I said, “There's something here that I want to write about.” In terms of the blank page, I think it's overcoming that fear of writing and procrastination and all of that. I think I have a specific writing playlist that I put on that helps me, that I've listened to so many times. You know, no words, but I know the music and it really helps me get in the zone. And then I start writing. And I think it's one of those things where sometimes I'm like, “Oh, I really don't like how this is sounding, but I'm going to push through anyways.” as Anne Lamott's blank first draft, just to get something out there and then I can play with it and work with it. Dr. Mikkael Sekeres: Great. I love the association you have with music and getting those creative juices flowing and picking ‘le mot juste' in getting things down on a page. It's also fascinating how we sometimes forget the true privilege that we have as healthcare providers in the people we meet, the cross section of humanity and the personalities who can trigger these wonderful stories. Dr. Ricky Leiter: Absolutely. Absolutely. It's such a privilege and I think it often will go in unexpected directions and can really impact, for me certainly, my practice of medicine and how I approach the next patients or even patients years down the road. You remember those patients and those stories. Dr. Mikkael Sekeres: Right. You write with such obvious love and respect for your patients. You also write about that tenuous phase of our careers when we're not yet attendings but have finished residency and have demonstrated a modicum of competence. You know, I used to say that fellowship is really the worst of all worlds, right? As an attending, you have responsibility, but you don't have to do as much of the grunt work. As a resident, you do the grunt work, but you don't really have the responsibility. And in fellowship, you've got it all. You've got to do the grunt work, and you have the responsibility. Can you tie those two concepts together, though? How does our relationship to our patients change over the course of our careers? Dr. Ricky Leiter: Early on, if you think about the imprinting of patients as you go down the road, so many of the patients who have imprinted on me were the ones earlier in my career, before I was more formed as a clinician because of experiences like the one I wrote about in “I Hope so Too,” where the skills are forming, and sometimes where it's smooth sailing, and sometimes we're muddling through. And those cases where we feel like we're muddling through or things don't go as we hope, those are the ones that really leave an impact. And I think it's those little moments that sort of nudge your career and your skill set in different ways. I think the patients now, they still leave a mark on me, but I think it's in different ways. And I think oftentimes it's less about my skills. Although my skills are still very much developing, even, you know, almost a decade out, they impact me differently than they once did. I feel more confident in what I'm doing, and it's more about my relationship to this situation rather than the situation's impact on my skills. Dr. Mikkael Sekeres: Got it. Got it. It's interesting. I once wrote a piece with Tim Gilligan, who also spent some time at Dana Farber and is a communications expert, about how there's this kind of dualism in how we're trained. We're trained with communications courses and how to talk to patients, and it almost does the opposite. It kind of raises the flag that, “Wait a second, maybe I've been talking to people the wrong way.” And as you get more mature in your career, I almost feel as if you revert back to the way you were before medical school, when you just talked to people like they were people and didn't have a special voice for patients. Dr. Ricky Leiter: Yeah, I think that's right. And I think in palliative care, we spend so much time thinking about the communication. And this was the most challenging piece about fellowship because then- and our fellowship directors told this to us, and now we teach it to our fellows. You know that you come in, the people who choose to go into palliative care, have a love of communication, have some degree of skill coming in, and then what happens is we break those skills down and teach them a new skill set. So it gets clunkier before it gets better. And the time I was writing about in this piece was August of my fellowship year, exactly when that process was happening, where I'm trying to incorporate the new skills, I had my old way of doing things, and it's just not always aligning. And I think you're right that as the skills become embedded, as you go on throughout your career, where it feels much more natural, and then you do really connect with people as people still using the skills and the techniques that we've learned in our communication courses, but they become part of who you are as a clinician. Dr. Mikkael Sekeres: Nicely put. Your story is particularly poignant because the patient you described was dying from the very treatment that cured his leukemia. It's this, I'm going to use the term badlands again. It's this terrible badlands we sometimes find ourselves where, yes, the treatment has been successful, but at the cost of a human life. Do you think that as healthcare providers, we react differently when a patient is sick, from side effects to our recommendations, as opposed to sick from their disease? Dr. Ricky Leiter: I think we probably do. It's hard because I think every patient in every case pulls at us in different directions. And this case was Carlos, who I called him, it was such a challenging situation for so many reasons. He was young. He really couldn't communicate with us. We were talking to his mom. Like, there were so many layers to this. But I think you're right. that underlying this, there's a sense of “We did everything we could beautifully, to cure him of his disease, and now he's dying of that, and what does that mean for us as clinicians, physicians. That becomes really hard and hard to sit with and hold as we're going back every day. And I say that as the palliative care consultant. So I can only imagine for the oncology team caring for him, who had taken him through this, what that felt like. Dr. Mikkael Sekeres: Well, you describe, again, beautifully in the piece, how the nursing staff would approach you and were so relieved that you were there. And it was, you know, you got the sense- I mean, obviously, it's tragic because it's a young person who died, but you almost got the sense there was this guilt among the providers, right? Not only is it a young person dying, but dying from graft versus host disease, not from leukemia. Dr. Ricky Leiter: Absolutely. There was guilt because of what he was dying of, because of how he was dying that he was so uncomfortable and it took us so long to get his pain under control and we really couldn't get him that balance of pain control and alertness that we always strive for was pretty much impossible from the beginning. And so it was layer upon layer of distress and guilt and sadness and grief that we could just feel every day as we stepped onto the floor. Dr. Mikkael Sekeres: Yeah. I don't know if you've ever read- there's a biography of Henry Kaplan, who was considered the father of radiation therapy, where there was this incredible moment during his career when he presented at the AACR Annual Meeting the first cures for cancers, right? No one believed it. It was amazing, actually curing cancer. And then a couple years later, people started dribbling into his clinic with cancers because of the radiation therapy he gave, and he actually went into a clinical depression as a result of it. So it can affect providers at such a deep level. And I think there's this undiscussed guilt that permeates the staff when that happens. Dr. Ricky Leiter: Absolutely, absolutely. It's right there under the surface. And we rarely give ourselves the space to talk about it, right? To really sit down and say, how are we approaching this situation? How do we feel about it? And to sit with each other and acknowledge that this is horrible. It's a horrible situation. And we feel guilty and we feel sad and we feel grief about this. Dr. Mikkael Sekeres: It's been just terrific getting to know you and to read your piece, Ricky Leiternd, a we really appreciate your writing. Keep doing what you do. Dr. Ricky Leiter: Oh, thank you so much. It's a privilege to get the piece out there and particularly in JCO and to be here with you. So I really appreciate it. Dr. Mikkael Sekeres: Until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all of ASCO's shows at asco.org/podcasts.   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.   Like, share and subscribe so you never miss an episode and leave a rating or review.  Guest Bio: Dr. Ricky Leiter is from the Dana-Farber Cancer Institute.

Many patients with epilepsy are unable to acheive optimal seizure control with medical therapy. Palliative surgical procedures, neurostimulation devices, and other nonpharmalogical treatments can lead to a meaningful reduction in seizures and improved outcomes. In this episode, Teshamae Monteith, MD FAAN, speaks with Daniel Friedman, MD, MSc, author of the article “Surgical Treatments, Devices, and Nonmedical Management of Epilepsy,” in the Continuum® February 2025 Epilepsy issue. Dr. Montieth is a Continuum® Audio interviewer and an associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Friedman is a professor (clinical) of neurology at NYU Grossman School of Medicine and Director of NYU Langone Comprehensive Epilepsy Center at NYU Langone Health in New York, New York. Additional Resources Read the article: Surgical Treatments, Devices, and Nonmedical Management of Epilepsy Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Guest: @dfriedman36  Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum Journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Monteith: This is Dr Teshamae Monteith. Today, I'm interviewing Dr Daniel Friedman about his article on surgical treatments, devices, tools, and non-medication management of epilepsy, which appears in the February 2025 Continuum issue on epilepsy. Welcome to the podcast. How are you? Dr Friedman: I'm well, how are you? Dr Monteith: Thank you for your article. Dr Friedman: Thank you for the opportunity to talk today. Dr Monteith: Why don't you introduce yourself? Dr Friedman: So yeah, so I'm Dan Friedman. I am a professor of neurology here at NYU Grossman School of Medicine and I am the director of the NYU Comprehensive Epilepsy Center. I'm primarily an adult neurologist and I treat teens and adults with hard- difficult-to-treat epilepsy, including surgical treatments for epilepsy. Dr Monteith: And I know you see a lot of patients because I did my residency there. And so, when you graduate, you get a lot of it, like I think many, many residents. What inspired you to choose epilepsy as a profession? Dr Friedman: I came to neurology through my interest in neuroscience. I was a neuroscience undergraduate. I was very interested in the brain and brain function. Particularly, I was interested in how neurons communicate and organize to entrain and rhythms and that encode information. And through that interest and through my experiences in the laboratory, I actually became interested in how they do that in pathological circumstances like seizures. And so, I started reading about epilepsy, and then when I started seeing patients with epilepsy, you know, I decided this is the specialty for me for a lot of reasons. One is it combines inpatient and outpatient care. You get to establish long-term relationships with patients. For many of my patients, I'm probably the doctor that they see most often. You see people across the lifespan. And what I'm going to talk about today is for some people, you actually get to cure their disease, which at the time I was coming into neurology was something pretty rare. Dr Monteith: Yeah, that's great. Why don't you tell us, what were you thinking when you started writing the article? What did you set out to do? Dr Friedman: What I really wanted to do is to educate neurologists out there about the options that they have for their patients with epilepsy, especially those with difficult-to-treat or drug-resistant epilepsy, and give them the tools to communicate those options. Especially for them to understand the rationale, why we choose the interventions that we do as epileptologists, how to appropriately refer patients and have them be partners in that discussion with patients and families. One of the things that we have known for a long time is that the time to referral for things like epilepsy surgery is too long. You know, the average patient with drug resistant epilepsy who undergoes epilepsy surgery waits about twenty years. And for patients who could have curative therapy, you know, become seizure free, that's a lot of life years lost. If we can get patients to that potentially life-altering therapy earlier, that'd be great. Dr Monteith: Yeah, that is really impactful as you think about it. So why don't you tell us what the essential points of your article? Dr Friedman: The central point of my article is really that when patients have drug-resistant epilepsy, which means that our available anti-seizure medicines are not controlling their seizures to the degree that they need, there are other treatment options. Some of those are what we call curative, which means that they could stop their seizures entirely; and some of them are palliative, they could reduce the frequency or severity of seizures and improve quality of life and other outcomes. The other thing that I wanted to highlight was, in addition to these types of therapies, there are other tools we have at our disposal that can improve the quality of life and safety of our patients with epilepsy, including devices for seizure monitoring. Dr Monteith: And how do you define drug-resistant epilepsy? I feel like that could be a moving target. Dr Friedman: The International League Against Epilepsy actually set out to define it about a decade ago, and they defined it as patients who fail at least two appropriately selected anti-seizure medicines due to lack of efficacy. Then they're still having ongoing seizures. What does that mean? So, that means that the medicine that was chosen was appropriate for the type of seizures that they have, whether it's focal or generalized, and that it didn't work because of a lack of efficacy and not because of side effects. And we know from multiple studies that once patients fail two medications, the likelihood that the third, fourth, fifth, etcetera, medicine will control their seizures becomes smaller and smaller. It's not impossible, but the rates fall below five percent. And so we call those patients drug-resistant. Dr Monteith: So, it sounds like despite newer therapies, really things haven't changed in ten years. Dr Friedman: Yeah, unfortunately, at least when the concept was first investigated back in 2000 by Quan and Brody, they found that a third of patients were drug-resistant. When they went back in the mid-2010s to relook at these patients, despite the introduction of many new medications, the rate of patients who were drug-resistant was essentially unchanged. There may be therapies that are emerging or in development that may have better odds, but right now we don't really understand what makes people drug resistant and how we can target that. Dr Monteith: But you do raise a good point that this is about efficacy and not tolerability. And at least for some of the newer medications, they're better tolerated. If you stop the medicine because you had some side effect, that might change how that person has classified better-tolerated treatments. Dr Friedman: It's true. And better-tolerated treatments, you can potentially use higher doses. One of the things that is not in the definition of drug-resistant epilepsy, but as a practicing neurologist, we all know, is that the patients have to take the medicine for it to be effective. And unfortunately, they have to take it every day. And if the medicine makes them feel bad, they may choose not to take it, present to you as drug-resistant, when in reality they may be drug-sensitive if you got them on medicine that doesn't make them feel bad. Dr Monteith: So why don't we talk about patients that are ideal candidates for epilepsy surgery? Dr Friedman: The ideal candidates for epilepsy surgery… and I'll start by talking about curative epilepsy surgery, where the goal of the surgery is to make patients seizure-free. The best candidates are patients who have lesional epilepsy, meaning that there is a visible MRI abnormality like a focal cortical dysplasia, hippocampus sclerosis, cavernoma in a part of the brain that is safe to resect, non-eloquent, and where you can safely perform a wide margin of resection around that lesion. It helps if they have few or no generalized tonic-clonic seizures and a shorter duration of epilepsy. So the ideal patient, the patient that if they came to my office, I would say you should get surgery right now, are patients with non-dominant temporal lobe epilepsy of a few years' duration. So as soon as they've shown that they're not responding to two medicines, those are the ideal patients to say, you would have the most benefit and the least risk from epilepsy surgery. We know from studies that patients with temporal lobe epilepsy do a little better with surgery. We know patients who have a visible lesion on MRI do better with epilepsy surgery. We know that patients who have infrequent secondarily generalized seizures do better. But all patients with drug-resistant epilepsy should be considered for some form of surgery because even if they're not candidates for a curative surgery, there may be some palliative options, whether it's surgical resections that lessen the severity of their seizures or neurostimulation devices that reduce the frequency and severity of seizures. Ideal candidates, the ones that you would push through sooner rather than later, are those who have the likelihood of the best outcomes and the least risk of neurocognitive decline. Dr Monteith: So, you mentioned that there may be other candidates that still benefit, although maybe not ideal. You mentioned neuromodulation. What other interventions are available? Dr Friedman: For patients who are not candidates for resective surgery, there are several neurostimulation options. There's vagus nerve stimulation, which has been around the longest. It is a device that is implanted in- under the skin near the clavicle and has a lead that goes to the left vagus nerve and delivers stimulation, electrical stimulation to the nerve. For reasons we don't fully understand, it can reduce the both the frequency and severity of seizures. Seldom does it make people seizure free, but the reduction in seizure frequency for many patients is associated with improved quality of life, reduced risk of injury, and even reduced rates of SUDEP. We also have two intracranial neurostimulation devices we use for epilepsy. One is the responsive neurostimulator. So, this is a device that- it has leads that are implanted directly into the seizure focus and sense electrocortical brain activity and deliver electrical stimulation to attempt to abort abnormal brain activity. So functioning kind of like a cardiac defibrillator for the heart, but for seizures in the brain. And because these devices have two leads, they can be used to treat people with more than one seizure focus---so up to two---or be used in patients who are not candidates for resection because their seizure focus is in language cortex, motor cortex, things that would be unable to resect. And the RNS has somewhat better efficacy in terms of percent reduction in seizures compared to the VNS, but obviously because it's an intracranial device, it's also a little riskier. It has more potential for neurosurgical adverse effects. There's also a deep brain stimulator for epilepsies, the same exact device that we use to treat movement disorders. We can implant in the thalamus, in either the anterior nucleus of the thalamus or now, for some patients, into the central median nucleus of the thalamus, and deliver open loop stimulation to treat epilepsy and reduce the frequency and severity of seizures as well. Unlike the RNS, you don't have to localize the seizure focus, so you don't need to know exactly where the seizures are coming from. And you could treat patients with multifocal epilepsy with seizures coming from more than two locations or even generalized seizures. Dr Monteith: So, it sounds like there are a lot of options available to patients. I think one of the things I find challenging is when we have patients that may have some cognitive dysfunction, especially in the hospital, and they've had some seizures that are very obvious, but then there are these, maybe, events that you wonder are seizures. So, what is the utility of some of these seizure detection devices? Dr Friedman: The development of seizure detection devices started out primarily with the observation that a majority of cases of sudden unexpected death and epilepsy, or SUDEP, occurred following tonic-clonic seizures. And there was a need to be able to monitor for convulsive seizures, especially that occur at night when people were otherwise unattended. And so, the first generation of devices that were developed came on the market, essentially detected convulsive seizures, and they alerted caregivers nearby who are able to come to the bedside, provide basic seizure first aid, turn people on the side. And theoretically all this---this hasn't been shown in studies---prevents SUDEP. And so, the ones that are currently available on the market are focused on the detection of convulsive seizures, mostly generalized tonic-clonic seizures, but some devices can also detect other seizures with very prominent motor components. What we don't have yet available to us, and what people are working on, are devices that detect nonconvulsive seizures. We know that patients who have focal impaired aware seizures are often amnestic for their seizures. They don't know they had a seizure if family members aren't there to observe them. They may never report them, which makes treating these patients very difficult. How do you quantify disease burden in your headache patients, for instance? You say, how many headache days did you have since we last met in the clinic? Your patients will be able to report on their calendar, this many days. Well, imagine if the patients had no awareness of whether or not they had a headache day. You wouldn't know if your therapy is working or not. In epilepsy, we need those types of devices which can tell us whether patients are having seizures they're unaware of, and that may be more subtle than convulsions. Dr Monteith: Oh, that'd be great for headache, too. You just gave me an idea, but that's the next podcast. So, you mentioned SUDEP, really important. How good are surgical interventions at reducing what we would think the prevalence of SUDEP? Dr Friedman: For me that is one of the primary motivations for epilepsy surgery in patients who are drug-resistant, because we know that if patients who are candidates for epilepsy surgery have high SUDEP rates. Estimates range from six to nine per thousand patients per year. If surgery is successful, their mortality rates go down to the general population level. It literally can be lifesaving for some patients, especially when you're talking about curative epilepsy surgery. But we also know that the biggest driver for SUDEP risk is tonic-clonic seizures and the frequency of those tonic-clonic seizures. So even our palliative interventions, which can reduce the frequency and severity of seizures, may also reduce the risk of SUDEP. So, we know in study- observational studies of patients with VNS and with RNS, for instance, the rates of SUDEP in patients treated with those devices are lower than expected for the drug-resistant epilepsy population. Dr Monteith: Let's talk a little bit about some of these prediction models. And you have a lot of great work in your article, so I don't want to get into all the details, but how do you use that in the real world? Do you communicate that with patients? How do you approach these prediction factors? Dr Friedman: There are two places where, I think, clinical prediction tools for epilepsy surgery have a role. One is, for me, in my clinic where I'm talking to patients about the risks and benefits for surgery, right? You want to be able to accurately communicate the likelihood that the surgery is going to give you the desired outcome. So patients and their families can make educated decisions, be weighing the risks and benefits. I think it's important to be realistic with patients because surgery, like- you know, any surgery is not without risk, both acute risks and long-term risks. You're removing part of the brain, and, you know, every part of the brain is important. That's where I use prediction tools. But I think it's also important for the general neurologist, especially trying to triage which patients you are going to be aggressive with referring to a comprehensive epilepsy center for evaluation. Where you may use your limited time and capital with patients to counsel them on surgical treatments. Where a healthcare system with limited resources prioritizes patients. So, there's a significant need for having prediction tools that only take the input that a general neurologist seeing a patient in the clinic would have at hand. You know, the history, an MRI, an interictal EEG. Dr Monteith: I guess part of that prediction model includes adverse outcomes that you're communicating as well. Dr Friedman: Certainly, for me, when I'm discussing surgery for the patient in front of me, I will use prediction models for adverse outcomes as well that are informed by the kind of surgery we're proposing to do, especially when talking about things like language dysfunction and memory dysfunction after surgery. Dr Monteith: So, you mentioned a lot of great advances, and certainly since I was a resident, which wasn't that long ago. Why don't you tell me how some of these interventions have changed your clinical practice? Dr Friedman: Thinking about epilepsy surgery, like other surgical specialties, there's been a move to more minimally invasive approaches. For instance, when I started as an epilepsy fellow fifteen years ago, sixteen years ago, most of our surgeries involve removing a large portion of the skull, putting electrodes on the brain, doing resections through big craniotomies which were uncomfortable and risky, things like that. We now do our phase two or intracranial EEG monitoring through small burr holes in the brain using robotically placed electrodes. For many of our patients, we can actually treat their epileptic focus with a laser that is targeted through a small catheter and MRI guidance. And patients are usually home in two days with, you know, a lot less discomfort. Dr Monteith: Well, that's great. I didn't expect that one, but I do think that translates to many areas of neurology. Really just this idea of meeting their goals and personalizing their care. My last question is, what out of these advances and what you know about the future of epilepsy, what makes you the most excited and what gives you the most hope? Dr Friedman: I think there are a lot of exciting things in epilepsy. Last count I heard, there's something like over a hundred biotech companies developing epilepsy therapies. So that gives me hope that people are still interested in meeting the unmet needs of patients with epilepsy. And some of these therapies are really novel. For instance, there's a trial of stem cell treatments for drug-resistant temporal lobe epilepsy that's ongoing now, where inhibitory interneuron progenitor cells are implanted in the brain and kind of restore the brain circuit disruptions that we see in some of these epilepsies. There are combinations of drug and device therapies or gene therapy and device therapies that are in development, which have a lot of promise, and I think we'll have much more precise and targeted therapies within the next decade. Dr Monteith: Awesome. I really appreciate our conversation, and thank you so much for your wonderful article. I learned a lot reading it. Dr Friedman: Thank you. Dr Monteith: Today I've been interviewing Dr Daniel Friedman, whose article on surgical treatments, devices, tools, and non-medication management of epilepsy appears in the most recent issue of Continuum on epilepsy. Be sure to check out Continuum audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshmae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

This episode is the first in a 4-part special series in partnership with Stanford Healthcare, sponsorsored by Kensington Senior Living. Grant Smith, M.D. and Emily Linderman, BCC from the Palliative Care team at Stanford Health Care are sharing all the basics of palliative care - when to start it, who can benefit from it, and what a PC team does for patients and caregivers.   Here are a few highlights from our conversation: Palliative care teams are transdisciplinary (consisting of workers with different skills, like physicians, social workers, nurses, and chaplains) and support quality of lifePalliative care can be provided at any age and stage of an illnessPalliative care teams are great at helping patients to understand all the information being thrown at them, facilitating family conferences, and coordinating patient care You can find more resources and information about palliative care at caringinfo.org and getpalliativecare.org  Connect with our special series sponsor Kensington Senior Living: Website: kensingtonseniorliving.com Social media: Instagram  LinkedIn Facebook Information for Jennifer O'Brien Website: jenniferaobrien.com  Read more about Jennifer O'Brien here. Purchase your copy of Care Boss by Jennifer O'Brien here. Buy your copy of The Hospice Doctor's Widow: An Art Journal of Caregiving and Grief here.  Hospice Navigation Services is here for you. If you have questions about hospice care or need to troubleshoot the care you're already receiving, book a session with an expert Hospice Navigator at theheartofhospice.com.   Connect with The Heart of Hospice Podcast and host Helen Bauer Website: theheartofhospice.com Email: helen@theheartofhospice.com More podcast episodes: The Heart of Hospice Podcast Book podcast host Helen Bauer to speak at your event or conference by sending an email to helen@theheartofhospice.com.

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

Join us for an insightful episode featuring seasoned Pediatric Nurse Practitioner Meggan Mikal-DeMont DNP, APRN-FPA, PCNS-BC, CPNP-PC, CHPPN ®, FPCN® with more than10 years of experience in palliative care and pain management. In this whole-hearted interview, she reflects on her husband's nine-month experience with Stage IV colorectal cancer and offers an insider's perspective as both a palliative care clinician and caregiver- how as a couple they navigated the miracle they were hoping for within the system, how these experiences have transformed Meggan's clinical practice, and how life has unfolded since then. Listen for what the health care teams did well, areas where they could improve, and how administrators can champion hospice and palliative care services to make end of life easier for patients and their families.     Meggan Mikal DNP, APRN-FPA, PCNS-BC, CPNP-PC, CHPPN®, FPCN®Meggan Mikal-DeMont is the nurse practitioner of Pediatric Advance Care Team - Palliative & Pain at Advocate Children's Hospitals in Oak Lawn, IL.  Pursuing her interest in working with families that have children living with complex and series illnesses, Meggan has completed a fellowship in pediatric neurodevelopmental disabilities through the Illinois Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program. She also has completed a fellowship in pediatric palliative and hospice nursing through University of Illinois in Chicago and through the Coleman Foundation. This led her to also become a board-certified pediatric hospice and palliative nurse in 2009.  Meggan, along with an interdisciplinary committee, started the Pediatric Palliative and Supportive Care program at Advocate Children's Hospital - Oak Lawn in October of 2012.  Her background as a pediatric intensive care nurse is where her love and passion for working with children with critical and chronic illness grew.  She is an End-of-Life Nursing Education Consortium (ELNEC) trainer and received that training at St. Jude's Hospital in Memphis, TN.  Meggan is an active member of the Hospice and Palliative Nurses Association (HPNA) where she serves on the Advocacy and Legislative Committee. She participated as both an item writer and chair for the pediatric hospice and palliative nurse exam from 2010-2016. Meggan was also recently inducted as a Fellow of Palliative and Hospice Nursing (FPCN®) and is so thrilled to be recognized for her true passion and purpose to this field.   Becoming a widow and a solo parent in 2017 after her husband Andrew died from advanced colorectal cancer has only grown her passion for delivering and advocating for nothing short of the best delivery of palliative and hospice care. Meggan is blessed to be given a new chapter and now lives with her husband Nate, eight year old son Andy, bonus seven year old daughter Elizabeth, and two and a half year old rescue dog Zoey, in Plainfield.   Within palliative care, Meggan has a strong interest in the areas of patient-provider boundaries, patient and family advocacy, and the delivery of diverse, equitable, and inclusive care.   Meggan believes that caring for children with serious illnesses truly starts at the grassroots of relationships. She believes that the family is the center of the care being provided and it is a relationship built on partnership. Helping children live life to their fullest ability without burdensome symptoms is something that she strives to achieve each day.  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.  

Palliative physician Dr. Samantha Winemaker says her line of work has a branding problem. Instead of thinking of it as "the Grim Reaper service" to be called in at the 11th hour, she says patients benefit from a palliative approach as soon as they're faced with a life-limiting illness. "Dr. Sammy" meets a new patient and his family for the first time - showing how her person-centered care treads the fine line between honesty and hope. 

This episode features Dr Madhurangi Perera (Cancer and Palliative Care Outcomes Centre, School of Nursing and  Australia Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia)   What is already known about the topic? Providing palliative and supportive care in the home setting for people with heart failure is advantageous because care can be provided in accordance with an individual's way of life. Home-based palliative and supportive care for people with heart failure has the potential to improve person and caregiver outcomes and reduce healthcare costs.   What this paper adds? The components of home-based palliative and supportive care are symptom management; expert communication; multidisciplinary team involvement; continuity of care; education; end-of-life discussions; and caregiver support. While initiation of care, the services provided in the home-setting and health care approaches provided differed across the reported studies, in all included studies, nursing staff were strategically placed to provide a wide range of services in the home-setting. Continuous and early liaison between cardiology, palliative care and primary care providers is needed to provide continuous, non-fragmented care.   Implications for practice, theory, or policy The detailed findings of this review which highlight the components of home-based palliative and supportive care can provide guidance to enable health care providers to tailor care for this population. Future research into the perspectives of people with heart failure on each of the identified components and their implementation will assist service providers to gain a better understanding of how to enable home-based palliative and supportive care for persons with heart failure.   Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163241290350   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk  

Grief isn't only an issue after a person dies. Anticipatory grief shows up long before a person has passed away. Families facing dementia, ALS, cancer, renal failure, and other serious illnesses can experience anticipatory grief long before the very end of life.This week we take a look at anticipatory grief from the inside because my family is facing it right now.This episode is for you if you are a clinician who cares for the ill and aging or if you are a person who has an ill or aging person in your life.Share this episode with someone in your life who needs it.I'm glad you're here.Delia 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 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/

Host Annamaria Scaccia talks to Joel Stern, KCA Board member and a dedicated peer mentor, to discuss the importance of advocating for Palliative care. From pain management to quality of life, their conversation sheds light on why palliative care matters for kidney cancer patients. Visit kidneycancer.org for more support and resources. Hosted on Acast. See acast.com/privacy for more information.

Treatment of hepatocellular carcinoma (HCC), like that of many other cancers, spans a spectrum from curative to palliative intent. To explore the "grey zone" of treatment goals for intermediate-stage HCC patients, Dr. Sabeen Dhand interviews a panel of experts in the field: medical oncologists Dr. Adam Burgoyne and Dr. Lingling Du, along with interventional radiologists Dr. Kirema Garcia-Reyes and Dr. Zachary Berman. Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion: https://www.cmeuniversity.com/course/take/125739 --- This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific. --- SYNPOSIS The discussion begins with an explanation of the Barcelona-Clinic Liver Cancer (BCLC) staging system. While this system takes into account helpful factors such as liver function, performance status, and tumor burden, it fails to fully capture the true heterogeneity of the HCC patient population. Additional considerations include tumor biology, response to previous treatments, and the location of metastases. The specialists then share their experiences in treating patients with comorbid gastrointestinal cancers and mixed tumors, discuss the benefits of an interventional oncology clinic setting, and highlight virtual opportunities for connecting with tumor boards. They also offer advice on patient education regarding treatment options. --- TIMESTAMPS 00:00 - Introduction to BCLC Staging 03:02 - Impact of Performance Status 06:29 - Predictors of Survival in HCC 09:51 - Palliative versus Curative Treatment Intent 13:55 - Comorbid and Mixed Gastrointestinal Cancers 16:51 - Adverse Effects of Treatment 20:37 - Interventional Oncology in the Clinic Setting 23:06 - Navigating Multiple Provider Viewpoints 28:01 - Complex Case Examples --- RESOURCES BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update (Reig et al, 2022): https://www.journal-of-hepatology.eu/article/S0168-8278(21)02223-6/fulltext CME Accreditation Information: https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

Episode 184: Multiple Myeloma BasicsSub-Interns and future Drs. Di Tran and Jessica Avila explain the symptoms, work up and treatment of multiple myeloma. Written by Di Tran, MSIV, Ross University School of Medicine; Xiyuan Yang, MSIV, American University of the Caribbean. Comments by Jessica Avila, MSIV, American University of the Caribbean. Edits by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Di: Hi everyone, this is Di Tran, 4th year medical student from Ross university.  It's a pleasure to be back.  To be honest, this project is a part of teamwork of two medical students, myself and another 4th year, her name is XiYuan.  She came from the AUC. Unfortunately, due to personal matters she was unable to make it to the recording today which makes me feel really sad. Jessica: My name is Jessica Avila, MSIV, American University of the Caribbean.Di: The topic we will present today is Multiple Myeloma. Multiple myeloma is typically a rare disease and it's actually a type of blood cancer that affects plasma cells in the bone marrow.Jessica: Let's start with a case: A 66-year-old male comes to his family doctor for an annual health checkup. He is not in any acute distress but he reports that he has been feeling tired and weaker than usual for the last 3 months. He also noticed that he tends to bruise easily. He has a history of arthritis and chronic joint pain, but he thinks his back pain has gotten worse in the last couple of months. Upon checking his lab values, his family doctor found that he has a calcium level of 10.8 and a creatinine level of 1.2, which has increased from his baseline. Given all that information, what do you think his family doctor is suspecting? And what kind of tests she can order for further evaluation?Di: Those symptoms sound awfully familiar – are we talking about the CRAB? You know, the diagnostic criteria for Multiple Myeloma.Jessica: Exactly! Those are called “myeloma-defining events.” Do you remember what those are?Di: CRAB criteria comes in 4 flavors.  It's HYPERCALCEMIA with >1mg/dL, RENAL INSUFFICIENCY with serum creatinine >2mg/dL, ANEMIA with hemoglobin value 10% plasma cells, PLUS any one or more of the CRAB features, we can make the official diagnosis of multiple myeloma. Di:  Before we go deeper, let's back up a little bit and do a little background.  So, what do we know about the immunoglobulins, also known as antibodies? Back from years of studying from medical school, we know that the plasma cells are the ones that producing the antibodies that help fight infections.  There  are various kinds that come with various functions.  Each antibody is made up of 2 heavy chains and 2 light chains.  For heavy chains, we have A, D, E, G, M and for light chains we have Kappa and Lambda.Jessica: Usually, the 5 possible types of immunoglobulins for heavy chains would be written as IgG, IgA, IgD, IgE, and IgM.  And the most common type in the bloodstream is nonetheless the IgG. Di: What is multiple myeloma? In myeloma, all the abnormal plasma cells make the same type of antibody, the monoclonal antibody.  The cause of myeloma is unknown, but there are lots of studies and evidence that show a number of potential etiologies, including viral, genetic, and exposure to toxic chemicals, especially the Agent Orange, which is a chemical used as herbicide and defoliant. It was used as a chemical warfare by the U.S. military during the Vietnam War from 1961 to 1971.Jessica: We need to order some specific blood tests to see if there is elevated monoclonal proteins in the blood or urine. So, to begin with we'll need to take a very thorough history and physical exam. Next, we'll do labs, such as CBC, basic metabolic panel, calcium, serum beta-2 microglobulin, LDH, total protein, and some not so common tests: serum protein electrophoresis (SPEP), immunofixation of blood or urine (IFE), quantitative immunoglobulins (QIg), serum free light chain assay, and serum heavy/light chain ratio assay.If any of the results is abnormal, we should consider referring our patient to an oncologist.Di: Interesting! I read that Multiple Myeloma symptoms vary in different patients.  In fact, about 10-20% of patients with newly diagnosed myeloma do not have any symptoms at all.   Otherwise, classic symptomatic presentations are weakness, fatigue, increased bruising under the skin, reduced urine output, weakened bones that is likely prone to fractures, etc. And if multiple myeloma is highly suspected, a Bone Marrow biopsy should be done with testing for flow cytometry and fluorescent in situ hybridization (FISH). Actually, if any of the “Biomarkers of malignancy (SLIM)” is met we can also diagnose multiple myeloma even without the CRAB criteria. Jessica: The diagnosis is made if one or more of the following is found: >= 60% of clonal plasma cells on bone marrow biopsy, > 1 lytic bone lesion on MRI that is at least 5mm in size, or a biopsy confirmed plasmacytoma. Di: Imaging comes in at the final step especially if we able to find one or more sites of osteolytic bone destruction > 5mm on an MRI scan.Jessica: What if the bone marrow biopsy returns > 10% of monoclonal plasma cells, but our patient doesn't have either the CRAB or the Biomarker criteria? Di: That's actually a very good question, since Multiple Myeloma is part of a spectrum of plasma cell disorders. That's when smoldering myeloma comes into play. It is a precursor of active multiple myeloma. Smoldering myeloma is further categorized as high-risk or low-risk based on specific criteria.A less severe form is called Monoclonal Gammopathy of Undetermined Significance, or simply MGUS, with < 10% bone marrow involvement. Those are diagnoses we give once we rule out actual multiple myeloma, which are defined by the amount of M-protein in the serum.Jessica:  When to get started on treatment? Multiple Myeloma is on a spectrum of plasma cells proliferative disorders, starting from MGUS to Smoldering Myeloma, to Multiple Myeloma and to  Plasma Cell Leukemia.  Close supervision/active watching is enough for MGUS and low risk Smoldering Myeloma. But once it has progressed to high-risk smoldering myeloma or to active Multiple Myeloma, chemotherapy is usually required. Some situations may require emergent treatment to improve renal function, reduce hypercalcemia, and to prevent potential infections.Di: As of 2024, treatment of Multiple Myeloma comprises the Standard-of-Care approved by the FDA. In fact, the quadruple therapy is a combination of 4 different class of drugs that include a monoclonal antibody, a proteasome inhibitor, an immunomodulatory drug, and a steroid. Jessica: They are Darzalex (daratumumab), Velcade (bortezomib), Revlimid (lenalidomide) and dexamethasone.  Other treatment plans for Multiple Myeloma include chemotherapy, immunotherapy, radiation therapy (for plasmacytomas) and stem cell transplants. The patient will also be on prophylaxis acyclovir and Bactrim while on chemotherapy. Sometimes anticoagulants are also considered because the chemo increases the risk of venous thromboembolic events.Di: Although the disease is incurable, but with the advancing of novel therapies and clinical trials patients with multiple myeloma are able to live longer.  Problem is the majority of patients diagnosed with Multiple Myeloma are older adults (>65), the risk of falling is adding to multiple complications of the disease itself, such as bone density loss, pain, neurological compromises, distress and weakness.  Palliative care may come in help at any point in time throughout the course of treatment but is most often needed at the very end of the course. Jessica, can you give us a conclusion for this episode?Jessica: Multiple Myeloma may not be the most common cancer, but we have to be aware of the symptoms and keep it in our differential diagnosis for patients with bone pain, easy bruising, persistent severe headaches, unexplained renal dysfunction, and remember the CRAB: HyperCalcemia, Renal impairment, Anemia and Bone lesions.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:International Myeloma Foundation. (n.d.). International Myeloma Working Group (IMWG) criteria for the diagnosis of multiple myeloma. https://www.myeloma.org/international-myeloma-working-group-imwg-criteria-diagnosis-multiple-myeloma Laubach, J. P. (2024, August 28). Patient education: Multiple myeloma symptoms, diagnosis, and staging (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/multiple-myeloma-symptoms-diagnosis-and-staging-beyond-the-basics.University of California San Francisco. (n.d.). About multiple myeloma. UCSF Helen Diller Family Comprehensive Cancer Center. https://cancer.ucsf.edu/research/multiple-myeloma/about Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

In this episode of Nurse Converse, Courtney Thibeault and Nurse Courtney team up to address the often-avoided topic of death and dying in healthcare. They discuss the lack of standardized education on difficult conversations surrounding end-of-life care, highlighting the importance of equipping nurses with the skills to navigate these sensitive discussions with patients. Join them for an enlightening discussion that aims to empower nurses to navigate one of the most challenging aspects of patient care.>>The Talk Nurses Don't Talk About Enough: Death and DyingJump Ahead to Listen:[01:07] Death and Dying Conversations.[05:05] End-of-life patient care conversations.[09:23] Palliative care versus hospice care.[12:44] Hospice care benefits and misconceptions.[16:21] Difficult conversations in healthcare.[20:13] The importance of difficult conversations.[21:48] Palliative care resources for families.[25:09] Importance of hospice conversations.Connect with Nurse Courtney on social media:Instagram: @court.nurse Connect with Courtney Thibeault on social media:Instagram: @nursesofinstagram For more information, full transcript and videos visit Nurse.org/podcastJoin our newsletter at nurse.org/joinInstagram: @nurse_orgTikTok: @nurse.orgFacebook: @nurse.orgYouTube: Nurse.org

Episode Resources:Click here to download the app ‘Palliative Wound Pro' for Apple devicesClick here to download the app ‘Palliative Wound Pro' for Android devices About the Guest:Anne Walsh, ANP-BC, ACHPN, CWOCN, has been a registered nurse since 1995, beginning her career in home health care. She became certified in wound, ostomy, and continence nursing in 2001 and earned her master's degree and nurse practitioner certification in 2003. In 2008, Anne achieved advanced certification in hospice and palliative nursing and has since dedicated her career to working as a WOC nurse practitioner in hospice and palliative care.Recognizing the shortage of wound and palliative care-certified clinicians, Anne developed the “Wound Care Pro” app, a valuable resource for clinicians treating patients with wounds, whether the goal is healing or palliation. Her expertise and innovative approach continue to make a significant impact on patient care and clinician education.

Olivia sat in our couch almost 3 years ago when she was just about to shift her career path to focus on a population she was passionate about. As she entered the world of palliative massage therapy and working with her local hospice, I'm not sure if she knew what was to come. Fast forward to today and Olivia is one of the go-to therapists in our profession who has taken loads of courses, read countless books, and learned from the experiences of her patients and their families about how important her work is. Today she has a fulfilling practice working with palliative patients and their loved ones, teaches workshops to other healthcare workers as well as families, is studying to add death doula to her repertoire, teaching with the Canadian Massage Conference, and is launching her first full course in a couple of months. A day before setting off to Ireland where she found a hospice to teach at, she came back to fill us in on her journey. Check out Olivia's courses at https://www.anadamassage.com/projects-2 2rmtsandamic.com

Health Canada's 5th annual report on medical assistance in dying was released in December, reflecting numbers and demographics from 2023. For the first time, race and Indigenous identity, and disability were measured. For a discussion on who is requesting and receiving MAID, and for what illnesses, we welcome James Downar, Clinical Research Chair in Palliative and End of Life Care, Faculty of Medicine, University of Ottawa; Rebecca Vachon, Program Director of Health at Cardus Canada; zSonu Gaind, a psychiatrist and professor at University of Toronto; and Sandy Buchman, a palliative care doctor working out of North York General Hospital.See omnystudio.com/listener for privacy information.

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: Augusta Precious Metals. Our partners Augusta Precious Metals are the best Gold IRA provider in the business. Text TRIGGER to 35052 to get your free info kit. 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: https://twitter.com/triggerpod https://www.facebook.com/triggerpod/ https://www.instagram.com/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? Learn more about your ad choices. Visit megaphone.fm/adchoices

Ciaran O'Neill is the Ussher Associate Professor in Nineteenth-Century History at Trinity College Dublin. His work mainly focuses on the social and cultural history of Ireland and empire, the history of education and elites, colonial legacies, modern literature, and public history. In this interview, he discusses Power and Powerlessness in Union Ireland: Life in a Palliative State (Oxford UP, 2024), a survey of the state in nineteenth-century Ireland. Life in a Palliative State is an exploratory book that challenges assumptions about who might have been powerful, or powerless, in Union Ireland. It decenters sectarian division, popular and parliamentary politics, and the tradition of physical-force nationalism and emphasizes transnational phenomena, a settler colonial diaspora, and minority groups on the island. Departing from the conventional focus on political leaders like Parnell and De Valera, the book concentrates on the everyday dynamics of power and resistance during the Union. Structured as interlocking essays spanning the long nineteenth century, the book begins by defining the power structures that governed Ireland. Subsequent chapters examine the governance of Ireland, the development of infrastructure, and the mapping of its population and territory. Drawing on feminist theories of power, the book also explores marginalized groups and their agency within Irish society, debunking the myth of Irish ‘ungovernability.' One is the Irish diaspora, positioned as both a resource and a threat within the wider context of European settler colonialism. By analyzing the diaspora's influence and the phenomenon of remittances, the book challenges prevailing notions of powerlessness. By tracing a geographical journey from East to West, the book questions traditional representations of authenticity and colonization Power and Powerlessness in Union Ireland: Life in a Palliative State is published with Oxford University Press. Aidan Beatty is a lecturer in history at Carnegie Mellon University Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

Ciaran O'Neill is the Ussher Associate Professor in Nineteenth-Century History at Trinity College Dublin. His work mainly focuses on the social and cultural history of Ireland and empire, the history of education and elites, colonial legacies, modern literature, and public history. In this interview, he discusses Power and Powerlessness in Union Ireland: Life in a Palliative State (Oxford UP, 2024), a survey of the state in nineteenth-century Ireland. Life in a Palliative State is an exploratory book that challenges assumptions about who might have been powerful, or powerless, in Union Ireland. It decenters sectarian division, popular and parliamentary politics, and the tradition of physical-force nationalism and emphasizes transnational phenomena, a settler colonial diaspora, and minority groups on the island. Departing from the conventional focus on political leaders like Parnell and De Valera, the book concentrates on the everyday dynamics of power and resistance during the Union. Structured as interlocking essays spanning the long nineteenth century, the book begins by defining the power structures that governed Ireland. Subsequent chapters examine the governance of Ireland, the development of infrastructure, and the mapping of its population and territory. Drawing on feminist theories of power, the book also explores marginalized groups and their agency within Irish society, debunking the myth of Irish ‘ungovernability.' One is the Irish diaspora, positioned as both a resource and a threat within the wider context of European settler colonialism. By analyzing the diaspora's influence and the phenomenon of remittances, the book challenges prevailing notions of powerlessness. By tracing a geographical journey from East to West, the book questions traditional representations of authenticity and colonization Power and Powerlessness in Union Ireland: Life in a Palliative State is published with Oxford University Press. Aidan Beatty is a lecturer in history at Carnegie Mellon University Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/history

Ciaran O'Neill is the Ussher Associate Professor in Nineteenth-Century History at Trinity College Dublin. His work mainly focuses on the social and cultural history of Ireland and empire, the history of education and elites, colonial legacies, modern literature, and public history. In this interview, he discusses Power and Powerlessness in Union Ireland: Life in a Palliative State (Oxford UP, 2024), a survey of the state in nineteenth-century Ireland. Life in a Palliative State is an exploratory book that challenges assumptions about who might have been powerful, or powerless, in Union Ireland. It decenters sectarian division, popular and parliamentary politics, and the tradition of physical-force nationalism and emphasizes transnational phenomena, a settler colonial diaspora, and minority groups on the island. Departing from the conventional focus on political leaders like Parnell and De Valera, the book concentrates on the everyday dynamics of power and resistance during the Union. Structured as interlocking essays spanning the long nineteenth century, the book begins by defining the power structures that governed Ireland. Subsequent chapters examine the governance of Ireland, the development of infrastructure, and the mapping of its population and territory. Drawing on feminist theories of power, the book also explores marginalized groups and their agency within Irish society, debunking the myth of Irish ‘ungovernability.' One is the Irish diaspora, positioned as both a resource and a threat within the wider context of European settler colonialism. By analyzing the diaspora's influence and the phenomenon of remittances, the book challenges prevailing notions of powerlessness. By tracing a geographical journey from East to West, the book questions traditional representations of authenticity and colonization Power and Powerlessness in Union Ireland: Life in a Palliative State is published with Oxford University Press. Aidan Beatty is a lecturer in history at Carnegie Mellon University Learn more about your ad choices. Visit megaphone.fm/adchoices

#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

Talking about advance directives, goals of care, and end-or-life wishes can be scary. Even if the conversation doesn't scare you, finding the right time and the right way to bring it up can be a challenge.This week I share my own recent experience of having a goals of care conversation with a loved one, and give practical guidance for how to get started with your own courageous conversations.Let's talk about it!Dr. DeliaDelia Chiaramonte, MDwww.integrativepalliative.com#palliativecare Coping 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/

In this episode of Creedal, we discuss what the Incarnation reveals about human dignity and apply those lessons to the ongoing debate about assisted suicide in the UK. Zac provides a detailed overview of the proposed legislation on assisted suicide, arguing against it from both moral and policy perspectives, and highlighting the dangers of framing such issues in a misleading way. In this conversation, Zac discusses the complex issues surrounding assisted dying legislation, emphasizing the need for a nuanced understanding of dignity, autonomy, and the healthcare system. He critiques the slippery slope of assisted suicide laws, highlighting the potential for abuse and the importance of palliative care. Zac argues for the necessity of hope in end-of-life decisions and the ethical responsibilities of healthcare providers. Takeaways Mass hysteria reflects humanity's chronic existential anxiety. Advent serves as a reminder to place hope in Jesus. The incarnation elevates human dignity and opens possibilities for eternal life. Assisted suicide is currently being debated in the UK Parliament. The UK has a long-standing prohibition against assisted suicide since 1961. The recent second reading of the bill indicates majority support in Parliament. Assisted suicide raises significant moral and practical concerns. Public support for assisted dying is often framed misleadingly. Dignity in dying is a term used to garner support for assisted suicide. Assisted suicide is always a bad idea from both moral and policy standpoints. A lack of autonomy does not diminish dignity. Canada's assisted suicide statistics are alarming. Coercion can be implicit in decisions about assisted suicide. Palliative care should be prioritized over assisted suicide. Hope is essential in discussions about end-of-life care. Sound Bites "Our ultimate hope lies in Jesus Christ." "Mass hysteria is a feature of humanity." "Advent is a time to reassess our hope." "This is a giant sea change for the UK." "Assisted suicide is always a problem." "Assisted suicide is bad policy." "We have a broken healthcare system." "Autonomy does not change your dignity." Chapters 00:00- Introduction and Context of Current Events 02:32 - The Significance of Advent and Human Dignity 08:37 - Assisted Suicide: The UK Debate 22:47 - Arguments Against Assisted Suicide 42:30 - The Importance of Hope in End-of-Life Decisions