Podcasts about palliative

In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Maisha T. Robinson, MD, MSHPM, FAAN, FAAHPM, who served as the guest editor of the December 2025 Neuropalliative Care issue. They provide a preview of the issue, which publishes on December 2, 2025. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Robinson is the Chair of the Division of Palliative Medicine and an assistant professor of neurology at Mayo Clinic in Jacksonville, Florida. Additional Resources Read the issue: continuum.aan.com Subscribe to Continuum®: shop.lww.com/Continuum 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: @LyellJ Guest: @neuropalldoc Full episode transcript available here Dr Jones: Most of us who see patients with chronic progressive neurologic disease are aware of the value of palliative care. The focus on symptom management and quality of life is a key aspect of helping these patients. But how many of us are comfortable starting the conversation about palliative care or care at the end of life? Today we have the opportunity to speak with a leading expert on neuropalliative care, Dr Maisha Robinson, about how we can better integrate neuropalliative care into our practices. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Maisha Robinson, who is Continuum's Guest Editor for our latest issue of Continuum on neuropalliative care, and our first-ever issue fully dedicated to this topic. Dr Robinson is an assistant professor of neurology at Mayo Clinic in Florida, where she is Chair of the Division of Palliative Medicine, and she also serves on the AAN Board of Directors as Chair of the Member Engagement Committee. Dr Robinson, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners? Dr Robinson: Well, Dr Jones, thank you for having me. Really a pleasure to be here. I'm Maisha Robinson at the Mayo Clinic in Jacksonville, Florida. I spent my time as a neurohospitalist, a general palliative care physician, and a neuropalliative care physician. Dr Jones: So, this is a topic that at Continuum, we have heard about from subscribers for a long time requesting a fully dedicated issue to palliative care. And we've titled this neuropalliative Care. So, we want to respond to our subscribers and bring them content that they're interested in. I also think that palliative medicine is a big education gap in our specialty of neurology and something that we have room to improve on. So, let's start with the basics, Dr Robinson. Palliative medicine has been around for a long time, but this concept of "neuropalliative care" feels relatively new. What is neuropalliative care? Dr Robinson: That's a great question. Generally, what I would say is palliative care, first of all, is really just a specialty that focuses on trying to improve quality of life for people that have a serious or advanced medical condition. And neuropalliative care is really palliative care for people with neurologic conditions. And you'll see a number of neurologists doing neuropalliative care, but also there are internists as well, and people from other specialties, who focus on patients with neurologic disease and really trying to improve their quality of life. Dr Jones: Got it. And so, it's really the principles of palliative medicine in a specialty-specific context, which I think is important for us given the prevalence of chronic disease in our specialty. And I was obviously reading through these articles in this issue, and in the really wonderful articles, there are some themes that came up multiple times in various different articles. And one of them was obviously the importance of communication with patients and families. I think, and I'm speaking a little bit from personal experience here, many physicians feel uncomfortable bringing up the discussion of palliative care. And I'm sure that is something that reflects on your practice, too. How often do you have a patient who shows up to clinic and they ask you, why am I here? Dr Robinson: It happens all the time, because colleagues who are referring patients are nervous to tell them that they're sending them to palliative care. But we try to tell people it's really just to normalize it, to say that the palliative care team is going to see you, they're going to help with some symptoms, they're going to help you think about big picture, and they're going to be sort of an added layer of support to your team. And I think if people approach it from that standpoint, then patients and family members will say, that sounds great, I need a little extra support. Dr Jones: So, I think most neurologists have a threshold at which they would feel more comfortable having specialty support, having a palliative medicine specialist to help them in symptom management with the patient. For the palliative care that they provide themselves---and we want our subscribers to read this issue and feel more comfortable with delivering some palliative care on their own---how would you encourage them to begin that conversation? How should they initiate that conversation with a patient about working more toward palliative management of symptoms? Dr Robinson: So, one of the things we recommend is really introducing an approach to palliative care very early in the disease process. So, discussions about big picture and goals of care, discussions about who might help make medical decisions if the person can't make them for themselves. Those kinds of things can be discussed very early on. And in fact, that's palliative care. And then they can talk to patients more about the fact that as the disease progresses, there may be an additional team that can help walk along alongside the neurologist in helping you prepare for what's to come. You know, I think it's very important for patients and family members who feel like you're not abandoning them, but you're adding additional resources. And so, I like the way that we often will suggest to people to say partner or collaborate or bring in extra resources with the palliative care team. I think patients and family members will respond to that. Dr Jones: Yeah. So, by talking about it early, you kind of, at least, help to avoid that problem of the patient perceiving the introduction of palliative care as the quote-unquote "giving-up problem." Is that right? Dr Robinson: Correct. Because we also don't want to see people who are just being referred to us for end-of-life care. Palliative care is about much more than that. But if patients will Google palliative care, they may see hospice come up. And so, introducing the concept early and discussing some palliative topics early will allow the patient and family members to think that, okay, this isn't because I'm at the end of life. This is just because my clinician wants to make sure that I have all the bases covered. Dr Jones: This was also mentioned in several of the articles, the studies that have shown how frequently palliative care is initiated very near the end of life, which is usually, I think, perceived as a missed opportunity, right? To not wait so long to take advantage of what palliative care has to offer. Dr Robinson: That's correct. And the benefit of palliative care is that oftentimes we work alongside an interdisciplinary team, a team that could be quite helpful to patients and their support systems throughout the course of the disease. So, we have chaplains, we have nurses, we often have other clinicians, advanced practice providers as well, who work with us. We have spiritual advisors as well. And the patients and family members could benefit from some of those resources throughout the course of the disease. Who they might need to meet with may vary depending on what the disease is and how they're doing. But there's definitely some benefit to having a longitudinal relationship with the palliative care team and not just seeking them out at the end of life. Dr Jones: So- that's very helpful. So, it'll obviously vary according to an individual provider's level of comfort, right, where they're comfortable providing certain palliative management care versus when they need to have some assistance from a specialist. Are there types of care or are there certain thresholds that you say, wow, this patient really should go see a specialist in palliative medicine or neuropalliative care? Dr Robinson: So, I think that if there are, for instance, refractory symptoms, where the neurologist has been working with a patient for a while trying to manage certain symptoms and they're having some challenges, that person may benefit from being referred to palliative care. If patients are being hospitalized multiple times and frequently, that may suggest that a good serious-illness conversation may be necessary. If there are concerns about long-term artificial nutrition, hydration, or functional and cognitive decline, then some of those patients have benefited from palliative care. Not only the patient, but also the caregiver, because our team really focuses on trying to make sure that we're walking through the course of disease with these patients to ensure that all of the needs are managed both for the patient and the family member. Dr Jones: Got it. And that's very helpful. And I know that we talk about a lot of these decisions happening in an ideal environment when there's good access to the neurologist and good access to a palliative medicine specialist or even a neuropalliative medicine expert. In your general sense, I- and maybe we'll talk a little bit here in a minute or two about the growing interest in neuropalliative care. But in terms of access, in terms of availability of really, truly neuropalliative expertise, what is your sense of how widely available that is in the US? Dr Robinson: There's a shortfall of palliative care clinicians in the United States. Everybody who needs a palliative care clinician won't have access to one. And I think your point about the primary palliative care is so important. That's really what we encourage all clinicians, neurologists, neurosurgeons, even, physiatrists, the neurology care team members need to be comfortable with at least initiating some of these conversations. Because, to your point, not everyone's going to have access to a palliative care physician. But by reading issues such as this one, attending some courses---for instance at the American Academy of Neurology meetings---, doing some online trainings, those types of things can be helpful to bring any neurology clinician up to speed who certainly may not have access to a palliative care physician. Dr Jones: So, I know---and this is in part from my own conversations with patients in my own practice---there are a number of fears that patients have when they have a chronic disease, something that's progressive or something that we don't have a curative treatment for. But I think one of, if not the most common fear among patients is pain, and pain that can't be managed adequately during the course of chronic illness or at the end of life. One of the interesting concepts that I saw mentioned in a few of the articles in this issue is this concept of total pain. So, not just the somatic pain that I think we tend to think of as clinicians and patients tend to think of as patients, but a more holistic definition of pain. Walk us through that and how that relates to palliative medicine. Dr Robinson: So, Dame Cicely Saunders, the modern-day founder of palliative medicine, really described this biopsychosocial model for pain. And so, you're right, it's not just physical pain, but it's psychological pain, it's spiritual pain. And oftentimes when we are taking care of patients with neurologic disease, they may have some physical pain, but a lot of them are thinking about, for instance, the things that they will miss, which may cause some internal discomfort. Things that they're grieving, the life they thought they were going to have, the person that they used to be, the life they used to have, and what they anticipated their life as being. And some of that can cause people to have not only the spiritual discomfort, but also some psychological discomfort as well. And so, when we're thinking about how to provide rehensive care to these patients, we have to be thinking about all of these aspects. Dr Jones: It's really helpful. And I guess the more you can identify those, the more you can either help yourself or find the right expert to help the patient. I thought that was an interesting expansion of, of my view of how to think about pain. And another observation that came up in several of the articles was a lack of high-quality clinical trial evidence to inform a lot of the interventions in neuropalliative care. Some of them are common-sense, some of them are based on clinical experience or expert advice. In your own practice, if there was one key knowledge gap to close---in other words, if there was one pivotal trial that we could do to answer one question in helping patients with chronic neurologic disease---what would you say is the main gap? Dr Robinson: I think the real gap is, who needs palliative care and when? That seems very simple. We have tried things such as automatic triggers for palliative care, for instance, in patients with ALS, or we've said that maybe all glioblastoma patients should see palliative care. But is that true? Are we utilizing the resources in the best possible way that we can? We're not sure. And so, you'll see these practices doing things all a little bit different because we don't have a best practice and it's not really standardized about when people should see palliative care, or why, for instance, they should see palliative care, or who should see palliative care. And I think if we could help drill that down, we can provide some better guidance to our colleagues about when and why and who should see palliative care. Dr Jones: It's a really kind of a fundamental, foundational, who needs the service to begin with or who needs to care. Okay, that's- that is a big gap. So, one of the interesting concepts that I read- and it was in Benzi Kluger's article on neuropalliative care for patients who have movement disorders. I think it's a concept that is interesting, really, maybe in the management of patients with a lot of different chronic, progressive neurologic diseases. And it's this idea of stealing victories or bringing joy to patients. In other words, not just managing or trying to minimize some of the negative aspects or symptoms of disease, but looking for opportunities to bring something positive to their experience or improving their quality of life. Tell us a little more about that, because I think that's something patients would appreciate, but I think neurologists would appreciate that, too. Dr Robinson: Dr Kluger loves to talk about sustaining and finding joy in patients who have really serious or advanced neurologic conditions. He likes to talk about stealing victories, which can relate to the fact that patients and their loved ones can find even some benefit despite having a serious or advanced neurologic condition. Neurologists and neurology clinicians also can steal victories in their patients when they notice, for instance, that they've gained a new skill, and they've lost a skill that they used to love because of the advancing disease. And this is just an opportunity for not only the patients and family members, but also the care providers to recognize that in the midst of decline, there are positive things to be found. Dr Jones: I think it gives patients a sense of maybe reclaimed autonomy when they can say, well, there's maybe nothing I can do to cure this disease in the conventional sense, but I can maybe go on this trip with my family, which has been something I've always wanted to do. Or, I can do these things, so I can attend certain events that I want to. And I think that autonomy and independence aspect of that, I think that I think that was really meaningful and something that I'm going to bring back to my own practice in my care of patients who have ALS, for example. When you think about neuropalliative care---and you've been a leader in this area, Dr Robinson---what do you think the biggest change in neuropalliative care has been over the last few years? Dr Robinson: I think there's a growing cohort of people who are recognizing that there is some benefit in having dedicated specialists who focus on palliative care for patients with neurologic disease. When I said I was going to do neuropalliative care, somebody asked me, why would a neurologist be interested in palliative care? Over the last decade and a half, we've seen that shift. And not only are our colleagues recognizing the benefit, but also patients and caregivers are. Some are even asking for palliative care. I think people are recognizing that not only having their primary neurologist or neurology clinician taking care of them, they have this extra layer of support, and this extra team really focused on quality-of-life issues can be beneficial. Dr Jones: So, one of the things that I think you and I have both seen, Dr Robinson, is a growing interest among neurology trainees in palliative medicine. And maybe that's anecdotal, but in my own practice, I've seen more and more trainees express an interest in this. For neurology residents who are interested in this as a component of or maybe a focus of their career, what would you recommend to them? How should they go about this? Dr Robinson: Yes, it used to be that every neurology resident interested in palliative care would call me or email me or send me a message, but now there are so many that I can't keep up. We're excited about the growing number of people interested in neuropalliative care. What I would say to those people is that you can really try to hone your skills by, for instance, doing a rotation with the palliative care team at your hospital, if there is one. If there isn't one, you might even ask to spend some time with the local hospice agency, which may be helpful to you. If you're attending some of the national meetings---for instance, the American Academy of Neurology meeting---you may want to go to a course and learn a little bit about palliative care. There are a couple that are offered every year. There is an education opportunity for education in palliative and end-of-life care as well. And so, there are a number of resources that you can find in addition to this issue of Continuum as well. Dr Jones: I find it gratifying that trainees ask about this. And I'm sorry, I think I've probably sent a bunch of trainees your way for advice about this, and you've been incredibly generous with your time and expertise. So, I find it very gratifying that our neurology trainees are interested in this area, because it's an important area of medicine. It's also probably a challenging practice just from the cognitive load and the emotional load of caring for patients who are moving through a progressive illness. What is your thinking about how to have a sustainable career in palliative medicine? What is your approach to that? Is it for everyone? Dr Robinson: Yeah, the issue with palliative care is that we do see some very challenging situations, and frankly some very sad situations. But I actually love what I do because I think that we're helping patients and their family members during very, very difficult times. I feel like this is why I went to medical school, to try to be there for people when they need me the most. The way that I think about it is, the patients and family members will be going through this anyway. We're trying to help improve their quality of life as they're going through it. And what you might find interesting is that these patients are so grateful. And their loved ones, they're so grateful. Even if they're nearing the end of life, just to have someone who's helping them see that, for instance, the pain could be better, or that they have more resources for the loved ones to be able to take care of them. And so, I think that helps sustain us, realizing that we are really having a positive benefit on the patients and also their family members. Dr Jones: Well, I think that's a great point to end on. And these are patients who need help. Even if we don't have a curative therapy, they do need support. And that's an important service and a function and an important facet of our profession. So, Dr Robinson, I want to thank you for joining us, and I want to thank you for such a great discussion of neuropalliative care. I learned a lot from our conversation today. I've learned a lot reading the articles and the experts that you put together. This is an important topic. I'm really grateful to you to having assembled this team of expert authors and put together an issue that I think will be really important for not only our junior readers, but also our more experienced subscribers as well. Dr Robinson: Thank you, Dr Jones, for the opportunity. Dr Jones: Again, we've been speaking with Dr Maisha Robinson, Guest Editor of Continuum's most recent issue and first issue fully dedicated to neuropalliative care. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae 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 the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.

Learn about a training course for professionals entering the palliative care field to prepare them for the emotional and spiritual demands of this work. My guest Meina Dubetz is a registered nurse specializing in Palliative and Oncology Care and also a Certified Grief Educator and Reiki Master. She is the author of the book When… Continue reading Ep. 530 Six Pillars of Care for Palliative Care Providers with Meina Dubetz RN

How do we explain illness and death to a child? Is it possible to find moments of joy even in the face of terminal suffering?In this profound conversation, we explore the world of Palliative Care—a medical field that treats the human being, not just the body. We discuss the critical difference between hospitals and hospices, the devastating impact of loneliness, and the "spiritual pain" that often accompanies physical suffering.A major focus of this episode is on children in palliative care. We hear the heart-wrenching yet inspiring stories of kids like Tasleena, and discuss the delicate balance of honesty and hope when talking to children about their diagnosis. Whether you are a medical professional, a caregiver, or just someone seeking to understand the human condition, this conversation offers life-changing perspective.

Palliative care nurse turned fragrance founder and CEO Octavia Morgan joins us to share how scent became both a healing practice and a business, ultimately leading to Ulta Beauty's first Black- and woman-owned prestige fragrance house. Octavia breaks down practical layering, budget-friendly ways to customize your signature scent, and how she created her first fragrance, Legendary, for her hospice patients. We also get personal about the leap from nursing to entrepreneurship, fear vs. obedience, and the one non-negotiable that keeps her centered: a daily hour of self-devotion. Stay for her holiday recs and a rapid-fire on unexpected notes (hello, oud), “soft life” accords, and the power of pouring into yourself first, so you can better show up for everyone else around you.In this episode we discuss:Layering 101: build from the heaviest scent, then medium, then lightClean, sensual scents that don't read “essential oil”Founder wellness: the one-hour daily ritual & how to move stagnant energyTaking the leap: getting contracts, “burning the boats,” and betting on your callingHoliday picks: Dark Rose, Vanilla Supreme, and 4- and 8-piece discovery setsConnect with Octavia:https://octaviamorgan.com/https://www.ulta.com/ Connect with Be Well, Sis:Instagram – @bewellsis_podcastSubstack – bewellsis.substack.comFollow, rate, and share this episode!We're supporting St. Jude Children's Research Hospital. Head over to www.stjude.org/bewellsis right now and sign up to be a monthly donor. Together, we can make a real impact.Want to get in touch? Maybe you want to hear from a certain guest or have a recommendation for On My Radar? Get in touch at hello@editaud.io with Be Well Sis in the subject line! Have you're on Not Well, Sis rant to contribute? Click here to send it into the show!Be Well, Sis is hosted by Dr Cassandre Dunbar. This episode was edited by Victoria Marin. Our Production Manager is Kathleen Speckert. Be Well, Sis is an editaudio collaboration. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

KEY POINTSYour Health is launching a new hospice program to complete the continuum of care.Hospice is not new to leadership—team members have decades of experience.Palliative care and hospice work together:Palliative can continue indefinitelyHospice begins when disease progression reaches an advanced stage and patients choose comfort over curative treatmentHospice helps patients avoid unnecessary ER visits, hospital stays, and stressful care transitions.The new program allows patients to stay with their same care team, maintaining continuity and trust.Eligibility begins with specific diagnoses and a provider's order, supported by clinical and non-clinical indicators like frequent falls, increased symptoms, or significant weight loss.The “six-month rule” is based on normal disease progression, not an exact timeline.The new hospice service enhances value-based care, controlling costs while improving outcomes.Your Health staff play an important role in asking, “**What matters to you?**”The program ultimately expands patient choice and honors their wishes with compassion and dignity. www.YourHealth.Org

In this episode, host Catherine Moore, LCSW, breaks down what it means to be a Palliative Care Social Worker — a role focused on enhancing quality of life for patients with serious or life-limiting illnesses.You'll learn how palliative social workers support the emotional, social, and spiritual needs of patients and families through psychosocial assessments, family meetings, and advance care planning — all while collaborating with nurses, physicians, and chaplains as part of an interdisciplinary team.Catherine explains salaries, how to get started, the difference between hospice and palliative care (hint: palliative care isn't just for end-of-life) and explores the key skills you'll need, including:- Communication & compassion in difficult conversations- Grief counseling, trauma-informed care, and crisis intervention- Navigating family conflict with cultural humility- Self-awareness, emotional boundaries, and self-care to prevent compassion fatigueWhether you're a new MSW graduate exploring career paths or simply curious about medical social work, this episode offers a clear, compassionate look into palliative care and the heart of this meaningful field.____________________________________⁠Tap Here to Subscribe⁠ to the Social Workers, Rise! Email Resource List⁠Tap Here⁠ to shop career courses for Social Workers.____________________________________Thank you to our SPONSORSHPSO Professional liability insurance designed for healthcare providersRISE Directory for Clinical Supervision

Wie füttere ich mein Tier am Lebensende richtig? In dieser Episode erfährst du, warum Fütterung in der palliativen Betreuung so viel mehr ist als reine Nahrungsaufnahme. Ich zeige dir, welche Veränderungen im Körper alter Tiere eine Rolle spielen, wann Diätfutter sinnvoll sein kann – und warum manchmal das Lieblingsleckerli die schönste Form von Fürsorge ist. Mit einfühlsamen Geschichten aus meiner Praxis und klaren Antworten auf typische Fragen wie „Mein Tierarzt sagt Diätfutter, aber mein Tier rührt es nicht an – was soll ich tun?“ oder „Ist es schlimm, wenn mein Hund nur noch Leberwurst frisst?“ möchte ich dir Mut machen: Es gibt nicht den einen richtigen Weg. Wichtig ist, dass dein Tier Freude am Napf erlebt und du die gemeinsame Zeit ohne Schuldgefühle genießen kannst. Hör jetzt rein und erfahre, wie du deinem Tier am Lebensende mit Liebe durch den Magen ganz viel Lebensqualität schenkst.

November is National Hospice and Palliative Care Month. Join A Cure in Sight, an ocular melanoma foundation, for an insightful conversation with Suzanne O'Brien, RN, on the important distinctions between palliative care and hospice care. In this episode, Suzanne sheds light on the significant gaps in end-of-life education that leave many families overwhelmed and unsupported during some of the most challenging moments of their lives. As the Founder & CEO of Doulagivers Institute, Suzanne B. O'Brien has dedicated her life to increasing access to high-quality end-of-life education and compassionate care. Drawing from her firsthand experience at the bedside of more than 1,000 patients as a hospice nurse and palliative care professional, she has created free trainings and resources to empower both caregivers and practitioners worldwide. https://doulagivers.com/

Palliative care physician Dr. BJ Miller survived a near-death experience and lost three limbs at just 19 years old. In this intimate conversation, he tells Sarah how confronting mortality reshaped his purpose, and opened his heart to awe, humor, creativity, and love. BJ has been on a mission to redefine end-of-life care through his work at Mettle Health and his book, "A Beginner's Guide to the End." He invites you to challenge the fear and silence around death, and imagine a better way to live — and die.

Dopo anni di lavoro come infermiera in Italia, Alessia Aielli si è trasferita in Australia, ed è ora Project Officer di Palliative Care Australia. L'abbiamo incontrata alla National Multicultural Health and Wellbeing Conference 2025 di Melbourne.

Opioids remain a cornerstone of palliative care for patients with serious illnesses like cancer, yet their use is often misunderstood, undertreated, or approached with unnecessary hesitation. This episode explores what pharmacists need to know about assessing opioid appropriateness, questioning therapy when warranted, and supporting comfort-focused care within established clinical and ethical standards. Tune in to build confidence in your role and contribute meaningfully to the care of patients facing serious illness.HOSTJoshua Davis Kinsey, PharmDVP, EducationCEimpactGUESTLorin Fisher, PharmD, BCACPClinical Assistant ProfessorUniversity of Iowa College of PharmacyJoshua Davis Kinsey and Lorin Fisher have no relevant financial relationships to disclose.Pharmacists, REDEEM YOUR CPE HERE!CPE is available to Health Mart franchise members onlyTo learn more about Health Mart, click here: https://join.healthmart.com/CPE INFORMATION Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Identify the role of opioids in managing pain and other symptoms for patients receiving palliative care.2. Describe key considerations for evaluating opioid prescriptions in the context of serious illness, including appropriate use and safety concerns. 0.05 CEU/0.5 HrUAN: 0107-0000-25-330-H01-PInitial release date: 11/10/2025Expiration date: 11/10/2026Additional CPE details can be found here.

Opioids remain a cornerstone of palliative care for patients with serious illnesses like cancer, yet their use is often misunderstood, undertreated, or approached with unnecessary hesitation. This episode explores what pharmacists need to know about assessing opioid appropriateness, questioning therapy when warranted, and supporting comfort-focused care within established clinical and ethical standards. Tune in to build confidence in your role and contribute meaningfully to the care of patients facing serious illness. HOSTJoshua Davis Kinsey, PharmDVP, EducationCEimpactGUESTLorin Fisher, PharmD, BCACPClinical Assistant ProfessorUniversity of Iowa College of PharmacyJoshua Davis Kinsey and Lorin Fisher have no relevant financial relationships to disclose. Pharmacist Members, REDEEM YOUR CPE HERE! Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)CPE INFORMATIONLearning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Identify the role of opioids in managing pain and other symptoms for patients receiving palliative care.2. Describe key considerations for evaluating opioid prescriptions in the context of serious illness, including appropriate use and safety concerns. 0.05 CEU/0.5 HrUAN: 0107-0000-25-330-H01-PInitial release date: 11/10/2025Expiration date: 11/10/2026Additional CPE details can be found here.Follow CEimpact on Social Media:LinkedInInstagram

The parents of Harvey Morrison Sherratt have said they were “shocked” at a whistleblower's claims that Children's Health Ireland had removed their son from its active spinal surgery waiting list after it wrongly determined he was a “palliative” patient. The claims were published in the Sunday Times yesterday. We discussed further with David Cullinane, Sinn Féin Spokesperson for Health.

The parents of Harvey Morrison Sherratt have said they were “shocked” at a whistleblower's claims that Children's Health Ireland had removed their son from its active spinal surgery waiting list after it wrongly determined he was a “palliative” patient. The claims were published in the Sunday Times yesterday. We discussed further with David Cullinane, Sinn Féin Spokesperson for Health.

คุณมองเห็นการเจ็บป่วยระยะท้ายแบบไหน ? ระหว่างการที่ได้รับการรักษาทุกรูปแบบโดยอาจจะไม่สามารถสื่อสารกับคนที่รักได้ หรือการที่ได้มีเวลาอยู่กับคนที่รักแบบยังมีสติและสื่อสารบอกความรู้สึกให้กับพวกเขาได้อยู่  . Palliative care หรือชื่อไทยว่าการดูแลแบบประคับประคอง มีคนเข้าใจผิดมากว่าเป็นการไม่รักษาแล้ว แต่ไม่ได้เป็นแบบนั้น ไม่มีการปล่อยจอยไม่รักษาชีวิตผู้ป่วย เพียงแต่ไม่มีการเร่งและไม่ยื้อชีวิต เพื่อต้องการให้ผู้ป่วยวาระท้ายได้มีคุณภาพชีวิตที่ต้องการมากที่สุด เช่น แทนที่จะต้องโดนเสียบสายเพื่อหายใจ เพื่อรักษา เพื่อให้อาหาร แต่เปลี่ยนมาเป็นการได้ได้กินอาหารที่อยากกิน ได้อยู่พูดคุยล้อมรอบด้วยคนที่รักแทน . แล้วการดูแลแบบนี้นั้นมีข้อดีอย่างไร ? วาระที่มีคุณภาพนั้นเป็นแบบไหน ? ควรเข้าไปเริ่มการดูแลตอนไหน แล้วมีโรคอะไรที่ควรเริ่มการดูแลแบบนี้บ้าง ? รายการใน Episode นี้มีคำตอบให้กับทุกคน ดำเนินรายการโดย กอเตย - ปิญชาดา ผ่องนพคุณ - Death Planner นักวางแผนการตายดี และผู้ก่อตั้ง Baojai Family และ แพทย์หญิง นิษฐา เอื้ออารีมิตร  ผู้ก่อตั้งและผู้อำนวยการโรงพยาบาลคูน Learn more about your ad choices. Visit megaphone.fm/adchoices

Palliative care isn't “giving up”—it's teaming up. Nurse practitioner Minerva Sabine explains how comfort, clarity, and support can begin from day one of a serious diagnosis—not just at the end. In this conversation, she demystifies palliative care, outlines who can benefit, and shares how early involvement can ease stress for both patients and families.You'll learn how palliative teams coordinate with doctors, manage symptoms, and guide meaningful conversations about goals and values. Minerva also shares powerful real-world stories that highlight the difference this approach makes in quality of life and peace of mind.Timestamps0:00 - Intro3:25 - What palliative care really is—and how it differs from hospice7:10 - When to involve palliative care and what families can expect10:45 - The interdisciplinary team: medicine, emotion, and spirit14:20 - Common misconceptions and real patient stories18:30 - How palliative care supports families and improves quality of lifeWhat's NextIf palliative care might help you or a loved one, start by asking your doctor for a referral. Visit The Conversation Project to explore free guides that help families talk about wishes and values before a crisis.Stay connected with Seniority Authority on Facebook and Instagram for more practical, positive conversations about growing older with purpose.

Palliative care with homeopathy is the most gentle and beautiful things.  The patient may be using other medications, and often if a medication is the reason for the life-ending disease, stopping it may not be possible at this stage.  Homeopathy can be used alone or in conjunction with other modalities to ensure the best life-span for the patient as well as a life worth living. All views presented are based on credible sources, but they are explained through the individual's viewpoint.  Doing your own research while integrating new information is always important when forming your own viewpoint. Please feel free to contact me and share ideas on any of the topics on this podcast. I would love to hear from you at hownatureheals@gmail.com The information in this podcast is not meant to address individual health needs, it is general in nature and should not be used as medical information for your health unless used in combination with your health practitioner.  

Since 2010, the Association of Cancer Care Centers (ACCC) has produced an annual Trending Now in Cancer Care report, highlighting the biggest challenges, solutions, and opportunities in oncology. In this episode, CANCER BUZZ speaks with Lindsey Causey, DNP, APRN, ANP-BC, AOCNP, nurse practitioner at Cone Health Cancer Center, about part 2 of the 2025 trend report. She shares takeaways from the in-person discussions at the ACCC Annual Meeting & Cancer Center Business Summit (AMCCBS) that informed this report, as well as how she uses the information from ACCC's trend reports at her own cancer center. Part 2 of the 2025 Trending Now in Cancer Care report focuses on payer-driven challenges and solutions, comprehensive cancer care services, research and clinical trials, and mobile screening to engage communities in cancer prevention and education. The full article can be found in Oncology Issues, the official journal of ACCC. Lindsey Causey, DNP, APRN, ANP-BC, AOCNP Nurse Practitioner Cone Health Cancer Center Greensboro, NC “Many patients come into my clinic and they say, I just feel like a piece of me goes to one office, a piece of me goes to another office. I don't want to be seen as pieces of a whole person. I want to be seen as the whole person and know what to do and feel like I have all my answers in one place. “ “[The trend report] really allows you to reflect on what the current state is first and then understand what might need to happen to be able to bring some of these things to fruition.” “Early palliative care is essential, not just because it helps with patients and improving their symptoms and wellbeing, it also increases their survival, but it can also help reduce provider burnout by partnering with palliative care.” Resources: 2025 Trending Now in Cancer Care: Part 1 2025 Trending Now in Cancer Care: Part 2 Archived Reports CANCERBUZZ episode: 2025 Trending Now in Cancer Care: Part 1  

This episode offers practical guidance for nurse practitioners on how to effectively communicate with patients and their families regarding end-of-life care in an acute hospital setting. It emphasizes the importance of thorough chart review, including lab results and imaging scans, to provide factual and empathetic information. Join me regularly as I dive deep into Nurse Practitioner workflow, entrepreneurship, wealth-building strategies, day trading insights, and invaluable resources specifically tailored for Nurse Practitioners and healthcare professionals ready to take charge of their financial future.✨ FREE PDFs Included: https://drive.google.com/drive/folders/1kSL6jTzabuFSleSIZNcJo6F4BG_qtd3n?usp=sharingPractical strategies for maximizing NP income

Caregiving doesn't just happen in the current moment - it brings old family roles that we've been playing out since childhood back to life. The "responsible one" burns out, and the "favorite" expects everyone to defer to them. The "ghost" fades into the background, and the "rebel" resists every decision. In this episode Dr. Delia Chiaramonte explores the hidden scripts that siblings carry into caregiving, why they cause so much conflict, and how you can step out of those roles instead of letting them cause stress and chaos.Once you see your "script" you can start to write a new one.What role do you play?www.integrativepalliative.comCoping Courageously: A Heart-Centered Guide for Navigating a Loved One's Illness Without Losing Yourself is available here: www.copingcourageously.com Please review this podcast wherever you listen and forward your favorite episode to a friend! And be sure to subscribe!Sign up to stay connected and learn about upcoming programs:https://trainings.integrativepalliative.com/IPI-stay-in-touchI'm thrilled to be listed in Feedspot's top 15 palliative podcasts!https://blog.feedspot.com/palliative_care_podcasts/

All Home Care Matters and our host, Lance A. Slatton were honored to welcome Jonathan Cottor as guest to the show.   About Jonathan Cottor, MBA, MPH. :   Jonathan Cottor is a devoted father whose journey with his son Ryan, diagnosed with Spinal Muscular Atrophy at 9 months old, profoundly shaped his life. Ryan defied expectations, living an extraordinary 17 years until his death in December 2018. Inspired by their experience, Jonathan and his wife co-founded Ryan House, a pioneering children's respite, palliative, and hospice care home in Phoenix, Arizona.   After a 30-year career in corporate marketing and leadership, Ryan's death became the catalyst for Jonathan to align his work with his passion. He earned a Master of Public Health (MPH) from the Johns Hopkins Bloomberg School of Public Health, specializing in policy and advocacy, along with a certificate in Maternal and Child Health.   Jonathan is now a recognized national thought leader in pediatric palliative care.   He has been instrumental in building a coalition of community-based pediatric palliative care home models, culminating in the creation of the National Center for Pediatric Palliative Care Homes and its flagship initiative, Children's Respite Homes of America.   About National Center for Pediatric Palliative Care Homes (NCPPCH):   The National Center for Pediatric Palliative Care Homes (NCPPCH) is a national nonprofit advancing an innovative solution: local, community-based homes that provide overnight respite, palliative, and hospice care tailored to the needs of medically fragile children and young adults, particularly those with life-limiting conditions.      

#161: In honor of World Alzheimer's Month, in this week's whiff of wisdom, Clinical Aromatherapist Madeleine Kerkhof explains how you can use scent to support a loved one living with dementia. To listen to the original full episode go to episode #42.Whiff of Wisdom is a biweekly format that spotlights an inspirational insight from a previous guest. The aim is to offer you a whiff of wisdom for your aromatic life, as well as give you some inspiration to try new things that use your sense of smell more. Note: please only use essential oils and CO2 extracts on the most vulnerable if you are trained to do so. Essential oils are highly concentrated substances that need to be used with the utmost safety in mind. Thank you.Links to Madeleine's books:Complementary Therapies in Palliative end of Life CareCO2 Extracts in Aromatherapy: 50 Extracts For Clinical ApplicationFollow Frauke on Instagram: ⁠⁠⁠⁠@an_aromatic_life ⁠⁠⁠⁠Visit Frauke's website ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.anaromaticlife.com⁠⁠⁠⁠⁠⁠⁠⁠⁠Get No Place for Plants children's book on Amazon⁠Learn about Frauke's ⁠⁠⁠⁠⁠⁠⁠Scent*Tattoo Project

Today, we're exploring some of the complexities of real-life palliative care cases that frontline staff have faced in practice. Joining me are four members of the London Ambulance Service's dedicated Palliative and End-of-Life Care Team: Karina Catley, Natalie Nabunya, Rowena Rickson, and Jodie Grace. Together, we'll examine real-life case studies that illustrate the unique challenges of caring for patients and their families during their final moments. From managing uncontrolled seizures in the community to supporting a family's cultural and spiritual wishes after death, these stories highlight the difficulties of decision-making when time is limited, documentation is incomplete, and emotions are intense. Along the way, we'll explore key principles such as the doctrine of double effect, the role of shared decision-making, and the importance of recognising dying in the field. We'll also discuss how clinicians can communicate compassionately, respect cultural values, and navigate the legal and public health frameworks that guide this care. This is a conversation about dignity, humanity, and the privilege of supporting people at the end of their lives, offering lessons for all of us working in pre-hospital care.

Palliative care doesn't mean giving up. It means getting support—while continuing treatments like chemo, dialysis, or radiation. A lot of people think palliative care is the same as hospice. It's not. Elder Care Coordinator Debra King dives into this topic with Shelby Kelley, a nurse practitioner of palliative care.

When someone is nearing the end of life, the idea of leaving behind a “goodbye” or legacy letter can feel meaningful, but also overwhelming. What do you say? How do you start? In this episode, Dr. Delia offers a gentle guide to writing a letter that captures your love, gratitude, and wisdom without the pressure to be perfect.You'll learn:Why legacy letters matter so deeply for both the writer and the readerSimple tips to make the process less overwhelmingTen powerful prompts to spark your writing — from sharing what you've cherished in your life to what you love most about your personWhether you're a patient, a caregiver, or simply someone who wants to capture your story for those you love, this episode will help you find the right words.Coping Courageously: A Heart-Centered Guide for Navigating a Loved One's Illness Without Losing Yourself is available here: www.copingcourageously.com Please review this podcast wherever you listen and forward your favorite episode to a friend! And be sure to subscribe!Sign up to stay connected and learn about upcoming programs:https://trainings.integrativepalliative.com/IPI-stay-in-touchI'm thrilled to be listed in Feedspot's top 15 palliative podcasts!https://blog.feedspot.com/palliative_care_podcasts/

In this episode, I'm joined by Dr. Megan Anderson, founder of Rainbow Bridge Veterinary Services, Ireland's first mobile hospice and palliative care service for pets. We explore her journey, the difference between palliative and hospice care, the heart behind providing in-home gentle euthanasia, and the critical role that bereavement support plays in helping families say goodbye with love and dignity.Connect with Megan:Website: rainbowbridgevets.ieInstagram: @rainbowbridgevetsirelandFacebook: Rainbow Bridge Veterinary ServicesBuy my Book The Pet Loss Journals (UK) ⁠https://amzn.eu/d/gt1T2sj⁠Buy my Book The Pet Loss Journals (US) ⁠https://a.co/d/b8URs3G⁠Journal Prompts: ⁠⁠FREE Journal Prompts Guide⁠⁠ Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.lightafterloss.ie/⁠⁠⁠E-mail: ⁠⁠⁠⁠⁠⁠⁠⁠⁠info@lightafterloss.ie⁠⁠⁠⁠⁠⁠⁠⁠⁠  Instagram: ⁠⁠⁠⁠⁠_lightafterloss⁠⁠⁠⁠⁠⁠Join my Patreon Here for Bonus Episodes⁠⁠⁠ If you haven't yet, please consider leaving a 5 star rating or a review for this episode if you enjoyed it!Louise x

Should we be doing more to save questionable teeth? What if you could buy more time — without compromising patient care? Dr. Omar Ikram returns for a powerful episode diving into the real-world decision-making between endodontics and implants. Together with Jaz, they explore tough scenarios — like teeth with nasty cracks or minimal remaining structure — and ask the critical question: when is it truly time to extract? They break down concepts like retained roots, root burial, amputation, and a new term Jaz introduces — palliative endodontics. Because sometimes the best outcome isn't immediate replacement, but smart, strategic delay. https://youtu.be/5msP908JvuI Watch PDP238 on Youtube Protrusive Dental Pearl: When discussing treatment longevity with older patients, tailor your language to be more relatable. Instead of saying, “I plan my dentistry to age 100,” say, “I want this to last well into your eighties or nineties.” This makes the conversation more personal and realistic, helping patients better connect with the concept of long-term outcomes. Key Takeaways Understanding the limitations of implants compared to natural teeth is vital. Medical history significantly impacts dental treatment decisions. Managing patient expectations is crucial for satisfaction. Palliative endodontics can provide temporary relief and management. Reading and interpreting CBCT scans requires skill and experience. If it's not that five millimeter defect, it's up to you. The second molar is a good one because often second molars can't be replaced with an implant. Retaining roots is definitely a good way to go. You need to risk assess the patient before extraction. Palliative endo is technically always an option. Success in endo can be often difficult to achieve. Asymptomatic and functional is a good criteria. If endo is on the table, it's feasible. Highlights of this episode: 00:00 Teaser 00:35 Introduction 01:48 Protrusive Dental Pearl 04:15 Interview with Dr. Omar Ikram: Philosophy and Growth 10:17 Endodontics vs. Implants: Treatment Planning 16:35 Antidepressants and Dental Implant Failure 19:37 Managing External Cervical Resorption (ECR) 22:30 Patient Communication 24:16 Cracks and Complications in Endodontics 29:12 Endodontic Protocol 30:50 Challenges with CBCT and Cracks 32:07 Second Molars: Retain or Extract? 35:05 Retaining Roots for Future Implants 36:21 Root Burial and Special Cases 40:08 Root Amputation: A Niche Solution 40:57 Key Signs to Rethink Root Canal Treatment 43:17 Cracked Teeth: Poor Prognosis 47:08 Stained Crack Tooth 50:19 Success vs. Survival in Endodontics 56:02 Final Thoughts and Upcoming Events Want to sharpen your endo game even further? Watch Stop Being Slow at Root Canals! Efficient RCTs with Dr Omar Ikram – PDP163 Check out Specialist Endo Crows Nest — led by Dr. Omar Ikram, offering expert care, hands-on courses, and practical tips for real-world endodontics. This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes A and C. AGD Subject Code: 070 ENDODONTICS (Endodontic diagnosis) Aim: To help clinicians develop a deeper understanding of when to preserve a tooth through endodontic treatment versus when to consider extraction and implant placement. Dentists will be able to - Identify key red flags that may contraindicate definitive root canal treatment. Understand the concept of palliative endodontics and how it can be used to delay or defer implant placement responsibly. Recognize the value of retained roots in maintaining alveolar bone, particularly in medically compromised or high-risk patients. #PDPMainEpisodes #EndoRestorative #BreadandButterDentistry

Welcome to Episode 50 of the HPNA Palliative Perspective podcast—a meaningful milestone, and one that gave us pause to reflect on the incredible leaders who've shaped the hospice and palliative care space. In early conversations about this episode, we considered dedicating it to Betty Ferrell, a visionary in the field and the longtime Editor-in-Chief of JHPN, the Journal of Hospice and Palliative Nursing.  But, in true Betty fashion, those close to her reminded us she prefers to stay out of the spotlight. So instead, we're honoring her legacy in a way we think she'd appreciate: by celebrating the educators.  In this episode, we're shining a light on the hospice and palliative nurse educators featured in an upcoming issue of JHPN—innovators who are creating new programs and pushing boundaries in their Schools of Nursing to bring both primary and specialty palliative care to the forefront of nursing education. Their work is not only advancing the field but also shaping the future of compassionate care.  Join Andra Davis, PhD, MN, RN, and Megan Lippe, PhD, MSN, RN, ANEF, FPCN®, FAAN—guest editors of the November issue of JHPN—as they share powerful insights on preparing the next generation of nurses in hospice and palliative care. Educating future nurses requires more than just a solid curriculum—it demands mentorship, creativity, and a deep, ongoing commitment. In this episode, we explore why palliative care is no longer a “nice to have,” but a necessity in nursing education. From shifts in accreditation standards to real-world bedside challenges, Drs. Davis and Lippe discuss the essential role faculty and mentors play in helping students navigate the emotional, clinical, and human complexities of whole person care. We also explore how practicing nurses can be part of this movement—supporting learners and strengthening the future of compassionate care.   Podcast Notes/Links  JPHN Article, releasing in Nov— https://journals.lww.com/jhpn/pages/default.aspx   Betty Ferrell, speaking at HPNA Annual Conference, link  Scope, Standards and Competencies for the Hospice & Palliative RN & APRN, link  The Corner https://www.aacnnursing.org/elnec/elnec-faculty-corner      Megan Lippe, PhD, MSN, RN, ANEF, FPCN®, FAAN Dr. Lippe is Associate Professor with tenure at the University of Texas Health San Antonio and a national leader in palliative nursing education. Her work focuses on educational innovation, simulation, interprofessional collaboration, and social justice. She serves as a co-investigator for the End of Life Nursing Education Consortium (ELNEC), helping advance palliative care education in nursing programs across the country. She has co-authored several key works in the field of palliative care, including undergraduate and graduate palliative care competence statements endorsed by the American Association of Colleges of Nursing (CARES and G-CARES, respectively), ELNEC Undergraduate/New Graduate and ELNEC Graduate online curricula, and the scopes section of the new Hospice and Palliative Nurses Association (HPNA) Scopes, Standards, and Competencies for Hospice and Palliative Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs). In collaboration with colleagues, she has conducted research that led to the development of new tools to assess palliative care curriculum, self-competence, and knowledge among nursing students and entry-level nurses. Honors include 2019 Cambia Sojourns Scholar, 2017 ELNEC Award, and 2019 HPNA New Investigator Award. She is a fellow of the American Academy of Nursing, the Academy of Nursing Education and of Palliative Care Nursing by HPNA.      Andra Davis, PhD, MN, RN Is an Associate Professor of Nursing at the University of Portland, where she teaches across both undergraduate and graduate programs. She is a co-investigator with the End-of-Life Nursing Education Consortium (ELNEC) and brings extensive clinical expertise in cancer symptom management, palliative care, and primary palliative nursing education. Dr. Davis's research centers on strengthening palliative care education, including revising national competency guidelines and developing outcome measures for undergraduate nursing programs. She is recognized for her leadership at regional and national levels in advancing the integration of palliative care into nursing curricula. Internationally, she collaborates with nursing colleagues in Thailand that expand access to palliative education, research, and caregiver wellbeing. Her scholarship also contributes to the evidence base for nurse-led, evidence-informed symptom management guides for patients undergoing cancer treatment.   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.  

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

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

Dr. Michael Rabow, a palliative care physician, explores the wide-ranging side effects of androgen deprivation therapy (ADT) for prostate cancer and emphasizes strategies to reduce harm while improving quality of life. He outlines cardiovascular, hormonal, and emotional risks—including heart disease, osteoporosis, depression, and loss of vitality—and explains how early assessment and monitoring can help manage these effects. Dr. Rabow highlights evidence-based interventions such as physical activity and cognitive behavioral therapy (CBT), both of which improve symptoms like fatigue, sexual dysfunction, and emotional distress. He also reviews pharmacological options and stresses the importance of personalized, team-based care and shared decision-making over time. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40815]

Dr. Michael Rabow, a palliative care physician, explores the wide-ranging side effects of androgen deprivation therapy (ADT) for prostate cancer and emphasizes strategies to reduce harm while improving quality of life. He outlines cardiovascular, hormonal, and emotional risks—including heart disease, osteoporosis, depression, and loss of vitality—and explains how early assessment and monitoring can help manage these effects. Dr. Rabow highlights evidence-based interventions such as physical activity and cognitive behavioral therapy (CBT), both of which improve symptoms like fatigue, sexual dysfunction, and emotional distress. He also reviews pharmacological options and stresses the importance of personalized, team-based care and shared decision-making over time. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40815]

Dr. Michael Rabow, a palliative care physician, explores the wide-ranging side effects of androgen deprivation therapy (ADT) for prostate cancer and emphasizes strategies to reduce harm while improving quality of life. He outlines cardiovascular, hormonal, and emotional risks—including heart disease, osteoporosis, depression, and loss of vitality—and explains how early assessment and monitoring can help manage these effects. Dr. Rabow highlights evidence-based interventions such as physical activity and cognitive behavioral therapy (CBT), both of which improve symptoms like fatigue, sexual dysfunction, and emotional distress. He also reviews pharmacological options and stresses the importance of personalized, team-based care and shared decision-making over time. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40815]

Dr. Michael Rabow, a palliative care physician, explores the wide-ranging side effects of androgen deprivation therapy (ADT) for prostate cancer and emphasizes strategies to reduce harm while improving quality of life. He outlines cardiovascular, hormonal, and emotional risks—including heart disease, osteoporosis, depression, and loss of vitality—and explains how early assessment and monitoring can help manage these effects. Dr. Rabow highlights evidence-based interventions such as physical activity and cognitive behavioral therapy (CBT), both of which improve symptoms like fatigue, sexual dysfunction, and emotional distress. He also reviews pharmacological options and stresses the importance of personalized, team-based care and shared decision-making over time. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40815]

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

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

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.

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

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

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

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

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

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  

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. 

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

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

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