Podcasts about palliative medicine

In this special episode, recorded on June 24 and released on June 25, we bring you a timely dispatch from Washington, D.C., where the Hospice and Palliative Nurses Association (HPNA) leadership and staff engaged in direct advocacy on Capitol Hill.   Join Gayle Gerdes, Vice President of Health Policy Source and consultant to HPNA, and HPNA Manager of Advocacy and Health Policy Sarah Potter as they reflect on their experiences meeting with congressional staffers about HPNA's public policy priorities and amplifying the voices of hospice and palliative care nurses. This episode offers an insider look at the policy priorities that matter in 2025, from protecting federal programs that support nursing research, education, and workforce development to enactment of policies that improve access to quality hospice and palliative care—and how HPNA is uniquely positioned as an interprofessional voice in the conversation.   Key highlights include:   The purpose and power of advocacy—why storytelling matters   Updates on the current climate in Washington, proposed cuts to healthcare programs that impact the interprofessional team and patient access to care, and HPNA's efforts to advance legislation supporting hospice and palliative care nursing  HPNA's collaborations with national coalition partners and legislative champions in the House and Senate  Reflections on the importance of nurse-led advocacy and new opportunities for HPNA members to share their stories and effect policy change at the state and national levels  Whether you're new to policy or a seasoned advocate, this episode will leave you inspired to raise your voice—and equipped to do so effectively.       Gayle Gerdes  Gayle Gerdes is Vice President at Health Policy Source, a government relations firm in Washington, D.C. that provides strategic consulting and lobbying services to a broad group of clients in the health care space. Her health care background is an extensive mix of government and private sector experience. She spent several years on Capitol Hill where she worked in both the House and the Senate focusing her time on health care legislation. Later she moved to The Concord Coalition where she worked with the media, Members of Congress, and related organizations to educate the public on the federal budget and deficit. In particular, she delved into the relationship of Medicare and Social Security with the federal budget. In addition, Gayle has experience serving on the board of the Los Alamos Medical Center, and she has recently consulted for The Brooks Group and The Concord Coalition. Gayle graduated from the University of Arkansas with a B.A. in English and Communications.    Sarah PotterSarah Potter is the Manager of Advocacy and Health Policy at the Hospice and Palliative Nurses Association (HPNA). Sarah has more than 20 years of experience in government relations, health policy, and communications, with a focus on healthcare workforce issues, Medicare, Medicaid, children's health, quality improvement, and the Affordable Care Act. She has developed and implemented state and federal advocacy campaigns and advocacy education programs for several national organizations, including the Pew Charitable Trusts, Independent Sector, the Premier Healthcare Alliance, and the Brookings Institution. Sarah began her career on Capitol Hill as a legislative and communications staffer for Rep. Karen McCarthy of Missouri and Senator Joe Lieberman of Connecticut and holds dual degrees in Journalism and Political Science from the University of Missouri     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.

This episode features Victoria Ali  (Lancaster University, Lancaster, UK. Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK)   What is already known about the topic? Nurses deliver care for patients and those important to them across acts that may intentionally or potentially hasten death, navigating this care within the boundaries of healthcare systems and professional regulation. The increase in permissive legislation relating to assisted dying is challenging healthcare professionals to consider how an assisted death sits alongside accepted or ‘traditional' healthcare practices at the end of life. Providing care in these situations can be challenging and requires emotional labour to navigate.   What this paper adds? This review allows recognition of how the emotional labour involved in providing care, and its subsequent impact, is often better recognised within assisted dying than for other acts that may be perceived as death hastening. The ‘normalising' of care, and consequently dying, within acts that may be perceived as hastening death limits the recognition of the emotional labour required for nurses to provide care in these circumstances. When supporting a patient through an assisted death, nurses focus on optimising the experience for the patient, whereas in other acts that may hasten death, nurses' primary focus is on the experience of those present with the patient.   Implications for practice, theory, or policy The impact on nurses' emotional well-being due to the expectation to engage in significant emotional labour, in all care that may be perceived as death hastening, should be considered in daily practice, policy and organisational structure. The provision of emotional support should be considered for nurses when involved in the delivery of care that may hasten death, either through intentional acts (an assisted death) or unintended consequence of the care. Normalising care that may be perceived as death-hastening can impact nurses' feelings of agency within care delivery and may need to be considered in jurisdictions with permissive assisted dying legislation as these practices embed within organisations.     Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163251331162   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk

This episode features Jing-Da Pan (Department of Oncology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong Province, China)   What is already known about the topic? Family members are crucial in advance care planning for patients with life-limiting illnesses, particularly in Asia, where cultural values stress family-centeredness and paternalism. No study so far has attempted to systematically synthesize this information within the Asian context and there is a lack of a model to describe Asian family members' involvement in advance care planning.   What this paper adds? Asian family members are willing to participate in advance care planning but face difficulties in translating this willingness into action. Barriers include inadequate legislation, insufficient public education, and influences from Confucianism or traditional beliefs. A culturally sensitive model with six dimensions was developed to illustrate Asian family members' participation in advance care planning.   Implications for practice, theory, or policy Asian governments should enact advance care planning legislation to ascertain its legal status and allocate more relevant resources to educate the public to overcome the barriers to Asian family members' participation in advance care planning. Future efforts in advance care planning in Asia should prioritize developing culturally sensitive models which align the willingness, beliefs, and actions of Asians and the proposed conceptual model should be verified by more advanced statistical tests, thus confirming its validity in different Asian regions. Due to the paradoxical impact of filial piety on advance care planning, a culturally specific intervention is needed to help family members understand that respecting dying patients' decisions is a filial act, ultimately improving their involvement in advance care planning.   Full paper available from:     https://journals.sagepub.com/doi/10.1177/02692163251317856   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk

In this episode, we hear from Deb Russell, RN, MSN, FNP-BC, APRN-CNP, ACHPN® with over 20 years in the field, currently leading care in an outpatient, harm-reduction-based palliative clinic. She provides palliative support to patients undergoing active cancer treatment who are also living with substance use disorders—a population with complex and often unmet needs.  Deb shares firsthand insight into:  Navigating symptom management during cancer treatment in patients with active addiction  Building trust through a harm-reduction approach  Collaborating closely with an interdisciplinary team including a physician and pharmacist  Deb shares the unique challenges and clinical considerations—of meeting this patient population where they are—safely managing pain, communication, and care coordination. This conversation offers practical insights and compassionate strategies for anyone caring for patients with co-occurring serious illness and SUD.      Deb Russell, RN, MSN, FNP-BC, APRN-CNP, ACHPN® Deb Russell, RN, MSN, FNP-BC, APRN-CNP, ACHPN® is a dedicated Nurse Practitioner specializing in Palliative Care, with a focus on cancer and addiction. With a deep commitment to patient-centered care, Deb provides compassionate support to patients battling both cancer and substance use disorders.   With over 18 years of experience mostly inpatient, now in the ambulatory setting, Deb works closely with the interdisciplinary team to develop care plans that improve patient outcomes. Deb is passionate about bridging the gap between oncology and addiction, advocating for treatment approaches that empower patients throughout their journey.  Deb has co-authored a paper “Creating a Palliative Care Clinic for Patients with Cancer and Substance Use Disorder” and presented a poster at the Oncology Nursing Congress on” Nurse Practitioner Integration in a Multidisciplinary Team Caring for Patients with Cancer and Addiction”.    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.

Both hospice and geriatric care are underutilized and misunderstood despite offering critical support for quality of life, especially for older adults.  In this episode, Maria Torroella Carney, Chief of Geriatric and Palliative Medicine for Northwell Health and co-author of "The Aging Revolution," discusses the importance of reframing healthcare systems to better serve the growing aging population. She highlights the need for increased home care, caregiver support, and innovative technologies, emphasizing the role of family caregivers as an "invisible workforce." Maria addresses the rising number of "elder orphans" who lack family support and the need to identify them early and provide necessary resources. She also shares that while palliative care is gaining traction, geriatric medicine faces a decline in interest, underscoring the need for initiatives like the Age-Friendly Health System. Tune in to discover the specific policy changes that could improve hospice access and what healthcare systems should do to better address the unique needs of older adults! Resources: Connect with and follow Maria Torroella Carney on LinkedIn. Discover more about Northwell Health on LinkedIn and their website. Buy Maria Torroella Carney's The Aging Revolution here.

In this deeply personal and resonant episode, longtime hospice nurse and podcast host of The Heart of Hospice, Helen Bauer, BSN RN CHPN®, shares an intimate look at the soul of hospice nursing — the part that's rarely documented but always deeply felt. With more than seven years behind the mic and a career alongside patients and families at the bedside, Helen reflects on the intimacy and intensity of hospice care, and the challenges of translating those sacred moments into clinical notes and checkboxes.  Together, we explore the personhood-centered mindset that defines exceptional hospice nursing: arriving as a blank slate, open and eager to learn who the patient is, then crafting care that honors the individual's story, values, and needs. Helen speaks candidly about the emotional toll of the work, the cumulative grief nurses carry, and the resilience it takes to keep showing up — not just for patients, but for ourselves.  Listeners will hear reflections on:  The artistry and difficulty of painting a picture through documentation  How hospice nurses excel at education and advocacy, even outside traditional care settings  What we're doing well as a community — and where we can grow  The value of Hospice Navigation Services and empowering families with information  The quiet power of showing up, day after day, with care and presence  This episode is a tribute to hospice nurses everywhere — a reminder that your work matters, your presence is powerful, and you are just as important as the care you provide.  Whether you're a hospice nurse, a health care professional, or a family member navigating end-of-life care, this episode will speak to the heart of what it means to accompany someone at life's end — with compassion, courage, and creativity.    Helen Bauer, BSN RN CHPN®  Helen Bauer is a highly experienced hospice nurse with more than 15 years dedicated to end-of-life care. Her expertise spans across bedside care, caregiver support, nursing leadership, and hospice consulting. Since 2016, she has been the voice behind The Heart of Hospice podcast, where she shares her deep knowledge and compassionate approach to end-of-life care.  As the founder of Hospice Navigation Services, Helen provides unbiased, expert guidance and support for individuals and families navigating the complexities of hospice and serious illness. Her work as an End of Life Educator and Advocate focuses on empowering caregivers and hospice workers, ensuring that those facing serious illness experience the best possible care at the end of life. Known for her compassion, empathy, and respect, she remains a trusted resource in the field of hospice care.    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.

More and more people are, “doing their own research.”  Self-identified experts and influencers on podcasts (podcasts!) and social media endorse treatments that are potentially harmful and have little to no evidence of benefit, or have only been studied in animals.  An increasing number of federal leaders have a track record of endorsing such products. We and our guests have noticed that in our clinical practices, patients and caregivers seem to be asking for such treatments more frequently.  Ivermectin to treat cancer.  Stem cell treatments. Chelation therapy.  Daneila Lamas wrote about this issue in the New York Times this week -after we recorded - in her story, a family requested an herbal infusion for their dying mother via feeding tube. Our guests today, Adam Marks, Laura Taylor, & Jill Schneiderhan, have coined a term for such therapies, for Potentially Unsafe Low-evidence Treatments, or PULET. Rhymes with mullet (On the podcast we debate using the French pronunciation, though it sounds the same as the French word for chicken).  We discuss an article they wrote about PULET for the American Journal of Hospice and Palliative Medicine, including: What makes a PULET a PULET?  Key ingredients are both potentially unsafe and low evidence.  If it's low evidence but not unsafe, not generally an issue.  Think vitamins. If it's potentially unsafe, but has robust evidence, well that's most of the treatments we offer seriously ill patients!  Think chemo. What counts as potentially unsafe? They include what might be obvious, e.g. health risks, and less obvious, e.g. financial toxicity. What counts as low-evidence?  Animal studies? Theoretical only? Does PULET account for avoiding known effective treatments? Do elements of care that are often administered to seriously ill patients count? Yes. Think chemotherapy to imminently dying patients, or CPR. How does integrative medicine fit in with this?  Jill Schneiderhan, a family medicine and integrative medicine doc, helps us think through this. How ought clinicians respond?  Hint: If you're arguing over the scientific merits of a research study, you're probably not doing it right.  Instead, think VitalTalk, REMAP, and uncover and align with the emotion behind the request. Does the approach shift when it's a caregiver requesting PULET for an older relative who lost capacity? How about parents advocating for a child? For more, Laura suggests a book titled, How to Talk to a Science Denier.   And I am particularly happy that the idea for this podcast arose from my visit to Michigan to give Grand Rounds, and the conversations I had with Adam and Laura during the visit.  We love it when listeners engage with us to suggest topics that practicing clinicians find challenging. And I get to sing Bon Jovi's Bad Medicine, which is such a fun song! -Alex Smith  

It's late at night. You're in a hospital room, holding the hand of a loved one just diagnosed with a serious illness. The doctor has explained the treatment options. However, the weight of the diagnosis still feels overwhelming. You ask yourself: How do we make the most of the time we have? How do we ensure they're comfortable, supported, and able to live well—despite what lies ahead? This is where palliative care plays a vital role. It's a medical specialty focused on improving quality of life for patients and families during some of life's most difficult moments. In fact, few people understand this better than Dr. Steven Pantilat. He's a pioneer in the field and one of the nation's most trusted voices in redefining care for serious illness. As the Chief of the Division of Palliative Medicine at UCSF, Steve has spent decades pushing for patient-centered care. He began during the AIDS crisis in San Francisco, where he saw firsthand how much compassion matters—especially when a cure is out of reach. As a result, those early experiences shaped his mission: to place dignity and empathy at the heart of healthcare. Therefore, in this episode, Steve walks us through that journey—from early crisis care to becoming a national leader. We explore the major challenges he's faced, the lessons he's learned, and his bold vision for the future: a healthcare system where palliative care is standard for everyone facing serious illness. Moreover, his story reminds us that healthcare is not just about curing disease—it's about caring for people. Do you have thoughts on this episode or ideas for future guests? We'd love to hear from you. Email us at hello@rosenmaninstitute.org.

What it is like to be caught in the net-of-work that caring so often involves. Transcription link: https://liveuclac-my.sharepoint.com/:b:/g/personal/rejusya_ucl_ac_uk/EX2MHwUH7H9LhW1eCACV4yEByQ5IW6kCxjcB8JOjujelSA?e=cYxv6t Duration: 25:41:00 Language of episode: English Presenter:This podcast miniseries is presented by Dr Sarah Yardley, Associate Professor in Palliative Medicine, Marie Curie Palliative Care Research Department, University College London. Sarah collaborated with Lucy, Patricia, Elizabeth, Shona, Catherine, Marion, Raj, Shania, Amrita and Martin to narrate the stories. Some words have been voiced by Sarah's academic colleagues at the request of the contributors. Guests: This podcast miniseries is presented by Dr Sarah Yardley, Associate Professor in Palliative Medicine, Marie Curie Palliative Care Research Department, University College London. Sarah collaborated with Lucy, Patricia, Elizabeth, Shona, Catherine, Marion, Raj, Shania, Amrita and Martin to narrate the stories. Some words have been voiced by Sarah's academic colleagues at the request of the contributors. Producer: Lewis Young, Anna de Wolf Evans Maria Christodoulou and Clara Harris edited and produced the miniseries.

Reflections on the end of caring episodes and hear some final thoughts on the other themes in this mini series. Transcription link: https://liveuclac-my.sharepoint.com/:b:/g/personal/rejusya_ucl_ac_uk/EQF3Nzr9SUhEnwtBBHTdxlgB0NHpkf4yq8fJ-BH5PkZckQ?e=oqkkY5 Date of episode recording: 2025-04-09T00:00:00Z Duration: 40:28:00 Language of episode: English Presenter:Sarah Yardley Guests: This podcast miniseries is presented by Dr Sarah Yardley, Associate Professor in Palliative Medicine, Marie Curie Palliative Care Research Department, University College London. Sarah collaborated with Lucy, Patricia, Elizabeth, Shona, Catherine, Marion, Raj, Shania, Amrita and Martin to narrate the stories. Some words have been voiced by Sarah's academic colleagues at the request of the contributors. Producer: Lewis Young, Anna de Wolf Evans Maria Christodoulou and Clara Harris edited and produced the miniseries.

Learning from carers how they find ways to work the system. Transcription link: https://liveuclac-my.sharepoint.com/:b:/g/personal/rejusya_ucl_ac_uk/Ee-3E0Eo_JhNhJkziPzGYogB0gwosf1PBIUK9uH6ZYkCfw?e=Uo93uo Date of episode recording: 2025-04-09T00:00:00Z Duration: 48:48:00 Language of episode: English Presenter:Sarah Yardley Guests: This podcast miniseries is presented by Dr Sarah Yardley, Associate Professor in Palliative Medicine, Marie Curie Palliative Care Research Department, University College London. Sarah collaborated with Lucy, Patricia, Elizabeth, Shona, Catherine, Marion, Raj, Shania, Amrita and Martin to narrate the stories. Some words have been voiced by Sarah's academic colleagues at the request of the contributors. Producer: Lewis Young, Anna de Wolf Evans Maria Christodoulou and Clara Harris edited and produced the miniseries.

Exploring how care functions or not from the perspectives of people drawn into caring roles and what needs to change. Transcription link: https://liveuclac-my.sharepoint.com/:b:/g/personal/rejusya_ucl_ac_uk/Ee3OFfHdGZdIupz8pHGeIV0B_nWDUpr5TWL1Bm9HKlEtrA?e=mgKBUE Date of episode recording: 2025-04-09T00:00:00Z Duration: 35:46:00 Language of episode: English Presenter:Sarah Yardley Guests: This podcast miniseries is presented by Dr Sarah Yardley, Associate Professor in Palliative Medicine, Marie Curie Palliative Care Research Department, University College London. Sarah collaborated with Lucy, Patricia, Elizabeth, Shona, Catherine, Marion, Raj, Shania, Amrita and Martin to narrate the stories. Some words have been voiced by Sarah's academic colleagues at the request of the contributors.

Explanations of how do you become a carer and what does it mean. Transcription link: https://liveuclac-my.sharepoint.com/:b:/g/personal/rejusya_ucl_ac_uk/EcsopN9KWjtLpSyK2luAzH8BSNBv43rY9s2KLrVwRlU5LA?e=MzCHIS Date of episode recording: 2025-04-09T00:00:00Z Duration: 35:46:00 Language of episode: English Presenter:Sarah Yardley Guests: This podcast miniseries is presented by Dr Sarah Yardley, Associate Professor in Palliative Medicine, Marie Curie Palliative Care Research Department, University College London. Sarah collaborated with Lucy, Patricia, Elizabeth, Shona, Catherine, Marion, Raj, Shania, Amrita and Martin to narrate the stories. Some words have been voiced by Sarah's academic colleagues at the request of the contributors.

In this episode of the HSE Talking Health and Wellbeing Podcast, we discuss palliative care with Jacinta Kelly, Director of Nursing, North West Hospice, Sligo and Dr. Feargal Twomey, Consultant in Palliative Medicine, Milford Hospice and HSE Mid West, HSE Clinical Lead, Palliative Care. The discussion demystifies palliative care, emphasising its role beyond end-of-life scenarios and its applicability to patients of all ages and various illnesses. Both guests share freely their personal and professional insights on this sensitive area. Key takeaways include the importance of early engagement, holistic care approaches, and the need for training and coordination among healthcare providers. The episode highlights the work of the staff across the health service who support and work in palliative care and points to the significance of compassionate support for patients and their families. For more information, visit https://www.hse.ie/eng/about/who/cspd/ncps/palliative-care/   To get in touch with the podcast email Healthandwellbeing.communication@hse.ie   Produced by GKMedia.ie

In this episode, we explore the profound impact of Kelli Anspach MSN, CV-BC, NPD-BC, CHPN®'s thriving and sustainable training program, which has successfully trained more than 1,000 hospital nurses over the past 10 years through the End-of-Life Nursing Education Consortium (ELNEC) program, founded by Betty Ferrell PhD, MSN, CHPN®. By providing nurses with the essential skills and knowledge to lead compassionate palliative care conversations, this initiative empowers staff to facilitate critical "goals of care" discussions with patients and families. In this episode, Kelli and Brett discuss how this training not only enhances collaboration with palliative care teams but also drives improved patient satisfaction and better overall care outcomes. Additionally, the conversation takes a closer look at the return on investment (ROI) for hospitals and demonstrates how training nurses across all service lines is a cost-effective strategy to elevate patient care, boost nurse confidence, and foster a more supportive health care environment. With the right education, staff can empower frontline nurses across various serious illness service lines to make a lasting, positive impact on patient care. HPNA is proud to partner with Betty Ferrell and City of Hope to offer virtual ELNEC Train-the-Trainer courses twice per year. Visit the HPNA website for more information on upcoming courses and to learn how you can make a difference at the system level in your own health care organization.     Kelli Maher Anspach, MSN, CV-BC, NPD-BC, CHPN® Kelli has her BSN and MSN from Drexel University. She holds multiple certifications: Cardiac Vascular Certified Nurse, Nursing Professional Development Specialist, Certified Hospice and Palliative Nurse. Kelli has her ONS chemotherapy administration certification, is a certified Aromatherapy provider, and a Level 2 Reiki practitioner. Kelli has planned, presented, hosted, and facilitated many conferences from Women and Heart Disease to Nursing Research to Integrative Therapies but the most rewarding was her work with End of Life Nursing Education Consortium (ELNEC). Kelli implemented ELNEC across a five-hospital health system from 2013-2018.  This included securing grant money for the project and educating more than 900 staff in end-of-life patient care. Kelli was the Winner of International ELNEC Award for excellence in education, has as presented at local and national conferences, and is published in her field.  Kelli continues to be a strong advocate for palliative care and started a palliative care champion model for nurses in her health system to support identified knowledge and practice gaps. Kelli is a Nurse Residency Facilitator where she helps to support and mentor new graduate nurses in their transition to their first year as a professional nurse and lectures for the program on End-of-Life Nursing and Self Care. She teaches classes in oncology, telemetry nursing, and preceptor development for her health system. Kelli is a mother of three, loves to dance and hike, and enjoys her day-to-day role as a Clinical Nurse Educator at Lankenau Medical Center, part of Main Line Health System.   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.

Join Two Worlds Cancer Collaboration Director Camara van Breemen in conversation with Dr. Gayatri Palat, Professor of Palliative Medicine at Mehdi Nawaz Jung Institute of Oncology and Regional Cancer Centre in Telangana, India. Dr. Gayatri is also a founding member of the Pain and Relief Palliative Care Society in Hyderabad and TWCC's  program director in India. Camara, Director of community care and provincial outreach at Canuck Place Children's Hospice in Vancouver, Canada, is one of our regular podcast hosts.

In this episode, Dr Kat Ralston chats with Prof Miriam Johnson about palliative care in heart failure. They discuss the evidence supporting specialist palliative care input in this patient group and explore how to develop effective integrated services. They chat about holistic, needs based assessment and share top tips on the approach to the debilitating symptom of breathlessness. Professor Miriam Johnson is Professor of Palliative Medicine at Hull York Medical School, Associate Director of the Wolfson Palliative Care Research Centre at the University of Hull. She is Adjunct Professor of Palliative Medicine at the University Technology Sydney, Sydney, Australia. For twenty years (2000 to 2020), she also provided consultant palliative physician services to Scarborough General Hospital and Saint Catherine's Hospice, Scarborough where she set up one of the UK's first integrated palliative care services for people with heart failure. Dr Kat Ralston is a geriatric medicine registrar in Edinburgh. She is also the Education Co-Vice Chair and the joint Podcast Lead for the RCPE Trainee & Members' Committee (T&MC). Recording date: 5 December 2024 -- Useful Links -- Abel et al (2024), Hospital admissions in the last year of life of patients with heart failure, https://doi.org/10.1093/ehjqcco/qcad047. Balata et al (Oct 2024), Early integration of palliative care versus standard cardiac care for patients with heart failure (EPCHF): a multicentre, parallel, two-arm, open-label, randomised controlled trial, https://doi.org/10.1016/j.lanhl.2024.08.006. Barnes-Harris et al, Barriers and facilitators for cardiopulmonary resuscitation discussions with people with heart failure, https://doi.org/10.1371/journal.pone.0314631. Campbell et al (2018), Which patients with heart failure should receive specialist palliative care?, https://doi.org/10.1002/ejhf.1240. Date et al, Modified-release morphine or placebo for chronic breathlessness: the MABEL trial protocol, https://doi.org/10.1183/23120541.00167-2023. Ekström et al, Effect of regular low-dose extended-release morphine on chronic breathlessness in chronic obstructive pulmonary disease: the BEAMS randomized clinical trial, http://doi.org/10.1001/jama.2022.20206.  Ferreira et al, The effect of regular, low-dose, sustained-release morphine on routine physical activity in people with persistent breathlessness– a hypothesis-generating study, https://doi.org/10.1183/13993003.01484-2022. Johnson et al (2024), Benefits of specialist palliative care by identifying active ingredients of service composition, structure, and delivery model: A systematic review with meta-analysis and meta-regression, https://doi.org/10.1371/journal.pmed.1004436. Jordan et al (2020), Duration of palliative care before death in international routine practice: a systematic review and meta-analysis, https://doi.org/10.1186/s12916-020-01829-x. King et al (2022), Concurrent Validity and Prognostic Utility of the Needs Assessment Tool: Progressive Disease Heart Failure, https://doi.org/10.1016/j.jpainsymman.2022.01.014. McConnell et al (2023), Integrating palliative care and heart failure: a systematic realist synthesis (PalliatHeartSynthesis), https://doi.org/10.1136/openhrt-2023-002438. Roch et al (2020), Utility of the integrated palliative care outcome scale (IPOS): a cross-sectional study in hospitalised patients with heart failure, https://doi.org/10.1177/1474515120919386. Breathing, Thinking Functioning Model - https://www.btf.phpc.cam.ac.uk/ Caring Together - https://www.mariecurie.org.uk/professionals/working-in-partnership/caring-together Scottish Palliative Care Guidelines - https://rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/ -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE events -- https://www.rcpe.ac.uk/events -- Become an RCPE Member -- https://www.rcpe.ac.uk/membership/join-college Feedback: cme@rcpe.ac.uk

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

Dawn Gross speaks at the 2025 Public Forum on Healing with Integrative Cancer Care in February. The gathering was designed to bridges wisdom traditions with emerging frontiers in healing. This year's forum explores transformation through the intersections of integrative cancer care with consciousness and healing arts, featuring distinguished speakers and practitioners from diverse backgrounds. The day included engaging presentations on patient advocacy, expressive arts, and innovative approaches to cancer care. Dawn Gross, MD, PhD, (aka DrAsYouWish) is a national thought leader in Hospice & Palliative Medicine, Writer, Podcaster and Magic Wand Bearer, who pioneers revolutionary palliative medicine as the art of patient care, scientific curiosity and storytelling. Medical director of ANX Hospice and UCSF Palliative Care physician, Dawn earned her MD and PhD in immunology from Tufts University and completed her fellowship training in hematology with an emphasis in bone marrow transplant at Stanford University. She transitioned to the field of hospice and palliative medicine after her father died in 2006. Dawn considers grief an injury and has developed a novel approach to its healing in what she refers to as the ICU “ISEEYOU for the Soul.” She is the creator and host of the radio program, Dying to Talk. Her writing has been published widely including in The New York Times, JAMA, Science and Annals of Internal Medicine. She is an internationally invited speaker most recently sharing true stories from the bedside about what matters most in her 2024 TEDx talk “Ask. The Time is Now” and her new book, Heart Sounds: How a Stethoscope, A Magic Wand, and a Fishing Pole Teach Us to Listen for What Matters Most. Learn more at: www.drasyouwish.com The New School at Commonweal is a collaborative learning community offering conversations about nature, culture, and inner life---so that we can all find meaning, meet inspiring people, and explore the beauty and grief of our changing world. Please like/follow our YouTube channel for more great podcasts. Find out more about The New School at Commonweal on our website: tns.commonweal.org. And like/follow our Soundcloud channel for more great podcasts.

Dr. Mellar Davis discusses the joint guideline from MASCC, ASCO, AAHPM, HPNA, and NICSO on opioid conversion in adults with cancer. He reviews the limited evidence, and the formal consensus process used to develop the guideline. He shares the key recommendations on pre-conversion assessment, how opioid conversion should be conducted, including opioid conversion ratios, and post-conversion assessment. We touch on gaps and questions in the field and the impact of these new recommendations.  Read the full guideline, “Opioid Conversion in Adults with Cancer: MASCC-ASCO-AAHPM-HPNA-NICSO Guideline” at www.asco.org/supportive-care-guidelines. TRANSCRIPT This guideline, clinical tools, and resources are available at http://www.asco.org/supportive-care-guidelines. Read the full text of the guideline in the Supportive Care in Cancer, https://link.springer.com/article/10.1007/s00520-025-09286-z   Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges and advances in oncology. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Mellar Davis from Geisinger Medical Center, lead author on “Opioid Conversion in Adults with Cancer: Multinational Association of Supportive Care and Cancer, American Society of Clinical Oncology, American Academy of Hospice and Palliative Medicine, Hospice and Palliative Nurses Association, Network Italiano Cure di Supporto and Oncologia Guideline.” Thank you for being here today, Dr. Davis. Dr. Mellar Davis: Thank you. I'm glad to be here. Brittany Harvey Before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Davis, who has joined us here today, are available online with the publication of the guideline, which is linked in our show notes. So then, to dive into the content here, Dr. Davis, can you provide an overview of both the scope and purpose of this guideline on opioid conversion in people with cancer? Dr. Mellar Davis: This is an important topic in management of cancer pain and this topic came up as a result of a survey that MASCC had done, which involved 370 physicians in 53 countries. They were queried about how they change or convert one opioid to another, which is a common practice, and we found that there was quite a divergence in opioid conversion ratios. To step back a little bit, about two thirds of patients with advanced cancer have moderate to severe pain and most of the time they're managed by opioids. But about 20% or 40% require a switch either because they have an adverse reaction to it or they don't respond to it, or the combination of both. Rarely, it may be that they need a route change, perhaps because they have nausea or vomiting. So, the opioid conversion works basically because of the complexity of the new opioid receptor which has at least four exons to it as a result of that non-cross tolerance between opioids. As a result of the survey, we convened a group of specialists, 14 international specialists, to look to see if we could develop an international guideline. And we did a systematic review which involved viewing 21,000 abstracts and we came up with 140 randomized trials and 68 non-randomized trials. And after reviewing the data, we found that the data was really not strong enough to provide a guideline. As a result, ASCO, MASCC, the AAHPM, the HPNA and the Italian Group formed a supportive network that allowed us then to do a Delphi guideline based upon ASCO modified criteria for doing Delphi guidelines. And so we then involved 27 additional international experts informing the guideline to it. And this guideline is then the result of the Delphi process. It consists basically of a pre-conversion ratio recommendations, conversion ratios, which is actually a major contribution of this guideline, and then what to do after converting someone to another opioid. Our target audience was not only oncologists, but also we wanted to target nurses, pharmacists, hospitalists, primary care physicians, patients and caregivers. Brittany Harvey: I appreciate that background information, particularly on the evidence that is underpinning this and the lack of quality of evidence there, which really transformed this into a formal consensus guideline. We're glad to have all of these organizations coming together to collaborate on this guideline. So then next I'd like to review the key recommendations. So starting with, what is recommended for pre-conversion assessment? Dr. Mellar Davis: In regards to pre-conversion, physicians and clinicians need to be aware of pain phenotypes. That is, there are pains that are more opioid refractory than others, such as neuropathic pain, hence, they may be more resistant to the opioid that you're converting to. One needs to be aware of the fact that patients may not be compliant, they're either afraid of opioids not taking what was prescribed, so it's important to query patients about whether they are taking their opioid as prescribed. Occasionally, there are patients who will divert their medication for various reasons. Pain may be poorly controlled also because of dosing strategies that are poorly conceived, in other words, giving only ‘as needed' opioids for continuous cancer pain. And there are rare circumstances where an opioid actually induces pain and simply reducing the opioid actually may improve the pain. The other issue may be cancer progression. So that poorly controlled pain or rapidly increasing pain may actually be a result of progressive cancer and changing treatment obviously will be important. And you need to assess the pain severity, the quality of the pain, the radiating localizing effects, which does require not only a physical exam but also radiographic examinations. But the other thing that's very important in opioid conversions are pain scales with function. A significant number of patients don't quite understand a numerical scale which we commonly use: 0 to 10, with 10 being severe pain and 0 being no pain. They may in fact focus more on function rather than on pain severity or pain interference with daily activities or roles. Sometimes patients will say, “Oh, my pain is manageable,” or “It's tolerable,” rather than using a numerical scale. Choices of opioids may be based on cost, drug-drug interactions, organ function, personal history or substance use disorder so that one will want to choose an opioid that's safe when converting from one to another. And obviously social support and having caregivers present and understanding the strategy in managing pain will be important. Brittany Harvey: Thank you, Dr. Davis, for reviewing those pre-conversion assessment considerations and particularly the challenges around some of those. So, following this pre-conversion assessment, what are the recommendations on how opioid conversion should be conducted? Dr. Mellar Davis: Opioid conversions are basically the safe dose. People have used the term ‘equianalgesia', but the panel and the consensus group felt that that would be inappropriate. So a conversion ratio is the dose at which the majority of patients will not experience withdrawal or adverse effect. It would be the safe dose. Thereafter, the dose will need to be adjusted. So, in converting, that's only the first step in managing pain, the doses need to be adjusted to the individual thereafter. There are a significant number of conversions that are done indirectly, that is that there has not been a study that has looked at a direct conversion from one opioid to another in which one needs to convert through another opioid. We call that a ‘morphine equivalent daily dose'. So, most of the time a third opioid is used in the conversion. It allows you then to convert when there hasn't been a direct study that has looked at conversion between those two opioids, but it is less accurate and so one has to be a little bit more careful when using morphine daily equivalents. We found, and I think this is the major advantage to the guideline, is that commonly used opioids - oxycodone, morphine, hydromorphone - we did establish conversion ratios to which we found in the MASCC guideline they were widely divergent and hope that actually, internationally, they will be adopted. We also found some conversion ratios for second-line opioids. However, we felt also that an opioid like methadone, which has a unique pharmacology, should be left to experts and that experts should know at least several ways of converting from morphine usually to methadone. There is what appears to be a dose-related increased potency of methadone relative to morphine, which makes it more difficult, particularly at higher doses, to have an accurate conversion ratio. Most patients will have transient flares of pain. We came up with two suggestions. One is using a 10 or 15% of the around-the-clock dose for the breakthrough dose, but we also realized that there was a poor correlation between the around-the-clock dose and the dose used for transient flares of pain. And so the breakthrough dose really needs to be adjusted to the individual responses. There was also a mention of buprenorphine. One of the unique things about buprenorphine is that if you go from high doses of a drug like morphine to buprenorphine in a stop-start dosing strategy, you can precipitate withdrawal. And so one has to be careful and have some experience in using buprenorphine, which can be an effective analgesic. Brittany Harvey: Yes, I think that the conversion ratios that you mentioned that are in Table 3 in the full guideline are a really useful tool for clinicians in practice. And I appreciate the time that the panel and the additional consensus panel went through to develop these. I think it's also really key what you mentioned about these not being equianalgesic doses and the difficulties in some of these conversions and when people need to really look to specialists in the field. So then, following opioid conversion, what assessments are recommended post-conversion? Dr. Mellar Davis: Post-conversion, probably the cardinal recommendation is close observation for response and for toxicity. And I think that probably summarizes the important parts of post-conversion follow up. So assessment should be done 24-48 hours after conversion and patients followed closely. Assessment scales should include patient personalized goals. Now, it used to be in the past that we had this hard stop about a response being below 4 on a 0 to 10 scale, but each patient has their own personal goals. So they gauge the pain severity and their function based upon response. So a patient may function very well at “a severity of 5” and feel that that is their personal goal. So I think the other thing is to make sure that your assessment is just not rote, but it's based upon what patients really want to achieve with the opioid conversion. The average number of doses per day should be assessed in the around-the-clock dose so those should be followed closely. Adverse effects can occur and sometimes can be subtle. In other words, a mild withdrawal may produce fatigue, irritability, insomnia and depression. And clinicians may not pick up on the fact that they may be actually a bit under what patients have or they're experiencing withdrawal syndrome. It's important to look for other symptoms which may be subtle but indicating, for instance, neurotoxicity from an opioid. For instance, visual hallucinations may not be volunteered by patients. They may transiently see things but either don't associate with the opioid or are afraid to mention them. So I think it's important to directly query them, for instance, about visual hallucinations or about nightmares at night. Nausea can occur. It may be temporary, mild, and doesn't necessarily mean that one needs to stop the second opioid. It may actually resolve in several days and can be treated symptomatically. Pruritus can occur and can be significant. So close observation for the purposes of close adjustments are also necessary. As we mentioned, you want to start them on an around-the-clock of breakthrough dose, but then assess to see what their response is and if it's suboptimal then you'll need to adjust the doses based both upon the around-the-clock and the breakthrough dose or the dose that's used for breakthrough pain. Also looking at how patients are functioning, because remember that patients frequently look at pain in terms of function or interference with their roles during the day. So, if patients are able to do more things, that may, in fact, be the goal. Brittany Harvey: Thank you for reviewing all of these recommendations across pre-conversion assessment, how opioid conversion should be conducted, including conversion ratios, and what assessments are recommended after opioid conversion. I think it's really important to be watching for these adverse events and assessing for response and keeping in mind patient goals. So, along those lines, how will these guideline recommendations impact both clinicians and people with cancer? And what are the outstanding questions we're thinking about regarding opioid conversion? Dr. Mellar Davis: I think it's important to have a basic knowledge of opioid pharmacology. There's, for instance, drugs that are safer in liver disease, such as morphine, hydromorphone, which are glucuronidated. And there are opioids that are safer in renal failure, such as methadone and buprenorphine, which aren't dependent upon renal clearance. I think knowing drug-drug interactions are important to know. And sometimes, for instance, there may be multiple prescribers for a patient. The family physician's prescribing a certain medication and the oncologist is another, so being aware of what patients are on, and particularly over-the-counter medications which may influence opioid pharmacokinetics. So complementary medications, for instance, being aware of cannabis, if patients are using cannabis or other things, I think, are important in this. There are large gaps and questions and that's the last part of the guideline that we approach or that we mentioned that I think are important to know. And one is there may be ethnic differences in population in regards to clearance or cytochrome frequencies within communities or countries, which may actually alter the conversion ratios. This has not been explored to a great extent. There's opioid stigmata. So we are in the middle of an opioid crisis and so people have a great fear of addiction and they may not take an opioid for that reason, or they may have a relative who's been addicted or had a poor experience. And this may be particularly true for methadone and buprenorphine, which are excellent analgesics and are increasingly being used but may in fact have the stigmata. There are health inequalities that occur related to minority groups that may in fact not get the full benefit of opioid conversions due to access to opioids or to medical care. Age, for instance, will cause perhaps differences in responses to opioids and may in fact affect conversion ratios. And this may be particularly true for methadone, which we have not really explored to a great extent. And finally, the disease itself may influence the clearance or absorption of an opioid. So for a sick patient, the opioid conversion ratio may be distinctly different than in a healthy individual. This is particularly seen with transdermal fentanyl, which is less well absorbed in a cachectic patient, but once given IV or intravenously has a much longer half life due to alterations in the cytochrome that clears it. And so conversion ratios have frequently been reported in relatively healthy individuals with good organ function and not that frequently in older patient populations. So just remember that the conversion ratios may be different in those particular populations. Brittany Harvey: Yes. So I think a lot of these are very important things to consider and that managing cancer pain is key to quality of life for a lot of patients and it's important to consider these patient factors while offering opioid conversion. I want to thank you so much for your work to review the existing literature here, develop these consensus-based recommendations and thank you for your time today, Dr. Davis. Dr. Mellar Davis: Thank you. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/supportive-care-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.   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.  

Join us for an insightful episode featuring seasoned Pediatric Nurse Practitioner Meggan Mikal-DeMont DNP, APRN-FPA, PCNS-BC, CPNP-PC, CHPPN ®, FPCN® with more than10 years of experience in palliative care and pain management. In this whole-hearted interview, she reflects on her husband's nine-month experience with Stage IV colorectal cancer and offers an insider's perspective as both a palliative care clinician and caregiver- how as a couple they navigated the miracle they were hoping for within the system, how these experiences have transformed Meggan's clinical practice, and how life has unfolded since then. Listen for what the health care teams did well, areas where they could improve, and how administrators can champion hospice and palliative care services to make end of life easier for patients and their families.     Meggan Mikal DNP, APRN-FPA, PCNS-BC, CPNP-PC, CHPPN®, FPCN®Meggan Mikal-DeMont is the nurse practitioner of Pediatric Advance Care Team - Palliative & Pain at Advocate Children's Hospitals in Oak Lawn, IL.  Pursuing her interest in working with families that have children living with complex and series illnesses, Meggan has completed a fellowship in pediatric neurodevelopmental disabilities through the Illinois Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program. She also has completed a fellowship in pediatric palliative and hospice nursing through University of Illinois in Chicago and through the Coleman Foundation. This led her to also become a board-certified pediatric hospice and palliative nurse in 2009.  Meggan, along with an interdisciplinary committee, started the Pediatric Palliative and Supportive Care program at Advocate Children's Hospital - Oak Lawn in October of 2012.  Her background as a pediatric intensive care nurse is where her love and passion for working with children with critical and chronic illness grew.  She is an End-of-Life Nursing Education Consortium (ELNEC) trainer and received that training at St. Jude's Hospital in Memphis, TN.  Meggan is an active member of the Hospice and Palliative Nurses Association (HPNA) where she serves on the Advocacy and Legislative Committee. She participated as both an item writer and chair for the pediatric hospice and palliative nurse exam from 2010-2016. Meggan was also recently inducted as a Fellow of Palliative and Hospice Nursing (FPCN®) and is so thrilled to be recognized for her true passion and purpose to this field.   Becoming a widow and a solo parent in 2017 after her husband Andrew died from advanced colorectal cancer has only grown her passion for delivering and advocating for nothing short of the best delivery of palliative and hospice care. Meggan is blessed to be given a new chapter and now lives with her husband Nate, eight year old son Andy, bonus seven year old daughter Elizabeth, and two and a half year old rescue dog Zoey, in Plainfield.   Within palliative care, Meggan has a strong interest in the areas of patient-provider boundaries, patient and family advocacy, and the delivery of diverse, equitable, and inclusive care.   Meggan believes that caring for children with serious illnesses truly starts at the grassroots of relationships. She believes that the family is the center of the care being provided and it is a relationship built on partnership. Helping children live life to their fullest ability without burdensome symptoms is something that she strives to achieve each day.  Brett Snodgrass, DNP, FNP-C, ACHPN®, FAANP Dr. Brett Snodgrass has been a registered nurse for 28 years and a Family Nurse Practitioner for 18 years, practicing in multiple settings, including family practice, urgent care, emergency departments, administration, chronic pain and palliative medicine. She is currently the Operations Director for Palliative Medicine at Baptist Health Systems in Memphis, TN. She is board certified with the American Academy of Nurse Practitioners. She is also a Fellow of the American Association of Nurse Practitioners and an Advanced Certified Hospice and Palliative Nurse. She completed a Doctorate of Nursing Practice at the University of Alabama – Huntsville. She is a nationally recognized nurse practitioner speaker and teacher. Brett is a chronic pain expert, working for more than 20 years with chronic pain and palliative patients in a variety of settings. She is honored to be the HPNA 2025 podcast host. She is married with two daughters, two son in laws, one grandson, and now an empty nest cat. She and her family are actively involved in their church and she is an avid reader.  

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

This episode features Moyke Versluis (Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands Graduate school of Social and behavioral sciences, Tilburg University, Tilburg, The Netherlands).   What is already known about the topic? Patients who are aware of their limited prognosis are more likely to be actively involved in advance care planning. Many patients with advanced cancer are unaware of their limited prognosis.   What this paper adds? More patients with advanced cancer become aware of their limited prognosis during their last year of life. Some patients do not want to know their prognosis, and their wish to not know their prognosis is persistent during their last year of life.   Implications for practice, theory, or policy It is important for physicians to recognise that the patients' perception of prognosis may change as the disease progresses and to invite patients to discuss their needs and wishes regularly. Although some patients may prefer not to know their prognosis, it remains important to respectfully explore their preferences and wishes for end-of-life care.   Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163241301220   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

https://www.coachsimranmd.com/ ORDER MY NEW BOOK SWEET INDULGENCE!!! https://www.amazon.com/Chef-AJs-Sweet-Indulgence-Guilt-Free/dp/1570674248 or https://www.barnesandnoble.com/w/book/1144514092?ean=9781570674242 GET MY FREE INSTANT POT COOKBOOK: https://www.chefaj.com/instant-pot-download MY BEST SELLING WEIGHT LOSS BOOK: https://www.amazon.com/dp/1570674086?tag=onamzchefajsh-20&linkCode=ssc&creativeASIN=1570674086&asc_item-id=amzn1.ideas.1GNPDCAG4A86S Disclaimer: This podcast does not provide medical advice. The content of this podcast is provided for informational or educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health issue without consulting your doctor. Always seek medical advice before making any lifestyle changes. Simran Malhotra MD DipABLM CHWC Dr. Simran Malhotra is a triple board-certified physician in internal medicine, hospice & palliative care, and lifestyle medicine as well as a certified health and wellness coach. She was recognized as a "Top Doc" by Baltimore Magazine in Palliative Medicine for three consecutive years (2019, 2020, 2023). Dr. Malhotra is a diplomate of the American College of Lifestyle Medicine (ACLM) and has completed several certifications, including T. Colin Campbell's Plant-Based Nutrition (2019), CHEF Culinary Coaching (2020), and WellCoaches Health and Wellness Coaching (2022). With nearly a decade of experience in both inpatient and outpatient palliative care, Dr. Malhotra leverages the invaluable lessons learned from end-of-life care to advocate for the importance of lifestyle medicine and a positive mindset in enhancing overall well-being. As a mother of two and a BRCA 1 previvor, Dr. Malhotra is deeply committed to her mission. After undergoing a risk-reducing bilateral mastectomy & total hysterectomy at 32 years old due to her strong family history of cancer, she founded Wellness By LifestyleMD, a platform dedicated to educating busy parents about the transformative power of lifestyle & mindset changes on wellbeing, quality of life and longevity. In addition to her entrepreneurial pursuits, Dr. Malhotra writes a column for Everyday Health called "Awaken Your Wellness" and has been featured in various media outlets (TIME, Glamour, Yahoo, MSN, etc.), blogs and podcasts, sharing her unique insights from both her work in palliative care as well as her experiences as a patient and genetic mutation carrier passionate about using lifestyle as medicine. Website: Wellness By Lifestyle MD | By SimranMD https://www.coachsimranmd.com/ This is the viral video she reffered to where her husband sings to her: https://www.youtube.com/watch?v=0GojJnrqpeE Shop Dr.Simran's Favorite Lifestyle and Wellness Tools Here: https://www.searchbubble.com/drsimran.malhotra?fbclid=PAZXh0bgNhZW0CMTEAAaaKcnXfpgCEfg6ORr5JmAn03UOQ-64T9bNP1tXmWV9BZ5XD50C3wwfxwpg_aem_UW7k5m26dzvVWFVHGYc4bQ Awaken Your Wellness Columnist at Everyday Health https://www.everydayhealth.com/columns/awaken-your-wellness/ Co-Author of the book “How Healers Heal” https://www.amazon.com/dp/1961549018?linkCode=ssc&tag=onamzchefajsh-20&creativeASIN=1961549018&asc_item-id=amzn1.ideas.1GNPDCAG4A86S&ref_=aip_sf_list_spv_s_ofs_mixed_d_asin Instagram: Simran Malhotra

Dying to Tell You: The Caring Perspective—E05 with Dr. John Mulder Dr. Mulder shares his incredible story of a patient who was at the end of her life but, beyond medical explanation, not yet ready to go. And how he stumbled quite by accident on what seemed like the answer. Dr. John Mulder currently serves as the Executive Director for Trillium Institute, Chief Medical Consultant for Hospice and Palliative Care for Holland Home, and the Medical Director of Palliative Care for University of Michigan Health-West in Grand Rapids, MI. He is a frequent speaker on end of life, ethics, and palliative issues and has been honored as the recipient of the 2019 Palliative Medicine Community Leadership Award by the American Academy of Hospice and Palliative Medicine. We invite you to sit with Dr. Mulder and Cody as they discuss the deep reverence, compassion, and understanding it takes to serve in palliative care. --- Dying To Tell You: The Caring Perspective is a series of interviews with healthcare professionals who sit down with Cody to share stories of patients and experiences that have changed how they practice, how they view death, and how they live their lives.

About Maria Torroella Carney: Dr. Maria Torroella Carney is a highly respected internist, geriatrician, and palliative care physician with a robust background in public health. She is the Chief of the Division of Geriatric and Palliative Medicine at the Zucker School of Medicine and an Associate Professor of Medicine. She also holds the position of Chief of Geriatric and Palliative Medicine for Northwell Health. As the first geriatrician to serve as a health department commissioner in New York State, Dr. Carney has made significant contributions to the field of longevity promotion and the care of vulnerable populations. Her research focuses on advanced care planning, shared decision-making, elder abuse, and capacity assessment. She has received numerous awards for her outstanding community service and leadership.Things You'll Learn:Hospice is a model of care focused on quality of life, not just end-of-life, and includes comprehensive support services. It's underutilized due to a lack of understanding and difficult decisions required regarding foregoing certain treatments.Patients should be able to explore hospice without feeling obligated to stop other care immediately.Family caregivers are an "invisible workforce" that requires more support, education, and resources. They are integral to the healthcare team yet often overlooked.Elder orphans, those aging without family support, are a growing concern and need early identification and tailored support.Geriatric medicine and palliative care are in their infancy and require more attention and specialists to meet their increasing needs. There's an insufficient number of professionals in these fields.Resources:Connect with and follow Maria Torroella Carney on LinkedIn.Discover more about Northwell Health on LinkedIn and their website.Buy Maria Torroella Carney's The Aging Revolution here.

This episode features Amy Brown (Marie Curie Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK. Swansea University Medical School, Swansea University, Swansea, UK)   What is already known about the topic? The third World Health Organization Global Patient Safety Challenge ‘Medication without harm', emphasises the need for improved infrastructure through better reporting practices and cross-organisational learning from adverse events and near misses. Medication is implicated in one-fifth of serious palliative care patient safety incidents, with approximately 25% of these incidents involving continuous subcutaneous infusions. Inadequate analysis of continuous subcutaneous infusions as safety-critical, risk-prone interventions dependent on complex structural and human factor issues is a lost opportunity for learning.     What this paper adds? Continuous subcutaneous infusion incidents occur across all settings including the home, hospices and hospitals and particularly after the transfer of patients between settings with harm present in nearly three-quarters of reports. Multiple points of system failure were identified in continuous subcutaneous infusion incident reports including monitoring and supply (405, 31%), administration (383, 29%) and prescribing (268, 20%); recurring contributory factors included discontinuity of care within and between care settings, inadequate time, inadequate staffing and unfamiliarity with protocols. Narrative descriptions of psychological and social harm, alongside physical harm risk, are not being adequately recognised or responded to through existing approaches to measure harm in palliative care, hindering learning in practice   Implications for practice, theory, or policy The structural changes needed to minimise harm and maximise safety in palliative care are likely to be replicated in other parts of the world where patient safety reporting practices are less well established, for example, shifting from focussing on lack of experience and competency at an individual practitioner-level to addressing deficits in working environments and infrastructures for care provision. When patients move between care locations, more attention should be given to the timeliness and effective transfer of medication management (e.g. if someone is discharged from hospital to a care home that rarely uses continuous subcutaneous infusions for palliative care, this needs to be preceded by refreshing staff skills and ensuring they can access further community support if needed). Professional training and further research are needed to increase quality of reporting of psychological and social harms (including for families and other stakeholders involved) to facilitate organisational learning and pinpoint precise targets for further improvement.     Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163241287639  If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk

Where can you create care and connection in unexpected places?...Chistiaan Rhodius is a Dutch doctor specialized in palliative medicine. Together with his wife and four children he currently lives and works in Oslo (Norway). He is convinced that 'if we ignore death we miss out on life'. He is passionate for stories and the shaping of new stories (through the process of improvisation). At this moment he explores ways of how the artwork of Edvard Munch can stimulate our storytelling. Today, Abbie and Christiaan explore Christiaan's work in palliative care and the perspective that has emerged out of his experience. Christiaan introduces the Patient Dignity Question- What do I need to know about you as a person in order for me to give you the best possible care? Abbie and Christiaan discuss improvisation as “plan A,” navigating “tender conversations,” and the “palliative paradox."...Stories Lived. Stories Told. is created, produced & hosted by Abbie VanMeter.Stories Lived. Stories Told. is an initiative of the CMM Institute for Personal and Social Evolution....Music for Stories Lived. Stories Told. is created by Rik Spann....⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Explore all things Stories Lived. Stories Told. here⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠.Explore all things CMM Institute here.

  This episode features  Dr Masanori Mori (Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan)   What is already known about the topic? As in Western countries' health-care systems, advance care planning is being increasingly implemented in Asian ones, but consensus on its definition and recommendations based on Asian culture are lacking. In high-context, Confucian-influenced Asian societies, explicit conversations about end-of-life care with patients are not always the norm. Family involvement is crucial in decision-making. Health-care providers in Asia uncommonly involve patients in advance care planning, partly due to their lack of knowledge and skills in advance care planning, personal uneasiness, fear of conflicts with families and their legal consequences, and the lack of a standard system for advance care planning.   What this paper adds? A key domain not previously highlighted in Western Delphi studies is “a person-centered and family-based approach” that facilitates families' involvement to support an individual's engagement in advance care planning and the attainment of the individual's best interest through shared decision-making. Treatment preferences in Asian contexts are often shaped by relationships and responsibilities toward others, with families and health-care providers supporting individuals to meaningfully participate, even in the presence of physical or cognitive impairments.   Implications for practice, theory, or policy Our definition and recommendations can guide clinical practice, education, research, and policy-making in advance care planning, not only in the Asian sectors included in our study, but also in regions with Asian residents and other areas where implicit communication and family-centered decision-making are valued. Our findings, combined with the existing evidence, will help future investigations to develop culturally sensitive advance care planning interventions, identify appropriate outcomes, and build an infrastructure where Asian individuals receive care consistent with their values, goals, and preferences.   Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163241284088   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk  

In this episode, we explore two innovative projects—Project UPHOLDS (Utilizing Palliative care for Heart failure Optimized using Lay navigators to Decrease Suffering) and Project ADAPT HF (ADdressing All Pain Through navigator-led palliative care optimized for Heart Failure)—which focus on utilizing community-based lay navigators to optimize palliative care for heart failure, especially among older Black adults. We delve into the importance of shared decision-making and how co-designed interventions are shaping pain management trials, with a special emphasis on inclusivity and addressing under-representation in research. Rachel shares her personal journey and career trajectory, highlighting the privilege of being able to advocate for these communities and the impact of culturally responsive care. Rachel Duncan Wells, PhD, MSN, RN, CNL Dr. Rachel Wells is an Assistant Professor and Core Mixed Methods Faculty in the School of Nursing at the University of Alabama at Birmingham. As a nurse and Clinical Nurse Leader with more than 10 years of clinical experience in cardiac critical care, palliative medicine, and rural health, her research bridges the fields of chronic illness care and early palliative care and is focused on refining palliative care access for under resourced older adults living with serious illness. Specifically, Dr. Wells has focused on the development and testing of highly efficient and effective models of early palliative care for those living with advanced heart failure. Her emerging program of research focuses on the examination of active palliative care intervention elements and dosing of palliative care to develop optimized interventions that uniquely address palliative care needs, a novel approach to addressing health disparities in under resourced palliative care populations. She has been involved with a number of federally-, foundationally-, and intramurally funded grants as a PI and Co-I that have involved intervention development and tailoring and clinical trials testing and implementation of models of early palliative care for those living with serious illness and their family caregivers. Dr. Wells is regularly engaged in the American Academy of Hospice and Palliative Medicine, American Heart Association, American College of Cardiology, and the Hospice and Palliative Nurses Association, where she has championed efforts to educate clinicians and others to identify, monitor, and intervene early for cardiovascular challenges in under resourced populations.    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.

Dr. Farr Curlin is a palliative medicine physician and Josiah Trent Professor of Medical Humanities in the Trent Center for Bioethics, Humanities, & History of Medicine at Duke University. Listen to Farr discuss health in the context of palliative medicine, medical aid in dying and the interaction of patient and physician values.

Dr. Janet Abrahm is a Fellow of the American Academy of Physicians, Fellow of the American Academy of Hospice and Palliative Medicine, and a Fellow of the American Society of Clinical Oncology. She is a Professor of Medicine at Harvard Medical School, a former practicing oncologist, and an internationally recognized expert in supportive and palliative care for patients with cancer. She has over 20 years of experience in the forefront of palliative care at Dana-Farber Cancer Institute. She is the author of the newly updated Comprehensive Guide to Supportive and Palliative Care for Patients with Cancer as well as an award-winning clinician and educator in palliative care. This week she joins me to talk about the latest updates in palliative care. We chat about palliative precedes, the treatment of cancer related fatigue, new thinking about cancer cachexia and more.You can learn more about Dr. Abrahm and her work at janetabrahm.com.Here's to healing the heart of the healers,Dr. DeliaDelia Chiaramonte, MDwww.integrativepalliative.com Coping Courageously: A Heart-Centered Guide for Navigating a Loved One's Illness Without Losing Yourself is available here: www.copingcourageously.com A free guide for physicians to help reclaim your joy at work and in life https://trainings.integrativepalliative.com/pl/2148540010Please review this podcast wherever you listen and forward your favorite episode to a friend! And be sure to subscribe!Sign up to stay connected and learn about upcoming programs:https://trainings.integrativepalliative.com/IPI-stay-in-touchI'm thrilled to be listed in Feedspot's top 15 palliative podcasts!https://blog.feedspot.com/palliative_care_podcasts/

Join Dr. Clancy and guest Katey Kooi for a discussion of the benefits of music therapy in palliative and end-of-life care. CME Credit Available:  https://uiowa.cloud-cme.com/course/courseoverview?P=0&EID=72842  Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guest: Katey Kooi, MT-BC Music Therapist, Supportive and Palliative Care University of Iowa Health Care Financial Disclosures:  Dr. Clancy, Ms. Kooi, and the members of the Rounding@IOWA planning committee have disclosed no relevant financial relationships. Nurse: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 1.0 ANCC contact hour. Pharmacist and Pharmacy Tech: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this knowledge-based activity for a maximum of 1.0 ACPE contact hours. Credit will be uploaded to the NABP CPE Monitor within 60 days after the activity completion. Pharmacists must provide their NABP ID and DOB (MMDD) to receive credit. Pharmacist UAN: JA0000310-0000-25-039-H99-P Pharmacy Tech UAN: JA0000310-0000-25-039-H99-T Physician: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.) References/Resources:  Gutgsell, Kathy Jo et al. (2013) Music Therapy Reduces Pain in Palliative Care Patients: A Randomized Controlled Trial. Journal of Pain and Symptom Management, Volume 45, Issue 5, 822 – 831. Gallagher, Ragman, Rybicki. (2018) Outcomes of Music Therapy Interventions on Symptom Management in Palliative care patients. American Journal of Hospice and Palliative Medicine Vol 35(2) 250-257. Hilliard R. E. (2003). The effects of music therapy on the quality and length of life of people diagnosed with terminal cancer. Journal of music therapy, 40(2), 113–137. https://doi.org/10.1093/jmt/40.2.113 Bradt J, Dileo C, Grocke D, Magill L. (2011) Music interventions for improving psychological and physical outcomes in cancer patients.Cochrane Database Syst Rev. Aug 10;(8) Ramesh B. (2024) Role of Music Therapy in Palliative Care—Methods and Techniques. Journal of Palliative Care. https://journals.sagepub.com/doi/10.1177/08258597241235110 Whitford, Kevin J. et al.Music Therapy Intervention to Reduce Caregiver Distress at End of Life: A Feasibility Study Journal of Pain and Symptom Management, Volume 65, Issue 5, e417 - e423 https://www.jpsmjournal.com/article/S0885-3924(23)00035-0/fulltext Sarah Kordovan, Pia Preissler, Anne Kamphausen, Carsten Bokemeyer, and Karin Oechsle. (2016)Prospective Study on Music Therapy in Terminally Ill Cancer Patients during Specialized Inpatient Palliative Care Journal of Palliative Medicine  19:4, 394-399. Lopez, G., Christie, A.J., Powers-James, C. et al. (2019). The effects of inpatient music therapy on self-reported symptoms at an academic cancer center: a preliminary report. Support Care Cancer 27, 4207–4212. https://doi.org/10.1007/s00520-019-04713-4 Brungardt A, Wibben A, Tompkins AF, Shanbhag P, Coats H, LaGasse AB, Boeldt D, Youngwerth J, Kutner JS, Lum HD.(2021) Virtual Reality-Based Music Therapy in Palliative Care: A Pilot Implementation Trial. J Palliat Med. May;24(5):736-742. Ghetti, C. M., Schreck, B., & Bennett, J. (2023). Heartbeat recordings in music therapy bereavement care following suicide: Action research single case study of amplified cardiopulmonary recordings for continuity of care. Action Research, 0(0). https://doi.org/10.1177/14767503231207993  

We're thrilled to announce the 2025 relaunch of our *Healthy Widow Healthy Woman* podcast.  Widowhood in the 21st Century with Dr. Debbie Oliver, Professor at Washington University in St. Louis, Division of Palliative Medicine.

Doctors are trained to cure, treat, and fix. So, how do physicians end up in a field of medicine where the objectives are different? In this episode, Dr. Mulder and Dr. Beckrow discuss how they came to work in the area of advanced illnesses and the purpose that they have found being injected into challenging situations and precarious relationships. 

In this episode, three HPNA Diversity, Equity, Inclusion, & Belonging (DEIB) Committee members reflect on their lived experience- how positionality impacts the way they show up to their work as hospice and palliative care clinicians and researchers and how they've shifted from cultural competency toward cultural responsiveness. Together, these experts discuss how our knowledge and actions must evolve in the face of new information, and how we can foster a healthcare environment that not only acknowledges but celebrates individual identity and culture. Whether you're a clinician, researcher, or anyone passionate about making healthcare more equitable, this conversation provides valuable insight into how we can all "do better" by truly seeing each person as they are.   Nancy Dias, PhD, RN, MSN, FPCN® Nancy Dias is an Associate Professor in the Nurse Science Department at the College of Nursing. Her work experience in nursing includes both experiences in the United States and internationally (India and Oman) as a clinician, educator, administrator, and a researcher. She completed her PhD at Duke University School of Nursing and a 1-year T32 post-doctoral fellowship from Indiana University School of Nursing. As a researcher, she has a niche for a very significant and innovative aspect of pediatric palliative care services that includes caregiver health outcomes, their bereavement processes, social and structural determinants of health, and innovative technology. Her academic initiatives have focused on transforming educational curriculum to integrate a nursing curriculum with a goal “charting a path to achieve health equity”. Her entrepreneurial skills are exemplified through her role as a co-founder of the Indo-American Evidence based practice Academy and development of an innovative app for bereaved families. She has received several research grants and among many awards, she is the recipient of the Research Nurse of the Year Award 2020, from North Carolina Nurses Association. She has also been recognized with several other awards including, East Carolina University College of Nursing Outstanding Faculty award (2022), Outstanding Mentor award from Sigma Theta Tau's Beta Nu chapter (2024). She was inducted as the Fellow in Palliative Care Nursing in 2024. She has international collaborations with nurses in India and Egypt and mentors these nurse scientists with whom she shares common research and scholarship interest. She has several publications and presentations done locally, nationally, and internationally.  Adrienne Jones-Adamczyk, MBE, RN, ACNP-BC ACHPN®, HEC-C Adrienne Jones-Adamczyk MSN, MBE, RN, ACNP-BC, ACHPN®, HEC-C is a Senior Clinical Ethics Specialty Program Director for Banner Health. She has more than 14 years of experience as a board-certified Acute Care Nurse Practitioner and is an Advanced Certified Hospice and Palliative Care Nurse. She has spent her career in Neuroscience, Palliative Medicine, Home Hospice, and Hospice GIP settings. The clinical conundrums and ethical dilemmas of the COVID-19 pandemic inspired her to continue her education in bioethics, and she obtained a Master of Bioethics degree in May 2023 from Harvard Medical School. She continues her work in equity and human flourishing as an active member of the HPNA Diversity, Equity, Inclusion, and Belonging Committee. Katherine Doyon, PhD, MED, RN, CHPN® Kate Doyon is an assistant professor at Boise State University, School of Nursing. She serves on HPNA's Diversity, Equity, Inclusion, and Belonging Committee and Research Advisory Committee and is a former co-chair of the Emerging Scholars Special Interest Group. She is a certified hospice and palliative care nurse and volunteers on the CHPN® Credentialing Committee. She is a member of the most recent Cambia Sojourns Leadership scholars' program. Kate is passionate about mentoring the next generation of hospice and palliative care nurse scientists and mentors several nurse scholars. She is the recipient of the HPNF Research Scholar Award, the first author of the section on health equity for the HPNA Research Agenda and a reviewer for palliative care journals and conferences including the Annual Assembly of Hospice and Palliative Medicine. Through her advocacy, mentorship, and research of equitable hospice and palliative care, Dr. Doyon exemplifies the highest standards of HPNA's commitment to compassionate care.   

Dulce M. Cruz, MD, FAAHPM, AGSF, joins the Faculty Factory this week to discuss an innovative, one-of-a-kind approach to supporting and educating hospice family caregivers through a video series that offers practical advice and emotional support. At Johns Hopkins Hospital in Baltimore, Dr. Cruz serves as an Assistant Professor in the Department of Medicine, Division of General Internal Medicine, in the Section of Palliative Medicine. Her groundbreaking work in palliative care for Latino family caregivers began with identifying a significant need for support among these caregivers, leading her to create engaging educational videos in the form of telenovelas, designed to resonate with pop culture lovers while delivering a powerful educational message. Once you hear Dr. Cruz's commitment to executing this idea, including teaching herself video production, we are confident you will leave the discussion inspired. This approach to problem-solving is sure to spark new ideas on how we can better serve others in our community of academic medicine professionals, as we are a group especially equipped to learn on the fly in pursuit of accomplishing gargantuan tasks. Learn More You can contact Dr. Cruz via Email: dcruzoli@jhmi.edu. Watch Caregivers Like Me (English Version): https://www.youtube.com/watch?v=ck6Bs1T2Zck Cuidadores Como Yo Caregivers: https://www.youtube.com/watch?time_continue=3&v=HXF-F-apTCc

Arguably among the worst of all medical afflictions, the dementias slowly destroy one's personality, take a tremendous emotional, physical, and financial toll on patients and families, and are irreversible and inexorably fatal. Winter's End: Dementia and Its Life-Shortening Options is constructed around a lengthy and detailed nonfiction account that is layered with the voices of approximately 100 palliative medicine practitioners, legal scholars, bioethicists, social workers, nurses, neurologists, psychiatrists, and other authorities from North America and Europe.This book explores how and when one might prepare to foreshorten life after being diagnosed with a dementing illness, while not ignoring the reality that for most people such actions are unthinkable and unacceptable. Dan Winter was one of the exceptions, and after being diagnosed with early-onset Alzheimer's disease, he resolved to hasten his death. He struggled over what method to employ and the timing of when to act.Winter's End is intended to catalyze conversations between clinicians, people affected by dementias, and the general public. It is a spellbinding and provocative book about a taboo subject that is increasingly germane to all aging societies that value patient autonomy.Lewis Cohen, MD is a professor emeritus of Psychiatry and a Palliative Medicine researcher, who has received numerous literary and academic honours. He is a Guggenheim fellow and was a Rockefeller Bellagio scholar and a Bogliasco Foundation resident. He is a recipient of the Thomas and Eleanor Hackett Memorial Lifetime Achievement Award from the Academy of Consultation-Liaison Psychiatry and his research has been funded by NIH and the Robert Wood Johnson Foundation. As a medical student, Dr. Cohen studied under Anna Freud, who interested him in end-of-life issues.Buy the book from Wellington Square Bookshop - ​https://www.wellingtonsquarebooks.com/book/9780197748640

This brief episode offers an update from Mary Lynn McPherson, PharmD, PhD, FAAHPM and Alexandra L. McPherson, PharmD, MPH. Listen for an update on the patient discussed in Episode 38. Related Resources: Episode 38: Discharged to Airport: Navigating Complex Symptom Management Down on the Pharm: Contemporary Issues in Pharmacopalliation   About the Speakers: Mary Lynn McPherson, PharmD, PhD, FAAHPM Dr. McPherson has practiced hospice and palliative care as a clinical pharmacist her entire career. She is a professor at the University of Maryland and executive program director of the online Graduate Studies in Palliative Care (Graduate Certificates, MS, PhD) program. She has served as a resource to medical staff for pain and symptom consultations, opioid conversion calculations, methadone dosing and other medication-related issues. McPherson is particularly interested in assuring patients with a serious illness receive goal-concordant medication therapy. She has authored five books including the popular Demystifying Opioid Conversion Calculations: A Guide to Effective Dosing and numerous peer-reviewed articles and chapters.   Alex McPherson, PharmD, MPH Dr. McPherson received her Bachelor of Science in International Business from the University of Maryland in College Park, MD, followed by her Master of Public Health (MPH) with a dual certificate in International Health and Pharmaceutical Assessment, Management, and Policy from Boston University in Boston, MA. She went on to receive her Doctor of Pharmacy from the University of Maryland School of Pharmacy in Baltimore, MD. Subsequently she completed a Pharmacy Practice Residency at Einstein Medical Center in Philadelphia, PA and Pain Management and Palliative Care Specialty Residency at the University of Maryland School of Pharmacy/MedStar Health. She is currently a Palliative Care Clinical Pharmacy Specialist at MedStar Washington Hospital Center in Washington, DC, where she serves as faculty in the interdisciplinary Hospice and Palliative Medicine Fellowship program. In addition, she serves as a faculty member for the nation's first M.S. in Medical Cannabis Science and Therapeutics (University of Maryland School of Pharmacy), and M.S. in Palliative Care (University of Maryland Graduate School) programs. She is an active member of the American Academy of Hospice and Palliative Medicine and the Society of Pain and Palliative Care Pharmacists and has published and presented internationally on topics pertaining to pain management and palliative care. Her academic interests include early integration of palliative care in advanced illness, navigating transitions of care at the end-of-life, and the pharmacologic management of symptoms in serious illness. Her newest interest includes the integration of narrative medicine practices as a tool for reducing burnout and improving resiliency among palliative care providers.

This episode features Professor Raymond Voltz (Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany; Center for Health Services Research, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany)   What is already known about the topic? The wish to hasten death is frequent in patients with serious illness and can associated with immense burden, potentially leading to suicidality or a wish for assisted suicide. Many patients retain their will to live throughout their entire illness trajectory, even in palliative stages and at the end of life. In some studies, both phenomena are found to be negatively correlated, yet simultaneous expressions of both a high wish to hasten death and a high will to live are possible.   What this paper adds? We confirm the negative correlation between the wish to hasten death and the will to live over the observation time of 4–6 week after an open conversation in the group analysis. However, there was a substantial number of outliers of this pattern with clinically relevant changes in both phenomen. Three illustrative cases show that factors like patient personality and individual situation influence uncommon trajectories of wish to hasten death and will to live.   Implications for practice, theory, or policy Clinical and research assessment should be aware of the fact that a wish to hasten death does not necessarily imply a low will to live and vice versa, thus both phenomena should be addressed simultaneously and proactively. The application of secondary analysis using an integrative mixed-methods-approach of validated questionnaires and in-depth interviews might be effective to reveal the nature of ambiguous or seemingly paradoxical phenomena such as double awareness of wish to hasten death and will to live. As the double awareness of the wish to hasten death and the will to live is common at the end of life, but can be hard to endure, health professionals should develop an open and accepting attitude to support patients in dealing with it.   Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163241269689   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk

In this episode, we talk with Dr. William Breitbart, Chairman of the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer Center, and a pioneer in psycho-oncology. Dr. Breitbart sheds light on the critical yet often overlooked issue of meaning and purpose in cancer care. He delves into how patients may encounter a profound loss of meaning, which can lead to anxiety and depression, even if they are not clinically diagnosed with depression. Drawing from his extensive experience, Dr. Breitbart shares insights from his pioneering work in the psychiatric and neuropsychiatric dimensions of cancer and palliative care. He discusses strategies to assist patients in rediscovering meaning and enhancing their quality of life during challenging times. Join us for a conversation that underscores the vital intersection of mental health and cancer treatment, featuring Dr. Breitbart's significant contributions to the field, including his groundbreaking work on Meaning-Centered Psychotherapy. William Breitbart, M.D. Chairman, Jimmie C Holland Chair in Psychiatric Oncology; Chairman, Department of Psychiatry and Behavioral Sciences at Memorial Sloan-Kettering Cancer Center Dr. Breitbart is a pioneer and leader in the field of psycho-oncology. At Memorial Sloan-Kettering Cancer Center, he led the way for innovative, award-winning initiatives that provided high-quality research focusing on psychiatric and neuropsychiatric aspects of cancer and palliative care. He is the Chairman, Jimmie C Holland Chair in Psychiatric Oncology, Chairman, Psychiatry Service, Department of Psychiatry and Behavioral Sciences at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York. Dr. Breitbart is also a Professor of Clinical Psychiatry at Weill Medical College of Cornell University. Dr. Breitbart is known for numerous influential leadership roles, and has been recognized in the field of psycho-oncology for his contributions, receiving top research awards and lifetime achievements since 2003. He has edited/written twelve textbooks, including Psychiatric Aspects of Symptom Management in the Cancer Patient, published by the American Psychiatric Press, Psycho-oncology - 1st, 2nd and 3rd Editions, and Handbook of Psychiatry in Palliative Medicine- 1st and 2nd Editions. Dr. Breitbart recently authored treatment manuals on Meaning-Centered Group and Individual Psychotherapy in Advanced Cancer Patients by Oxford University Press. He is currently editor-in-chief of the Cambridge University Press' international palliative care journal, Palliative & Supportive Care. Dr. Breitbart also helped found IPOS Press and authored the IPOS Press/Oxford University Press Text Psychosocial Palliative Care. --- Support this podcast: https://podcasters.spotify.com/pod/show/aimatmelanoma/support

This episode features Jodie Crooks (Marie Curie, London, UK) and Dr Briony Hudson (Marie Curie, London, UK; Marie Curie Palliative Care Research Department, University College London, London, UK).   What is already known about the topic? Research into palliative care for people experiencing homelessness is complex and requires input from people with lived experience. There is a dearth of evidence and/or guidance in how to support researchers to involve people with lived experience of homelessness in palliative care research.   What this paper adds? Co-production of palliative and end-of-life-care research with people with lived experience of homelessness needs to be transparent, prioritise building rapport, be trauma-informed and person-centred. Reimbursement should always be offered to co-producers. The method of reimbursement should consider the context of involvement (i.e. the individual's circumstances) where possible. There is a need to evidence the impact of involvement, to facilitate a change in research culture which prioritises hearing the voices of different groups.   Implications for practice, theory, or policy Involving people with lived experience of homelessness can help researchers to identify unknown unknowns within the field of palliative care: it can validate, enhance and direct research to the intricacies of their experiences. The TIFFIN recommendations provide guidance for how to achieve co-production within this field in a trauma informed way.   Full paper available from:     https://journals.sagepub.com/doi/full/10.1177/02692163241259667   If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu:  a.nwosu@lancaster.ac.uk

Join us for the 5th Annual JOWMA Conference: Transforming Healthcare Through Innovation & Research on January 5, 2025, from 8am to 5pm in NYC! Spend the day immersed in expert-led scientific sessions, hands-on surgical simulations, specialty roundtables, and a networking lunch tailored for healthcare professionals and students. PLUS, we're offering a full premed program with panels, roundtables, and networking dedicated to aspiring medical students.

In this episode, Mary Lynn McPherson, PharmD, PhD, FAAHPM and Alexandra L. McPherson, PharmD, MPH discuss a complicated case involving a patient in her mid-50s from East Africa who is suffering from metastatic cancer. The conversation highlights the challenges of complex pain & symptom management while supporting a patient's goals of care. Related Resources: Down on the Pharm: Contemporary Issues in Pharmacopalliation About the Speakers: Mary Lynn McPherson, PharmD, PhD, FAAHPM Dr. McPherson has practiced hospice and palliative care as a clinical pharmacist her entire career. She is a professor at the University of Maryland and executive program director of the online Graduate Studies in Palliative Care (Graduate Certificates, MS, PhD) program. She has served as a resource to medical staff for pain and symptom consultations, opioid conversion calculations, methadone dosing and other medication-related issues. McPherson is particularly interested in assuring patients with a serious illness receive goal-concordant medication therapy. She has authored five books including the popular Demystifying Opioid Conversion Calculations: A Guide to Effective Dosing and numerous peer-reviewed articles and chapters.   Alex McPherson, PharmD, MPH Dr. McPherson received her Bachelor of Science in International Business from the University of Maryland in College Park, MD, followed by her Master of Public Health (MPH) with a dual certificate in International Health and Pharmaceutical Assessment, Management, and Policy from Boston University in Boston, MA. She went on to receive her Doctor of Pharmacy from the University of Maryland School of Pharmacy in Baltimore, MD. Subsequently she completed a Pharmacy Practice Residency at Einstein Medical Center in Philadelphia, PA and Pain Management and Palliative Care Specialty Residency at the University of Maryland School of Pharmacy/MedStar Health. She is currently a Palliative Care Clinical Pharmacy Specialist at MedStar Washington Hospital Center in Washington, DC, where she serves as faculty in the interdisciplinary Hospice and Palliative Medicine Fellowship program. In addition, she serves as a faculty member for the nation's first M.S. in Medical Cannabis Science and Therapeutics (University of Maryland School of Pharmacy), and M.S. in Palliative Care (University of Maryland Graduate School) programs. She is an active member of the American Academy of Hospice and Palliative Medicine and the Society of Pain and Palliative Care Pharmacists and has published and presented internationally on topics pertaining to pain management and palliative care. Her academic interests include early integration of palliative care in advanced illness, navigating transitions of care at the end-of-life, and the pharmacologic management of symptoms in serious illness. Her newest interest includes the integration of narrative medicine practices as a tool for reducing burnout and improving resiliency among palliative care providers.    

Today we're diving into the challenges caregivers face and practical advice on how to care for others while also caring for your well-being. Whether you're caring for an aging parent, an ill spouse, or a child with special needs, being a caregiver often leads to exhaustion and burnout. Joining me is Dr. Delia Chiaramonte, an integrative palliative care physician and host of The Integrative Palliative Podcast. Dr. Chiaramonte shares her personal story and offers strategies for setting boundaries, asking for help, and managing the emotional challenges of caregiving. Whether you're a physician caring for a loved one or know someone in this position, this episode is full of invaluable insights. In this episode we're talking about: The most common mistakes caregivers make and when to ask for help. Dr. Chiaramonte's personal journey as a caregiver and how it shaped her approach. Practical steps for balancing caregiving with self-care. The importance of setting boundaries and why it's crucial to get help before reaching burnout. Strategies for overcoming guilt, shame, and challenging emotions that may come up around caregiving. Examples of how families can navigate caregiving challenges successfully. Links for this episode: www.integrativepalliative.com www.CopingCourageously.com Starting November 13th, the Doctor's Crossing Carpe Diem podcast will be moving to a bi-weekly schedule. There will be no new episode on November 6th, but we're excited to continue bringing you inspiring and insightful content every other week starting November 13th. Thank you for your continued support, and we look forward to sharing more episodes with you on this new schedule! Thank you for listening!

In EPISODE 177 OF GROWING OLDER LIVING YOUNGER, Dr. Gillian Lockitch talks with Dr. Brad Stuart about his book "Facing Death: Spirituality, Science, and Surrender at the End of Life." Dr. Stuart discusses his transition from emergency medicine to hospice care, emphasizing how he came to realize the importance of healing over simply curing. He shares personal experiences and scientific insights into near-death experiences and the role of the default mode network in the brain. He highlights the spiritual and emotional aspects of end-of-life care, advocating for a holistic approach that includes mental, emotional, and spiritual well-being. He also touches on the potential of psychedelic therapy in addressing death anxiety and depression. Brad Stuart, MD is a physician specializing in end-of-life care, a healthcare innovator, and an author and international speaker. He has devoted his career to helping make the end of life a vital part of life itself. After graduating from Stanford Medical School and practicing internal medicine in the ER and ICU, he switched over to hospice practice to care for the dying. As Senior Medical Director for the largest healthcare system in Northern California, he created the first large-scale Advanced Illness Management (AIM) program in the US, funded by a $13 million award from the Center for Medicare and Medicaid Innovation. He was featured in the HBO special, Letting Go: A Hospice Journey. Brad has been recognized as Physician of the Year by the California Association of Health Services at Home, named a Top 20 national difference-maker by HealthLeaders' Media, and designated as a Visionary by the American Academy of Hospice and Palliative Medicine. Episode Timeline 0:01 Introduction to Dr. Stuart's journey from ER/ICU doctor into end-of-life care 12:48 The evolution of Dr. Stuart's approach to medicine 17:49 Personal experiences with death and recalled experiences   36:42 Neuroscience and Near-Death Experiences   43:16 Conclusion and Final Thoughts   Book : Facing Death: Spirituality, Science, and Surrender at the End of Life. https://www.bradstuartmd.com Schedule a free Discovery Call with Dr. Gillian And if you have not already done so, follow, rate and review this Growing Older Living Younger podcast.

Did you know that the rate of new HIV infections among Black women is 10 times that of white women and four times that of Latina women. Why is this the case? Thanks to HealthyWomen with support from Merck, we're having an essential conversation about HIV and how we must protect ourselves from contracting the virus. OUr guest this week Dr. Ada Stewart breaks down all the facts plus ways that people are now living longer with HIV.You don't want to miss this conversation!Listen and learn:How HIV diagnosis and treatment has changed over the past few decadesThe rumors abouht HIV that are completely false - and the truths we all need to knowProtection and the information we need to share with our girlfriendsHow we must advocate with our health care providers to ensure we're getting testedListen now and share your iTunes review with us!Follow now

In this episode, Holli and Brett discuss the integration of the Family Frailty Score as an assessment tool for patients undergoing advanced heart failure therapies. Various key considerations surrounding the tool are discussed, including multidisciplinary team involvement, socioeconomic challenges, patient and family support, and more. Featuring: Brett Snodgrass, DNP, FNP-C, ACHPN®, FAANP Holli Martinez FNP-BC, ACHPN®, FPCN Brett Snodgrass, DNP, FNP-C, ACHPN®, FAANP Brett Snodgrass has been a registered nurse since 1997 and a family nurse practitioner since 2007, 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 is a nationally recognized nurse practitioner, speaker and teacher. Brett Is a chronic pain expert, working for more than 20 years with chronic pain patients in a variety of settings. She currently serves on the TN Chronic Pain Task Force. She is a director at large of the TN Pain Society. Past awards include AANP State Excellence Award for Tennessee for her work across the state on the TN Chronic Pain Task Force, as well as advocating for TN Full Practice Authority for Nurse Practitioners and the 2017 Memphis Business Journal Healthcare Hero Award. Holli Martinez FNP-BC, ACHPN®, FPCN Holli has been a nurse for 26 years with the last 17 as an advanced practice registered nurse. In addition to providing palliative care consultations to patients and families, Holli also serves as the Program Director for the Supportive and Palliative Care Program at the University of Utah Hospital and Huntsman Cancer Institute; an adjunct faculty member for the University of Utah College of Nursing; past Board president for the Hospice and Palliative Nurses Association and the Hospice and Palliative Nurses Foundation; and faculty member for UCoPE - Utah Certificate of Palliative Education and Senior Faculty for VitalTalk. She is Board certified as a Family Nurse Practitioner and an Advanced Certified Hospice and Palliative Nurse. Holli has been inducted as an HPNA Fellow in Palliative Care Nursing and has been honored with the Cambia Foundation Sojourns Award and the American Association of Nurse Practitioners State of Utah Award for Excellence.

Did you know that the Treat and Reduce Obesity Act aims to expand Medicare coverage to include critical obesity treatments and medications, recognizing obesity as a chronic disease? In this episode, Dr. Sherika Newman, a board-certified family medicine physician and palliative care physician, shares her expertise on patient advocacy. She discusses its importance and how patients can advocate for themselves and their loved ones in medical settings. She also covers practical tips for self-advocacy, the role of family members as advocates, and the benefits of having a professional advocate, especially for complex medical situations. Dr. Sherika highlights the psychological aspects of obesity and the need for effective communication with healthcare providers. Finally, she explores how individuals can push for better obesity care coverage at their workplaces and through legislative efforts. Listen now and learn how to be a powerful advocate for yourself or your loved ones!   Episode Highlights: About Dr. Sherika Newman Importance of self-advocacy and having an external advocate Ways to find advocates Advocacy in weight loss management Effective advocacy strategies   Connect with Dr. Sherika Newman: Linked In | www.linkedin.com/in/sherika-newman-do Instagram | @drsherika Youtube | @myDITF   About Dr. Sherika Newman Dr. Sherika Newman is a distinguished graduate of Florida A&M University and a Board-Certified Family Medicine physician with added qualifications in Hospice and Palliative Medicine through fellowship training. She earned her Doctor of Osteopathic Medicine from Nova Southeastern University in Florida. With over a decade of experience in Palliative Medicine, Dr. Newman has achieved national recognition and serves as a faculty member with the Center to Advance Palliative Care. She founded **Doctor in the Family** to partner with patients and their families, ensuring they receive the care they desire and avoid the care they don't. Her mission is to provide everyone with access to a trusted doctor in the family, ready to assist with medical questions and guidance.   Resources: FREE! Discover the 5 Reasons Your Weight-Loss Journey Has Gotten Derailed (And How To Get Back On Track!)

Are you living a life that reflects your core values and desired feelings?  Join us for an inspiring conversation with Dr. Wittry, where we delve into the powerful practice of identifying these essential elements to craft a life that aligns with them.