Podcasts about respecting choices

A pragmatic trial evaluates the effectiveness of a treatment or intervention in “real-world” clinical practice.  Outcomes are typically assessed from available records.  Eligibility in pragmatic trials are often broad, and don't have the exclusions of efficacy studies, which examine treatment effects under highly controlled conditions in highly select populations. Today we are delighted to welcome Jennifer Wolff, Sydney Dy, and Danny Scerpella, who conducted a pragmatic trial of advance care planning (ACP) in primary care practices; and Jasmine Santoyo-Olsson, who wrote an accompanying commentary in JAMA Internal Medicine. We spend the last portion of the podcast discussing the surprising finding of the study.  In the primary care practices that received the advance care planning intervention, rates of advance care planning were higher (about double). Shockingly, rates of potentially burdensome intervention (intubation, CPR, etc) were also higher in the advance care planning intervention group.  What?!?  Not a typo. We spend some time unpacking and contextualizing the potential reasons for this surprising finding, including: Disconnect between relatively low rates of new advance directives (12% in intervention arm vs 7% control) and higher rates of potentially burdensome treatment among decedents (29% in intervention arm vs 21% control).  Only 5% of intervention patients received the facilitator led component of the intervention (there were other components, facilitator-led was the most engaged component). Was there really a causal connection between the intervention, new advance directives, and higher rates of potentially burdensome interventions? Potential that care received, though potentially burdensome, was in fact aligned with goals, and might represent goal concordant care. Potential that documenting advance directives without a robust conversation about prognosis might have led to these findings.  My goals will differ if I think I probably have 2 years to live vs 10 years. Comparison to a trial Yael Shenker discussed in our podcast on AAHPM/HPNA plenary abstracts (also used the Respecting Choices intervention, outcome differed). Implications for the larger discussion over the value of advance care planning, and additional research into advance care planning.  As I say on the podcast, I'm sure Sean Morrison would be delighted to point to these findings as evidence that advance care planning doesn't work, and in fact may be harmful. And I got to sing in Spanish for the second time. I hope my pronunciation is better than my Urdu, or French! -Alex Smith  

In today's podcast we were delighted to be joined by the presenters of the top scientific abstracts for the Annual Assembly of the American Academy of  Hospice and Palliative Medicine (AAHPM) and the Hospice and Palliative Medicine Nurses Association (HPNA).  Eric and I interviewed these presenters at the meeting on Thursday (before the pub crawl, thankfully).  On Saturday, they formally presented their abstracts during the plenary session, followed by a wonderful question and answer session with Hillary Lum doing a terrific job in the role of podcast host moderator. Our three guests were Marie Bakitas, who conducted a trial of tele/video palliative care for Black and White inpatients with serious illness hospitalized in the rural south; Yael Shenker, for a trial of patient-directed Prepare-for-your-care vs. facilitated Respecting Choices style advance care planning interventions; and, Na Ouyang, who studied the relationship between prognostic communication and prolonged grief among the parents of children who died from cancer.  From just the abstracts we had so many questions. We covered some of our questions on the podcast, others you can ponder on your own or in your journal clubs, including: Marie's tele/video palliative care intervention was tailored/refined with the help of a community advisory board. Does every institution need to get a community advisory board to tailor their rural tele-palliative care initiative (or geriatrics intervention) to the local communities served?  Who would/should be on that board? How to be sensitive to the risks of stereotyping based on recommendations from the few members of the board to the many heterogeneous patients served? Advance care planning has taken a beating. For the purposes of a thought exercise, no matter what you believe, let's assume that there are clear important benefits. Based on the results of Yael's study, should resources be allocated to resource intensive nurse facilitated sessions (Respecting Choices), which had significantly better engagement, or to low resource intensive patient-facing materials (Prepare), which had significantly less engagement but still plenty of engagement (e.g. 75% vs 61% advance directive completion)? One interpretation of Na's study is that clinicians can lean on the high levels of trust and high ratings of communication to engage with parents of children with cancer about prognosis.  Another interpretation is that clinicians avoided telling the parents prognosis in order to bolster their ratings of trust and communication quality.  Which is it? Bonus: Simon says he composed the song Sounds of Silence in a dark echoing bathroom about his concerns that people had stopped listening to each other in the 1960s (still resonates, right?).  Garfunkel says Simon was writing about Garfunklel's friend and college roomate Sandy, who was blind.  Who's got the right of it?   Enjoy! -Alex Smith   

Kiki and Pia delve into the intricate topic of motherhood through a feminist lens, particularly within the metal community. This episode offers a rich discussion on societal expectations, personal choices, and the evolving definitions of family and parenting. Kiki, who identifies as childfree by choice, and Pia, a mother of two, provide contrasting yet complementary perspectives that shed light on the complexities of motherhood. Both Kiki and Pia discuss how societal norms often dictate that women should aspire to become mothers. Kiki recalls being frequently asked about her future plans for children, while Pia shares her own experiences of being questioned about her desire to have children. They agree on the necessity of challenging these societal narratives and recognizing that happiness and fulfillment can exist outside of motherhood. Chapter marks Choosing Motherhood vs. Childfree Life (00:01:14) Personal Growth and Changing Perspectives (00:05:21) Romanticization of Parenthood (00:18:51) Phobia of Pregnancy (00:24:44) Identity Beyond Motherhood (00:27:41) Respecting Choices in Motherhood (00:36:17) Show notes We Awake Podcast Episode with Marnie Recorded on August 7th, 2024. Bleeding Metal was created and is produced by ⁠⁠⁠⁠@kikigege87⁠⁠⁠⁠ and ⁠⁠⁠⁠@power_pia⁠⁠⁠⁠ and is now co-hosted by ⁠⁠⁠⁠@suzanavalenca⁠⁠⁠⁠ and ⁠⁠⁠⁠@martha_wingen⁠⁠⁠⁠. Bonus episode edited by Pia. Subscribe now to the Bleeding Metal Podcast wherever you listen and ⁠⁠⁠⁠find us on the internet⁠⁠⁠⁠. Intro music by ⁠⁠⁠⁠Savvier Nelson⁠⁠⁠⁠ with vocals from ⁠⁠⁠⁠PERSONA-singer Jelena Dobric⁠⁠⁠⁠.

In this enlightening episode of The Health Feast, Dr. Rak and Po are joined by Dr. Tom Rifai, MD, FACP, a pioneering leader in lifestyle medicine and the creator of the Flex5 system. With a refreshing approach to health and wellness, Dr. Rifai shares his journey from overcoming personal struggles with binge eating to becoming a vocal advocate for truth in the wellness industry. Together, they dive into the myths and misinformation that dominate today's health landscape, offering listeners practical insights on how to navigate these challenges. Dr. Rifai discusses the importance of finding your "why" in health, the transformative power of self-love, and how his Flex5 system empowers individuals to achieve sustainable, long-term well-being. Whether you're seeking to cut through the noise of fad diets or looking for inspiration on your wellness journey, this episode is packed with actionable advice and powerful insights that will help you embrace true health. 00:48 Dr. Rak's Intro to the Guest 05:20 Meet Tom Rifai: A Social Media Truth Teller 06:42 The Dangers of Misinformation in Health 07:40 Tom Rifai's Journey into Lifestyle Medicine 08:49 Early Inspirations and Career Path 10:17 Personal Struggles and Family Influences 12:26 The Turning Point: Choosing Medicine 14:43 The Evolution of Lifestyle Medicine 19:06 Balancing Health and Enjoyment 22:05 Binge Eating: A Personal Battle 34:37 Reverse Discrimination and Healthy Executives 34:52 Larry's Non-Negotiable Journey 36:28 Respecting Choices and Slips 38:11 Compassionate Accountability 38:52 Exercise and Non-Exercise Activity 39:45 The 5 Percent Fun Zone 41:36 Understanding Slips and Corporate Manipulation 43:52 The Journey to Maintenance 47:14 Bariatric Surgery Insights 58:37 Final Thoughts and Self-Love Guest Bio Dr. Tom Rifai is a distinguished physician and expert in lifestyle medicine and metabolic health, renowned for his work in wellness, weight management, and disease prevention. With a career spanning over two decades, Dr. Rifai has helped countless patients reverse or significantly improve conditions like type 2 diabetes, prediabetes, and heart disease through his "lifestyle first" approach. He has served as the Regional Medical Director of Metabolic Health and Weight Management at the Henry Ford Health System, where he led efforts to standardize and integrate multidisciplinary care based on his Reality Meets Science® program. This program, centered on the 5 Keys to optimal wellness, has been instrumental in transforming the lives of many. Dr. Rifai is also a Clinical Assistant Professor of Medicine at Wayne State University and a Harvard Medical School Continuing Medical Education (CME) course director, where he has educated thousands of healthcare providers on the prevention of type 2 diabetes. His contributions to the field have earned him the title of Fellow of the American College of Physicians. Beyond his clinical work, Dr. Rifai is a passionate educator, public speaker, and media contributor, with appearances on TV, radio, and in print. His personal journey, including overcoming challenges with binge eating, adds a layer of empathy and insight to his coaching and patient care, making him a trusted expert and a relatable mentor in the pursuit of health and wellness. Online Platforms: Website: https://realitymeetsscience.com/ LinkedIn: https://www.linkedin.com/in/flex5/ Follow @thehealthfeast on IG and YT for more. The Health Feast is available wherever you get podcasts and at thehealthfeast.com. Level up your health journey! Learn how to work with Dr. Rak 1:1 or join a health Tribe for a transformative health journey. Limited spots are available! Visit us at https://www.rakyourlife.com Disclaimer: The Health Feast is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. As with any changes affecting your health, we recommend and encourage you to consult your medical doctor or other qualified healthcare professionals before making lifestyle changes. The opinions expressed are our own and do not necessarily reflect the views of our employers.

For 20 years, I have been advocating for the vulnerable and dying.  For ten years, I trained and mediated elder disputes at the LA County Department of Consumer Affairs.  I helped elders with family issues, including financial abuse and end-of-life care.   In 2012, I earned an Executive Juris Doctor (EJD) from Concord Law School, a division of Purdue Global, majoring in Health Law.  My internship was in Pediatric Hospice, where I spent a year attending Interdisciplinary Team Meetings and writing about my experiences.For many years, I have been a hospice volunteer sitting at the bedside of many dying patients.  In addition to supporting their families, I help tie up their final loose ends so they can pass in peace.  I have been a Thanatologist since 2015. I am certified as an expert in caring for the dying and bereaved and teaching others about the dying process.  I have clinical bioethics training and sat on two hospital bioethics committees.In 2020, I became a Board-Certified Patient Advocate (BCPA) and started Ending Well Patient Advocacy, LLC.  I weaved my past experiences into a business that specializes in giving people a voice in planning the last chapter of their life.  I earned Facilitator certificates through Respecting Choices® and now offer community classes and presentations on advance care planning and surrogacy.In January 2021, I became the Surrogate Consultant for the Final Exit Network (FEN).  My role is to help FEN members and their partners who act as surrogates or healthcare proxies enforce and honor the patient's Advance Directives.Follow Knowledgeable Aging:Facebook: https://www.facebook.com/Knowledgeable-Aging-102638398162823Twitter: https://twitter.com/KnowledgeAgingInstagram: https://www.instagram.com/knowledgeableaging/LinkedIn: https://www.linkedin.com/company/knowledgeable-aging/?viewAsMember=trueSpotify: https://open.spotify.com/show/05OHF9FkmhzCO5PDsyGfGqNewsletter: https://www.knowledgeableaging.com/newsletter/

Death has always been a taboo topic in Singapore. With our ageing population rising as well as Health Minister Ong Ye Kung's plans to increase the proportion of people dying at home or in palliative care settings instead of hospitals, is it time we begin talking more openly about our end-of-life plans? In this episode, host and Associate Director at the Institute of Policy Studies Liang Kaixin chats with guests Dr Chong Poh Heng, Medical Director at HCA Hospice Limited and Tay Jia Ying, an end-of-life doula and Founder of Happy Ever After. They discuss the concept of what a good death means, the changes needed to allow more people to spend their final moments at home and when people should begin thinking of their end-of-life plans. Read more about palliative care in Singapore: CNA (2 July 2022): IN FOCUS: Dying at home may seem ideal to many, but it's not always straightforward The Straits Times (2 June 2022): MOH to boost palliative care at home, better support caregivers About our guests: Chong Poh Heng Medical Director HCA Hospice Limited Dr Chong is Vice Chair of Singapore Hospice Council and Medical Director at HCA Hospice Limited. He founded Star PALS (Paediatric Advanced Life Support), a specialist paediatric palliative care service under HCA Hospice in 2012.  He advocates in his field nationally as chairperson of the paediatric and young adults Advanced Care Planning (ACP) task force, and internationally at Asia Pacific Hospice Network (APHN) Paediatric Palliative Care Special Interest Group respectively.   Dr Chong received the Healthcare Humanity Award in 2015, and won the Leader of Good (adult category) at the President's Volunteerism and Philanthropy Award ceremony in 2021. Tay Jia Ying Founder Happy Ever After Jia Ying started her exploration into end-of-life work in 2013 through her involvement as a producer with Both Sides, Now, an arts-based community engagement project on end-of-life issues. After seven years working with the community, she founded Happy Ever After in 2021 to connect directly with individuals to support them and their loved ones in navigating the complexities of life and death, love and loss, hopes and fears, laughter and tears. She is a certified end-of-life doula with The Dying Year, and a certified Respecting Choices 1st Steps Advance Care Planning facilitator. She is also a member of the National End-of-life Doula Alliance (NEDA), and is NEDA proficient. On Diversity is a podcast inspired by the Institute of Policy Studies Managing Diversities research programme. In each episode, we chat with guests to explore what diversity means to them, the changes they are making, and the changes they hope to see in an increasingly fragmented society. More from On Diversity Season 3 Episode 6: Social Worker Burnout with Louis Ng, MP for Nee Soon GRC and Cindy Ng-Tay, Director of Home at Children's Aid Society Season 3 Episode 5: Leaving the Law Profession with Andrew Chan, Partner at Allen & Gledhill LLP and Michelle Yeo, Of Counsel at LVM Law Chambers LLC Season 3 Episode 4: Racism at Work with Dharesheni Nedumaran, Head of Diversity, Equity and Inclusion, APAC, at Mediabrands and Shamil Zainuddin, Research Associate at IPS Social Lab Season 3 Episode 3: Ableism at Work with Cassandra Chiu, a vision impaired counsellor and advocate for PWDs, and Justin Lee, Senior Research Fellow at IPS Season 3 Episode 2: Ageism at Work with Heng Chee How, Deputy Secretary-General of the National Trade Union Congress (NTUC), and Associate Professor Helen Ko of the Master & PhD in Gerontology Programmes at the Singapore University of Social Sciences (SUSS) Season 3 Episode 1: Sexism at Work, with Corinna Lim, Executive Director of the Association of Women for Action and Research (AWARE) and Simran Toor, Chief Executive Officer at SG Her Empowerment Limited (SHE)  Season 2 Episode 9: Youth Mental Health, with Dr Jacqueline Tilley, Assistant Professor of Clinical Psychology at the National Institute of Education (NIE) and Asher Low, Founder of Limitless Season 2 Episode 8: What Makes Us Singaporean, with Matthew Matthews, Principal Research Fellow of IPS and Head of IPS Social Lab, and Oon Shu An, Singaporean actress and host See omnystudio.com/listener for privacy information.

Advance Care Planning is a process, not a one-time event that includes an individual and their loved ones.  People's goals change over time.  As we saw with COVID-19, many patients changed their minds regarding ventilators and life support. Stephanie Anderson from Respecting Choices says it's not just enough to educate about advance care planning but about introducing “shared decision-making.”  Learn more about these conversations and what you need to focus on when implementing.

Carol Schoneberg has been a hospice educator and grief counselor in Maine since 1992. She has served as an End-of-Life Educator, Bereavement Services Manager, and grief counselor at Hospice of Southern Maine— Maine's only free-standing not-for-profit hospice—since its inception in 2004. Carol provides end-of-life education to staff, volunteers, healthcare providers, universities, and the community at large. Certified as an Advance Care Planning Facilitator Trainer through the Respecting Choices program at Gundersen-Lutheran Hospital in La Crosse, Wisconsin in 2001, she believes strongly that helping people talk about their choices for end of-life care can make a huge difference in the way families experience the dying process. Her experiences working with the dying and the bereaved have inspired and taught her much about the resiliency of the human spirit. Contact Carol Schoneberg: https://www.hospiceofsouthernmaine.org/ https://www.linkedin.com/company/hospice-of-southern-maine/ https://www.instagram.com/hospiceofsouthernmaine/ https://www.facebook.com/HospiceofSouthernMaine Contact Kendra Rinaldi: https://www.griefgratitudeandthegrayinbetween.com/

For 20 years, I have been advocating for the vulnerable and dying.  For ten years, I trained and mediated elder disputes at the LA County Department of Consumer Affairs.  I helped elders with family issues, including financial abuse and end-of-life care.   In 2012, I earned an Executive Juris Doctor (EJD) from Concord Law School, a division of Purdue Global, majoring in Health Law.  My internship was in Pediatric Hospice, where I spent a year attending Interdisciplinary Team Meetings and writing about my experiences.For many years, I have been a hospice volunteer sitting at the bedside of many dying patients.  In addition to supporting their families, I help tie up their final loose ends so they can pass in peace.  I have been a Thanatologist since 2015. I am certified as an expert in caring for the dying and bereaved and teaching others about the dying process.  I have clinical bioethics training and sat on two hospital bioethics committees.In 2020, I became a Board-Certified Patient Advocate (BCPA) and started Ending Well Patient Advocacy, LLC.  I weaved my past experiences into a business that specializes in giving people a voice in planning the last chapter of their life.  I earned Facilitator certificates through Respecting Choices® and now offer community classes and presentations on advance care planning and surrogacy.In January 2021, I became the Surrogate Consultant for the Final Exit Network (FEN).  My role is to help FEN members and their partners who act as surrogates or healthcare proxies enforce and honor the patient's Advance Directives.Follow Knowledgeable Aging:Facebook: https://www.facebook.com/Knowledgeable-Aging-102638398162823Twitter: https://twitter.com/KnowledgeAgingInstagram: https://www.instagram.com/knowledgeableaging/LinkedIn: https://www.linkedin.com/company/knowledgeable-aging/?viewAsMember=trueSpotify: https://open.spotify.com/show/05OHF9FkmhzCO5PDsyGfGqNewsletter: https://www.knowledgeableaging.com/newsletter/

When it comes to grief, there isn't one path to follow. Grief evolves. It ebbs and flows and can hit us when we least expect it. And while the thought of outrunning grief may sound good, learning how to navigate the feelings associated with grief will better serve us in the long run. Join Rolfe and Cancer Wellness Center in this candid discussion of an all-too-often taboo subject, where we shared: - Ways grief may appear in our lives (and how it differs in each of us) - Stages of Grief: diagnosis, treatment, end of life, loss - Practical approaches to managing grief - How you can carry on when grief remains with you About the speakers: Mary F. Mulcahy, MD is a practicing medical oncologist with more than ten years experience in caring for patients and families with terminal illness. She is a sought-after speaker providing education to medical providers, advocacy groups, and patients. She is an Associate Professor in the Department of Hematology-Oncology at Northwestern University Feinberg School of Medicine. She received her medical degree from the University of California San Diego, completed her residency at Boston University and her fellowship at Northwestern Memorial Hospital. She has expertise in the treatment of pancreatic biliary, esophageal, and liver cancers. She is experienced in liver-directed therapy for primary and metastatic liver tumors. Celeste Gallati is a member of the Life Matters Media Board of Directors. Celeste has two decades of experience in the financial services industry serving in various human resources and project management roles. She holds an MBA and a Master of Labor and Industrial Relations from the University of Illinois at Urbana-Champaign and has completed the Philanthropy and Nonprofit Organizations Certificate Program at Northwestern School of Professional Studies. In addition, she is a Respecting Choices certified advance care planning facilitator. After being widowed at 35 and serving as a caregiver for her mother who had dementia, Gallati understands the importance of having end-of-life discussions with loved ones and is passionate about helping others have these vital conversations.  Priscilla Andrews, MA, LCPC, Clinical Manager joined Cancer Wellness Center's clinical staff in 2007. She holds an MA in Community Counseling from Loyola University Chicago and has completed post-graduate training in polyvagal theory and emotionally-focused therapy. In addition to working with people through the Counseling Program, she also facilitates the monthly Multiple Myeloma Networking Group. Her areas of interest include survivorship issues, building motivation for behavior changes, recovery from trauma, and couples work. To access the slides for this episode, watch full episodes and learn more about Rolfe Foundation and Wellness Wednesday click here: https://rolfefoundation.org/get-involved/events-programs/wellness-wednesday-3/

In this episode, Carol shares an experience of grief. She was in her early 20's when a friend jumped off the Golden Gate Bridge. It was the first suicide or death she had experienced of a close friend. She remembers how nobody talked about it; no one talked about anything.Originally from San Francisco, Carol Schoneberg has been a hospice educator and grief counselor in Maine since 1992. She has served as an End-of-Life Educator, Bereavement Services Manager, and grief counselor at Hospice of Southern Maine—Maine's only free-standing not-for-profit hospice—since its inception in 2004. Carol provides end-of-life education to staff, volunteers, healthcare providers, universities, and the community.In 2001 Carol participated in the Respecting Choices program at Gundersen-Lutheran Hospital in La Crosse, Wisconsin, where she became certified as an Advance Care Planning Facilitator Trainer. She strongly believes how helping people talk about their choices for end-of-life care can make a huge difference in the way families experience the dying process.Working with the dying and the bereaved has inspired and taught her much about the human spirit's resiliency. Support the show (https://healgrief.org/donations/)

"Advance care planning is not enough. It's critically important that we develop highly reliable systems." Dr. Stephanie Anderson Respecting Choices® Advance care planning - clarifying your wishes in advance about the kind of care you want to receive - improves outcomes for patients, families and healthcare providers. The data is so conclusive that legislation was passed in the 1990's to increase the number of Americans having an advance directive. The legislation failed, but it's a great start. In this conversation with Emily Lauri and Dr. Stephaie Anderson, we explore the problem and possible solutions. Meet Dr. Stephanie Anderson Dr. Stephanie Anderson is the executive director of Respecting Choices, a division of C-TAC Innovations. She is responsible for designing and leading strategy and operations including the delivery of this internationally recognized program. She has over 25 years of experience in palliative care, hospice, home care, case management, and emergency medicine. Dr. Anderson earned her doctor of nursing practice degree from the University of Iowa specializing in health systems administration. Dr. Anderson has served in a variety of leadership roles. In these roles, her palliative care program was awarded Joint Commission Certification and the system received the Circle of Life award from the American Hospital Association. She co-chaired the Iowa Physician Orders for Scope of Treatment (IPOST) movement, resulting in new legislation and statewide implementation. Dr. Anderson joined Respecting Choices in 2013 as a senior faculty consultant and evolved into the director of consultation and education services prior to her current role. Dr. Anderson currently chairs the National POLST central region leaders group, co-chairs the POLST program assistance committee and a member of the program standards committee. She is vice president of Advance Care Planning - international. Dr. Anderson believes person-centered decision making based on an individual's goals and values truly transforms care and should be the top priority to delivering exceptional whole-person healthcare. Person-Centered Decision Making Respecting Choices' goal is to design a system of person-centered care that is guided by the best scientific evidence and is aligned with an individual's goals and values. This system requires a shared decision-making process that involves respectful interaction among providers, individuals, and families, and keeps the focus of planning on what matters most to each and every person for any healthcare decision. Episode Credits Pat Cupples provided original music for this episode. Additional music is from the band Hotels & Highways. Photo credit: Gundersen Health System Join us to learn more: "Medicare 2021: What Changed?"

"Advanced care planning is not enough. It's critically important that we develop highly reliable systems." Dr. Stephanie Anderson Respecting Choices® Advance care planning - clarifying your wishes in advance about the kind of care you want to receive - improves outcomes for patients, families and healthcare providers. The data is so conclusive that legislation was passed in the 1990's to increase the number of Americans having an advance directive. The legislation failed, but it's a great start. In this conversation with Emily Lauri and Dr. Stephaie Anderson, we explore the problem and possible solutions. Meet Dr. Stephanie Anderson Dr. Stephanie Anderson is the executive director of Respecting Choices, a division of C-TAC Innovations. She is responsible for designing and leading strategy and operations including the delivery of this internationally recognized program. She has over 25 years of experience in palliative care, hospice, home care, case management, and emergency medicine. Dr. Anderson earned her doctor of nursing practice degree from the University of Iowa specializing in health systems administration. Dr. Anderson has served in a variety of leadership roles. In these roles, her palliative care program was awarded Joint Commission Certification and the system received the Circle of Life award from the American Hospital Association. She co-chaired the Iowa Physician Orders for Scope of Treatment (IPOST) movement, resulting in new legislation and statewide implementation. Dr. Anderson joined Respecting Choices in 2013 as a senior faculty consultant and evolved into the director of consultation and education services prior to her current role. Dr. Anderson currently chairs the National POLST central region leaders group, co-chairs the POLST program assistance committee and a member of the program standards committee. She is vice president of Advance Care Planning - international. Dr. Anderson believes person-centered decision making based on an individual’s goals and values truly transforms care and should be the top priority to delivering exceptional whole-person healthcare. Person-Centered Decision Making Respecting Choices’ goal is to design a system of person-centered care that is guided by the best scientific evidence and is aligned with an individual’s goals and values. This system requires a shared decision-making process that involves respectful interaction among providers, individuals, and families, and keeps the focus of planning on what matters most to each and every person for any healthcare decision. Episode Credits Pat Cupples provided original music for this episode. Additional music is from the band Hotels & Highways. Photo credit: Gundersen Health System Join us to learn more: "Medicare 2021: What Changed?"

Today we speak with Registered Nurse, Wilma Rice, an Educational Specialist from Roper St. Francis. Wilma is passionate about patient care, and part of this passion has her working with end-of-life issues as a Respecting Choices instructor, and assisting with a state pilot project introducing Physicians Order for Scope of Treatment (POST) to South Carolina. Enjoy our conversation with Wilma Rice!

Randi Belisomo, DBe, is the President and Co-Founder of Life Matters Media. She serves as a reporter at WGN-TV in Chicago and is a frequent contributor to Chicago Public Radio, Relevant Radio and WGN 720 AM. She writes about issues related to end of life healthcare and policy for Reuters Health.Belisomo holds a doctorate from Loyola University-Chicago in bioethics and health policy, as well as an M.S.J. from Northwestern University’s Medill School of Journalism. She is a Phi Beta Kappa graduate of the University of Notre Dame. She is a multiple Emmy Nominee and a Peter Lisagor Award winner for best in-depth series, best feature and best sports story.She currently serves on the boards of Living Water International and Mental Health America- Illinois. She is a chair person of the Carlos Hernandez Award in Meritorious Journalism at DePaul University and a member of the Illinois Task Force for the Physician Orders for Life Sustaining Treatment (POLST). She is a Respecting Choices certified advance care planning facilitator and instructor.Having served as a caregiver and widowed at a young age, Belisomo knows that end of life issues impact everyone at some point. She hopes that through the work of Life Matters Media, the inevitable challenges with which life presents and often surprises us will be made easier for the organization’s audiences. See acast.com/privacy for privacy and opt-out information.

Carol Schoneberg has been a hospice educator in Maine since 1992. She has served as an end-of-life educator, bereavement services manager, and grief counselor at Hospice of Southern Maine—Maine’s only free standing not-for-profit hospice—since its inception in 2004. Carol provides end-of-life education to staff, volunteers, healthcare providers, universities, and the community at large. Certified as an advance care planning facilitator trainer through the Respecting Choices program at Gundersen-Lutheran Hospital in La Crosse, Wisconsin, she believes strongly that helping people talk about their choices for end-of-life care can make a huge difference in the way families experience the dying process. Her experiences working with the dying and the bereaved have inspired and taught her much about the resiliency of the human spirit. https://www.themainemag.com/radio/radio-guests/carol-schoneberg/

Date: January 26, 2012 Featuring: Ellen Goodman, Columnist, Author, founding member of The Conversation Project Ira Byock, MD, Professor, Dartmouth Medical School; Director of Palliative Medicine, Dartmouth-Hitchcock Medical Center Bernard “Bud” Hammes, PhD, Director, Medical Humanities and Respecting Choices®, Gundersen Health System Martha Hayward, Lead for Public and Patient Engagement, Institute for Healthcare Improvement Most of us, if asked, say we care a great deal about will happen to us when we’re at the end of our lives. And yet, because we’d also rather focus on just about anything but death and dying, especially if we’re young and healthy or aging well, we’re all vulnerable to what can transpire by default: spending our last few days in an ICU, even if that’s at odds with our needs and preferences. The reasons for this disconnect are complex but often stem from the fact that individual and family decisions come late, are hashed out during a crisis, and in the very setting — a hospital — that promises high-tech and high-intervention cures for just about everything.  This scenario is slowly starting to change. There are now numerous efforts, some medically-based and many more that are grassroots, successfully promoting alternative perspectives and practices so that people who’d prefer to die at home can do so, and benefit from pain management and comfort over costly and heroic measures. But when you get right down to it, “dying well” is quite personal and, as such, needs to start in a personal place: by having a conversation with the people you’re closest to about how you want to die and how they, surviving friends and family members, can feel okay carrying out your wishes. Equally important: initiating or being open to that conversation, perhaps several conversations, when the circumstances aren’t so fraught and there’s time to digest and reflect and integrate the information.  All of this and more are what’s behind a new initiative getting underway in 2012 called The Conversation Project (TCP), which will be discussed on the January 26 WIHI. In collaboration with IHI, award-winning columnist and founding member Ellen Goodman and the project’s team members seek to create a cultural movement with one basic goal: to help every American say what they want at the end of life so that family members and medical providers have the guidance they need to respect those preferences. To get there, TCP wants to normalize discussions that can at times feel “too big to broach” by encouraging loved ones to talk to one another when circumstances aren’t so charged — when everyone is healthy — and the environment is more conducive to a good exchange. Around the kitchen table, for instance, rather than the hospital bed.   To launch a national campaign to bring about this change, Ellen Goodman and members of TCP have turned to many, many experts on death and dying, palliative care, and successful partnerships with patients and families, including two outspoken champions of change on the clinical and community side: Dartmouth’s Ira Byock and Gundersen Health System’s Bud Hammes. With IHI’s Martha Hayward also on board, WIHI host Madge Kaplan invites you to get an early look at a unique initiative in the making from the architects themselves. Increasingly, that’s going to become all of us —­having “The Conversation” and telling others how it went and what we learned in the process. It’s hoped that many will benefit, including health professionals who often find themselves at a loss for words, brought up short by their training, and caught in the cross hairs of their own and others’ conflicting emotions and wishes.

Date: November 19, 2015 Featuring: Kate Lally, MD, FACP, Director of Palliative Care, Care New England; Hospice Medical Director, VNA of Care New England; Clinical Assistant Professor of Medicine, Alpert Medical School of Brown University Harriet Warshaw, Executive Director, The Conversation Project Holly Oh, MD, Chief Medical Officer, The Dimock Center Jocelyn Moore, Managing Director, The Glover Park Group On October 30, the US Centers for Medicare & Medicaid Services (CMS) announced that, starting January 1, CMS will reimburse physicians and other practitioners for talking with any Medicare recipient about their health care preferences at the end of life – also known as advance care planning. Caught up in a political maelstrom several years ago, CMS has now caught up with a growing desire of patients and loved ones to express, and have health care respect, their wishes. Talking with a trusted provider, before one is faced with a terminal illness, can be an important part of the process. The good news is that more people today appreciate the need to articulate their preferences regarding end-of-life care. We know this from surveys and our own experiences, and because multiple initiatives, including Respecting Choices and The Conversation Project (TCP), have tapped into a groundswell of interest in tools and resources to conduct discussions about end-of-life care wherever they can occur… around the kitchen table, at family gatherings, at community centers, and in the workplace. The next frontier is for health care to reliably “receive, record, and respect” everyone’s stated wishes. Will the new CMS payment options make advance care discussions more likely and encourage health professionals to gain the necessary skills? That’s certainly the hope, and we sorted through the latest developments on this WIHI.

Recognize and manage end of life symptoms with competence and confidence. In this extensive discussion with Dr. Brooke Worster, Assistant Professor of Medicine at Sydney Kimmel Medical College and Medical Director, of the Palliative Care Service at Thomas Jefferson University Hospitals we discuss scripts for having difficult conversations, managing patient/family expectations, what comes in the hospice “E” kit, terminal delirium, the “death rattle”, air hunger, and more. Full show notes available at http://thecurbsiders.com Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Time Stamps 00:00 Intro 03:10 Rapid fire questions 08:33 Defining hospice and palliative care 11:28 Case discussion 21:28 Gunderson, MI and Respecting Choices 24:25 How to counsel patients about home hospice? 37:10 Hospice “E” kit and how to use it 42:09 Air hunger, terminal delirium, death rattle, and Cheyne Stokes breathing 52:48 What is the PCM’s role while patient is on hospice? 58:19 Cancer survivorship and palliative care 60:33 Take home points 62:20 Outro Tags: assistant, care, doctor, end, education, family, foam, foamed, health, hospice, hospitalist, hospital, internal, internist, life, nurse, medicine, medical, palliative, physician, practitioner, primary, resident, student, symptom

Listen NowThe lowlight during the 2009-2010 ACA debate was Governor Palin's invention of "death panels" (PolitiFact's 2009 "Lie of the Year") in response to a proposal to allow Medicare to pay physicians whom voluntarily counsel patients about advanced care planning or directives.   The fear mongering was so convincing the proposal was dropped by the Congress and later, via rule making, by the White House.  The facts remain that while far and away most Americans die of a long term chronic, eventually fatal ilness/es, according to AHRQ, Pew and others only approximately twenty to thirty percent of Americans have an advanced directive or a living will including those severely or terminally ill.  During this 28-minute discussion Mr. Sabatino discusses the importance and benefits of advanced care planning and the various types of advanced care directives (living wills, durable power of attorney, POLST, and others), reasons for our hesitancy in planning for advanced illness and completing directives, limitations (e.g., portability problems) and operational challenges.  He notes specifically advanced care planning is not a one time conversation or a check the box exercise.  He describes what steps are being taken to improve advanced care planning, for example through opportunities presented via the movement towards electronic health/medical records.        Charlie P. Sabatino is the Director of the American Bar Association's Commission on Law and Aging where he is responsible for research and education in health law, long‑term care, guardianship and capacity issues, surrogate decision‑making, legal services delivery for the elderly and professional ethics.  He has written extensively on capacity issues, surrogate decision-making and advance care planning.  Mrs. Sabation is also an Adjunct Professor at Georgetown University Law Center, currently serves as a legal consultant to the National POLST Paradigm Task Force and is a board member of the Coalition to Transform Advance Care.  Mr. Sabatino is a Fellow and former president of the National Academy of Elder Law Attorneys.  He received his A.B. from Cornell, his J.D. from Georgetown and is a member of the Virginia and D.C. bars.For ABA information on advanced care planning and directives see:  http://www.americanbar.org/groups/law_aging/resources/consumer_s_toolkit_for_health_care_advance_planning.html and for Respecting Choices information see: http://www.gundersenhealth.org/respecting-choices. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com