Tuesday, December 13, 2011
Friday, September 16, 2011
Friday, June 24, 2011
June 28: free, important webinar from CAPC on unprecedented public opinion research on pallative care http://bit.ly/k9RJNN hpm
Friday, April 29, 2011
New health care chaplaincy webinars from experts on palliative care for chaplains and other spiritual care providers
Details at www.healthcarechaplaincy.org/learn or https://secure.healthcarechaplaincy.org/cart/productsubcats.aspx?SubCategory=7
Each webinar is 90-minutes long, includes time for discussion/question and answers, and costs $35. If you purchase the webinar but cannot attend for any reason, you will still be able to view the webinar recording for six months after the event.
All of the webinars run 2-3:30 pm Eastern Time.
May 3rd, 2011
Advanced Care Planning for Aging, Illness, and Incapacity
Who should attend: Anyone interested in this vital topic, chaplains, other religious professionals, and other spiritual care providers.
Become familiar with the concepts, vocabulary and tools that are necessary for preparing for the legal and spiritual needs that arise as people age, become incapacitated, or face life-limiting illness.
Expert presenters:
Robert Wolf, Esq. – Senior Vice President, Innovation and Development, HealthCare Chaplaincy
Martin Montonye, DMin, BCC -- Vice President, Academic Affairs, HealthCare Chaplaincy
May 9th, 2011
Caring in the Presence of Loss:
Who should attend: Anyone interested in this vital topic, chaplains, other religious professionals, and other spiritual care providers.
Learn to identify the needs of people grieving, explore the experience of grief and bereavement, and discuss the various interventions to provide supportive care.
Learn the contribution of Kubler-Ross' stage theory of grief; be able to define the terms anticipatory grief, bereavement, grief and mourning; and identify the skills necessary to engender trust and openness in a relationship with someone who is dying.
Expert presenter:
Martin Montonye, DMin, BCC -- Vice President, Academic Affairs, HealthCare Chaplaincy
June 14th, 2011
The Role of Chaplaincy within a Changing Culture
Who should attend: Professional and volunteer chaplains
Cultural competence is an increasingly important issue in health care and one where chaplains can have a major impact. Learn the current salient issues in making a health care institution culture-friendly for patients, families, and staff, and include new Joint Commission standards and assessment issues. Emphasis will be placed on the role that chaplains can have in being the “culture broker” for the institution.
Expert presenters:
George Handzo, BCC, CSSBB -- Vice President, Chaplaincy Care and Leadership Practice, HealthCare Chaplaincy
Sue Wintz, MDiv, BCC -- Managing Editor, PlainViews® e-newsletter for spiritual care providers, HealthCare Chaplaincy
June 28th, 2011
Spiritual Screening, History Taking, and Assessment
Who should attend: Professional and volunteer chaplains
Based on the work of the National Consensus Conference on Spiritual Care in Palliative Care, learn a system for integrating spiritual screening, history taking, assessment and care planning into the palliative care team. Emphasis will be placed on the role of the chaplain within the overall spiritual care function of the palliative care team
Expert presenter:
George Handzo, BCC, CSSBB -- Vice President, Chaplaincy Care and Leadership Practice, HealthCare Chaplaincy
September 13th, 2011
Palliative Care: Creating an Effective Transdisciplinary Team
Who should attend: Chaplains, other spiritual care providers, and other health care professionals
Teamwork is essential in providing quality care to patients receiving palliative care. This program is designed to enhance the clinical skills and effectiveness of healthcare professionals caring for palliative patients and their families. The content will include developing a team, defining roles, care and collaboration, leadership and communication skills, conflict resolution and finding meaning. In addition, a physician, nurse, social worker and chaplain will demonstrate teamwork by providing a case review
Expert presenter:
Martin Montonye, DMin, BCC -- Vice President, Academic Affairs, HealthCare Chaplaincy
October 11th, 2011
Organ Donation: Important Religious, Spiritual and Practical Aspects
Who should attend: Anyone interested in this vital topic, chaplains, other religious professionals, and other spiritual care providers.
Learn the facts about the organ donation and referral process; the ethical, religious and cultural considerations that families may have when deciding about donation and the role that each faith leader plays in saving lives.
Expert presenter:
Karen Cummings, New York Organ Donor Network
--------------------------------------------------------------------------------
Improve your practice with these online courses
HealthCare Chaplaincy introduces a new approach in continuing education for chaplains, clergy, counselors, educators, health care professionals and others with online courses that:
•Bring up-to-date subject matter to you at your convenience
•Add to, or refresh, your professional skills
•Provide opportunity for dialogue with peers
What Chaplains and Clergy Need to Know About Cultural Self-Awareness” created by the Rev. Dagmar Grefe, PhD, Manager of Spiritual Care Services/ACPE Supervisor, Childrens Hospital, Los Angeles; Templeton Visiting Scholar, HealthCare Chaplaincy
This course contains up-to-date, relevant information for chaplains, clergy, and other professionals on developing cultural self-awareness. Cultural self-awareness is awareness of interactions of cultural groups, and awareness of the psychological processes that occur automatically and impact on our social behaviors. Social psychology provides a framework for understanding why human beings categorize others, develop stereotypes, and respond to others in automatic ways. Included in this online course are methods to improve cultural self-awareness. The information is based in psychological research and theory.
--------------------------------------------------------------------------------
"What Chaplains and Clergy Need to Know About The Confused Patient: Delirium and Dementia” created by David A Harrison, MD, PhD, Department of Psychiatry & Behavioral Sciences, University of Washington; Templeton Visiting Scholar, HealthCare Chaplaincy
This course contains up-to-date, relevant information for chaplains, clergy, and other professionals on the often overlooked and under-diagnosed disorder of delirium. It also contains information about, and useful clarifying comparisons with, dementia, because delirium and dementia are often confused one for the other. Case studies provide examples of the risk factors, signs, and potentially life-long negative impacts for patients with delirium, as well as the progression of dementia on patient and family members. Recommended intervention strategies for patients and families of patients with delirium and dementia are included in this course.
Price: $40 per course.
To purchase, click here.
Each of these courses:
•Contains an online, self-directed learning module that you can access as often as you like, at your convenience, for up to one year.
•Contains bookmarks, so that you can close the course and resume your learning later from that place.
•Allows for repeated course completions to reinforce learning.
•Includes an invitation to participate in a facilitated, online, community of practice for peer to peer learning.
•Provides a certificate of completion, accessible and printable after the learner completes the course at least once
Each webinar is 90-minutes long, includes time for discussion/question and answers, and costs $35. If you purchase the webinar but cannot attend for any reason, you will still be able to view the webinar recording for six months after the event.
All of the webinars run 2-3:30 pm Eastern Time.
May 3rd, 2011
Advanced Care Planning for Aging, Illness, and Incapacity
Who should attend: Anyone interested in this vital topic, chaplains, other religious professionals, and other spiritual care providers.
Become familiar with the concepts, vocabulary and tools that are necessary for preparing for the legal and spiritual needs that arise as people age, become incapacitated, or face life-limiting illness.
Expert presenters:
Robert Wolf, Esq. – Senior Vice President, Innovation and Development, HealthCare Chaplaincy
Martin Montonye, DMin, BCC -- Vice President, Academic Affairs, HealthCare Chaplaincy
May 9th, 2011
Caring in the Presence of Loss:
Who should attend: Anyone interested in this vital topic, chaplains, other religious professionals, and other spiritual care providers.
Learn to identify the needs of people grieving, explore the experience of grief and bereavement, and discuss the various interventions to provide supportive care.
Learn the contribution of Kubler-Ross' stage theory of grief; be able to define the terms anticipatory grief, bereavement, grief and mourning; and identify the skills necessary to engender trust and openness in a relationship with someone who is dying.
Expert presenter:
Martin Montonye, DMin, BCC -- Vice President, Academic Affairs, HealthCare Chaplaincy
June 14th, 2011
The Role of Chaplaincy within a Changing Culture
Who should attend: Professional and volunteer chaplains
Cultural competence is an increasingly important issue in health care and one where chaplains can have a major impact. Learn the current salient issues in making a health care institution culture-friendly for patients, families, and staff, and include new Joint Commission standards and assessment issues. Emphasis will be placed on the role that chaplains can have in being the “culture broker” for the institution.
Expert presenters:
George Handzo, BCC, CSSBB -- Vice President, Chaplaincy Care and Leadership Practice, HealthCare Chaplaincy
Sue Wintz, MDiv, BCC -- Managing Editor, PlainViews® e-newsletter for spiritual care providers, HealthCare Chaplaincy
June 28th, 2011
Spiritual Screening, History Taking, and Assessment
Who should attend: Professional and volunteer chaplains
Based on the work of the National Consensus Conference on Spiritual Care in Palliative Care, learn a system for integrating spiritual screening, history taking, assessment and care planning into the palliative care team. Emphasis will be placed on the role of the chaplain within the overall spiritual care function of the palliative care team
Expert presenter:
George Handzo, BCC, CSSBB -- Vice President, Chaplaincy Care and Leadership Practice, HealthCare Chaplaincy
September 13th, 2011
Palliative Care: Creating an Effective Transdisciplinary Team
Who should attend: Chaplains, other spiritual care providers, and other health care professionals
Teamwork is essential in providing quality care to patients receiving palliative care. This program is designed to enhance the clinical skills and effectiveness of healthcare professionals caring for palliative patients and their families. The content will include developing a team, defining roles, care and collaboration, leadership and communication skills, conflict resolution and finding meaning. In addition, a physician, nurse, social worker and chaplain will demonstrate teamwork by providing a case review
Expert presenter:
Martin Montonye, DMin, BCC -- Vice President, Academic Affairs, HealthCare Chaplaincy
October 11th, 2011
Organ Donation: Important Religious, Spiritual and Practical Aspects
Who should attend: Anyone interested in this vital topic, chaplains, other religious professionals, and other spiritual care providers.
Learn the facts about the organ donation and referral process; the ethical, religious and cultural considerations that families may have when deciding about donation and the role that each faith leader plays in saving lives.
Expert presenter:
Karen Cummings, New York Organ Donor Network
--------------------------------------------------------------------------------
Improve your practice with these online courses
HealthCare Chaplaincy introduces a new approach in continuing education for chaplains, clergy, counselors, educators, health care professionals and others with online courses that:
•Bring up-to-date subject matter to you at your convenience
•Add to, or refresh, your professional skills
•Provide opportunity for dialogue with peers
What Chaplains and Clergy Need to Know About Cultural Self-Awareness” created by the Rev. Dagmar Grefe, PhD, Manager of Spiritual Care Services/ACPE Supervisor, Childrens Hospital, Los Angeles; Templeton Visiting Scholar, HealthCare Chaplaincy
This course contains up-to-date, relevant information for chaplains, clergy, and other professionals on developing cultural self-awareness. Cultural self-awareness is awareness of interactions of cultural groups, and awareness of the psychological processes that occur automatically and impact on our social behaviors. Social psychology provides a framework for understanding why human beings categorize others, develop stereotypes, and respond to others in automatic ways. Included in this online course are methods to improve cultural self-awareness. The information is based in psychological research and theory.
--------------------------------------------------------------------------------
"What Chaplains and Clergy Need to Know About The Confused Patient: Delirium and Dementia” created by David A Harrison, MD, PhD, Department of Psychiatry & Behavioral Sciences, University of Washington; Templeton Visiting Scholar, HealthCare Chaplaincy
This course contains up-to-date, relevant information for chaplains, clergy, and other professionals on the often overlooked and under-diagnosed disorder of delirium. It also contains information about, and useful clarifying comparisons with, dementia, because delirium and dementia are often confused one for the other. Case studies provide examples of the risk factors, signs, and potentially life-long negative impacts for patients with delirium, as well as the progression of dementia on patient and family members. Recommended intervention strategies for patients and families of patients with delirium and dementia are included in this course.
Price: $40 per course.
To purchase, click here.
Each of these courses:
•Contains an online, self-directed learning module that you can access as often as you like, at your convenience, for up to one year.
•Contains bookmarks, so that you can close the course and resume your learning later from that place.
•Allows for repeated course completions to reinforce learning.
•Includes an invitation to participate in a facilitated, online, community of practice for peer to peer learning.
•Provides a certificate of completion, accessible and printable after the learner completes the course at least once
Those involved in spiritual care/palliative care can find helpful new webinars from experts starting May 3. http://bit.ly/iWtabA hpm
Thursday, April 14, 2011
Untreated pain is a huge global problem. But a problem that is solvable.
Palliative care pioneers such as HealthCare Chaplaincy trustee Dr. Kathy Foley, Mary Calloway, Dr. Bal Mount, Dr. Betty Ferrell and others have not only worked to help eradicate physical pain in the lives of people around the world but have sought to keep in front of the world how pervasive and devastating pain is in the lives of so many people.
Clearly, solving this problem is far from simple.
No one denies that the diversion and abuse of legal pain medicines is also a huge problem.
Yet the abuse is not a legitimate excuse to keep people in pain when a remedy is available.
What so many of us fail to appreciate is how huge a public health problem pain is. It not only takes away quality of life from so many but costs economies untold real money.
Even though I know about this problem in my head, I admit that I often find it so difficult to get my hands around it because of its enormity.
Thus I would commend to you this posting on the prominent palliative care blog Pallimed (http://bit.ly/g2ju64) which links to two new short videos at http://bit.ly/fqeAis and http://bit.ly/dLRLWH.
These videos are grim, but are not even close to the experience of those suffering in intractable pain.
They remind us of what an unnecessary scourge pain is.
Clearly, solving this problem is far from simple.
No one denies that the diversion and abuse of legal pain medicines is also a huge problem.
Yet the abuse is not a legitimate excuse to keep people in pain when a remedy is available.
What so many of us fail to appreciate is how huge a public health problem pain is. It not only takes away quality of life from so many but costs economies untold real money.
Even though I know about this problem in my head, I admit that I often find it so difficult to get my hands around it because of its enormity.
Thus I would commend to you this posting on the prominent palliative care blog Pallimed (http://bit.ly/g2ju64) which links to two new short videos at http://bit.ly/fqeAis and http://bit.ly/dLRLWH.
These videos are grim, but are not even close to the experience of those suffering in intractable pain.
They remind us of what an unnecessary scourge pain is.
Thursday, April 7, 2011
Share This Now With Your Hospital Administrator and Risk Manager
A recent issue of Modern Healthcare, the weekly health news magazine that virtually all hospital administrators read, recently published an article on new strategies for dealing with patients and families after medical error (“Going beyond saying you’re sorry: More hospitals using quick remediation strategies following medical error”, March 28, 2011, pp. 32-33).
The article highlights a program at the University of Michigan Health System which replaces the traditional approach run by the hospital attorneys to an approach based on transparency and “remediation” which generally seems to involve a quick payment offer or at least not changing the patient for the procedure which resulted in the error.
This approach is clearly a big step forward in compassionate patient care and did reduce the lawsuits at this hospital.
However, something is missing.
It overlooks the potential contribution of the chaplain.
Many of us who are professional chaplains have long claimed that we can help reduce hospital lawsuits, though of course we cannot prove it. The lack of evidence notwithstanding, this article which many hospital administrators and risk managers will read, gives chaplains an opportunity to remind their management how they could make any program of this kind even better.
Chaplains are not there to defend the hospital or make any offers, but to help patients and families express and process the sometimes intense feelings that these events evoke and be a caring presence. Often it can be the unique expertise of the chaplain that reduces conflict and facilitates communication.
The chaplain’s active involvement sends a message that the hospital is truly interested in the person’s welfare and not just in protecting the hospital’s interests. In cases like this, chaplains are an essential and valuable resource to bridge the often divergent interests of risk management and patient-centered care.
I suggest that you share this now with your hospital administrator and risk manager, and talk with them about establishing a protocol where “exceptional” cases automatically trigger a chaplain referral and response as a member of the professional healthcare team.
The article highlights a program at the University of Michigan Health System which replaces the traditional approach run by the hospital attorneys to an approach based on transparency and “remediation” which generally seems to involve a quick payment offer or at least not changing the patient for the procedure which resulted in the error.
This approach is clearly a big step forward in compassionate patient care and did reduce the lawsuits at this hospital.
However, something is missing.
It overlooks the potential contribution of the chaplain.
Many of us who are professional chaplains have long claimed that we can help reduce hospital lawsuits, though of course we cannot prove it. The lack of evidence notwithstanding, this article which many hospital administrators and risk managers will read, gives chaplains an opportunity to remind their management how they could make any program of this kind even better.
Chaplains are not there to defend the hospital or make any offers, but to help patients and families express and process the sometimes intense feelings that these events evoke and be a caring presence. Often it can be the unique expertise of the chaplain that reduces conflict and facilitates communication.
The chaplain’s active involvement sends a message that the hospital is truly interested in the person’s welfare and not just in protecting the hospital’s interests. In cases like this, chaplains are an essential and valuable resource to bridge the often divergent interests of risk management and patient-centered care.
I suggest that you share this now with your hospital administrator and risk manager, and talk with them about establishing a protocol where “exceptional” cases automatically trigger a chaplain referral and response as a member of the professional healthcare team.
Tuesday, March 8, 2011
Good dialogue about how to explain palliative care
From Pallimed blog: http://bit.ly/hYK14G
Jim Siegel said...
Christian -- Thanks much for this post and raising the question about the term "non-hospice palliative care.” From my marketing & communications perspective, I shy away from saying what something is not, because it reminds people more of “the not" and thus can be counterproductive. However, since so many health care professionals think palliative care and hospice care are synonymous, and almost everyone in the general public that I speak to about it thinks that as well, the directness of the expression is intriguing, because it attacks the misperception head on. Since superb communicator Diane uses the term, that sure is an endorsement. Also, you mention the palliative care elevator pitch, and in case this is useful for Pallimed readers, here’s the elevator pitch that we’ve adopted here at HealthCare Chaplaincy: “Palliative care matches patient wishes to treatment goals and reduces suffering.” PS. The cloud is one cool visual and thanks for the link to Wordle.
March 07, 2011
Larry Boggeln, MD said...
I like "non-hospice palliative care" for the same reason..attacking misperception directly. Nice succinct elevator pitch. I personally would amend it slightly, such as "Palliative Care is a medical specialty that reduces suffering through an interdisciplinary team, focusing on patient-identified treatment goals."
March 07, 2011
Lisa Morgan said...
Thanks for raising the language issue. The term non-hospice palliative care is a term that CAPC effectively used early on with clinical audiences (not patient/family) that didn't know palliative care could be provided upstream. I would not necessarily recommend that the term be used with patients/families/general public. Jim is correct to point out the problematic nature of defining something by what it is not. The palliative care field faces a communications challenge in this respect. Upstream patients and families who confuse palliative care and hospice do respond to being told bluntly that the two are different. This is because the explanation addresses a direct question already in their minds. Referring clinicians have told us that this directness is very helpful. However, people who don't know what palliative care is at all can become confused. CAPC is currently in the process of conducting major public opinion and messaging research that will help guide our definitions and messages now and into the future. Stay tuned later this spring!
March 07, 2011
Jim Siegel said...
Lisa and Larry -- Thanks for the helpful feedback. That CAPC is conducting major public opinion and messaging research to help develop definitions and messages is hugely valuable and another instance where CAPC is taking the lead in a vital area. I like the amended elevator pitch, but I think that works more for the professional audience than the public audience. I recognize that I was not clear that the general public is the target of the elevator pitch that I cited. A second talking point that we do make is that palliative care is delivered by a transdisciplinary team that includes physicians, nurses, professional chaplains, social workers, and others. Your thoughts?
March 07, 2011
Drew Rosielle MD said...
Lisa thanks for the history of the phrase - yes it makes sense as a short-cut way of talking with other clinicians/health professionals/hospital administrators, but not families.
I've said on the blog before, and won't pass up this opportunity again, that I think we suffer as a community due to lack of any sort of accurate, non-euphemistic (you start throwing around 'quality of life' and people start thinking about support groups and wigs for cancer survivors...not that there's anything wrong with that), and very succinct (one sentence) way of describing to lay people what we do in palliative care. And in a way that wouldn't lead my mother to respond 'Isn't that what all doctors do?'
Christian, you didn't exactly say this, but I wonder if you are concerned the phrase stigmatizes hospice. While we need to, absolutely de-link ourselves from being connected solely to EOL care, it's also true that hospice care, as a whole, provides immaculate care which promotes quality of life, alleviates suffering, supports patients & families emotionally, and is aligned with care goals (usually, b/c if it wasn't then they'd likely not be in hospice). The only problem, you know, is that hospice is, b/c Medicare made it so, for people at life's end. It's like 'we're not for dying people - hospice is - not that there's anything wrong with that.'
Anyway, despite my longing for a non-euphemistic sentence I have found that, at the bed side, you can usually help people understand in a few sentences, tailored to what the consult reason is, and that from a practical standpoint I have a MUCH more difficult time helping patients understand the difference between an hospital-based palliative consult service which also runs clinics and home based palliative care programs. Eats up a lot of time at times.
I'll also say that I usually tell patients I see as a consultant, straight up, b/c I figure many of them are worried about it, that we do take care of a lot of people who are dying, make sure they're comfortable and in the place they want to be, help them figure out when it's time for hospice care, etc., and that's a role we play in the institution, although that's not why Dr. XYZ asked us to see you today. I may be oblivious to the effects of this, but I haven't noticed any major problems, and even for patients who completely aren't ready to 'go there,' I've signalled to them, from the beginning, that we're a team who is comfortable going there and it's a safe topic in our presence. I think it helps down the road, and half the time anyway patients are so terrified of this, to have the door opened to talk about it, in a safe and less threatening manner (ie framed as this is something our team does for some patients so we can talk about it hypothetically here, not this is something that your pulmonologist thought was so urgent that she wanted us to talk with you, NOW, about your death), allows them to begin to discuss what they worry the most about. So, for the most part, I think it helps us to foreground, a little, our expertise and confidence in providing excellent EOL care, not hide from it. Of course these are already patients who have agreed to see us, referred to us by people who understand what we do....
March 07, 2011
Earl Quijada said...
I’m not a fan of the phrase “non-hospice palliative care”. I first heard it used at AAHPM 2010 Boston by Diane Meier in context of “improving optics” on Capitol Hill as anything with “death”, “end of life” etc...immediately produces a lightening rod for controversy. I don’t remember the phrase being discussed in context of describing palliative care to colleagues or patients and families. I don’t imagine that if “non-hospice palliative care” were used that it would be contained in whatever intended silo. So that said, it will get to the patient and it does stigmatize hospice. In my opinion, it minimizes what we do best, end of life care. I don’t think Balfour Mount coined palliative care to “cloak” the death part.
That being said, of course I don’t think we should be passing out death cards. Our expertise lies in knowing how to handle this part of life in the context of each individual’s narrative. I don’t think there is a non-euphemistic phrase to describe what we do. Do we clinically need one and do all specialties have one? I don’t think we need one clinically and if we’re trying to create a phrase for someone other than patients/families it’s almost as if we’re trying to justify something.
If we were to use a phrase, I prefer something morally neutral like Advance Illness Management (AIM) that Brad Stuart uses. Phrases with “quality”, “relieve suffering”, and even “matching preferences” to me can sometimes create a tone that we’re doing something that someone ought to be doing but isn’t (bad bad).
Jim Siegel said...
Christian -- Thanks much for this post and raising the question about the term "non-hospice palliative care.” From my marketing & communications perspective, I shy away from saying what something is not, because it reminds people more of “the not" and thus can be counterproductive. However, since so many health care professionals think palliative care and hospice care are synonymous, and almost everyone in the general public that I speak to about it thinks that as well, the directness of the expression is intriguing, because it attacks the misperception head on. Since superb communicator Diane uses the term, that sure is an endorsement. Also, you mention the palliative care elevator pitch, and in case this is useful for Pallimed readers, here’s the elevator pitch that we’ve adopted here at HealthCare Chaplaincy: “Palliative care matches patient wishes to treatment goals and reduces suffering.” PS. The cloud is one cool visual and thanks for the link to Wordle.
March 07, 2011
Larry Boggeln, MD said...
I like "non-hospice palliative care" for the same reason..attacking misperception directly. Nice succinct elevator pitch. I personally would amend it slightly, such as "Palliative Care is a medical specialty that reduces suffering through an interdisciplinary team, focusing on patient-identified treatment goals."
March 07, 2011
Lisa Morgan said...
Thanks for raising the language issue. The term non-hospice palliative care is a term that CAPC effectively used early on with clinical audiences (not patient/family) that didn't know palliative care could be provided upstream. I would not necessarily recommend that the term be used with patients/families/general public. Jim is correct to point out the problematic nature of defining something by what it is not. The palliative care field faces a communications challenge in this respect. Upstream patients and families who confuse palliative care and hospice do respond to being told bluntly that the two are different. This is because the explanation addresses a direct question already in their minds. Referring clinicians have told us that this directness is very helpful. However, people who don't know what palliative care is at all can become confused. CAPC is currently in the process of conducting major public opinion and messaging research that will help guide our definitions and messages now and into the future. Stay tuned later this spring!
March 07, 2011
Jim Siegel said...
Lisa and Larry -- Thanks for the helpful feedback. That CAPC is conducting major public opinion and messaging research to help develop definitions and messages is hugely valuable and another instance where CAPC is taking the lead in a vital area. I like the amended elevator pitch, but I think that works more for the professional audience than the public audience. I recognize that I was not clear that the general public is the target of the elevator pitch that I cited. A second talking point that we do make is that palliative care is delivered by a transdisciplinary team that includes physicians, nurses, professional chaplains, social workers, and others. Your thoughts?
March 07, 2011
Drew Rosielle MD said...
Lisa thanks for the history of the phrase - yes it makes sense as a short-cut way of talking with other clinicians/health professionals/hospital administrators, but not families.
I've said on the blog before, and won't pass up this opportunity again, that I think we suffer as a community due to lack of any sort of accurate, non-euphemistic (you start throwing around 'quality of life' and people start thinking about support groups and wigs for cancer survivors...not that there's anything wrong with that), and very succinct (one sentence) way of describing to lay people what we do in palliative care. And in a way that wouldn't lead my mother to respond 'Isn't that what all doctors do?'
Christian, you didn't exactly say this, but I wonder if you are concerned the phrase stigmatizes hospice. While we need to, absolutely de-link ourselves from being connected solely to EOL care, it's also true that hospice care, as a whole, provides immaculate care which promotes quality of life, alleviates suffering, supports patients & families emotionally, and is aligned with care goals (usually, b/c if it wasn't then they'd likely not be in hospice). The only problem, you know, is that hospice is, b/c Medicare made it so, for people at life's end. It's like 'we're not for dying people - hospice is - not that there's anything wrong with that.'
Anyway, despite my longing for a non-euphemistic sentence I have found that, at the bed side, you can usually help people understand in a few sentences, tailored to what the consult reason is, and that from a practical standpoint I have a MUCH more difficult time helping patients understand the difference between an hospital-based palliative consult service which also runs clinics and home based palliative care programs. Eats up a lot of time at times.
I'll also say that I usually tell patients I see as a consultant, straight up, b/c I figure many of them are worried about it, that we do take care of a lot of people who are dying, make sure they're comfortable and in the place they want to be, help them figure out when it's time for hospice care, etc., and that's a role we play in the institution, although that's not why Dr. XYZ asked us to see you today. I may be oblivious to the effects of this, but I haven't noticed any major problems, and even for patients who completely aren't ready to 'go there,' I've signalled to them, from the beginning, that we're a team who is comfortable going there and it's a safe topic in our presence. I think it helps down the road, and half the time anyway patients are so terrified of this, to have the door opened to talk about it, in a safe and less threatening manner (ie framed as this is something our team does for some patients so we can talk about it hypothetically here, not this is something that your pulmonologist thought was so urgent that she wanted us to talk with you, NOW, about your death), allows them to begin to discuss what they worry the most about. So, for the most part, I think it helps us to foreground, a little, our expertise and confidence in providing excellent EOL care, not hide from it. Of course these are already patients who have agreed to see us, referred to us by people who understand what we do....
March 07, 2011
Earl Quijada said...
I’m not a fan of the phrase “non-hospice palliative care”. I first heard it used at AAHPM 2010 Boston by Diane Meier in context of “improving optics” on Capitol Hill as anything with “death”, “end of life” etc...immediately produces a lightening rod for controversy. I don’t remember the phrase being discussed in context of describing palliative care to colleagues or patients and families. I don’t imagine that if “non-hospice palliative care” were used that it would be contained in whatever intended silo. So that said, it will get to the patient and it does stigmatize hospice. In my opinion, it minimizes what we do best, end of life care. I don’t think Balfour Mount coined palliative care to “cloak” the death part.
That being said, of course I don’t think we should be passing out death cards. Our expertise lies in knowing how to handle this part of life in the context of each individual’s narrative. I don’t think there is a non-euphemistic phrase to describe what we do. Do we clinically need one and do all specialties have one? I don’t think we need one clinically and if we’re trying to create a phrase for someone other than patients/families it’s almost as if we’re trying to justify something.
If we were to use a phrase, I prefer something morally neutral like Advance Illness Management (AIM) that Brad Stuart uses. Phrases with “quality”, “relieve suffering”, and even “matching preferences” to me can sometimes create a tone that we’re doing something that someone ought to be doing but isn’t (bad bad).
More Palliative Care Could Save Hospitals, Medicaid Millions: Study
More Palliative Care Could Save Hospitals, Medicaid Millions: Study
WNYC Radio
Tuesday, March 08, 2011
By Fred Mogul
Dr. Sean Morrison said bringing together doctors, nurses, chaplains and social workers to talk through treatment options with patients and their families makes sense not only for the patient with end-stage pancreatic cancer but also for the one in the early stages of a relatively curable leukemia.
And now, Dr. Morrison said, data suggests not only improved outcomes for patients, but potentially thousands of dollars' worth of savings per hospital visit and tens or hundreds of millions of dollars' worth of potential savings state-wide.
His study in the journal Health Affairs compared the treatment of hundreds of patients at four hospitals across New York State. The main savings come from shortening hospital stays and keeping people out of the Intensive Care Units.
"What we found is that when patients received palliative care plus usual care, it resulted in somewhere between $4,000 and $7,500 per admission to the hospital," said Morrison, an internist, geriatrician and palliative care specialist at Mt. Sinai Medical Center.
He estimated that could save the New York Medicaid program up to $250 million, if applied to all hospitals with 150 beds or more.
Morrison said about 80 percent of hospitals already have palliative care teams, but that doesn’t mean widespread savings would be easy to come by because there’s a wide variation in how effective these teams are.
He also said there's much resistance to expanding palliative care because hospitals can’t always bill Medicaid or insurers for it, and many doctors associate it with giving up on patients.
I posted this comment:
Dr. Morrison is right about palliative care’s benefits to patients, families and hospitals. Simply put, palliative care matches patient wishes to treatment goals, and reduces suffering. Palliative care may be right for someone who suffers from pain or other symptoms due to a serious illness such as cancer, cardiac disease, respiratory disease, kidney failure, Alzheimer’s, AIDS, Amyotrophic Lateral Sclerosis (ALS) and multiple sclerosis. Palliative care can be provided at any stage of illness and along with treatment meant to cure. Good information sites for the general public are getpalliativecare.org and healthcarechaplaincy.org and for health care professionals capc.org.
http://bit.ly/fyb43W
WNYC Radio
Tuesday, March 08, 2011
By Fred Mogul
Dr. Sean Morrison said bringing together doctors, nurses, chaplains and social workers to talk through treatment options with patients and their families makes sense not only for the patient with end-stage pancreatic cancer but also for the one in the early stages of a relatively curable leukemia.
And now, Dr. Morrison said, data suggests not only improved outcomes for patients, but potentially thousands of dollars' worth of savings per hospital visit and tens or hundreds of millions of dollars' worth of potential savings state-wide.
His study in the journal Health Affairs compared the treatment of hundreds of patients at four hospitals across New York State. The main savings come from shortening hospital stays and keeping people out of the Intensive Care Units.
"What we found is that when patients received palliative care plus usual care, it resulted in somewhere between $4,000 and $7,500 per admission to the hospital," said Morrison, an internist, geriatrician and palliative care specialist at Mt. Sinai Medical Center.
He estimated that could save the New York Medicaid program up to $250 million, if applied to all hospitals with 150 beds or more.
Morrison said about 80 percent of hospitals already have palliative care teams, but that doesn’t mean widespread savings would be easy to come by because there’s a wide variation in how effective these teams are.
He also said there's much resistance to expanding palliative care because hospitals can’t always bill Medicaid or insurers for it, and many doctors associate it with giving up on patients.
I posted this comment:
Dr. Morrison is right about palliative care’s benefits to patients, families and hospitals. Simply put, palliative care matches patient wishes to treatment goals, and reduces suffering. Palliative care may be right for someone who suffers from pain or other symptoms due to a serious illness such as cancer, cardiac disease, respiratory disease, kidney failure, Alzheimer’s, AIDS, Amyotrophic Lateral Sclerosis (ALS) and multiple sclerosis. Palliative care can be provided at any stage of illness and along with treatment meant to cure. Good information sites for the general public are getpalliativecare.org and healthcarechaplaincy.org and for health care professionals capc.org.
http://bit.ly/fyb43W
Friday, March 4, 2011
The truth about end-of-life planning
From The Huffington Post: http://huff.to/gyMTtA
Joseph Nowinski, Ph.D..Clinical psychologist; coauthor, 'Saying Goodbye: How Families Can Find Renewal through Loss'
Posted: March 3, 2011
Congress is debating the merits of the Affordable Care Act, and the usual suspects are leading the charge against it. They've already scored one victory. A few weeks ago, the news broke that the Obama administration was prepared to move ahead with the "end-of-life planning" provision of the Affordable Care Act, both of which have been the target of so much misinformation. Shortly thereafter, it was announced that end-of-life planning would not be authorized after all. It seems that this humane practice has fallen victim to yet another slanderous salvo. How did this happen?
First of all, it's vital that people understand exactly what end-of-life planning is, and what it is not. In an effort that would undermine badly needed health care reform in this country, demagogues like Sarah Palin created a fantasy called "death panels" and insinuated that health care reform would result in some government agency deciding when to "pull the plug" on terminally ill Americans. This tactic, outrageous as it was, did succeed, in that it scared many people and turned them against health care reform. It also reveals, however, how little many people understand about our health care system as well as how impotent they feel in the face of it. No populace that felt empowered about their health care system could possibly be stampeded in this way.
So what is end-of-life planning? It is, for one thing, not a death panel. On the contrary, the health care system that has existed in America prior to health care reform could be said to have been dominated by the equivalent of "death panels." They take the form of millions of denials, exclusions and outrageous premium increases that Americans with serious or terminal illnesses have received each and every year when they turned to their health insurers expecting help. I know of no one who does not know someone who has been the victim of such practices. In fact, in a survey just released by the Department of Health and Human Services, as many as half of Americans under the age of 65 have medical conditions that qualify them to either be denied coverage or else subjected to prohibitively high premiums. Naturally, the insurance industry insists that this number is inflated. But what if it is only a third of Americans? No matter what the percentages, do these practices not amount to de facto death panels? After all, where is one to turn if you are diagnosed with a terminal illness and then denied coverage or asked to pay a premium you can't possibly afford?
What end-of-life planning is, in the context of the Affordable Care Act, is for a patient with a terminal diagnosis to be able to meet with his or her primary care physician once a year to review the overall treatment program, consider various options and make rational decisions. There is no reason why close family members cannot be part of this process.
Not every man or woman who is facing impending death is open to end-of-life planning. Many individuals have shared with us their frustration in this regard -- often with unfortunate results. As an example, consider the woman whose father, suffering from severe dementia as well as kidney failure requiring dialysis, underwent cardiac bypass surgery. He died a week later from an infection of unknown origin. Why did this happen? Because, the daughter explained, her father had stubbornly refused to discuss such end-of-life decisions. "He didn't even know who I was," this woman said, "but I said yes to the surgery because the doctors wanted to do it and I didn't know what he would want." Such reports only serve to underscore the fact that there are many decisions that the terminally ill are well advised to make (preferably in consultation with loved ones) while they are lucid and capable of making them. Too many people die every year in hospitals and intensive care units simply because they did not have an opportunity to consider alternatives such as hospice or home care combined with palliative care, as opposed to heroic interventions when the chances for improvement are nil. Resources for end-of-life planning can be found on www.NewGrief.com.
Contrast the above scenario with recent research which shows that making palliative care available to the terminally ill -- including pain management, along with regular opportunities to talk with counselors and doctors -- results in patients reporting less depression, improved energy levels and a better quality of life in general. Hardly the image of a death panel.
Those of us who would prefer to offer the above alternative to Americans who are battling terminal illness need to stand up in any way we can in order to challenge misinformation and advocate for the humanity of end-of-life planning. We need to say it, loudly, clearly and often: The Affordable Care Act includes no death panels! There will be no death panels in America!
Joseph Nowinski, Ph.D..Clinical psychologist; coauthor, 'Saying Goodbye: How Families Can Find Renewal through Loss'
Posted: March 3, 2011
Congress is debating the merits of the Affordable Care Act, and the usual suspects are leading the charge against it. They've already scored one victory. A few weeks ago, the news broke that the Obama administration was prepared to move ahead with the "end-of-life planning" provision of the Affordable Care Act, both of which have been the target of so much misinformation. Shortly thereafter, it was announced that end-of-life planning would not be authorized after all. It seems that this humane practice has fallen victim to yet another slanderous salvo. How did this happen?
First of all, it's vital that people understand exactly what end-of-life planning is, and what it is not. In an effort that would undermine badly needed health care reform in this country, demagogues like Sarah Palin created a fantasy called "death panels" and insinuated that health care reform would result in some government agency deciding when to "pull the plug" on terminally ill Americans. This tactic, outrageous as it was, did succeed, in that it scared many people and turned them against health care reform. It also reveals, however, how little many people understand about our health care system as well as how impotent they feel in the face of it. No populace that felt empowered about their health care system could possibly be stampeded in this way.
So what is end-of-life planning? It is, for one thing, not a death panel. On the contrary, the health care system that has existed in America prior to health care reform could be said to have been dominated by the equivalent of "death panels." They take the form of millions of denials, exclusions and outrageous premium increases that Americans with serious or terminal illnesses have received each and every year when they turned to their health insurers expecting help. I know of no one who does not know someone who has been the victim of such practices. In fact, in a survey just released by the Department of Health and Human Services, as many as half of Americans under the age of 65 have medical conditions that qualify them to either be denied coverage or else subjected to prohibitively high premiums. Naturally, the insurance industry insists that this number is inflated. But what if it is only a third of Americans? No matter what the percentages, do these practices not amount to de facto death panels? After all, where is one to turn if you are diagnosed with a terminal illness and then denied coverage or asked to pay a premium you can't possibly afford?
What end-of-life planning is, in the context of the Affordable Care Act, is for a patient with a terminal diagnosis to be able to meet with his or her primary care physician once a year to review the overall treatment program, consider various options and make rational decisions. There is no reason why close family members cannot be part of this process.
Not every man or woman who is facing impending death is open to end-of-life planning. Many individuals have shared with us their frustration in this regard -- often with unfortunate results. As an example, consider the woman whose father, suffering from severe dementia as well as kidney failure requiring dialysis, underwent cardiac bypass surgery. He died a week later from an infection of unknown origin. Why did this happen? Because, the daughter explained, her father had stubbornly refused to discuss such end-of-life decisions. "He didn't even know who I was," this woman said, "but I said yes to the surgery because the doctors wanted to do it and I didn't know what he would want." Such reports only serve to underscore the fact that there are many decisions that the terminally ill are well advised to make (preferably in consultation with loved ones) while they are lucid and capable of making them. Too many people die every year in hospitals and intensive care units simply because they did not have an opportunity to consider alternatives such as hospice or home care combined with palliative care, as opposed to heroic interventions when the chances for improvement are nil. Resources for end-of-life planning can be found on www.NewGrief.com.
Contrast the above scenario with recent research which shows that making palliative care available to the terminally ill -- including pain management, along with regular opportunities to talk with counselors and doctors -- results in patients reporting less depression, improved energy levels and a better quality of life in general. Hardly the image of a death panel.
Those of us who would prefer to offer the above alternative to Americans who are battling terminal illness need to stand up in any way we can in order to challenge misinformation and advocate for the humanity of end-of-life planning. We need to say it, loudly, clearly and often: The Affordable Care Act includes no death panels! There will be no death panels in America!
What Makes Us Unique, What Makes Us Similar
"Our uniqueness is what gives us value and meaning. Yet in the telling of stories we also learn what makes us similar, what connects us all, what helps us transcend the isolation that separates us from each other and from ourselves." -- Dean Ornish, MD
Thursday, March 3, 2011
About the power of laughter
“The ultimate weapon,” he wrote, “in the face of evil or sorrow, sadness or death, is not stoic virtue and the stiff upper lip but laughter, for where laughter is, God cannot be far away.”
-- The Rev. Peter Gomes
-- The Rev. Peter Gomes
Something so true about everyone that I read just this morning
"That every one of us matters. And that we have the power to befriend and strengthen the life in one another to change the world, one heart at a time." -- from the preface to the book "Kitchen Table Wisdom" by Rachel Naomi Remen, MD.
Wednesday, March 2, 2011
Tribute to the Rev. Peter J. Gomes
The Rev. Peter J. Gomes, a Harvard minister, theologian and author died recently at age 68. He was a highly visible presence on campus whose reach was much wider.
I found his writings instructive and inspirational to me, who is not a Christian.
Yesterday’s New York Times obituary (http://ping.fm/w2SpK) reminded me of that:
In his 1996 best seller, “The Good Book: Reading the Bible with Mind and Heart,” Mr. Gomes urged believers to grasp the spirit, not the letter, of scriptural passages that he said had been misused to defend racism, anti-Semitism and sexism, and to attack homosexuality and abortion. He offered interpretations that he said transcended the narrow context of modern prejudices.
“The Bible alone is the most dangerous thing I can think of,” he told The Los Angeles Times. “You need an ongoing context and a community of interpretation to keep the Bible current and to keep yourself honest. Forget the thought that the Bible is an absolute pronouncement.”
But Mr. Gomes also defended the Bible from critics on the left who called it corrupt because passages had been used to oppress people. “The Bible isn’t a single book, it isn’t a single historical or philosophical or theological treatise,” he told The Seattle Gay News in 1996. “It has 66 books in it. It is a library.”
In 1991 he announced that he was gay. He then said:
“I now have an unambiguous vocation — a mission — to address the religious causes and roots of homophobia,” he told The Washington Post months later. “I will devote the rest of my life to addressing the ‘religious case’ against gays.”
I never met him. I wish I had.
May his memory be a blessing.
I found his writings instructive and inspirational to me, who is not a Christian.
Yesterday’s New York Times obituary (http://ping.fm/w2SpK) reminded me of that:
In his 1996 best seller, “The Good Book: Reading the Bible with Mind and Heart,” Mr. Gomes urged believers to grasp the spirit, not the letter, of scriptural passages that he said had been misused to defend racism, anti-Semitism and sexism, and to attack homosexuality and abortion. He offered interpretations that he said transcended the narrow context of modern prejudices.
“The Bible alone is the most dangerous thing I can think of,” he told The Los Angeles Times. “You need an ongoing context and a community of interpretation to keep the Bible current and to keep yourself honest. Forget the thought that the Bible is an absolute pronouncement.”
But Mr. Gomes also defended the Bible from critics on the left who called it corrupt because passages had been used to oppress people. “The Bible isn’t a single book, it isn’t a single historical or philosophical or theological treatise,” he told The Seattle Gay News in 1996. “It has 66 books in it. It is a library.”
In 1991 he announced that he was gay. He then said:
“I now have an unambiguous vocation — a mission — to address the religious causes and roots of homophobia,” he told The Washington Post months later. “I will devote the rest of my life to addressing the ‘religious case’ against gays.”
I never met him. I wish I had.
May his memory be a blessing.
Monday, February 21, 2011
Chaplaincy Testifies at Medicaid Redesign Hearing
To curb the projected $9 billion New York State budget gap created in part by enormous expenditures in state health care, Governor Andrew Cuomo has created a new task force named the “Medicaid Redesign Team” to assess the reform possibilities in the New York State Medicaid system.
Medicaid accounts for about one-third of all state spending, making it a key target area for cost-cutting and deficit reduction.
Established by executive order by the governor, the 27-member team is made up of a variety of health care professionals and members of advocacy organizations. Leading the team are Michael Dowling, president and chief executive officer of the North Shore-LIJ Health System, and Dennis Rivera, president of the labor union SEIU Healthcare. The team’s role in the reform process is two-fold: 1) to provide good ideas for how to lower costs and improve quality in New York’s Medicaid Program; 2) to evaluate ideas generated through stakeholder and staff engagement.
A total of 3,000 ideas were submitted to the New York State Health Department, both at public hearings and on the department’s website. These were narrowed down to 49 of the most promising items and submitted by the Health Department to the governor’s Medicaid Redesign Team.
Claire Altman, HealthCare Chaplaincy’s executive vice president and chief operating officer, testified at the February 22nd hearing and those suggestions are reflected in one of the recommended proposals covering long-term care. To read Claire’s full testimony, click here
Medicaid accounts for about one-third of all state spending, making it a key target area for cost-cutting and deficit reduction.
Established by executive order by the governor, the 27-member team is made up of a variety of health care professionals and members of advocacy organizations. Leading the team are Michael Dowling, president and chief executive officer of the North Shore-LIJ Health System, and Dennis Rivera, president of the labor union SEIU Healthcare. The team’s role in the reform process is two-fold: 1) to provide good ideas for how to lower costs and improve quality in New York’s Medicaid Program; 2) to evaluate ideas generated through stakeholder and staff engagement.
A total of 3,000 ideas were submitted to the New York State Health Department, both at public hearings and on the department’s website. These were narrowed down to 49 of the most promising items and submitted by the Health Department to the governor’s Medicaid Redesign Team.
Claire Altman, HealthCare Chaplaincy’s executive vice president and chief operating officer, testified at the February 22nd hearing and those suggestions are reflected in one of the recommended proposals covering long-term care. To read Claire’s full testimony, click here
Saturday, February 19, 2011
Study Finds Early Palliative Care Extends Life and Improves Quality of Life for Cancer Patients. Video: http://bit.ly/c2bVwH
U.S. State Department Profiles
HealthCare Chaplaincy’s Imam Yusuf Hasan http://bit.ly/aKmsTP spirituality
HealthCare Chaplaincy’s Imam Yusuf Hasan http://bit.ly/aKmsTP spirituality
Friday, February 18, 2011
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