GeriPal

FEBRUARY 23, 2023

The patient is sick and getting sicker, and refuses to let you talk with family or other members of her inner circle. We owe it to the patient to explore the reasons behind the “no,” commonly not wanting to be a burden to their family. Should you stop at “no?” AlexSmithMD Transcript Eric: Welcome to the GeriPal podcast.

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Family Families Patient-Centered IT 97

GeriPal

JANUARY 25, 2024

Summary Transcript Summary In a JAMA 2020 systematic review of palliative care for non-cancer serious illness, Kieran Quinn found many positives, as we discussed on our podcast and in our editorial. He also found gaps, including very few studies of patients with lung disease, and little impact of trials on quality of life.

Patient-Centered 122

Patient-Centered IT Illness Patients 122

GeriPal

JULY 21, 2022

Often the work of the certified driving rehab specialist is to assess the older drivers goals, assess prognosis for driving, and help the family navigate discussions around driving cessation (hmmm…sounds like an approach to family meetings). Love to talk about also in the serious illness population. Eric: Yeah. Alex: Yeah.

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Families IT Family Diagnosis 102

GeriPal

JUNE 30, 2022

Should she have an operation, and risk the pain, potential complications, and attendant delirium associated with the operation? Eric: So we’re going to be talking about dementia and considerations around surgery for individuals with dementia. You have a patient with dementia severe enough that she cannot recognize relatives.

Patient-Centered 101

Patient-Centered Complication Patients IT 101

GeriPal

MAY 4, 2023

There’s all this stuff that we’re supposed to be doing at that stage of life and then you add the complexity of the serious illness. It is really difficult for the patients and the families. Patients that remind us of loved ones, patients that are often younger, really hard stories, complicated issues.

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IT Families Family Illness 83

GeriPal

MARCH 24, 2022

Then listen to these prior podcasts with Sean Morrison and Rebecca Sudore about this issue, and we recently discussed differences between Advance Care Planning and Serious Illness Communication with Juliet Jacobsen and Rachelle Bernacki. . And especially for those who may have nontraditional families. This is Eric Widera.

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Illness IT Healthcare Patient-Centered 72

GeriPal

MARCH 9, 2023

Two of our guests today, Stacy Fischer and Brian Anderson, are involved in large multicenter trials of psychedelics for patients with advanced cancer (Fischer) or life-limiting illness (Anderson). And some people in studies and just in clinical use have found that to be helpful, including for patients with serious illness. Eric: Yeah.

Patient-Centered 91

Patient-Centered Community IT Medical 91

GeriPal

JULY 11, 2024

We get a bit of, in the veteran population, kind of a mix of a lot of mental health issues thrown into these comorbid illnesses, including cirrhosis, but it’s usually the decompensated cirrhotics or the folks with liver cancer and cirrhosis, or one of both. I’ve seen patients post transplant when they start having complications.

Patient-Centered 109

Patient-Centered IT Patients Clinic 109

GeriPal

JULY 28, 2022

GeriPal post on “fast food” style palliative care in chronic critical illness. This is my early father’s day gift from the family. But at that time I was struck by how in that field, there wasn’t a focus or really interest in symptom management and support for patients and their families. Transcript. Eric: Yeah.

Illness 110

Illness Hospital Patient-Centered Patients 110

GeriPal

MAY 15, 2025

Prior podcasts on the ethics of nudging , and a different trial conducted by Kate and Scott in which the default for hospitalized seriously ill patients was to receive a palliative care consult. Participants were critically ill and intubated. P AI R stands for Palliative and Advanced Illness Research Center. What is sludge?

Patient-Centered 116

Patient-Centered Hospital IT Illness 116

GeriPal

FEBRUARY 8, 2024

The illness narratives suffering, healing, and the human condition. So there’s this, what is suffering to the individual, and is there some threshold that we could say, “This is real suffering,” or “This is the suffering we talk about in geriatrics or palliative care”? Pain Manag Nurs. doi: 10.1016/j.pmn.2023.11.004.

IT 137

IT Families Family Physicals 137

GeriPal

OCTOBER 26, 2023

Within hours of recording this podcast, I joined a family meeting of an older patient who had multiple medical problems including cancer, and a slow but inexorable decline in function, weight, and cognition. And so I knew that I wanted to do something related to palliative care because I work with people with advanced and serious illness.

Patient-Centered 132

Patient-Centered Hospital Patients IT 132

GeriPal

MARCH 7, 2024

We’ve invited two death doulas, Jane Euler and John Loughnane (who is also a family doc and palliative care physician), to talk about the role of a doula at the end of life. He looked very ill. John: I am what I am, which is a family practice doctor. I’m unsure what they do, how often they’re used, and who pays for their work.

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Provider Illness IT Healthcare 117

GeriPal

MAY 25, 2023

Complicated grief? And, you know, I really leaned in from my perspective as a primary care geriatrician to hearing from what my patients and their family caregivers are asking me for and asking me about, and they’re asking me about how they can prepare. Did the caregiver feel heard and understood? Did they have PTSD? Depression?

Community 95

Community IT Patient-Centered Primary Care 95

GeriPal

JUNE 9, 2022

We can’t possibly meet the needs of all people with newly diagnosed serious illness. She’s also a member of the PAIR Center, which stands for Palliative Advanced Illness Research Center. But definitely always had the bug to be the one to jump into the family meetings in the ICU, lead them. What does “early” really mean?

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Consulting Patient-Centered Diagnosis Referral 99

GeriPal

JANUARY 11, 2024

To be eligible in Canada patients must have a “ grievous and irremediable ” condition, including disability ; they do not have to have a terminal illness with a prognosis of less than 6 months. A planned expansion of MAID to include people with mental illness was placed on hold until March 2024. But that was separate from MAID.

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Illness IT Medical Provider 144

GeriPal

DECEMBER 14, 2023

On this podcast we talk about her paper in JAMA Internal Medicine which studied three hospitals that varied in the intensity of care they provided to seriously ill patients. And so I specifically chose hospitals that were at different intensities of care based on the Dartmouth Atlas around serious illness and end-of-life care.

Hospital 125

Hospital IT Patient-Centered Patients 125

GeriPal

AUGUST 25, 2022

And yet, disenrollment from hospice, either due to patient/family revoking the benefit or stabilization of illness (extended prognosis) is remarkably high for people with dementia among some hospices. It’s really a pretty traumatic experience for a lot of patients and families. AlexSmithMD. Transcript. Melissa: Sure.

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Families Family IT Patients 106

GeriPal

OCTOBER 19, 2023

And we have Scott Halpern, who is Professor of Medical Ethics and Health Policy and Director of the Palliative and Advanced Illness Research Center or Payer Center at the University of Pennsylvania. Alex: National POLST Collaborative. Good to know. And he’s a professional Uber driver for his daughter’s softball games.[laughter]

Patient-Centered 126

Patient-Centered IT Patients Illness 126

GeriPal

AUGUST 24, 2023

Harvey is probably best known for his work in developing dignity therapy, a psychological intervention designed specifically to address many of the psychological, existential, and spiritual challenges that patients and their families face as death approaches. Had multiple physical, psychological complications as a result of that.

Patient-Centered 98

Patient-Centered Patients IT Illness 98

GeriPal

MARCH 6, 2025

link] PEACH Good Wishes Program A program that provides meaningful gifts for unhoused individuals who are terminally ill. Michael’s Hospital in the Department of Family and Community Medicine. So we’re going to be today talking about serious illness palliative care in the homelessness population.

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Healthcare IT Community Illness 100

GeriPal

FEBRUARY 13, 2025

And so we worked closely with a community advisory group who, through focus groups, told us how it was that black and white individuals with serious illness had wanted to be treated. The black individuals wanted to have a separate one from the white individuals. So their caregivers did focus groups. Our consultation.

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Consulting Community Patient-Centered Families 63

GeriPal

MARCH 3, 2022

This idea that for critically ill patients in the ICU, geriatric conditions like disability, frailty, multimorbidity, and dementia should be viewed through a wider lens of what patients are like before and after the ICU event was transformative for our two guests today. Alex: What happens when people survive? Lauren: Yeah. Lauren: Yeah.

Patient-Centered 96

Patient-Centered Patients IT Illness 96

GeriPal

MAY 12, 2022

When we think about palliative care delivered here, like individuals with chronic pain, non-serious illness chronic pain, non-life threatening illness, oftentimes if we get consulted on them, we don’t even see them, may just be discontinued in most palliative care places. What do you think about that?

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Community IT Relationship Healthcare 115

GeriPal

MARCH 28, 2024

Alex: Recently you talked about the other trial, also with a nudge, and that was non-cancer, serious illness. I am part of some other work in the ICU world looking at time-limited trials and trying to better define what those are, how we talk about them, how we talk about them with patients and families. Kate: Sounds right.

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Consulting Patient-Centered IT Patients 115

GeriPal

APRIL 10, 2025

I asked emergency medicine clinicians what they thought when a patient who is seriously ill and DNR comes to the ED, and some responded, (paraphrasing), what are they doing here? Most emergency providers wanted to do the right thing for seriously ill patients, but they didnt have the knowledge, skills, or experience to do it.

Patient-Centered 77

Patient-Centered IT Hospital Patients 77

GeriPal

NOVEMBER 7, 2024

We also briefly mention Susan Wong’s terrific studies that found a disconnect between older adults with renal failure’s expressed values, focused on comfort, and their advance care planning and end-of-life care received, which focused on life extension; and another study that found quality of life was sustained until late in the illness course.

Management 116

Management Patient-Centered Patients IT 116

East Cary Family Physicians

OCTOBER 9, 2023

In this blog, East Cary Family Physicians explores the critical importance of fall shots, focusing on Respiratory Syncytial Virus (RSV), COVID-19, and the seasonal flu. Let’s delve into why fall is the perfect time to prioritize these vaccines and understand how they can safeguard your family’s health.

Family 52

Family Families Vaccination Illness 52

GeriPal

SEPTEMBER 8, 2022

Alex: Their own death in advance, terminally ill people. It’s complicated, it’s messy. How does that defer from is it complicated grief, prolonged grief disorder? Eric: Is that the same as complicated grief? They don’t want to interact with their family. Holly: In advance. Holly: Oh absolutely.

IT 100

IT Relationship Complication Specialization 100

GeriPal

JULY 25, 2024

The PPS is one of the most widely used prognostic tools for seriously ill patients, but the prognostic estimates given by the PPS are based on data that is well over a decade old. So the palliative performance scale, or PPS, is essentially a tool to help clinicians with prognostication for seriously ill or palliative care populations.

Families 106

Families Family Patient-Centered IT 106

GeriPal

MARCH 27, 2025

And so this is our way of supporting non English speaking families in advanced care planning. Alex 02:44 Still suffering from some illness from there, which is why I was sick and not in the office with Eric today. And I have a long interest in identifying family caregivers and supporting them in care delivery. Eric 06:26 Great.

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Primary Care IT Clinic Illness 79

GeriPal

MAY 1, 2025

Alex 00:07 We are delighted to welcome Peter Selwyn, who is a family medicine and palliative medicine doctor and chairman of the Department of Family and Social Medicine and director of the Palliative Care Program at Montefiore E instein and author of Surviving the the Personal Journey of an AIDS Doctor. Who are our guests?

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Primary Care IT Provider Clinic 94

Mesa Family Physician

MARCH 6, 2025

At Mesa Family Physicians, we firmly believe that preventing health problems before they arise is always preferable to treating them after they’ve developed. In this comprehensive guide, we’ll explore the best examples of preventive care that can help you and your family maintain optimal health throughout all stages of life.

Preventive Care 100

Preventive Care Preventative Care Family Physician Screening 100

GeriPal

SEPTEMBER 14, 2023

If you are interested in learning more and meeting a community of folks interested in hospital-at-home, check out the hospital-at-home user group at hahusersgroup.org or some of these publications: Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Annals of Int Med. There are some subtleties there.

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Hospital Patient-Centered Supply Chain IT 115

PEMBlog

DECEMBER 4, 2024

Aside from coughing forever, there’s some important complications you need to be aware of. So respiratory complications include apnea, secondary bacterial pneumonia, and pulmonary hypertension. And you definitely have to watch those kids very closely for the complications such as hypoxia and secondary infections.

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IT Vaccination Diagnosis Complication 52

GeriPal

JUNE 2, 2022

So take a listen and if you want a deeper dive into some of the references we discuss on the podcast, here is a list: Medscape article on how “ COVID-19 Vaccines Work Better and for Longer Than Expected Across Populations, Including Immunocompromised Individuals”. Stat news article about variants/COVID becoming more predictable.

Vaccination 100

Vaccination IT Hospital Management 100

GeriPal

JULY 16, 2024

I think what ageism, when you get right down to it, is, is not really seeing the individual in front of you and the individual in the setting of what they’re trying to accomplish and what matters to them, that it’s always appropriate. Eric 04:17 How do you think about that? There is a tension. So can I ask a question?

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Diagnosis IT Diagnose Physicals 141