GeriPal

DECEMBER 19, 2024

Still, we havent talked about integrating palliative care into psychiatry or in the care of those with severe mental illness. What does it look like to take a palliative approach to severe mental illness? Is “terminal” mental illness a thing? Eric 01:34 Oh, I love that. Dani 01:36 More to talk about there.

Illness 101

Illness Mental Health IT Patient-Centered 101

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?” Anne Kelly: Hi there. Nice to be here. Eric: Lynn or Anne?

Family 98

Family Families Patient-Centered IT 98

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

SEPTEMBER 28, 2023

First, a clinician’s thoughts must be encoded into words, then transmitted often via sounds, and finally decoded back to thoughts by a patient or family member. A “Three-Stage Protocol” for Serious Illness Conversations: Reframing Communication in Real Time Transcript Eric: Welcome to the GeriPal podcast. Simple, right?

Family 144

Family Families Patient-Centered IT 144

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.

IT 102

IT Family Families Diagnosis 102

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.

IT 83

IT Family Families 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.

Illness 73

Illness IT Healthcare Patient-Centered 73

GeriPal

AUGUST 11, 2022

– Serious Illness Conversation Guide podcast. What I fell in love with and felt incredibly compelled by was the taking care of seriously ill patients and particularly helping them negotiate emotionally the experience of being very seriously ill. There was no conversation with the patient or the family about this.

Illness 109

Illness IT Family Families 109

GeriPal

JUNE 30, 2022

Should she have an operation, and risk the pain, potential complications, and attendant delirium associated with the operation? And then, the family, her kids got together, my wife and her brother and sister got together and said, wait a minute, mom did not want this, right? She falls and breaks her hip. She has advance dementia.

Patient-Centered 101

Patient-Centered Complication Patients IT 101

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 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

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

FEBRUARY 8, 2024

The illness narratives suffering, healing, and the human condition. The more we can notice that, the more we can actually be present for that family and actually see how they’re experiencing it. Family member, and with some chagrin- Eric: Powerful nudge. Pain Manag Nurs. 2023 Dec 20:S1524-9042(23)00202-3. 2023.11.004.

IT 137

IT Family Families 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

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 117

Patient-Centered Hospital IT Illness 117

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?

Consulting 99

Consulting Patient-Centered Diagnosis IT 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.

Illness 144

Illness IT Medical Provider 144

GeriPal

OCTOBER 12, 2023

And, what if your surgeon openly discussed the expected ‘bad stuff’ of post-operative recovery, instead of rotely reciting a list of possible complications? What I need to navigate with that patient and their family, is it valuable to you? I did it before and this guy, he was 85, but he was climbing Mount Everest.” Every time.

IT 128

IT Family Families Patient-Centered 128

GeriPal

OCTOBER 24, 2024

Summary Transcript CME Summary Cannabis is complicated. Alex 00:30 And we are also delighted to welcome Eloise Theisen, who’s a palliative care nurse practitioner at Stanford and CEO and co- c ounder of Radical Health Clinician Network, which helps patients use cannabis to treat chronic and age related illness. Eric 45:24 Yeah.

Medical 99

Medical IT Patient-Centered Healthcare 99

GeriPal

MAY 22, 2025

Jenny Chen is a palliative care fellow at Yale who regularly sings for her seriously ill patients. And we got all into his family stuff and how he’d been suffering with cancer and his goal. Just encourage patients and families to bring music into their healthcare experience. And it was like the lights came on.

IT 97

IT Patient-Centered Patients Board-Certified 97

GeriPal

JUNE 15, 2023

Because the in serious illness care and care for older adults, their care is often very complex. And then when we started coming up with mortality models or other sorts of prediction models with five factors or seven factors, people were like, “That’s too complicated. Matt: I think you’re also… Go ahead.

IT 99

IT Patient-Centered Patients Healthcare 99

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.

Family 106

Family Families IT Patients 106

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

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. And he’s a professional Uber driver for his daughter’s softball games.[laughter] Alex: National POLST Collaborative.

Patient-Centered 126

Patient-Centered IT Patients Illness 126

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.

Provider 117

Provider Illness IT Healthcare 117

GeriPal

NOVEMBER 17, 2022

The songs about how saving lives is actually a pretty complicated business. And that’s the complication here is there’s so many things that the staff can be trained on. Some take care of people who’ve got more healthcare needs, more mental illness, more dementia. Alex: Yeah. Eric: Nice.

Community 97

Community IT Mental Health Medical 97

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. And that family was not necessarily a trusted network. Depression?

Community 96

Community IT Patient-Centered Primary Care 96

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.

Healthcare 100

Healthcare IT Community Illness 100

GeriPal

FEBRUARY 16, 2023

The last time this happened to me I immediately went on the defensive despite years of training in serious illness communication skills. What feelings do we have toward the patient and toward their families? And here’s an incredibly angry family member. How did you react? Afterwards, I thought there must be a better way.

Patients 109

Patients IT Family Families 109

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

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?

Community 115

Community IT Relationship Healthcare 115

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. And so it was really the patients, you know, the caregivers, the family members were the ones who were sort of the closest in observing. Our consultation.

Consulting 63

Consulting Community Patient-Centered Family 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 Hospital 96

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.

Consulting 115

Consulting Patient-Centered IT Patients 115

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

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

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 Complication Relationship Specialization 100