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

JUNE 12, 2025

But two, a very close relationship with potentially the palliative care physician or the individual who’s Sort of managing their pain, because the simulation itself can be 20 to 30 minutes of lying in that specific treatment position. Sometimes individuals have lung tumors that make it difficult for them to breathe.

Patient-Centered 102

Patient-Centered Referral Patients IT 102

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

AUGUST 29, 2024

Summary Transcript CME Summary Serious illness communication is hard. We must often deliver complex medical information that carries heavy emotional weight in pressured settings to individuals with varying cultural backgrounds, values, and beliefs. Eric 01:42 So we’ ve got an exciting topic today. Eric 05:03 Nice.

IT 132

IT Illness Families Family 132

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

JULY 21, 2022

Love to talk about also in the serious illness population. If they’re in a major car crash, they’re going to have more long-term complications probably than a 20-year-old would. That’s where it really gets to this individual risks and balances, individual situation. I’m going to first turn to Emmy.

Families 102

Families Family IT Diagnosis 102

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

OCTOBER 20, 2022

And so there was a report in 2009 by the Institute of Medicine saying that we need to equip all of these individuals in caring for older person in an evidence based manner. There’s the complications associated with immune senescence, comorbidities, atypical clinical presentations. One of your articles addresses that.

Complication 52

Complication Patient-Centered IT Patients 52

GeriPal

FEBRUARY 23, 2023

My favorite line from Emily’s paper: “Geriatric assent has not been widely adopted in clinical care, but bioethicists should advocate for this, as adoption of partial-involvement strategies can prolong the period in which individuals are (appropriately) engaged in decisions about their health care.” This is Eric Widera. Eric: Lynn or Anne?

Families 97

Families Family Patient-Centered IT 97

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. . Where does POLST fit in with this debate? This is Eric Widera. Alex: This is Alex Smith.

Illness 72

Illness IT Healthcare Patient-Centered 72

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. Patients that remind us of loved ones, patients that are often younger, really hard stories, complicated issues. Abby: I think Andrea, you’re hitting on adolescence is super hard.

IT 83

IT Families Family Illness 83

GeriPal

JULY 28, 2022

GeriPal post on “fast food” style palliative care in chronic critical illness. Areej: So when I was in college, I had a close friend who had a serious illness and actually died as a result of cancer. I entered medical school and I did a course that was offered that’s called living with a life threatening illness.

Illness 110

Illness Hospital Patient-Centered Patients 110

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. So less than six months to live.

Illness 144

Illness IT Medical Provider 144

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

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

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. And bringing more palliative care to the living with serious illness instead of dying from serious illness population.

Consulting 99

Consulting Patient-Centered Diagnosis Referral 99

GeriPal

MAY 25, 2023

Complicated grief? And I wonder when we think about targeting particular population, it’s not just, you know, how seriously ill they are. I think one of the strengths of a group visit is that you can choose the materials that you want that are actually most helpful to the individuals who come to your clinic. Depression?

Community 95

Community IT Patient-Centered Primary Care 95

GeriPal

OCTOBER 26, 2023

Ann: Well, I think teamwork is key in this space and I am a big baseball fan, big Red Sox fan, which is not a good thing to be right now, but I really think it’s indicative of how we should all be working together on this team to help our seriously ill patients. Ann: No, he was very excited. So we used a lot of rehab to death.

Patient-Centered 132

Patient-Centered Hospital Patients IT 132

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 6, 2025

link] PEACH Good Wishes Program A program that provides meaningful gifts for unhoused individuals who are terminally ill. So we’re going to be today talking about serious illness palliative care in the homelessness population. those experiencing homelessness). Really looking forward to the conversation.

Healthcare 100

Healthcare IT Community Illness 100

GeriPal

MARCH 7, 2024

He looked very ill. We are doulas for those with serious illness and those at end-of-life, just a longitudinal relationship, nonmedical support to provide presence. It sets space between us and the individuals we’re trying to take care of. The last thing I’ll say is I actually saw his very last performance.

Provider 117

Provider Illness IT Healthcare 117

GeriPal

AUGUST 24, 2023

Fox gives patients hope there may be a place that illness doesn’t touch Depression is a Liar Why is Being a Patient Such a Difficult Pill to Swallow Better Patient Care Calls for a ‘Platinum Rule’ to Replace the Golden One. Had multiple physical, psychological complications as a result of that. I mean, I was very much a clinician.

Patient-Centered 98

Patient-Centered Patients IT Illness 98

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

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

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. Melissa: The other scenario that exists is just disenrollment because an individual is hospitalized. But we were pleasantly surprised.

Families 106

Families Family IT Patients 106

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.

IT 137

IT Families Family Physicals 137

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. Lauren: Yeah. That’s just one hypothesis. Lauren: Yeah.

Patient-Centered 96

Patient-Centered Patients IT Hospital 96

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

MARCH 28, 2024

Alex: Recently you talked about the other trial, also with a nudge, and that was non-cancer, serious illness. Eric: And we’re going to get to results, but that’s why I also love that 2016 paper: I think it was the very first palliative care trial that ever looked at individuals getting curative therapy. 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

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. Eric 10:55 So one serious illness. Our consultation.

Consulting 63

Consulting Community Patient-Centered Families 63

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? Bargaining just so you know is more end of life before the death. Holly: In advance.

IT 100

IT Complication Relationship 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 Patients 106

GeriPal

MARCH 27, 2025

Alex 02:44 Still suffering from some illness from there, which is why I was sick and not in the office with Eric today. But the process of implementing this project across two big health systems in our area was very complicated and had its share of both challenges and rewards. And is it at all individualized to the patient?

Primary Care 79

Primary Care IT Clinic Illness 79

GeriPal

MAY 1, 2025

But the HIV we do see, and it feels tragic because the people who are dying of and affected by the more kind of traditional, if you call it that, kinds of complications, some of which can be fatal of HIV AIDS are the people who are not on treatment. And usually there’s a reason for that that is hard to sometimes overcome.

Primary Care 94

Primary Care IT Provider Clinic 94

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.

Hospital 115

Hospital Patient-Centered Supply Chain IT 115

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.

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Vaccination IT Hospital Management 100