Palliative Care Conversations

In the recent decade, public attention on the work of care for the terminally ill has greatly increased, largely through government funding of such work.  The American Board of Medical Specialties approved palliative medicine as a new medical specialty in 2006, followed by the first board certification granted for physicians in palliative medicine in 2008.  Clinical Chaplaincy has been an integral part of this emerging model of care.  In response, CPSP has developed a subspecialty certification for Board Certified Clinical Chaplains,  “Board Certified Clinical Fellow in Hospice and Palliative Care”   (FHPC). This will be a subspecialty credential for those first credentialed as Board Certified Clinical Chaplains (BCCC) or Board Certified Pastoral Counselors (BCPC). Procedure: CPSP Chapters  will receive requests from candidates for this certification, and will review the request.  The candidate for FHPC subspecialty certification may dow...

College of Pastoral Supervision & Psychotherapy 2012 Plenary Part 1 Palliative Care: Communication Near The End OF Life Kimberly Garner, M.D., J.D., M.P.H., F.A.A.F.P. Dr. Kimberly Garner is a staff physician at the Department of Veterans Affairs at the Geriatric Research, Education and Clinical Center in Little Rock, Arkansas. She is also an assistant professor of Geriatrics at the University of Arkansas for Medical Sciences. Dr. Garner is the medical director of the Geriatric Evaluation and Management Unit at the Central Arkansas Veterans Healthcare System which is a specialized intermediate unit which provides an interdisciplinary team approach in an inpatient setting. Dr. Garner received a juris doctorate degree from the University of Arkansas School of Law and a master’s of public health from the University of Arkansas for Medical Sciences. She received a B.S. in dietetics from Louisiana Tech University and her M.D. degree from the University of Arkansas for M...

Julien Olivier a CPSP colleague from New Hampshire sent me the link to this great resource below: This website could be very useful for persons seeking to be better informed concerning hospice and palliative care. Note that the course and credits (25) are FREE! Richard Payne, MD Activity Medical Director Professor of Divinity and Medicine Duke University Curriculum Outline Using the principles of palliative care, this activity is aimed at providing the clinician with the tools to evaluate patients for palliative care needs and to understand the regulations for palliative care and hospice eligibility. This curriculum is intended for pain specialists, oncologists, family practice care providers, hospice medical directors and other healthcare providers who treat patients with advanced life-threatening illnesses. In order to successfully complete this activity for AMA PRA Category 1 Credi t, learners must demonstrate performance by achieving a min...

Sometime ago Don Berwick, MD spoke about 20 improvements that doctors could make in the end of life care of their patients that begins in a simple conversation. Berwick recommended the following considerations as his top three suggestions: 1.Ask yourself as you see patients, "Would I be surprised if this patient died in the next few months?" For those "sick enough to die," prioritize the patient's concerns - often symptom relief, family support, continuity, advance planning, or spirituality. 2.To eliminate anxiety and fear, chronically ill patients must understand what is likely to happen. When you see a patient who is "sick enough to die" - tell the patient, and start counseling and planning around that possibility. 3.To understand your patients, ask (1) "What do you hope for, as you live with this condition," (2) "What do you fear?," (3) It is usually hard to know when death is close. If you were to die soon, what would be left ...

Health care reform is a scary subject for ordinary Americans and this is not been helped by the tone of the current national debate on this issue which has turned terrible nasty. One of the most heated concerns to have emerged recently relates to end-of-life conversations. End-of-life conversations are difficult at the best of times and made all the more difficult in these uncertain days of economic upheaval when many Americans have lost their jobs, health care insurance and homes. Unfortunately, some public figures and national leaders have chosen to offer their critique of the proposed health care reforms using only the most inflammatory language possible. The tenor of this debate does not bode well for the American public in terms of any real substantial change to a health care system which is too costly to sustain and unequal in terms of access. These difficult days call for true leadership which does not fail for lack of nerve to embrace the courage of change in the best interests...

Therapeutic Harp By Ann Bewley, Ph.D. Music as a Therapeutic Modality The beneficial relationship between music and healing has been well established for centuries. Documents dating back to 1500 BC depict Egyptian physicians employing music for healing the sick. In ancient Greece, Pythagoras taught his students ways in which certain musical notes, chords, and melodies could induce physical responses in the body. Twelfth-century abbess and physician Hildegard von Bingen employed treatments that are much like those now advocated by modern practitioners of holistic medicine. The use of music as a tool for healing continued in Europe through the 17th century until it began to fall out of favor during the dawn of the Age of Reason. However, current scientific research into the effectiveness of complementary therapies is providing new evidence that music can assist and effect healing. Music can alter brain and body chemistry and affect physiological rhythms such as pulse rate and breathing. ...

Aromatherapy and Acupunture may be used as complementary treatments that enhance the health care received from a physician or hospital. Aromatherapy Aromatherapy is a noninvasive method of healing based on the therapeutic use of essential oils. Essential oils are highly-concentrated, non-oily, subtle, volatile liquid steam distilled from various parts of aromatic plants. A variety of methods of application can be used to achieve the desired effect: inhalation, compress, ointment mixture, or dilution in a carrier oil, which is applied to the body using a systematic, light touch. Aromatherapy can complement other treatments, help to reduce stress and anxiety, relieve pain and nausea, and restore energy, health, and a sense of well-being. History Aromatherapy has been around for 6000 years or more. The Greeks, Romans, and ancient Egyptians all used aromatherapy oils. The Egyptian physician Imhotep recommended fragrant oils for bathing, massage, and for embalming their dead nearly 6000 yea...

20 Improvements in End of Life Care Changes Internists Could Do Next Week! Don Berwick, MD Institute for HealthCare Improvement at the ACP-ASIM Annual Meeting, April 22, 1999 (prepared by Americans for Better Care of the Dying) 1.Ask yourself as you see patients, "Would I be surprised if this patient died in the next few months?" For those "sick enough to die," prioritize the patient's concerns - often symptom relief, family support, continuity, advance planning, or spirituality. 2.To eliminate anxiety and fear, chronically ill patients must understand what is likely to happen. When you see a patient who is "sick enough to die" - tell the patient, and start counseling and planning around that possibility. 3.To understand your patients, ask (1) "What do you hope for, as you live with this condition," (2) "What do you fear?," (3) It is usually hard to know when death is close. If you were to die soon, what would be left undone in your...

This draft document has been prepared by George Hankins Hull Palliative Care The aim of palliative care is to ease the suffering that results from illness. Palliative care seeks to provide treatment for your symptoms, even when the underlying disease cannot be cured. The goals of palliative care are to relieve your pain and other discomfort and to help reduce your family’s stress. In addition, palliative care seeks to provide information to help you cope and live with a chronic illness. Palliative care encompasses emotional, social, and spiritual needs as well. During the course of your illness, a palliative approach to care can help you and your family to achieve a better quality of life. To request a palliative care consultation You or your family can make a request to consult a palliative care team representative by speaking with your nurse or doctor. Your health care team also may decide to request a palliative care consult. A palliative care representative will visit you within 24...

Special note: This information on models of palliative care was adapted from material provided by the Center to Advance Palliative Care. Adopted by George Hankins Hull Spiritual Care Coordinator LRGHealthcare Solo Practitioner Model Consultative service with Doctor (MD) or advanced nurse practitioner (ANP) provides initial assessment and communication with attending physician, nursing, and patient support staff. May or may not write patient orders. MD or ANP refers patients to needed services (e.g. social work, chaplain, dietitian, pharmacist, care manager, rehab therapist, pain management, alternative therapist or volunteer), discusses needs in patient conference, and communicates with clinicians. Assists patient and family with advance directives and plans for future. Service Model MD or ANP receives referrals from attending physician, hospital staff, patient, or family. All units in hospital deliver palliative care as part of their stated mission. MD or ANP develops protocols for...

Palliative care is life affirming and regards dying as a natural part of the human experience. The goal of palliative care is to achieve the best possible quality of life through: the relief of suffering control of symptoms the restoration of functional capacity while taking into account personal, cultural, religious values, beliefs, and practices of the individual patient and family concerned. Interdisciplinary Approach: Palliative care requires an interdisciplinary approach calling upon the expertise of, medical staff, nursing staff, care managers, social workers, chaplains and volunteers who in cooperation with family members and friends provide patient care. Smooth Transitions between Hospital and Community Services: Palliative care encompasses the full array institutional and community resources such as hospital, hospice, home care, long-term care, and adult day care to ensure a smooth transition between institutional settings and community services. Five Principles of Palliative...

Discussion: Sometime ago a New England newspaper, the Worcester Telegram & Gazette, carried a story entitled "Various Pathways Lead to a Good Death." in which a retired former chief of surgery, Dr. H. Brownell, spoke of his concern that too many patients die what he called ‘a bad death.’ In the article Brownell spoke about seeing patients, including his own, die in an intensive care unit with tubes poked into their chests, their bellies and just about every orifice of their bodies. He further commented about patients resuscitated with so much fluid that their faces were unrecognizable, arms black and blue from needles and blood sticks, in severe pain and unable to communicate—and with very little hope of survival. "No one," he commented, "should have to die like this." Janet L. Abrahm, M.D., F.A.C.P., at the University of Pennsylvania School of Medicine, Philadelphia, encourages physicians to broaden their concept of care for patients who are terminal...