Frank D. Ferris

A model to guide patient and family care: based on nationally accepted principles and norms of practice.

San Diego Hospice (F.D.F., K.B.), San Diego, California, USA; Saskatchewan Health District Management Services (H.M.B.), Regina, Saskatchewan, Canada; St. Mary’s Hospital Center (J.F.), Montreal, Quebec, Canada; Consultant (M.H.), Tottenham, Ontario, Canada; Maison Michel Sarrazin (C.L.), Sillery, Quebec, Canada; St. Elizabeth Health Care (M.L.), Markham, Ontario, Canada; British Columbia Cancer Agency (A.S.), Victoria, British Columbia, Canada; and Lakeridge Health Corporation (P.J.W.), Oshawa, Ontario, Canada

Ease of screening for depression and delirium in patients enrolled in inpatient hospice care.

BACKGROUND Major depression and delirium are prevalent, underrecognized, and undertreated in hospice and palliative care settings. Furthermore, they are both associated with significant morbidity and mortality. OBJECTIVE A screening study of patients receiving inpatient hospice care was conducted in order to determine the ease of screening for depression and delirium in patients with advanced, life-threatening illnesses by hospice social workers and nurses, respectively. METHODS A two-question depression screening tool was administered to 20 consecutive patients on admission to a hospice general inpatient care center by social work staff during their initial assessment. A delirium-screening tool was administered daily to 22 consecutive patients admitted to the ICC daily by nursing staff. Screening results were collected, as were patient and staff feelings about the burden of the screening process. RESULTS Of the 20 patients screened on admission for depression by social work, 70% (14/20) screened positive. Of the 22 patients screened daily for delirium by nursing, 64% (14/22) screened positive at least once during their admission. Screening for both conditions was considered relatively easy to accomplish by the hospice staff. There were no significant associations between a positive screen of depression or delirium and patient gender, age, ethnicity, terminal diagnosis, or marital status. DISCUSSION These results support the notion that depression and delirium are very common in hospice inpatients, and that screening for both is relatively easy and practical for hospice clinicians to conduct.

Strategic planning by the palliative care steering committee of the Middle East Cancer Consortium.

High quality comprehensive palliative care is a critical need for millions of patients and families, but remains only a dream in many parts of the world. The failure to do a strategic planning process is one obstacle to advancing education and pain prevention and relief. The Middle Eastern Cancer Consortium Steering Committee attendees completed an initial strategic planning process and identified “developmental steps” to advance palliative care. Underscoring the multi-disciplinary nature of comprehensive palliative care, discipline-specific planning was done (adult and pediatric cancer and medicine, pharmacy, nursing) in a separate process from country-specific planning. Delineating the layers of intersection and differences between disciplines and countries was very powerful. Finding the common strengths and weaknesses in the status quo creates the potential for a more powerful regional response to the palliative care needs. Implementing and refining these preliminary strategic plans will augment and align the efforts to advance palliative care education and pain management in the Middle East. The dream to prevent and relieve suffering for millions of patients with advanced disease will become reality with a powerful strategic planning process well implemented.

Dog with a Bone

MOST PEOPLE ARE SURPRISED to learn I started out to be a laboratory chemist. In 1977, when I was working on my master’s degree in clinical chemistry at the University of Toronto in the hospital laboratory after my undergraduate training in Cooperative Applied Chemistry at the University of Waterloo in Ontario, Canada, I initiated making hospital rounds with the clinicians. Both I and the technicians in the laboratory loved knowing how our work “fit in” with the actual care of patients. In addition to loving the clinical correlations, I made the observation that, if I ever wanted to be the head of the laboratory, I needed a medical degree. My mother was furious that I went back to school when I was so close to a perfectly respectable career. After medical school at McMaster University in Ontario, Canada, I trained in internal medicine at the Wellesley and Western Hospitals (University of Toronto). Then, I trained in radiation oncology at the Princess Margaret Hospital and Toronto-Bayview Regional Cancer Center (University of Toronto). It did not take me long to realize I was more interested in managing pain and other symptoms than I was debating whether the cure rate from whole beam radiation was 89.4% or 91.3% for stage IA Hodgkin’s disease. Since there were no palliative medicine fellowships in Canada in 1987, I negotiated my own 3-year fellowship in pain and symptom management with Dr. Ian Kerr, a medical oncologist at the Toronto-Bayview Regional Cancer Center. It took me 20 years after high school before I finally found my niche and got a real job. My mother was profoundly relieved! There were two “bad deaths” during that time that influenced me. My father had advanced Parkinson’s disease and died 1 week after moving to a nursing home. He had fallen out of bed and died of acute pneumonia 12 hours after returning from the hospital where he’d been x-rayed to rule out a hip fracture. I was furious at the care he received and his sudden, unexpected death. However, my mother, having just lost her husband of 35 years said, “Frank, your father is dead. Don’t waste your time being angry at the nursing home. Put your energy into activities that will make the world a better place for the living.” When my very Pioneers in Palliative Care

Leadership Development Initiative: Growing Global Leaders… Advancing Palliative Care

The International Palliative Care Leadership Development Initiative (LDI) was a model demonstration project that aimed to expand the global network of palliative care leaders in low- and moderate-resource countries who are well positioned to apply their new leadership skills. Thirty-nine palliative medicine physicians from 25 countries successfully completed the two-year curriculum that included three thematic residential courses, mentorship, and site visits by senior global palliative care leaders and personal projects to apply their new leadership skills. The focus on self-reflection, leadership behaviors and practices, strategic planning, high-level communication, and teaching skills led to significant personal and professional transformation among the participants, mentors, and the LDI team. The resulting residential course curriculum and the personal leadership stories and biosketches of the leaders are now available open access at IPCRC.net. Already, within their first-year postgraduation, the leaders are using their new leadership skills to grow palliative care capacity through significant changes in policy, improved opioid/other medication availability, new and enhanced educational curricula and continuing education activities, and development/expansion of palliative care programs in their organizations and regions. We are not aware of another palliative care initiative that achieves the global reach and ripple effect that LDI has produced.

Still Enthusiastic After All These Years.

We have been actively engaged in the practice of palliative medicine for 25 years. We also have been engaged in teaching, research, management, public speaking, and the politics of organized medicine. A common comment from fellows, colleagues, people who attend a lecture, or just from a committee member is, ‘‘I just love your enthusiasm.’’ The editors of this series asked us how we’ve sustained that enthusiasm for so longdparticularly since one of them said we are both ‘‘older than dirtdbut looking good in spite of it.’’ There are three sources that play an important role. The most reliable source of enthusiasm is the product of the direct care of patients and their families. You simply cannot make up the situations that present themselves. The pattern of engagement is the same. Genuine listening to the story. Suspending all other issues to be completely present in the moment. Asking questions that ‘‘deepen’’ the interview to extract all the associated details in the physical, emotional, practical, and spiritual domains. Mustering the courage to ‘‘lean in’’ to the pain rather than to try to fix it too soon. Then, to marvel as the best features of human beings become routinely displayed by our patients and their families: selfless love, compassion, long-suffering, patience, and courage. In the larger world, it seems we see portrayals of these only in novels, movies, plays, or poems. But in the practice of palliative medicine, it is remarkable how common those human virtues are. More remarkably, they are displayed by people who you would never predict, based on their other circumstances, they could possibly display. But they do, reliably, surprisingly, sometimes miraculously. It is a routine experience for each of us to just marvel at what we are privileged to witness by virtue of the

Opioid Consumption in Patients With Advanced Illnesses (S722)

Opioid Consumption in Patients With Advanced Illnesses (S722) Frank Ferris, MD, The Institute for Palliative Medicine at San Diego Hospice, San Diego, CA. Simon Schrick-Senasac, DO MS, Rush University Medical Center, Chicago, IL. Rosene Pirrello, BPham RPh, The Institute for Palliative Medicine at San Diego Hospice, San Diego, CA. (All authors listed above had no relevant financial relationships to disclose with the following exception: Ferris is on the speakers’ bureau and receives an honorarium from Salix Pharmaceuticals.)