Jane deLima Thomas

Misunderstandings about Prognosis: An Approach for Palliative Care Consultants When the Patient Does Not Seem To Understand What Was Said

Called in after discussions about prognosis between referring clinicians and patients, palliative care consultants sometimes find that the patient does not seem to understand what the referring clinician believes he or she explained. However, holding a more explicit discussion about prognosis may compromise the palliative care clinicians rapport with both the patient and the referring clinician. We therefore propose a two-part approach to explore apparent prognostic misunderstandings: first, generate a differential diagnosis for why the patient and referring clinician have different reports of what was said, and second, cultivate a partnership with the referring clinician to provide a unified patient care plan.

Advance Care Planning in Cognitively Impaired Older Adults: Advance Care Planning in Cognitively Impaired Older Adults

Older adults with cognitive impairment face many healthcare challenges, chief among them participating in medical decision‐making about their own health care. Advance care planning (ACP) is the process whereby individuals communicate their wishes for future care with their clinicians and surrogate decision‐makers while they are still able to do so. ACP has been shown to improve important outcomes for individuals with cognitive impairment, but rates of ACP for these individuals are low because of individual‐, clinician‐, and system‐related factors. Addressing ACP early in the illness trajectory can maximize the chances that people can participate meaningfully. This article recommends best practices for approaching ACP for older adults with cognitive impairment. The importance of providing anticipatory guidance and eliciting values to guide future care to create a shared framework between clinicians, individuals, and surrogate decision‐makers is emphasized. It is recommended that ACP be approached as an iterative process to continue to honor and support peoples wishes as cognitive impairment progresses and increasingly threatens independence and function. The article describes effective strategies for assessing decision‐making capacity, identifying surrogate decision‐makers, and using structured communication tools for ACP. It also provides guidelines for documentation and billing. Finally, special considerations for individuals with advanced dementia are described, including the use of artificial hydration and nutrition, decisions about site of care, and the role of hospice care.

Training Fellows to Be Leaders: Ensuring the Future of Palliative Care (FR401)

Objectives Learn how physicians in specific countries provide palliative care to their patient populations often with limited resources Understand specific cultural and political challenges to developing palliative care clinical, educational and research programs Describe roles of different health care providers practicing palliative care and how they meet the needs of their local populations Please join AAHPM’s International Scholars for a panel discussion. Each scholar will present for 10-15 minutes on the state of the practice of palliative care in their home country, with an emphasis on the roles of physicians, nurses, and other healthcare providers; the status of education and research in the field; and the unique challenges facing patients and providers. There will be time allotted after each presentation to field questions and dialogue from the audience. Prepare to be educated and inspired by these accomplished individuals who are leading and advancing the field of hospice and palliative medicine in their countries of origin.

Giving Feedback to Palliative Care Learners (522)

Quality Data Collection Tool (QDACT) in the Carolinas Palliative Care Consortium, the Palliative Care Outcomes Collaboration (PCOC) in Australia, and the Palliative Care Research Cooperative (PCRC) have contributed valuable lessons for creating data collection systems embedded in day-to-day practice to inform quality and research. Based upon these experiences, we will outline the necessary stepsdfrom idea to implementationdfor building a data collection culture, creating systems and processes for collecting and analyzing data, and producing reports to meet the diverse needs and perspectives of our provider and patient populations. Ultimately, we will discuss how to drive improved patient care by measuring and understanding performance.

Peer Mentoring: An Innovative Model for Professional Advancement in Hospice and Palliative Medicine (320)

Peer Mentoring: An Innovative Model for Professional Advancement in Hospice and Palliative Medicine (320) Rachelle Bernacki, MD MS, Dana Farber Cancer Institute, Boston, MA. Sandra SanchezReilly, MD, University of Texas Health Science Center at San Antonio and STVHCS, San Antonio, TX. Elise Carey, MD, Mayo Clinic Rochester, Rochester, MN. Jane DeLima Thomas, MD, Harvard Medical School, Boston, MA. Jen Kapo, MD, University of Pennsylvania, Philadelphia, PA. Laura Morrison, MD, Baylor College of Medicine and The Methodist Hospital, Houston, TX. VJ Periyakoil, MD, Stanford University, Palo Alto, CA. Lynn O’Neill, MD, Mount Sinai School of Medicine, New York, NY. (All speakers have disclosed no relevant financial relationships.)

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I stood quietly in the middle of the circle, with 4 or 5 friendly hands on my belly. Nothing in my career to that point had prepared me for this moment, but I found myself relaxing and enjoying the...