Survey: 8 in 10 people support payments for advance care planning | End-of-life talks need to happen sooner, experts say | Take care of dementia patients at home, physician says
September 30, 2015
Hospice and Palliative Medicine SmartBrief
News for physicians caring for the seriously ill

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Survey: 8 in 10 people support payments for advance care planning
A Kaiser Family Foundation survey found more than 80% of respondents support government or private-payer reimbursement to physicians for providing advance care planning. The CMS has proposed a Medicare payment for these patient discussions. The survey found 17% of respondents had discussed their end-of-life care preferences with a health care professional, and 89% said physicians should engage patients in such discussions. Kaiser Health News (9/30)
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Palliative Care for Care Managers - New Online Course Announced
CSU Institute for Palliative care announces Palliative Care for Care Managers. Designed by palliative care-experienced case managers working with leading health plans, it brings the compassion and practical thinking to deliver quality care while building stronger, healthier connections with patients and their families. Online and face-to-face. Learn more.
Palliative & Hospice Care Update
End-of-life talks need to happen sooner, experts say
Palliative care experts say families should have end-of-life conversations before people get sick and physicians should make advance care planning part of routine primary care. Physicians should set aside enough time for an uninterrupted talk and take care not to inject personal biases into the conversation. "Instead of focusing on CT scans and tests, part of our job as physicians is to get people to pause and reflect upon what's most important to them," said Dr. Diane Meier, director of the Center to Advance Palliative Care. The Wall Street Journal (tiered subscription model) (9/27)
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Take care of dementia patients at home, physician says
Dr. Mindy Fain, who heads up geriatrics, general internal medicine and palliative medicine at the University of Arizona College of Medicine, is pushing for dementia care to be mostly provided at a patient's home. Fain, who this week starts her term as president of the American Academy of Home Care Medicine, said the US health care system is set up to care for people who have conditions such as heart attacks or appendicitis, but institutional care is less optimal for aging adults who have chronic conditions and may develop dementia. Arizona Daily Star (Tucson) (9/26)
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Taking a pause after a patient dies helps hospital workers cope
Nurse Jonathan Bartels, who has emergency and palliative care experience, said pausing or taking a moment for reflection after a patient dies helps health care professionals relate and accept loss. The idea of a pause is now part of the University of Virginia's nursing school curriculum. Kaiser Health News (9/28)
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Patient & Family Perspective
Survey: Caregivers, patients lack understanding of heart failure
In a study, two-thirds of 80 in-home primary caregivers for people with advanced heart failure did not understand how severe the disease was or that it was a terminal illness, researchers reported at a meeting of the Heart Failure Society of America. Researchers also found many patients did not fully understand the severity of their condition, with some indicating they would be back to work within a year. Average survival for patients in the study was eight months. Medscape (free registration) (9/28)
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Other News
Medical Research
Study links some types of delirium with shorter survival
Hypoactive and mixed subtypes of delirium may be indicators of shorter survival for patients with terminal conditions, according to a 322-patient study in South Korea. Median survival after hospital admission was 17 days for patients with delirium and 28 days for patients who did not have delirium. The findings were reported in Psychosomatic Medicine. News (9/28)
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Health Policy & Practice
Hospitals face more patients without surrogate decision-makers
Health care experts say an aging population will mean an increasing number of older patients will be hospitalized without an appointed surrogate, family or friends to help guide their care. Most states have laws that list which relatives can give medical consent for an incapacitated patient, and some have added "close friend" and extended relatives to the list. The Cleveland Clinic's policy for hospital staff making end-of-life decisions includes protocols that add more oversight as a patient's condition worsens. The New York Times (free-article access for SmartBrief readers)/The New Old Age (9/25)
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State right-to-try laws remove safeguards, ignore rare diseases, researchers say
State laws giving terminally ill patients the right to try experimental drugs might put those patients at risk, do nothing for patients with rare diseases who are not at immediate risk of dying and disrupt the FDA's compassionate use program, researchers write in Annals of Internal Medicine. Reuters (9/28)
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Trends & Technology
Chaplains use telemedicine to counsel people in need
Chaplains are joining the telehealth trend, offering spiritual counseling on demand. The HealthCare Chaplaincy Network's "Chat With a Chaplain" service last year logged almost 5,000 interactions between people around the world and the service's chaplains. The service is free to individuals, but the nonprofit is signing up hospitals for a fee-based service. The Wall Street Journal (tiered subscription model) (9/27)
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ICD-10 is nearly here: Finalize your preparations
Review this mapping guide with ICD-9-CM and ICD-10-CM code conversions to assist you with understanding and applying the new code set. Please use this document as a reference tool rather than rather than the only means of code selection. Learn more.
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What's your level of knowledge of hospice and palliative medicine?
Test it with HPM PASS, an online practice test designed to help you assess your understanding of hospice and palliative medicine. It includes 150 test questions to evaluate your knowledge and uncover areas where additional review may be helpful. Learn more.
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It is said of money that it is more easily made than kept, and this is true of many things, such as friendship."
-- Samuel Butler,
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