GeriPal - A Geriatrics and Palliative Medicine Podcast

Today we have Lee Lindquist with us on the GeriPal podcast to talk about planning for the "4th quarter" of life. Dr. Lindquist is a geriatrician and chief of geriatrics at Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine in Chicago. Dr. Lindquist developed a website called PlanYourLifespan.org to help older adults create strategies for dealing with health crises, such as hospitalization, a serious fall, and dementia. Using the website, older adults can think about what services they may need in the last 10 or 15 years of their lives, what choices they can make now, and how to access these services when needed. Her work was also recently published in a a Journal of Hospital Medicine paper showing that the website helped older adults plan for posthospital discharge needs before a hospitalization occurs. So give it a listen and comment below on what you think should be address in the last quarter of life.

We have a great podcast this week exploring the advance care planning needs for hospitalized adults and what palliative care teams are doing (and not doing) to meet these needs. We've invited Kara Bischoff, a palliative care doctor and Assistant Professor at UCSF in the Department of Hospital Medicine, who published a paper in JAMA Internal Medicine on this very topic. Why was this JAMA IM paper so important for those who work in our field? This was a real world study, looking at over 73,000 consultations from the Palliative Care Quality Network (PCQN). They found palliative care teams consistently identified surrogates for patients, often addressed their preferences regarding life sustaining treatments, including code status, and frequently found a preference regarding life sustaining treatments that was different than what was previously documented before the consult. But rarely completed advance directives (only 3.2% of patients seen by palliative care teams) or Physicians Orders for Life-Sustaining Treatment (POLST) forms (12.3% of patients seen by palliative care teams).

Our guests this week are Lena Makaroun, MD, a research fellow at the VA Pudget Sound, and Sei Lee, MD, Associate Professor of Medicine at UCSF and frequent co-host on this podcast. They recently wrote a paper in JAMA Internal Medicine on wealth disparities in the US and England, and implications for mortality and disability. Major take home points: "It's not that great to be rich, but it really sucks to be poor." Those in the bottom quintile of wealth had the greatest difference in disability and mortality (ie worse). Differences between those in the highest quintile of wealth and the next highest were relatively minor in comparison. "Rather than saying universal healthcare doesn't help, I would just say it's not enough." Worse disability and mortality with lower wealth were observed in the US and England, both before and after age 65. Does this mean National Health Service isn't working? The authors expected to find less difference in England where universal coverage is, well universal, and not just after age 65 in the US (Medicare). The authors give thoughtful responses.

For this weeks podcast, we talk all about prognostication with Christian Sinclair. Christian is a palliative care physician at University of Kansas Medical Center, past president of AAHPM, recent AAHPM "Visionary" awardee, and Pallimed social media guru. We go over a lot of topics at the heart of prognostication in hospice and palliative care including: - The importance that prognostication plays in daily practice, especially in goals of care discussions - Helpful tools and skills to estimate prognosis - How prognosis changes the way we think about prescribing opioids - How to think about prognosis when it comes to hospice eligibility and why it may be that one of the most important tools used for prognostication in the hospice setting, the hospice eligibility guidelines, were last updated over two decades ago. So we have a ton to talk about and we would love for you to continue this discussion in the comment section of this blog, on Facebook or on twitter.

In this week's GeriPal podcast, we talk with Jessie Merlin, Palliative Care Faculty at the University of Pittsburgh, who is addressing another important aspect of this issue: the role of palliative care in chronic pain. We disucss issues such as: - Do outpatient palliative care providers see patients with chronic pain currently? (please take this survey to help Jessie figure this out!) - Should palliative care fellowship training include management of chronic pain? - Is there really a distinction between "cancer pain" and "non-cancer pain?" - To what extent is or should prognosis be a factor in determining treatment of pain? - Everybody Hurts by REM (and a hack rendition)

In this week's GeriPal Podcast, sponsored also by the Journal of the American Geriatrics Society, we talk with Tom Gill, MD, Professor of Medicine at Yale. With guest co-host Dan Matlock, MD, from the University of Colorado, we talk with Tom about his recent JAGS publication on the relationship between distressing symptoms, disability, and hospice enrollment. Tom conducted this study in a long running cohort of older adults that has made a number of outstanding contributions to the GeriPal literature (see links on the GeriPal website). Tom's song request? Stairway to Heaven. This podcast was recorded at the recent Beeson meeting, an aging research meeting, near Albuquerque, New Mexico. At the end, you hear about 30-40 of us singing the end of Stairway around a campfire. As in singing, "And as we wind on down the road...:" Nailed it!

On this week's podcast, we have invited Dr. Kimberly Curseen to talk about how implicit bias influences us as providers in geriatrics, hospice, and palliative care, as well as the role of that cultural competence and cultural humility should play in our practice. Kimberly Curseen, M.D. is an Associate Professor of Internal Medicine at Emory School of Medicine and Director of Outpatient Supportive/Palliative Care, Emory Healthcare.

On this GeriPal podcast we discuss the value of "scenario planning" in informed decision making with Gretchen Schwarze, Associate Professor in the Division of Vascular Surgery at the University of Wisconsin. Dr. Schwarze is a board-certified vascular surgeon and medical ethicist who recently wrote an article on this subject in the New England Journal of Medicine (NEJM). Scenario planning comes from the economics literature, but Dr. Schwarze advocates for its use in medicine, giving healthcare providers the tools to say "I cannot predict the future, but if all goes well, this is what is likely to follow, and if things go poorly, this is what we can expect." The aim is not to develop the "correct" scenario, but to describe a range of stories illustrating how the future might unfold.

Back in 2009, Pallimed created one of my favorite posts titled "Top 10 Contemporary Palliative Care Songs". In it, they made a list of "contemporary" songs from many different genres that have palliative themes. For todays podcast, we aim to update this list with songs that inspire, move, or make us think about geriatrics or palliative care. As with the Pallimed post, this is all personal preference. So we would love to hear from you. What one song would you have included in this podcast if you were sitting in the studio? Put it in the comments section on www.geripal.org

On this weeks podcast, we have Sarah Hooper, J.D., the Executive Director of the UCSF/UC Hastings Consortium on Law, Science and Health Policy, an interprofessional partnerships in education, research, and clinical training and service. We talk with Sarah about her work creating the Medical-Legal Partnership for Seniors Clinic (MLPS) in which law students and faculty provide free legal assistance to low-income older patients at the UCSF Medical Center and at the San Francisco VA.