Discover and read the best of Twitter Threads about #palliativecare

Most recents (11)

Read in the SMH (smh.com.au/politics/feder…) that @GregHuntMP is about to announce funding for CAR-T cell subsidised therapy in Australia. Some thoughts about this (& economic justice for palliative care patients): a thread 1/
Firstly, cancer is scary. That’s not a rocket-science statement, it’s a bleeding obvious. When we experience a huge diagnosis, it’s a massive upheaval in life - and one that (most) people would do anything, pay anything, to make go away. 2/
What happens though for those patients that don’t have curable disease? Setting aside the non-malignant palliative care patients for a moment - there are always a percentage of people who won’t or can’t get better with current therapy, although often not for a lack of trying. 3/
Read 23 tweets
Some time ago, I saw a pt with severe untreated suffering at #EOL alongside aggressive & unproven life-prolonging interventions. When I asked the medical team, they said they were doing “what the family wanted.”

Sharing some of my thoughts about this below 👇🏾👇🏾👇🏾
1/ Rejecting paternalism does not imply that we take ourselves out of the decision making process altogether. We should always work together with our pts & families rather than just “doing what they want.”

#hpm #hapc #bioethics
2/ We should move towards a “deliberative” rather than an “informative” model of decision making. Pts should share values/expectations & we propose medical treatments. It is crucial for all HCPs to have better training on having #goalsofcare conversations.

#hpm #hapc #bioethics
Read 7 tweets
1/ So I got quite a bit of "pushback" when saying that I would probably/most likely/am considering no longer using the joined # of #hpm or #hapc ... when tweeting about #PalliativeCare exclusively...

I also said I would explain myself to those wondering why...
2/ Quick disclaimer: I will entertain thoughtful discussion and opinions in this thread...

I won't entertain one sided views that try to shut me down with that "I'm big & your small, I'm smart & your dumb..." talk

I am expressing MY thoughts, keep your gaslighting to yourself
3/ One of the #CAPCSeminar19 keynotes was on messaging and how we brand ourselves.

It was a great conversation with Diane Meier and Mark Ganz (intentionally not tagging them) with the sharing of ACTUAL CAPC data but also ACTUAL life stories involving Mark's parents.
Read 15 tweets
Welcome to the Member of Congress Tracking Report for the week ending November 10, 2019. With Congress on recess this week, we are going to do things a bit differently this week. We are going to take a dive into #McConnellsGraveyard.
#MoCTrack 1/33
bit.ly/34FD5jk
#GOP keeps trotting out their tired talking point about the “do-nothing-Dems” and all we can concentrate on is #Impeachment.

NOT TRUE.

What you’ll find below are 30 bills of the 300+ that #McConnell has stalled in the Senate.

#MoCTrack #DemCast 2/33
demcastusa.com/2019/11/10/mit…
HR 1 - #ForThePeople

A bill that would improve voting rights, fix campaign finance regulations, and mandate ethics and accountability reforms.
💯 over 100 co-sponsors (236)

#MoCTrack #McConnellsGraveyard 3/33
vox.com/2019/3/8/18253…
Read 33 tweets
1/ In honor of #COPD Awareness Month, let’s solve the prevailing problem of rare #palliativecare (PC) in COPD, especially early.

See our qual exploration of clinicians in @PalliativeMed_j

liebertpub.com/doi/abs/10.108…

Care to take a stroll?

#pallipulm @pallipulm
@atscommunity
2/ First, a PSA:

Waiting for PC until end-stage #copd is too late & misses a golden opportunity to meet COPD patient & family needs earlier in the trajectory.

See our @AnnalsATS pub atsjournals.org/doi/abs/10.151….

@AnnalsATS will have a podcast on that soon, so stay tuned!
3/ Contrast “late” (the status quo if at all) to “early” PC, which brings comprehensive palliative & supportive care to patients & families before end-stage disease.

Others have explored PC in COPD.

The key here is “early”.

Lots to learn from #qualitative research!
Read 12 tweets
#Thread
Our new #OpenAccess work @AnnalsATS examines how ICU doctors talk to families when they don’t expect a patient to survive. Congratulations to @SVasherMD, Sandra Zaeh of the @JHUPCCMFellows, and @mneakin
#ICU #PalliativeCare @creativecommons

atsjournals.org/doi/abs/10.151…
63 intensivists in the intervention arm of the SCIP trial (NCT02721810) answered the question “Do you expect this patient to survive to hospital discharge?”

50 of the 63 in the intervention arm answered that they did NOT expect the patient to survive.
These intensivists then participated in a recorded simulated family meeting.

During the meeting, 25 intensivists told the actor playing the daughter that her dad might not live. The actor responded verbatim:

“What do you think is most likely to happen?”
Read 8 tweets
Wrote this piece with the help of a great team including @DrKevinHill. Below I'll share some of my thoughts about #opioids and opioid use disorder and how they present in #hpm and #palliative care, plus why we need to do a better job of addressing #addiction at end of life. 1/x
2/x Training in #KY gave me a front row seat to the #opioidcrisis. With an interest in #hpm I kept wondering what would happen to these individuals who developed an OUD and years later were prescribed opioids. How would I keep those patients safe and manage their pain?
3/x I continue to think that our field will struggle in years to come when survivors of the #opioidcrisis age, develop serious illness, and develop pain. Thinking about this, and reading @jeff_deeney article in @TheAtlantic theatlantic.com/health/archive… made me want to do more.
Read 13 tweets
On a serious note:
Tuesday is my father's 2nd yahrzeit
Sunday 4/21 was the 2y anniversary of his death.

In reflecting back, I have some thoughts for #medtwitter, #Jews and the general public...
1/

#death #dying #grief #PalliativeCare #medicine
1. Condolence notes just need to say, "I am thinking of you" or "I was sorry to hear your news" or "I am sorry for your loss."

Don't overthink it, and don't offer false platitudes. Send your note or make your call, and the person who is #mourning knows you care.
2/
2. Show up.
For #shiva, for #kaddish. The first week, there's a lot of people around in a #Jewish house of mourning. Then everyone goes home, and we are left alone.
Offer to go to lunch. Bring dinner. Take a walk.
Join us in shul. Kaddish that first time in services was hard.
3/
Read 14 tweets
I keep track of things and I like old books. The other day this old ledger caught my eye online so I bought it. I thought I could keep track of case notes. I like a little bit of history in my books.
It was interesting because it was the ledger from the Canada Southern Railway Line and had been used in 1877. It was mostly blank so I bought it. The ad mentioned that some pages had been used.
When it arrived, it had old book smell but it was in great condition. I pulled it open and noticed the perfectly written script and math scrawled on the inside cover.
Read 19 tweets
The other night at the hospital, I witnessed some shocking behavior & sub par care by a night shift #hospice #nurse-Hospice nurses ensure a dying patient receives dignified #EOL while being kept as comfortable as possible. For 12 hours -2/28-3/1, Melissa didn't get either. THREAD
I was sitting with Melissa, trying to calm her, she was agitated. RN Deb came in. She looked at me & asked who I was. Due to her tone, I told her I was family. She wanted to know who was staying over. We were curtly told only 2 were allowed, not 4. SHE was mistaken. #Hospice
Michele, patients mother very upset. RN Deb yelled at Melissa's Nieces. Told the little girls they were very bad & didn't belong up here. The girls weren't misbehaving. They weren't doing anything wrong, nor unattended in the common area of the #PalliativeCare #Hospice wing
Read 15 tweets
1/ There’s no debate- #palliativecare doesn’t hasten death, in fact for cancer pts it prolongs life. Even #palliative sedation doesn’t hasten death! The myth that a palliative approach shortens life (e.g. via opioid use) and is “giving up” is something we combat everyday.
2/ These “palliphobias” can lead to delayed symptom management, prognostication and advance care planning- this problem is very dangerous and pervasive, whether the patient wishes to die via #MAID or not. Not at all against #MAID at all but it does differ in intent.
3/ Anecdotally- have had several cases where well-meaning specialists didn’t recognize #palliative needs early. By the time we saw it was too late to request MAID, pt had lost capacity and had suffered greatly. No one had talked about EOL planning before me! #hpm
Read 3 tweets

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