Discover and read the best of Twitter Threads about #palliativecare

Most recents (24)

1/🧵 PRIMARY vs SPECIALTY #PalliativeCare:

When I combine intensive care w palliative care as an ICU doc, I’m delivering PRIMARY palliative care. I often consult a board-certified palliativist for additional help, & this is SPECIALTY palliative care. Today…
#medtwitter
2/ Today the most complicated thing I did in the ICU were NOT bronchoscopy or restarting a heart. It was helping people navigate these massive life choices, often shifting the treatment ladder we are climbing from the wall of cure to the wall of comfort. To me it’s the best…
3/ To me, primary #PalliativeCare is the most nuanced and critically important part of my vocation as an Intensivist. Just as the Winter gets you to a mountains 🏔, but Summer keeps you there, Palliative Care is not what brought me to the ICU but it definitely keeps me here.
Read 6 tweets
1/ Serious End-of-Life 🧵

…He told her, “Never give up on me because I’ll keep fighting to live.” What does it mean when a person valiantly asks this of a spouse & then illness leads to #transplant, #infection, and eventually #life support that doesn’t help?
 
#medtwitter
2/ First I just listened to her heartache and saw their immense love. “I made a #promise, Doctor.” My personal commitment became to help this couple uphold that promise, yet medical options had long since run out & failed him. I asked her to come into the hall.
 
#nursetwitter
3/ Always go out outside a pt’s room to discuss anything you don’t want the patient to hear, even when he is in a dense coma. Assume dying pts hear everything said & respect their dignity as your number one goal in all interactions. Here is what I said…
 
#PalliativeCare
Read 10 tweets
1/ 🧵🎥 Chronic Pain

#Pain comes in all shapes & sizes. Let’s explore how we process pain. Watch & Listen to what Anderson Cooper tells Stephen Colbert about #grief and #suffering: “You can’t have happiness without having loss and suffering.”
2/ My lucid & kind patient (pic w written perm) uses scalding water as a coping mechanism for abdominal pain from pancreatitis. He wants to share his rationale.

#MedTwitter #ChronicPain #nurse
3/ Before I share what he told me, I first want to make my mindset as his #physician clear: My first job is to believe in him. Then to understand him. Then to devise a plan to help him.
Read 13 tweets
1/ 🧵Wisdom in Medicine
 
What’s going on here? And why it’s key in #COVID19
 
It’s quite simple: we finally had the #wisdom to ask Mr. D the right question! He and his wife encouraged us to use this picture to teach what we learned.
 
#PalliativeCare #MedTwitter #NurseTwitter
2/ What we learned was to switch the preposition!
 
Mr. D was a pre-#COVID patient. On this day, he was taken off the vent after a MONTH. The incessant mantra had been, “What’s the matter WITH Mr. D?” He was surprised when we asked, “What matters TO you, Mr. D?”
3/ He has a tracheostomy, as you can see. We insert this airway through the neck to improve #comfort when someone is on a vent well beyond 10 days. He’s more comfortable because he no longer has a tube in his mouth. We used a program called the #A2Fbundle to reduce his #delirium.
Read 13 tweets
Our new paper is out !

We explore which aspects influence health professionals´ decisions regarding EoL decisions and care for cancer patients in Colombia. #palliativecare @palliativewise @BMC_series #cancercare #patientcare

doi.org/10.1186/s12904…

Starting thread ... 🧵
We did a qualitative descriptive-exploratory study based on phenomenology using semi-structured interviews incluiding several professionals´ and several urban hospitals. Main results 👇

Professionals consider :
👉Patient's clinical condition, cultural and social context, in particular treating indigenous patients requires special skills, so training in discussing EoL is extremely important.

👉Many patients deny their imminent death which hampers shared open conversations.
Read 9 tweets
1/🧵 Imagine 2 people, madly in love & married 28 years, in an impossible situation, both lives on the line & separated by different hospitals. Then imagine 2 sets of #nurses & #doctors separately determined to overcome ⛰ of obstacles…
(shared w perm)

#MedTwitter #NurseTwitter
2/ Last night this is what happened…

NOTE: the family wants to share their story to offer a glimpse of love ❤️ on all levels

For 3 years, Mark took care of Sharon, his #bride, as she battled breast #cancer. It relentlessly spread to her bones. He never stopped giving.
3/ She could tell he was spent and getting sick himself. “Mark, let’s get you to the doctor!” “Not until you are well, Sharon.” He remained laser focused on her every need. As she became weaker, he took her to get admitted yesterday.

#marriage #life #caregivers
Read 13 tweets
1/🧵#COVID19 Compassion

Our patient wants to live 3 days to see his grandson graduate. He has #COVID19 pneumonia & is extremely short of breath. He’s chosen NOT to go on a ventilator & is on 100% O2 HiFlow Canula. He’s afraid of tight-fitting a bipap mask.

#PalliativeCare
2/ The intern said, “I never saw a patient whose respiratory rate was twice his oxygen saturation!” Yep, last night his O2 sats dropped to 30% and he was breathing 60 times a minute! By morning he was 85% sat and RR was 28. Better but tenuous.

#TipsForNewDocs #MedStudentTwitter
3/ All of this raises some complicated ethical + treatment questions that I’d like to cover. We addressed this on rounds several times this week & at times it got a bit heated. His #nurse said she noticed herself flushed, mad, and heart rate >130…why?
Read 13 tweets
1/ #COVID19’s “Long Loneliness” was exacerbated by our flawed decision to separate pts from family at just the time they needed each other most. @doctor_oxford has captured the sorrow & pleads for us to come to our senses.
 
bit.ly/2Q98n0r
 
#medtwitter #PalliativeCare
2/ @doctor_oxford ✍🏻: “NHS did its best, but too many were isolated when they needed connxn most, leaving a legacy of deep trauma.” No doubt we dropped them “into Hades.” It was done w benevolent intent but in fear. PPE works & we must adjust visitation humanely.

@A_MacLullich
3/ One daughter who lost her dad said, “Even when they told us they were going to withdraw Dad’s life support, no one from the hospital offered us the chance to come in or suggested a video call or a phone call.” This is flat out wrong at every level & we know it.
 
@RandAwdish
Read 4 tweets
At a Court of Protection hearing today, before Mr Justice Keehan, I listened to doctors report on how they’d given ‘futile’ & ‘’burdensome’ treatment to a dying man over many weeks. It was like listening to a story of medical torture. #EOLC #NotSecretCourt
The patient, “KM”, in his 50s, was admitted to hospital on 19 Jan with breathlessness & chest pain after long haul flight. It was a pulmonary embolism. Clots reached his heart. He then had a cardiac arrest. Then tested positive for Covid. He has severe & irreversible lung damage.
He's been kept alive for the last 15 weeks with ExtraCorporeal Membrane Oxygenation (ECMO). A machine transports blood from the body to an artificial lung (oxygenator) that, like the human lungs, adds oxygen and removes carbon dioxide.
Read 39 tweets
1/ End of Life in #COVID19...
yesterday I was removing life support from a patient, according to his wishes as stated by his wife, to convert the goals of care to comfort measures only. I took some time in the room alone with him & considered...
@pallipulm #palliativecare
2/ just for a moment all the very difficult & also excellent things that happened in my own life that no one else understood. Then I looked at my patient & realized he had just as many highs & lows that only he knew. Here was an infinite treasure of a person...
#MedTwitter #Nurse
3/ and the actions I was about to take would allow his life to come to a peaceful natural end. I committed to do everything I could for him to make sure he didn’t suffer as he sauntered out of life. What a privilege & honor to be allowed to enter into the miracle of him...
Read 7 tweets
I WISH that I had good news to share with you all but sadly I don't. The #palliativecare doctor said he only treats end of life or #cancer pain & I am once again thrown back in the water like nasty stinky unwanted chum.
He said that I shouldn't be removed off Rx #opioids & in his opinion the the forced wean is too aggressive. I happened to have a horrible #crps attack so he got to literally see what that looks like. It's not pretty.
WHY are patients forced to go through this much shit in order to get basic care? I 100% feel discriminated against & it isn't ok. He did say that he was going to call my doctor tomorrow & speak to them directly to see if he can convince them to keep me on or adjust my meds.
Read 13 tweets
This is NOT a reason to choose Medical Aid in Dying. You haven’t run out of options. I STRONGLY suggest talking to someone and working on your #Mentalhealth

*I am NOT making light of this tweet*

I was in the same headspace not too long ago. Please read this @LibbyMbc
Following the deaths of VERY close #MBC friends, coupled with the pandemic, I felt the same way you do now. I was deeply depressed. My #palliativecare team had me speak with a therapist who specializes in people w Cancer.

Mind you I was already on an antidepressant....
I gave her every reason I rationalized why giving up was the answer. My son was old enough -he didn’t “need me” I would end up a burden. My parents are older- It would be easier if I wasn’t “a problem” My husband would be happier w/o me. At the time these were VALID in my head
Read 7 tweets
Ageism + racism = poor #quality, unsafe care

add sexism for older WOC

Elders of color face everything white elders do: bias, ridicule, exclusion, being devalued, seen as a liability

plus racism, xenophobia

I was a fierce advocate for my mom vs above

@TheIHI @MinorityHealth
It was my geriatrician & #palliativecare friends who told me I needed to protect my mom vs the system & they were right

You don’t get to be a daughter or grieving daughter. You don’t get to fall apart or have visible emotions

You have to stay a strong, aware, strategic WOC
@threadreaderapp please unroll
Read 3 tweets
Only order tests when it will affect clinical decisions! The routine ordering of tests increases health care costs, doesn’t benefit patients and may in fact harm them.

#FOAMed #MedEd #medtwitter #zentensivist
Transfusing RBCs at a threshold of 7 g/dL is associated with similar or improved survival, fewer complications and reduced costs compared to higher transfusion triggers.

#FOAMed #MedEd #medtwitter #zentensivist
Read 6 tweets
Patients are my greatest teachers & recently I’ve had a patient unexpectedly become one of my biggest cheerleaders - a 🧵

Over the past few mths, I’ve been providing #PalliCare to a patient whose elderly body is ailing them while their mind remains extraordinary & vibrant. 1/
During our visits at their home, I’ve learned that they immigrated to Canada bringing with them diverse life experiences, spending their adult lifetime in academia. They live alone, so upon realizing how big of a nerd I am, they have generously shared their passions & slivers 2/
of their vast knowledge & wisdom with me. Even assigning me homework! Each visit I leave inspired, wishing I had taken notes during these precious conversations. It is an incredible honour to share time with them caring for their body/mind/spirit. I always look forward to it. 3/
Read 9 tweets
Throughout December I'm doing a #PalliativeCareAdvent; every day I am going to challenge #misconceptions about #PalliativeCare, #EndOfLife and living with a #LifeLimitingIllness. Some personal, some factual. Do join me!
#Hospice #EOLC #PallMedEd #HPM

lucy-watts.co.uk/palliative-car… Image
Day 1
"#PalliativeCare is only for those who are imminently dying".

Palliative care can help people throughout their illness, from point of diagnosis. It can help people live well, live longer and focus treatment/care around their wishes.
#PalliativeCareAdvent #Misconceptions Image
Day 2
"#PalliativeCare can only occur in the absence of life-prolonging interventions"

It can be given during life-prolonging treatment or in the absence of it. It's about quality of life, symptom control, the person's wishes and preparing for the future. #PalliativeCareAdvent Image
Read 27 tweets
🆕global strategy to accelerate the elimination of #CervicalCancer launched today.

It rests on 3 🔑 pillars:
✅Prevention through HPV vaccination
✅Screening & treatment of precancerous lesions
✅Treatment & palliative care for invasive cervical cancer

👉bit.ly/38Qc6GV
Vaccination of young adolescents against Human Papillomavirus (HPV) is safe and prevents #CervicalCancer.

HPV is the cause of cervical #cancer and is the most common sexually transmitted infection.

👉 bit.ly/2QLlUW7

#VaccinesWork
#CervicalCancer can be prevented.
#CervicalCancer can be prevented.
#CervicalCancer can be prevented.
#CervicalCancer can be prevented.

In addition to vaccination, regular screening & treatment of precancerous lesions protects from #cancer.

👉 bit.ly/3jNWsOf
Read 8 tweets
Thank you to @BethDarnall for speaking at #Minnesota @MinnesotaDHS #Opioid Work Group mtg on Thursday: Spoke of importance of #patientcenteredcare, #patientconsent necessary if taper & strongly advised AGAINST force tapers & using pre-determined MME'S. #ChronicPain #NoOneSize
MN #opioid Work Group created Taper Guidance. It will be out 4 public comment soon. Some areas extremely problematic. Although it states NOT 2 taper solely 2 meet system or state policy; MN Quality Improvement requires Drs 2 meet MME thresholds = TAPER TO MEET STATE POLICY. 🤔
If #ChronicPain pt wants 2 try 2 taper from #opioid analgesics 4 any reason & CONSENTS, there needs 2 be safe way 2 do it. Problem throughout U.S, incl #Minnesota; is non-consensual tapering. Many experts, incl #addiction specialists, stress dangers & even state it's UNETHICAL.
Read 11 tweets
Grace Under Pressure: Addressing Conflict in Provisioning Care! With @navithadev, @DrMcCamey and @NnekaPhD! #CHEST2020
Trying something different: A panel discussion of different cases! #CHEST2020 #CHESTPalCare
Case 1: Patient with non-survivable brain injury. Family wants "everything done". #CHEST2020
Read 20 tweets
Palliative & End-of-Life Care in Ireland (pelci.ie) aims to inform policymakers & the general public.

We used @Altmetric to study research recognition in policy, mainstream media, social networks & Wikipedia.

@Altmetric Top 10 #palliativecare articles (thread):
#palliativecare research recognition in policy & media.

#1 most cited article (1356):

J Temel et al.
Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer
New England Journal of Medicine, August 2010
DOI: 10.1056/nejmoa1000678
nejm.org/doi/full/10.10…
#2 most cited article (997):

@petermay_tcd et al.

Economics of Palliative Care for Hospitalized Adults With Serious Illness
JAMA Internal Medicine, June 2018
DOI: 10.1001/jamainternmed.2018.0750
jamanetwork.com/journals/jamai…
Read 11 tweets
1/ ICU #diaries for Good #Death:
 
Especially at EOL, ICU #Diary is part of #A2Fbundle. My pt w/ home-hospice told me details recorded in #ICU by #nurse allowed her to decipher cryptic #delirium memories she was struggling with.

bit.ly/36DOtk3

#medtwitter #meded
2/ Then she told me of hours spent reading big-hearted comments others had written in her ICU diary, making her realize how much her life meant to others. It was a priceless gift to her at a critical juncture in what had a time of deep poverty in her life. #PalliativeCare
3/ ICU Diaries give family members at bedside a practical way of helping w/ loved one’s care & can help channel their worries in a focused way.
#criticalcare #pulmcc
Read 7 tweets
#PBM
Pharmacy Benefit Managers have undoubtedly created barriers 4 patients w #ChronicPain #intractablepain #PalliativeCare #RareDiseases w medical necessity for #opioid analgesics. Citing CDC GLs & going even further. This ex shows 67% decrease in Rxs.
benecardpbf.com/PBF/resources/…
All PBMs do something of this nature & plans vary. They should look for & prevent abuse & fraud, but as outlined in their own literature on policy, Benecard is absolutely interfering btw Drs & patients by using CDC GLs & unilateral decisions on what is appropriate for a patient.
Per CDC, based on their clarification of intent of #opioid guidelines; these policies meet definition of misapplication & misinterpretation. Being as @CDCgov @CDCInjury neglects to intervene in official capacity; PBMs, #healthcare insurance companies will continue this practice.
Read 5 tweets
Once again the conversation has started about whether we should change the name “palliative care.”

I appreciate the rationale including points made in a recent @washingtonpost article.

Allow me to present a counterpoint.

A 🧵, with videos:

#hapc #pedpc #MedEd #scicomm

1/
Yes, fear of palliative care comes from an association in some people’s minds with death.

As many including @SoniaMKhunkhun @anandiyermd @ctsinclair have pointed out, that is likely a failure of education and due to a cultural fear of death itself, not palliative care.

2/
When we conflate the scary thing with something that can help with the scary thing we risk missing a big opportunity for support.

As I’ve said before, it’s like confusing the fire with the fire department:

3/

Read 11 tweets

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