Publications by authors named "Christopher A Jones"

77 Publications

Top Ten Tips Palliative Care Clinicians Should Know About Trauma and Emergency Surgery.

J Palliat Med 2021 Jul;24(7):1072-1077

Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.

There is growing interest in, and need for, integrating palliative care (PC) into the care of patients undergoing emergency surgery and those with traumatic injury. Thus, PC consults for these populations will likely grow in the coming years. Understanding the nuances and unique characteristics of these two acutely ill populations will improve the care that PC clinicians can provide. Using a modified Delphi technique, this article offers 10 tips that experts in the field, based on their broad clinical experience, believe PC clinicians should know about the care of trauma and emergency surgery patients.
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http://dx.doi.org/10.1089/jpm.2021.0158DOI Listing
July 2021

Top Ten Tips Palliative Care Clinicians Should Know About Seizures at the End of Life.

J Palliat Med 2021 May 30;24(5):760-766. Epub 2021 Mar 30.

Department of General Internal Medicine and Palliative Care, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.

Seizures are physically burdensome and emotionally distressing for patients, families, caregivers, and clinicians. Patients with neurological diseases are at increased risk of having complex, difficult-to-control seizures at the end of life. Palliative care (PC) clinicians asked to provide management of these seizures may not be familiar or comfortable with more complex seizures or epilepsy. A team of neurologists and PC specialists have compiled a list of tips to guide clinicians on how to care for patients having seizures and to support their families/caregivers.
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http://dx.doi.org/10.1089/jpm.2021.0096DOI Listing
May 2021

Top Ten Tips Palliative Care Clinicians Should Know About End-Stage Liver Disease.

J Palliat Med 2021 Jun 16;24(6):924-931. Epub 2021 Mar 16.

Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

End-stage liver disease (ESLD) is an increasingly prevalent condition with high morbidity and mortality, especially for those ineligible for liver transplantation. Patients with ESLD, along with their family caregivers, have significant needs related to their quality of life, and there is increasing attention being paid to integration of palliative care (PC) principles into routine care throughout the disease spectrum. To provide upstream care for these patients and their family caregivers, it is essential for PC providers to understand their complex psychosocial and physical needs and to be aware of the unique challenges around medical decision making and end-of-life care for this patient population. This article, written by a team of liver and PC experts, shares 10 high-yield tips to help PC clinicians provide better care for patients with advanced liver disease.
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http://dx.doi.org/10.1089/jpm.2021.0097DOI Listing
June 2021

From Alleviating Suffering to Avoiding Addiction: A Call to Action to Evaluate and Mitigate Risk in Outpatient Specialty Palliative Care.

J Palliat Med 2021 03;24(3):316-317

Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.

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http://dx.doi.org/10.1089/jpm.2021.0008DOI Listing
March 2021

Top Ten Tips Palliative Care Clinicians Should Know About Medical Decision-Making Capacity Assessment.

J Palliat Med 2021 04 16;24(4):599-604. Epub 2021 Feb 16.

Division of Pediatric Palliative Care, Oregon Health and Science University, Portland, Oregon, USA.

Palliative care (PC) clinicians treat seriously ill patients who are at increased risk for compromised decision-making capacity (DMC). These patients face profound and complex questions about which treatments to accept and which to decline. PC clinicians, therefore, have the especially difficult task of performing thorough, fair, and accurate DMC assessments in the face of the complex effects of terminal illness, which may be complicated by fluctuating acute medical conditions, mental illness, or cognitive dysfunction. This study, written by a team of clinicians with expertise in PC, ethics, psychiatry, pediatrics, and geriatrics, aims to provide expert guidance to PC clinicians on best practice for complex DMC assessment.
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http://dx.doi.org/10.1089/jpm.2021.0022DOI Listing
April 2021

COPING With a New Normal: Navigating the Return to Society for Older Adults With Dementia and Their Caregivers.

J Palliat Care 2021 Jan 12:825859720984567. Epub 2021 Jan 12.

Department of Medicine and Palliative and Advanced Illness Research Center, 14640University of Pennsylvania, Philadelphia, PA, USA.

COVID-19 has stressed the healthcare system in ways our society has not seen before. Less visibly, elderly patients and their caregivers have been stressed as well, both by the virus and by the public health measures required to slow its spread. After months of isolating, patients with dementia and their caregivers are worried about reentering a society with different rules and expectations. Although an extremely complex topic, the re-entry of individuals with cognitive impairment back into society is critical for both the wellbeing of the person as well as the caregiver. Successful re-entry into society will vary based on a person's interests and baseline cognition, however, the ability to participate in activities and events that previously provided joy and stimulation is the first step. This paper, written by practicing geriatricians and palliative clinicians, offers some concrete counseling strategies and tips for caregivers to help navigate re-entry into society with their loved ones.
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http://dx.doi.org/10.1177/0825859720984567DOI Listing
January 2021

Top Ten Tips Palliative Care Clinicians Should Know About Teaching Trainees How to Conduct a Family Meeting.

J Palliat Med 2021 02 11;24(2):267-272. Epub 2020 Dec 11.

Department of Internal Medicine, Division of General Internal Medicine, Geriatrics and Palliative Care, Medical University of South Carolina, Charleston, South Carolina, USA.

The family meeting is an essential component of effective palliative care (PC); however, medical students and junior doctors-in-training often consider leading a family meeting to be a daunting task. The old "see one, do one, teach one" axiom should not apply in preparing trainees to conduct a family meeting. After a review of the literature on established PC curricula, trainee perceptions of their PC educational experiences, and documented educational interventions in preparing trainees to conduct a family meeting, we have compiled a list of 10 tips for clinical educators to consider in assisting their students to feel better equipped to conduct productive family meetings.
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http://dx.doi.org/10.1089/jpm.2020.0687DOI Listing
February 2021

Validation of the Neuropsychological Assessment Battery Screening Module (NAB-SM) in patients with traumatic brain injury.

Appl Neuropsychol Adult 2020 Dec 7:1-9. Epub 2020 Dec 7.

Deparmtent of Clinical Neuropsychology, University Hospitals Birmingham NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland.

This study cross-validates the screening module of the Neuropsychological Assessment Battery (NAB-SM) with a battery of well validated neuropsychological tests (Convergent Validity Test Battery: CVTB) in a Traumatic Brain Injury (TBI) population. Forty-four participants with "mild-complicated" to "severe" TBI were recruited from a cohort of patients attending an outpatient clinic at a UK major trauma center. The NAB-SM Total Index score and an abbreviated short-form, from which a TBI Index was derived, both showed good classification accuracy in predicting impairment as measured by the CVTB mean score. These indices also accurately identified impairment as defined by the base rate of low scores across individual CVTB indices measuring mental processing speed, working memory, memory and executive functioning. The NAB-SM and its derived TBI index therefore have significant utility as a cognitive screening tool for use in either inpatient (acute) or outpatient TBI populations.
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http://dx.doi.org/10.1080/23279095.2020.1852237DOI Listing
December 2020

A Multicenter Qualitative Analysis of Medical Student Narratives After a Palliative Care Elective.

Am J Hosp Palliat Care 2020 Nov 4:1049909120971565. Epub 2020 Nov 4.

Section of Supportive and Palliative Medicine, Department of Medicine, UT Southwestern Medical School, Dallas, TX, USA.

Background: The medical student experience of a clinical elective in palliative care (PC) remains understudied. Reflective narrative interventions can help students hone narrative competency skills, make sense of their clinical experiences and shed light on their perception of the rotation.

Objectives: To evaluate medical student written reflections after a PC clinical elective.

Design: Students were asked to write a short reflective essay after PC clinical electives using open-ended writing prompts.

Setting: Essays were collected from third and fourth-year medical students after completion of a PC elective at three geographically diverse academic medical centers in the United States.

Measurements: Essays were coded for themes using a conventional content qualitative method of analysis.

Results: Thirty-four essays were analyzed and four major themes emerged: reflection on the mission of medicine or motivation for being in medicine, reflection on professional skills or lessons learned, reflection on patient's experience and personal responses to PC rotation. Sub-themes were also identified.

Conclusions: Themes underscore the utility of the PC clinical elective as a meaningful experience that imparts useful skills, builds empathy, reminds students of their own motivations for being in medicine and serves as a catalyst for reflection on their own lives and relationships with their patients. Awareness of medical students' personal and emotional responses to a PC elective can help inform educators as they support their students and provide opportunities for reflection and education.
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http://dx.doi.org/10.1177/1049909120971565DOI Listing
November 2020

Top Ten Tips Palliative Care Clinicians Should Know About Caring for Jewish Patients.

J Palliat Med 2020 12 21;23(12):1658-1661. Epub 2020 Oct 21.

Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA.

Judaism, one of the world's oldest religions, claims an estimated 14.3 million members worldwide. There is great diversity in terms of identity, practice, and belief among people who identify as Jewish. As of 2017, 40% of the global Jewish community resided in the United States, making it essential for palliative care clinicians to understand religious and cultural issues related to their serious illness care. In this article, we will discuss 10 important concepts relevant to the inpatient care, advance care planning, and bereavement needs of Jewish patients and families.
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http://dx.doi.org/10.1089/jpm.2020.0601DOI Listing
December 2020

Top Ten Tips Palliative Care Clinicians Should Know About Cognitive Impairment and Institutional Care.

J Palliat Med 2020 11 21;23(11):1525-1531. Epub 2020 Sep 21.

Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.

Most long-term care (LTC) residents are of age >65 years and have multiple chronic health conditions affecting their cognitive and physical functioning. Although some individuals in nursing homes return home after receiving therapy services, most will remain in a LTC facility until their deaths. This article seeks to provide guidance on how to assess and effectively select treatment for delirium, behavioral and psychological symptoms for patients with dementia, and address other common challenges such as advanced care planning, decision-making capacity, and artificial hydration at the end of life. To do so, we draw upon a team of physicians with training in various backgrounds such as geriatrics, palliative medicine, neurology, and psychiatry to shed light on those important topics in the following "Top 10" tips.
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http://dx.doi.org/10.1089/jpm.2020.0552DOI Listing
November 2020

Terminal agitation and delirium in patients with cancer.

Lancet Oncol 2020 09;21(9):e410

Department of Geriatric Psychiatry, University Hospital of Psychiatry, Zurich, Switzerland; Dynamics of Healthy Aging University Research Priority Programme, University of Zurich, Zurich, Switzerland.

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http://dx.doi.org/10.1016/S1470-2045(20)30439-3DOI Listing
September 2020

Palliative Care for Trauma Patients: Today and into the Next Decade.

J Palliat Med 2020 09 8;23(9):1147-1148. Epub 2020 Jun 8.

Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

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http://dx.doi.org/10.1089/jpm.2020.0156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869872PMC
September 2020

Top Ten Tips Palliative Care Clinicians Should Know About Interventional Pain and Procedures.

J Palliat Med 2020 10 27;23(10):1386-1391. Epub 2020 Aug 27.

Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA.

Pain is a common symptom for patients with advanced illness. Palliative care (PC) clinicians are experts in pharmacologic and nonpharmacologic treatment of pain and other symptoms for these patients. True multimodal pain control should include consideration of interventional procedures and pumps to improve difficult-to-manage pain. This article, written by clinicians with expertise in interventional pain and PC, outlines and explains many of the adjunctive and interventional therapies that can be considered for patients with pain in the setting of serious illness. Only by understanding and considering all available options can we ensure that our patients are receiving optimal care.
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http://dx.doi.org/10.1089/jpm.2020.0487DOI Listing
October 2020

Patient-Centric Structural Determinants of Adherence Rates Among Asthma Populations: Exploring the Potential of Patient Activation and Encouragement Tool TRUSTR to Improve Adherence.

J Health Econ Outcomes Res 2020 15;7(2):111-122. Epub 2020 Jul 15.

trUSX, Inc., South Burlington, VT, USA.

Background: Lack of adherence with prescribed medications among the asthma populations exacerbates health outcomes and increases social and economic costs.

Objectives: The proposed study aims to model patient-centric structural determinants of adherence rates among asthma patients and explore the potential of mobile health apps such as the TRUSTR platform to improve adherence using its power of monetary and non-monetary chatbotting and non-non-monetary nudges. Following specific hypotheses are tested: (1) Patient attributes, such as their age and monetary medical condition, have significant effect on their adherence with the prescribed treatment plans. (2) Behavioral nudging with rewards and engagement via mobile health apps will increase adherence rates.

Methods: The patient population (N = 37 359) consists of commercially insured patients with asthma who have been identified from administrative claims in the HealthCore Integrated Research Database (HIRD) between April 1, 2018 and March 31, 2019. Two Structural Equation Models (SEMs) are estimated to quantify direct, indirect, and total effect sizes of age and medical condition on proportion of days covered (PDC) and medical possession ratio (MPR), mediated by patient medical and pharmacy visits. Fourteen additional SEMs were estimated to lateralize TRUSTR findings and conduct sensitivity analysis.

Results: HIRD data reveal mean adherence rate of 59% (standard deviation (SD) 29%) for PDC and 58% for MPR (SD 36%). Key structural findings from SEMs derived from the HIRD dataset indicate that each additional year in the age of the patient has a positive total effect on the adherence rate. Patients with poor medical condition are likely to have lower adherence rate, but this direct effect is countered by mediating variables. Further, each additional reward and higher engagement with a mobile app is likely to have a positive total effect on increasing the adherence rate.

Conclusions: HIRD data reveal mean adherence rate of 59% (SD 29%), providing the evidence for the opportunity to increase adherence rate by around 40%. Statistical modeling results reveal structural determinants, such as the opportunity to nudge, are higher among younger patients, as they have higher probability of being non-adherent. Methodologically, lateralization approach demonstrates the potential to capture real-world evidence beyond clinical data and merge it with clinical data.
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http://dx.doi.org/10.36469/jheor.2020.13607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398613PMC
July 2020

Top Ten Tips Palliative Care Clinicians Should Know About Opioid Use Disorder.

J Palliat Med 2020 09 21;23(9):1250-1256. Epub 2020 Jul 21.

Division of Geriatrics and Palliative Care, Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.

Since the prevalence of substance use disorders, and opioid use disorder (OUD) specifically, remains high and represents a public health crisis, it is critical that palliative care (PC) providers have a broad understanding of this class of chronic, yet treatable, diseases. Conceptualizing stigma associated with OUD, treatment modalities available, and educational opportunities are key factors in providing patient-centered care. A solid foundation of knowledge about OUD in the setting of serious illness is also crucial as PC providers often recommend or prescribe opioids for symptom management in patients who also have OUD. Furthermore, the PC interdisciplinary team is particularly well poised to care for patients suffering from OUD due to the inherently holistic approach already present in the specialty of PC. This article offers PC teams a framework for understanding the diagnosis and treatment of OUD, methods for performing risk stratification and monitoring, and an overview of opportunities to enhance our care of PC patients with OUD.
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http://dx.doi.org/10.1089/jpm.2020.0409DOI Listing
September 2020

Top Ten Tips Palliative Care Clinicians Should Know About Bereavement and Grief.

J Palliat Med 2020 08 2;23(8):1098-1103. Epub 2020 Jul 2.

Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.

Palliative care (PC) focuses on caring for the whole person, from birth to death, while managing symptoms and helping to navigate medical complexities. Care does not stop at the time of death, however, as assisting patients, families, and fellow clinicians through grief and bereavement is within PC's purview. Unfortunately, many clinicians feel unprepared to deal with these topics. In this article, PC and hospice clinicians define and explain bereavement, distinguish normative grief from pathological grief, offer psychometrically sound scales to screen and follow those suffering from grief, and discuss the interaction between grief and bereavement and the physical and mental health of those who are left behind after the death of a loved one.
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http://dx.doi.org/10.1089/jpm.2020.0341DOI Listing
August 2020

Six feet apart or six feet under: The impact of COVID-19 on the Black community.

Death Stud 2020 Jul 1:1-11. Epub 2020 Jul 1.

Roosevelt Perry Elementary School, Jefferson County Public Schools, Louisville, Kentucky, USA.

To date, 110,000+ people in the United States have died from the COVID-19 pandemic. In this paper, the authors will discuss COVID-19 relative to Black people and their overrepresentation among those who are infected and died from the disease. Their dying, death, and grief experiences are explored through a cultural and spiritual lens. The physical distancing, social isolation, misinformation, and restrictive burials and cremations now elicited by this unprecedented pandemic have had diminished familial, cultural, emotional, and economic impacts on the Black community. Implications for public health and Black peoples' involvement in the political process are also addressed.
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http://dx.doi.org/10.1080/07481187.2020.1785053DOI Listing
July 2020

Ethical Challenges in Care of Patients on Mechanical Circulatory Support at End-of-Life.

Curr Heart Fail Rep 2020 08;17(4):153-160

Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Purpose Of Review: Although the utilization of mechanical circulatory support (MCS) devices is increasing, ethical dilemmas regarding device deactivation and dying process persist, potentially complicating delivery of optimal and compassionate care at end-of-life (EOL). This review aims to study EOL challenges, left ventricular assist devices (LVADs) as a nuanced life support treatment, legal history in the US impacting EOL care, and suggestions to improve EOL care for patients on MCS support.

Recent Findings: Recent studies have demonstrated challenging aspects of EOL care for patients on LVAD support: low use of advanced directives, high rates of surrogate decision-making due to lack of patient capacity, difficult decision-making involving LVAD deactivation even with cooperating patients, and high rates of death in the hospital and ICU settings. Recent studies also suggest lack of consensus even among clinicians in approaching LVAD deactivation as beliefs equating LVAD deactivation with physician-assisted suicide and/or euthanasia remain. Optimal care at EOL will likely require collaborative efforts among multiple specialties, caregivers, and patients. In light of the complex medical, logistical, and ethical challenges in EOL care for LVAD patients, there is room for improvement by multidisciplinary efforts to reach consensus about LVAD deactivation and best practices for EOL care, development and implementation of LVAD-specific advance planning, and protocols for LVAD deactivation. Programmatic involvement of hospice and palliative care in the continuum of care of LVAD patients has the potential to increase and improve advance care planning, support surrogate decision-making, improve EOL compassionate care, and to support caregivers.
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http://dx.doi.org/10.1007/s11897-020-00460-4DOI Listing
August 2020

Maintaining Our Humanity Through the Mask: Mindful Communication During COVID-19.

J Am Geriatr Soc 2020 05 24;68(5):E12-E13. Epub 2020 Apr 24.

Department of Medicine and Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1111/jgs.16488DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262056PMC
May 2020

Top Ten Tips Palliative Care Clinicians Should Know About Amyotrophic Lateral Sclerosis.

J Palliat Med 2020 06 26;23(6):842-847. Epub 2020 Feb 26.

Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive and fatal neurodegenerative disorder with enormous palliative care (PC) needs that begin at the time of diagnosis. Although it is an uncommon disease, clinicians who work in PC or hospice are likely to encounter ALS somewhat frequently given the needs of patients with ALS with regard to psychosocial support, symptom management, advance care planning (ACP), caregiver support, and end-of-life care. As such, PC clinicians should be familiar with the basic principles of ALS symptoms, treatments, disease course, and issues around ACP. This article, written by a team of neurologists and PC physicians, seeks to provide PC clinicians with tips to improve their comfort and skills caring for patients with ALS and their families.
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http://dx.doi.org/10.1089/jpm.2020.0046DOI Listing
June 2020

Top Ten Tips Palliative Care Clinicians Should Know About Caring for Serious Illness in Pregnancy.

J Palliat Med 2020 05 10;23(5):712-718. Epub 2020 Jan 10.

Department of Medicine and the Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Palliative care (PC) teams are increasingly being called upon to provide care earlier and more remote from end of life. Because much of the field has grown out of hospice and geriatric care, most teams have little to no experience caring for pregnant women or their fetuses when serious or life-threatening illness strikes. This article, written by a team of oncologists (gynecologic, medical, and radiation) and PC providers, seeks to demystify the care of seriously ill pregnant women and their fetuses by exploring the diagnostic, treatment, prognostication, symptom management, and communication needs of these patients. Truly comprehensive PC extends throughout the life span, from conception to death, regardless of age. Accordingly, increased knowledge of the unique needs of these vulnerable groups will enhance our ability to provide care across this continuum.
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http://dx.doi.org/10.1089/jpm.2019.0651DOI Listing
May 2020

Top Ten Tips Palliative Care Clinicians Should Know About Psychosocial and Family Support.

J Palliat Med 2020 02 5;23(2):280-286. Epub 2019 Nov 5.

Department of Medicine, Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.

Palliative care (PC) is perhaps the most inherently interdisciplinary specialty within health care. Comprehensive PC is delivered by a core team of physicians, nurses, social workers, spiritual care providers, pharmacists, and others who address the broad range of medical, psychosocial, and spiritual needs of those living with serious illness. While PC clinicians are typically skilled in screening for distress, the best path to follow when patients screen positive for psychosocial distress or exhibit mental health challenges may not always be clear. This article brings together the perspectives of experienced social workers practicing across PC and hospice settings. It seeks to identify opportunities and rationale for the integration of palliative social work (PSW) in the provision of quality, person-centered, family-focused, and culturally congruent care for the seriously ill. Increasing recognition of the impact of social determinants of health highlights the critical importance of including PSW if we are to better understand and ultimately address the broad range of factors that influence people's quality of life.
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http://dx.doi.org/10.1089/jpm.2019.0506DOI Listing
February 2020

Top Ten Tips Palliative Care Clinicians Should Know When Caring for Patients with Brain Cancer.

J Palliat Med 2020 03 15;23(3):415-421. Epub 2019 Oct 15.

Department of Medicine and the Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.

The diagnosis of an aggressive, primary brain tumor is life altering for those affected and too often portends a poor prognosis. Despite decades of research, neither a cure nor even a therapy that reliably and dramatically prolongs survival has been found. Fortunately, there are a number of treatments that may prolong the life of select brain tumor patients although the symptom burden can sometimes be high. This article brings together neuro-oncologists, neurologists, and palliative care (PC) physicians to help shine a light on these diseases, their genetics, treatment options, and the symptoms likely to be encountered both from the underlying illness and its treatment. We hope to increase the understanding that PC teams have around these illnesses to improve care for patients and families.
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http://dx.doi.org/10.1089/jpm.2019.0507DOI Listing
March 2020

Top Ten Tips Palliative Care Clinicians Should Know About Physical Medicine and Rehabilitation.

J Palliat Med 2020 01 26;23(1):129-135. Epub 2019 Sep 26.

Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Physical medicine and rehabilitation (PM&R) is a specialty of medicine focused on optimizing function and quality of life for individuals with physical impairments, injuries, or disabling illnesses. Given the sometimes acute nature of the loss of function and even loss of independence, there are significant palliative care (PC) needs within patients seen by PM&R. This article, written by a team of PM&R and PC specialists, aims to help the PC team better understand the world of postacute care, expand their toolkit for treating musculoskeletal and neurological symptoms, improve prognostication for patients with brain and spinal cord injuries, and decide when patients may benefit from PM&R consultation and support. There is significant overlap between the populations treated by PM&R and PC. Better integration between these specialties will help patients to maintain independence as well as advance excellent patient-centered care.
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http://dx.doi.org/10.1089/jpm.2019.0440DOI Listing
January 2020

Top Ten Tips Palliative Care Clinicians Should Know About Caring for Patients with Hematologic Malignancies.

J Palliat Med 2019 11 19;22(11):1449-1454. Epub 2019 Jul 19.

Duke Cancer Institute, Durham, North Carolina.

Hematologic malignancies differ in several important ways from solid organ cancers, and warrant a unique approach to palliative care (PC) integration. As PC has moved upstream from end-of-life care, PC clinicians are increasingly asked to see patients with hematologic malignancies. Unfortunately, many PC specialists have limited knowledge of these diseases, and have had few prior opportunities to participate in their care. This article, written by hematologic oncologists and PC specialists, seeks to educate PC teams about the unique features of hematologic malignancies, to inform effective integration of PC into the care of these patients, their caregivers, and treating hematologists.
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http://dx.doi.org/10.1089/jpm.2019.0332DOI Listing
November 2019

Top Ten Tips Palliative Care Clinicians Should Know About Telepalliative Care.

J Palliat Med 2019 08 25;22(8):981-985. Epub 2019 Jun 25.

9Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.

The field of telehealth is rapidly growing and evolving across medical specialties and health care settings. While additional data are needed, telepalliative care (the application of telehealth technologies to palliative care) may help address important challenges inherent to our specialty, such as geography and clinician staffing; the burden of traveling to brick-and-mortar clinics for patients who are symptomatic and/or functionally limited; and the timely assessment and management of symptoms. Telepalliative care can take many forms, including, but not limited to, video visits between clinicians and patients, smartphone applications to promote caregiver well-being, and remote patient symptom-monitoring programs. This article, created by experts in telehealth and palliative care, provides a review of the current evidence for telepalliative care and potential applications and practical tips for using the technology.
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http://dx.doi.org/10.1089/jpm.2019.0278DOI Listing
August 2019

Top Ten Tips Palliative Care Providers Should Know About Caring for Veterans.

J Palliat Med 2019 Jun;22(6):708-713

3 Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Many of America's Veterans have unique medical and psychosocial needs related to their military service. Since most medical care received by Veterans occurs outside of the Department of Veterans Affairs (VA) health care system, it is imperative that all medical providers have a working understanding of the unique needs of Veterans and some of the many programs and services available to Veterans through the VA. This article, created by an interdisciplinary team of palliative care and hospice providers who care for Veterans throughout the country, seeks to improve the comfort with which non-VA clinicians care for Veterans while increasing knowledge about programs for which Veterans might qualify through the VA.
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http://dx.doi.org/10.1089/jpm.2019.0190DOI Listing
June 2019

A 360-degree assessment of teaching effectiveness using a structured-videorecorded observed teaching exercise for faculty development.

Med Educ Online 2019 Dec;24(1):1596708

d Department of Internal Medicine, Section on Gerontology and Geriatric Medicine , Wake Forest School of Medicine , Winston-Salem , NC , USA.

Background: Filming teaching sessions were reported in the medical literature in the 1980s and 1990s but appear to have been an underreported and/or underutilized teaching tool since that time. National faculty development programs, such as the Harvard Macy Institute (HMI) Program for Educators in Health Professions and the Stanford Faculty Development Center for Medical Teachers program, have attempted to bridge this gap in formal instruction in teaching skills through microteaching sessions involving videos for self- and peer-assessment and feedback.

Objective: Current video-feedback faculty development initiatives are time intensive and impractical to implement broadly at an institutional level. Further, results of peer feedback have not been frequently reported in the literature at the institutional level. Our research aims to propose a convenient and effective process for incorporating video analysis into faculty devleopment programs.

Design: Our work describes a novel technique using video-recorded, simulated teaching exercises to compile multi-dimensional feedback as an aid in faculty development programs that promote teaching-skill development. This research evaluated the effectiveness of a focused teaching practicum designed for faculty in multiple specialty departments with large numbers of older patients into a geriatrics-based faculty development program. Effectiveness of the practicum is evaluated using quantitative scoring and qualitative analysis of self-reflection as well as peer and trainee input.

Results: VOTE sessions demonstrate an important exportable product which enable faculty to receive a detailed 360-degree assessment of their teaching.

Conclusion: This intervention can be easily replicated and revised, as needed, to fit into the educational curriculum at other academic medical centers.
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http://dx.doi.org/10.1080/10872981.2019.1596708DOI Listing
December 2019

Top Ten Tips Palliative Care Clinicians Should Know About Psychopharmacology.

J Palliat Med 2019 May 29;22(5):572-579. Epub 2019 Mar 29.

1 Section of Palliative Medicine, Duke University School of Medicine, Durham, North Carolina.

Palliative care (PC) providers often prescribe psychotropic medications to address psychological and physical suffering of patients with serious medical illness. Consideration must be given to the significant medical comorbidities of the patient when selecting a medication. This article seeks to provide guidance on how to safely and effectively select a psychotropic agent for depression, anxiety, and other distressing symptoms for patients with serious illness. To do so, we draw upon a team of physicians and a pharmacist with training in psychiatry and PC to highlight the "Top 10" tips for selecting a psychotropic medication to provide relief for patients with serious medical illness.
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Source
http://dx.doi.org/10.1089/jpm.2019.0106DOI Listing
May 2019