In this episode Dr. Wyatt shares some ideas for helping others during this holiday season. The best antidote to despair is to care for someone else!
If you’d like to support this podcast and the End-of-Life University Interview Series you can visit our donation page at Patreon.com/eolu.
Here are some suggestions for reaching out to others in need during the holidays:
Visit a patient in a nursing home or long-term care facility
Bring music to a nursing facility with a choir or band
Visit an elderly neighbor in their home
Take a meal to a shut-in
Help elderly patients address holiday cards
Put up holiday decorations for a frail or ill person
Care for a pet for a hospice patient
Shovel snow for an elderly neighbor
Prepare a meal for a grieving family
Read holiday stories to patients at a nursing home
Help a hospice patient find gifts to give to loved ones
Provide childcare for a family dealing with grief or illness
No matter how you spend the upcoming holidays (Winter Solstice, Christmas, Hannukah, Kwanza), or with whom you celebrate, may you have an abundance of light and joy and love in your life. Many blessings to you and those you love!
In this episode Dr. Wyatt thanks her latest supporter on Patreon.com/eolu, Suzanne O’Brien RN, founder of Doulagivers. If you would like to help support this podcast and End-of-Life University Interview Series for the small contribution of $1 or $2 per month, go to Patreon.com/eolu and sign up to become a supporter!
In other personal news, Dr. Wyatt just reached the 50,000 word goal on her novel-writing challenge for the month of November! Stay tuned for more information on Starry Night, a novel about living and dying!
Go to DeathExpo.com if you are interested in getting the downloadable filed from Death Expo 2016. Tune in to Episode 65 to hear the highlights and take-aways from this fantastic educational event!
Next Dr. Wyatt shares the latest news and information about end-of-life issues that caught her eye during the month of November:
Survey of seniors in the U.S. shows that 27% have done absolutely no planning or preparing for the end of life. Those least likely to have prepared correlate with the following characteristics: age between 65-74, black or Hispanic, low-income, low education level, and diagnosis of Alzheimers.
Canadian study shows that for seniors who have completed Advance Directives, Values and Choices do not always align, showing a lack of guidance for choosing end-of-plans and confusion about basing choices on underlying values
a paper cited in the Journal of Pain and Symptom Management calls for improved consistency in honoring the EOL choices of patients in nursing homes and hospitals
Go Wish Card Game found helpful for patients completing their advance directives; helps them identify their values and priorities
Home-based Palliative Care shown to lower healthcare expenses in last year and 3 months of life, decrease hospital admissions and increase hospice utilizations. 87% of patients who receive palliative care at home are able to die at home, compared to only 24% of all Medicare patients who die at home
Review of 43 palliative care clinical studies shows that palliative care improves quality of life but does not extend life
UC Santa Cruz has started a program to pair pre-med students with hospice patients
Study shows doctors are reluctant to discontinue routine medications that are no longer indicated for their patients at the end of life due to lack of awareness, low priority, and fear of causing patient to feel abandoned
Colorado became 6th state in the U.S. to approved medically aided dying during the November election
AARP and the National Association of Area Agencies on Aging have a launched a campaign to identify seniors suffering with loneliness and isolation in order to connect them with community resources; 43% of seniors report loneliness which leads to medical consequences
new movie Collateral Beauty deals with grief and death and will be released on Dec. 16th
Canadian singer-songwriter Leonard Cohen died on November 7th at the age of 82
In this episode Dr. Karen Wyatt shares her favorite “take-aways” from the 12 presentations of the recent Death Expo event. If you missed Death Expo you can still purchase the recordings from the event for just $36 (which is a great price for 12 hours of education.) Go to this link to learn more.The speakers she highlights are:
Andrew George – LA photographer and creator of the “Right, before I die” photo series
Dr. Wyatt thanks her newest Patreon.com supporter Tracy Zagata. You can become a supporter as well by going to Patreon.com/eolu and signing up!
Sign up for Death Expo which will take place Nov. 10-13, and hear 12 speakers on EOL issues. Go to DeathExpo.com to register free to tune in to these excellent presentations.
This episode is taking place on Halloween and the Day of the Dead. Dr. Wyatt includes the following updates:
CMS report 52% increase in Medicare spending on hospice between 2007 and 2015 due to 38% increase in the number of patients receiving hospice care, primarily patients with dementia
the DEA is mandating 34% decrease in opioid production due to dramatic increase in opioid-related deaths since 1999 – rate has quadrupled during that time frame
JAMA Oncology reports that the cost of secobarbital, the drug most frequently prescribed in assisted dying cases, has increased by $25oo; there is no explanation except that drug companies can get away with it
California is the first state to require that palliative care teams have a chaplain for those patients who want to receive spiritual care
Debra Beaulieu writes in HealthLeaders Media that all clinicians should know the following about palliative care: 1) that it’s not just for dying patients 2) that it is often underutilized and 3) all clinicians should have basic palliative care skills
Study in J. Palliative Med showed that home-based palliative care (as opposed to hospital-based care) meets more of patients’ needs in the last 3 months of life and costs $12,000 less per patient
Controversial “doll therapy” for dementia patients
Study shows that 11% of female caregivers over the age of 50 have to leave their employment to fulfill caregiver duties, costing $300,000 in lost wages, benefits, and Social Security over time
Census data reveals that currently 25% of seniors are considered “Elder Orphans,” meaning that they have no children or close family to care for them; these numbers will only grow as Baby Boomers age, reinforcing the need for more caregivers
Medicare Care Choice Pilot Program is currently underway; patients can receive home-hospice care while continuing curative treatments if they have a diagnosis of cancer, COPD, CHF, or HIV; there are 140 participating hospices in the program
Survey shows that 1/2 of MS patients would consider medically assisted dying in the case of unbearable pain, being a financial burden to others, or if unable to enjoy what makes life worth living
Study reveals the 69% of MOLST or POLST forms have incomplete information and 14% have conflicting choices, making them nearly impossible for care providers to follow
the nation’s first conference on VSED was held in October at the Seattle U. School of Law and was featured in an article in the NY Times. Phyllis Shacter was a speaker – you can hear her EOLU interview in episode 25
Conversation Sabbath will take place November 11-20 with >30 congregations from various faiths participating; the focus will be on EOL conversations and theconversationproject.org will provide tools and resources for the event
Andrew Henderson, 28 year old performance artist who is terminally ill has created an art performance called Taking it to the Grave and will tattoo the secrets of his audience on his body before he dies
Miss Norma, the 90 year old woman who chose to go on a cross-country RV tour with her son and daughter-in-law rather than undergo treatment for cancer, has died
Have a safe and meaningful Day of the Dead! Tune in every Monday for a new episode and support EOLU at Patreon.com/eolu. Until next week remember to:
In this episode Dr. Wyatt begins by talking about Death Expo, a free online educational event,which is coming up on November 10-13, 2016! She describes the 12 speakers who will be presenting during the event. To sign up go to:
In this episode Dr. Karen Wyatt discusses the fact that according to the Nebraska End-of-Life Survey, even though 70% of patients surveyed want their doctors to discuss their end-of-life options but only 21% of them have actually had those conversations.
In addition, while 86% of doctors agree that they themselves would enroll in hospice if terminally ill, only 27% of them are comfortable discussing hospice as an option with terminally ill patients.
There is a huge disconnect between what patients want from their doctor and what they receive and also what doctors would do for themselves at the end-of-life and what they do for their patients.
Today’s conversation looks at reasons for this disconnect to point the way toward changes that are needed in how medicine approaches the end of life. Here are some of the attitudes and mindsets that make it difficult for some doctors to address death and dying, based on conversations between Dr. Wyatt and her colleagues:
“It’s not my job. My passion is for saving lives.” Ideally doctors must maintain their passion for life, but must also make room for death, since every patient will ultimately die. Doctors need to cultivate a view of life that includes the reality of death.
“I don’t have enough time and the end of life is less important than other issues I’m expected to discuss with patients.” The average primary care visit with an elderly patient last 15.7 minutes and covers 6 topics. Doctors need to view the end of life as the final stage of development and give it the same attention as the other stages of development.
“Death represents failure.” While death in general is a natural process and not a failure, for doctors the death of a patient can be a devastating experience, especially if it is unexpected. Doctors carry an enormous burden of responsibility for the health and wellbeing of their patients and mistakes can lead to complications and death. For doctors it is difficult to carry both responsibilities: to preserve life and promote health while also honoring death in its place.
“I don’t want to take away my patient’s hope.” Many doctors recognize that optimism and positivity are essential for a patient’s survival and wellbeing. But they view curative treatments as the source of that hope while failing to recognize that hope has many different meanings for patients. They promote ongoing treatment in order to keep hope alive while failing to offer emotional and spiritual support that can foster hope even in the face of death.
By recognizing the obstacles that keep doctors from engaging in end-of-life interactions with patients we can help overcome them over time. It’s important to have compassion for everyone involved as we try to move forward and evolve care at the end of life in our society.
You can support EOLU by making a small pledge of financial support ($1 or $2 per month) at Patreon.com/eolu. Be sure to tune in every Monday for a new episode, leave comments and write reviews on iTunes! Remember to:
Marggie Hatala – author and teacher of a writing class related to end of life; her books are “Sally: A Memoir” and the forthcoming “Life as Prayer”; learn more at www.marggiehatala.com
Next she begins the Update for September by talking about the new documentary film currently streaming on Neflix: Extremis, which won 1st place at the Tribeca Film Festival. Please see this film which takes place in the ICU at Highland Hospital in Oakland and features Dr. Jessica Nutik Zitter. This is a must-see film that brilliantly depicts the conundrum that exists at the end of life when painful decisions must be made. By showing the real-life conversations that take place in the ICU between staff, family members and patients, a case is made for everyone to complete their advance directives and prepare their loved ones to honor their wishes at the end of life. But the painful process of decision-making becomes apparent as each individual struggles with the unknown and the unknowable in these dire situations.
The other topics covered this month include:
BMJ Online report that patients who receive hospice care for the last 6 months of life have better pain control, fewer hospital days, and are less likely to die in the hospital or ICU.
Researchers at John Hopkins found that their palliative care program led to savings of ~ $19 million over 5 years in addition to improved quality of care and patient satisfaction.
Study originally published in Health Affairs and reported on Reuters online showed gaps in palliative care in the US. Read the article.
“What it feels like to die,” an article in The Atlantic discusses the active dying process from the patient’s perspective. Read the article.
Friends and Family Letter Project by Dr. VJ Periyakoil at Stanford includes 7 prompts for letter writers to leave messages for their loved ones. Read the article.
“7 Songs for a Long Life” documentary from Scotland that depicts how terminally ill patients use singing as therapy. Read the article.
The Friendly Atheist Julie Stahl reminds us not to impose our own religious or spiritual beliefs on those who are grieving and may not share your perspective. Read her blog.
Thanks for tuning in to the podcast! I hope you enjoy this information. If you feel inspired to offer a little support go to Patreon.com/eolu to join the community!