My awesome Spain trip is at an end as this episode airs and I’ll be making my way back to Colorado! You can check out all of my pictures on Instagram at kwyattmd!
Tune in next week to hear my stories from Spain!
In this presentation Stephanie Ryu will discuss her role as a chaplain on the palliative care team.
You will learn:
How the work of a palliative care chaplain differs from other chaplaincy work
The role of spiritual care in the whole-person approach to illness and healing
The importance of spirituality at the end of life
How chaplains assist patients of all religions and those who follow no religion
Stephanie Ryu is a graduate of St. Xavier University and Fuller Theological Seminary. She completed CPE Residency at Providence St. Joseph – Burbank in 2012-13 along with a 6-month fellowship in hospice and palliative care. She now serves as a Palliative Care Chaplain for Providence Health and Services.
In Part 3 of our series on palliative care I share an interview with Andrea Strouth MSW a social worker on the palliative care team. She’ll talk about her role on the team to help us understand why social workers play an important part in the care of patients with advanced illness.
At the time of this broadcast I’m still enjoying my Spain trip – probably eating some tapas in Barcelona! I’ll be returning home in a few weeks but meanwhile check out my photos on Instagram at kwyattmd!
In this presentation Andrea Strouth LCSW, MSW will discuss the role of the social worker on the palliative care team.
You will learn:
The duties of the palliative care team social worker
Why palliative patients might need social work services
How the multidisciplinary palliative care team functions as a unit
The rewards of working on a palliative care team
Andrea Strouthreceived her MSW from the University of Pennsylvania. She is currently working at Providence Health & Services-Southern California to help develop their outpatient palliative care program. Previously, Andrea worked at the Abramson Cancer Center at Penn Medicine and in the Medical and Cardiothoracic Intensive Care Units at Hahnemann University Hospital in Philadelphia, Pennsylvania. Her passion lies in advanced care planning and education surrounding end-of-life issues to ensure patients feel empowered in every aspect of their care.
Tune in next Monday for Part 4 of this series. If you find this content helpful please share it with other and consider leaving a review on iTunes! Also your contributions to my page at Patreon.com/eolu are always appreciated!
In Part 2 of our series on palliative care I share an interview with Rebekah Riemer a palliative care nurse. She’ll talk about her role on the team and why she decided to specialize in palliative care nursing.
My Spain trip continues this week as I visit more of Andalucia and take in some flamenco dancing. I’ll be returning home in a few weeks but meanwhile check out my photos on Instagram at kwyattmd!
In this presentation Rebekah Riemer RN will discuss the role of the nurse on the palliative care team and her own story of being called to work in palliative.
You will learn:
How Beka was introduced to palliative care as a family member of a patient and a patient herself
The typical duties of a palliative care nurse
How palliative care meets the physical, emotional and spiritual needs of patients and their families
The most common misperceptions about palliative care for the public and for healthcare providers
Rebekah “Beka” Riemer, RN, CCRN was an intensive care nurse for over eight years, working in surgical as well as medical ICUs and currently works as the Nurse Coordinator on the Inpatient Palliative Care Team at Providence Little Company of Mary in Torrance, California. She is on the team working towards the recertification of the Joint Commission’s Advanced Certification for Palliative Care. She serves on the Critical Care Committee representing nursing and Palliative Care, as well as on the Ethics Committee and Mortality Committee.
In addition, Ms. Riemer volunteers at the Leukemia Lymphoma Society of America (LLSA), Los Angeles, CA chapter. In 2013, she was 1st runner up for Woman of the Year, as she raised over $50,000 for leukemia/lymphoma research for the LLSA. Ms. Riemer has been an ELNEC-Critical Care faculty member for over five years.
She also spoke at the National Teaching Institute for Critical Care Nurses in 2017, speaking about the importance of integrating Palliative Care in Critical Care settings. She will also be published in the 5th edition of the Oxford Textbook for Palliative Care Nursing in the seventh chapter titled, “ Interdisciplinary Palliative Care Teams: Specialists in Delivering Palliative Care”.
Tune in next Monday for Part 3 of our series on palliative care! If you enjoy this content please share it with others who might find it helpful and consider leaving a review on iTunes!
This episode is the first of a 4-part series that introduces you to the members of a palliative care team. Today Dr. Colin Scibetta discusses his role as the physician on the team and how palliative care differs from hospice care. In future episodes you’ll hear from the team nurse, social worker and chaplain.
As this episode airs I am enjoying a trip through Spain, including cycling in the Andalucia region! I’ll be back home in a few weeks to report on the trip. Follow me on Instagram to see my photos at kwyattmd or this link: https://www.instagram.com/kwyattmd/
This interview will cover:
What palliative care consists of
The difference between palliative care and hospice
The benefits of palliative care for patients
How the whole-person approach of palliative medicine also benefits care providers
Why Providence Institute for Human Caring (et al) was awarded the Circle of Life Award from the American Hospital Association
Colin Scibetta MD is a fellowship-trained palliative medicine physician who complete his undergrad in neuroscience and biology at Wesleyan University. He then moved to Ecuador where he worked on a health initiative for indigenous communities impacted by oil development. Dr. Scibetta did his undergraduate medical training at the University of California, San Francisco School of Medicine, where he also completed an internal medicine residency and a fellowship in hospice and palliative medicine.
Remember to tune in next week for Part 2 of this palliative care series! If you enjoy this content be sure to share it with others who might find it helpful and consider leaving a review on iTunes.
In this episode I share my thoughts on how to approach the very difficult task of making an end-of-life decision about the treatment a loved one should receive. Many people are called upon to be decision-makers in these challenging situations and this episode serves as a guide for choosing the best option for someone we love.Download the handout below:
This episode is sponsored by Suzanne O’Brien and her training program for caring for others at the end of life at Doulagivers.com and by your generous donations on my page at Patreon.com/eolu! Join the team and receive special bonuses as a thank-you!
Thank you to all of my patrons and sponsors! Your support means everything to me!
Every day families are called upon to make nearly impossible decisions about the type of care a loved one should receive as they near the end of life. Here are some suggestions for how to navigate this challenging situation when there is no advance directive available for guidance:
Gather medical information from all healthcare providers involved in care
Ask direct questions:
What is the diagnosis and what complications have occurred?
What is the effectiveness of the recommended treatment?
What are the chances for recovery or improvement?
Are there side effects from the treatment or will it cause additional suffering?
What will happen if treatment is stopped?
What would you do if this were your loved one?
Get expert advice and guidance from a palliative care team if available in your hospital
Remember past conversations with your loved one that might give you clues as to his or her preferences for the end of life
Consider the statistics that most Americans prefer to die at home and most do not want aggressive treatment to prolong life in the face of an incurable condition
Ask your loved one for guidance by expressing your concern and your desire to make the best decision. Even though your loved one cannot verbalize, they can hear you – listen for any intuitive or “felt” guidance that might come to you about the best choice to make.
Be gentle with yourself and recognize that you have done your best in a challenging situation
Seek support from others outside your family
Tune in next week for another episode! Share this content with others who might it helpful and consider leaving a review on iTunes.
Learn about Stephen’s teachings on death phobia in our society and how palliative care and the medical system fail to address this problem.
In this episode I share an excerpt from an interview with Stephen Jenkinson, author of the book Die Wise, founder of Orphan Wisdom and subject of the documentary Griefwalker. Stephen discusses some of the problems with our approach to death in modern society, including the medical system.
Thank you to my latest supporter on Patreon.com/eolu: Bernadette Koch. I appreciate your willingness to contribute to this podcast and the End-of-Life University Series to keep them on the air. If you’d like to join the team, support this work, and get awesome bonuses at the same time, go to Patreon.com/eolu to learn more and sign up!
On July 24th I’m hosting Suzanne O’Brien RN for a free webinar where she’ll be teaching “End-of-Life Doula Training for Caregivers and Volunteers.” If you’d like to know more about the work of end-of-life doulas and learn important skills for caring for the dying, this webinar will be valuable for you.
Click here to sign up for the webinar (it’s free and you’ll receive the replay if you can’t attend live.)
My guest Stephen Jenkinson is a palliative care consultant, teacher, author and ceremonialist who is “revolutionizing grief and dying in North America.” As the author of Die Wise he teaches that “Dying well is a right and responsibility of everyone.”
Dying well is a right and responsibility of everyone. – Stephen Jenkinson
In this interview we discuss:
The origin of death phobia in our society
How the fear of non-existence is the greatest fear of most people
Why “lost” and “loss” are not helpful terms to use when discussing death
The danger of the “fighting illness” mentality of modern medicine
Why dying and grief are things that we “do” rather than events that “happen to us”
Why palliative care should be dying-centered rather than relief-centered
(This is an excerpt from the interview with Stephen. The full interview can be found at Patreon.com/eolu as a bonus for Platinum level supporters ($5 per month.))
Tune in every Monday for a new episode and if you like this content please share it with others or consider leaving a review on iTunes.
As you listen to this broadcast I am currently in Italy–traveling and doing research for my new book on grief (also eating … a lot!) This episode has been pre-recorded (along with several others) so that there will be no interruptions in the podcast. If you want to see photos of my journey follow me on Instagram or Facebook.
This podcast is generously sponsored by donations on my page at Patreon.com/eolu. Thank you to all of my patrons–your support means everything to me!! Submit your questions for the next “Hospice Happy Hour” Q&A Sessionhere and I’ll answer them next month. You can become a patron for just $1 or $2 per month and you’ll receive access to the Q&A recordings, the Top 10 Interviews from EOLU, and the opportunity to have your work promoted on this podcast. Go to Patreon.com/eolu to learn more!
Dr. Ira Byock is a leading palliative care physician, author, and public advocate for improving care through the end of life. He is the Founder and Chief Medical Officer for the Institute for Human Caring of Providence St. Joseph Health.
Tune in every Monday for a new episode of the podcast! If you enjoy this content please take a moment to leave a review on iTunes – it will help other listeners find the podcast.
In this episode I’ll share my own “supernatural” dreams that occurred while I was caring for hospice patients. It’s time to come forward and talk more openly about these experiences to help shed light on the dying process and the after-death realms.
Register now for “An Evening with Ira Byock MD” which will take place on Monday August 21st at 6 pm Pacific/9 pm Eastern. We will be celebrating the 20th Anniversary of his groundbreaking book Dying Well. Dr. Byock and I will discuss the changes in palliative and hospice care that have taken place over the past 20 years and what changes still must occur to ensure that everyone has the opportunity to “die well.”
Click here to learn more and register (it’s free and you’ll receive the replay if you can’t attend live.) You’ll also receive the Dying Well Readers Discussion Guide – a very helpful resource for leading a book group or workshop on Dying Well.
This podcast is supported by generous donations to my page at Patreon.com/eolu. A HUGE “Thank you” goes out to my latest donor: Jane Duncan Rogers of BeforeIGoSolutions.com – a non-profit located in Scotland. And thanks as well to all of the other supporters who are chipping in a few $ per month to help keep the podcast and the End-of-Life University Interview Series on the air! Learn more or become a patron at Patreon.com/eolu.
I am currently planning an Autumn trip to Italy where I will be eating amazing food, viewing sacred sites, cycling, and researching a new book on grief. You can view my Pinterest board if you are interested in seeing all the locations on my “wish-list” for the trip. Feel free to make suggestions if you have a favorite spot in Italy that I shouldn’t miss! I’ll be sharing photos on Instagram and Facebook once the trip begins.
This week I attended a meeting at the IANDS 2017 Conference in Denver (International Association for Near Death Studies.) I sat together in a small circle with individuals from all around the country who have had near-death experiences and also with end-of-life caregivers who have had unusual “supernatural” experiences while working with the dying.
I was impressed by the courage of the group members who were willing to share their stories and risk being labelled as “flakey” or even crazy. And that’s what inspired me to record this podcast episode.
During my work with hospice patients on multiple occasions I experienced vivid dreams where I saw my patients in “soul form” (or a disembodied state) before they had actually died. These dreams brought me much comfort and also eased my fear of death. On some occasions I was able to share the dreams with family members who were comforted, as well, by the visions I had seen.
I have never shared these dreams publicly out of a fear of being ostracized by the medical profession. But the time for secrecy has long passed and we need transparency and truth in all matters surrounding death and dying. So I’m telling these stories in hopes that others might be inspired to talk openly about their experiences as well. If you have a story to tell but no one to share it with I hope you will email me at email@example.com and describe your experience – let’s support one another!
Tune in next week for another new episode. Until then remember ….
It’s a brand new year! Let’s look ahead and see what’s possible in 2017!
In today’s episode of the podcast we’ll look ahead at the coming year, study the trends in the death-positive movement and discover where it might be possible to create new volunteer and career opportunities for ourselves and our communities in 2017.
First I’ll share my own goals for the coming year, which include revising, editing and publishing the two books I wrote in 2016. I also plan to release two new training courses this spring and have lined up a fascinating group of speakers for the End-of-Life University Interview Series. To stay up-to-date on all the latest interviews and offering from EOLU, be sure to to sign up for the mailing list here.
Thank you from the bottom of my heart to all the contributors to this podcast on Patreon.com/eolu. Your support helps pay for the expenses of creating this podcast and the EOLU Interview Series. If you’d like to become a patron just go to Patreon.com/eoluand sign up to contribute just $1 or $2 per month.
Here are some of the Trends I’ll be watching in 2017:
Increasing number of Palliative Care Programs in hospitals across the country. Though many of the current programs are either understaffed or underfunded, these problems are likely to be corrected in the near future. To meet current standards, each palliative care team must have a chaplain and a social worker so if you have training in either of those fields you might find employment opportunities in a palliative care program in your community.
Need for creative solutions for hospice care. Because for-profit hospices are taking over many of the smaller non-profit hospices there is a risk that uninsured patients or those with needs for expensive care might be turned away. There is a need for social-model hospices (see Episode 23) and possibly for community-based non-profit, non-Medicare-certified organizations that can help bridge gaps in services for hospice patients. Here are some recommended training programs for becoming an end-of-life doula or midwife:
Need for more caregivers. As baby boomers age and approach the end-of-life the caregiver shortage will become a much greater issue. Opportunities will exist to create caregiver training and support services in communities and even to start businesses that employ caregivers.
Community outreach can help support the changes that are slowly occurring in the healthcare system. One of the best ways to encourage change in healthcare is to empower consumers to demand changes from their physicians. This will require outreach and education in the community. Here are some ideas for outreach and links to learn more from previous podcasts:
Create an “Inreach” for members of the EOL community by starting a discussion group, networking event or collaboration opportunity for those who are already working in this arena.
Bring volunteer movements to your community. Consider starting a group of volunteer caregivers who can provide respite care for family caregivers or start your own chapter of Threshold Choir, Twilight Brigade, or No One Dies Alone.
Provide education for your community either as a voluntary act of service or as a paid instructor. Here are some possible ideas:
Assist people to correctly complete their advance directives.
Teach a community class on death and dying.
Teach about green burial, promote a natural burial ground in your community, help people access green burial supplies
I hope these ideas inspire your own personal goals for 2017! Stay connected with me and keep tuning in to the podcast. Let me know your own inspirations and plans for the New Year by adding your comments.
In this final episode of 2016 Dr. Wyatt thanks all of the patrons who have generously made contributions on Patreon.com/eolu this year! Thank you for offering your support for this podcast and the End-of-Life University interview series!
In this look back at 2016 we talk about the following positive events in the end-of-life arena:
In January JAMA dedicated a special issue to “Death, Dying and the End-of-Life”, which represents a positive breakthrough in awareness of EOL issues by the medical profession
Medical schools began adopting new training programs for students in pain management, palliative care, and communication skills around advance care planning. There is a college-level program that pairs pre-med students with hospice patients
Nursing homes and long-term care facilities are bringing in children and college students to interact with patients
Dementia rates in the US have dropped in the past year
Pilot studies are underway involving providing education and training to family caregivers and providing a small stipend to caregivers
A demonstration project is underway to study the benefits of providing curative care simultaneously with hospice care
Studies showed that palliative care lowers healthcare costs along with providing increased quality of life, improved pain management and fewer hospital days
Harvard study of adult development showed that relationships are a key to longevity
California and Colorado both passed assisted dying laws in 2016
The nation’s first conference on VSED was held this year
Conversation Sabbath took place for the first time in November, bringing discussions about death and dying into places of worship
Dying to Know Day was held in the US, inspired by the movement in Australia
Miss Norma, a 90-year old woman who refused treatment for her cancer, spent most of the year traveling around the country in an RV with her son and daughter-in-law, fully enjoying the last days of her life
Thank you for tuning in to the EOLU Podcast during 2016! I hope this has been a positive and productive year for you. May 2017 be filled with growth, surprises, peace and joy! See you next year and until then …
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:
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!
Today Dr. Karen Wyatt discusses several “Action Steps” you can take in your own community to help improve end-of-life care. Change begins with the individual and if you want to ensure that your own dying is handled with respect and dignity then you should start now to help implement change. This podcast offers tangible steps you can take–some are easy, some will require a lot more effort–to get your community talking about and making changes in how death and dying are managed. Some of the tips include:
Dr. Karen Wyatt interviews palliative care physician Dr. Ira Byock about his vision for improving care at the end-of-life.
This interview will focus on:
-Defining the “best care possible” for you and your loved ones
-Why preparation for end-of-life care is important
-How to advocate with your healthcare providers for the quality of care you want