#hpm - Healthcare Social Media Transcript

6/27/12 1:13 PM

#hpm transcript
Healthcare Social Media Transcript
From: To: Wed May 09 18:00:00 PDT 2012 Wed May 09 19:15:00 PDT 2012 change time period

New ! Explore analytics for this time period: #hpm analytics Explore the world of healthcare social media: Healthcare Conferences - Healthcare Tweet Chats - Disease Hashtags Learn more about #hpm at The Healthcare Hashtag Project

aliciabloom

it's that time...welcome to #hpm chat! please take a moment to introduce yourself.
Wed May 9 18:01:20 PDT 2012

rfberry

RT @aliciabloom: its that time...welcome to #hpm chat! please take a moment to introduce yourself #hpm
Wed May 9 18:03:43 PDT 2012

rfberry

Renee Berry in Menlo Park, CA, early palliative care advocate, started as a hospice volunteer. Hello! #hpm
Wed May 9 18:04:09 PDT 2012

aliciabloom

hello @rfberry! glad you're here. #hpm

Wed May 9 18:04:51 PDT 2012

_lizzy_

Lizzy Miles, thanatologist, hospice volunteer, social worker and passionate advocate about end-of-life issues. #hpm
Wed May 9 18:05:43 PDT 2012

aliciabloom

@KnowYourWishes are you coming over to #hpm chat? would love to see some of the #s4pm group join us!
Wed May 9 18:05:46 PDT 2012

http://hashtags.symplur.com/healthcare-hashtag-transcript.php?ha&smin=0&tdate=05-09-2012&thour=19&tmin=15&ssec=00&tsec=00&img=1

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rfberry

@aliciabloom is it just us tonight? haha I thought @ctsinclair said he was coming, & saw a tweet from @_lizzy_ not too long ago :) #hpm
Wed May 9 18:06:04 PDT 2012

aliciabloom

@_lizzy_ ! welcome. glad you're here. #hpm

Wed May 9 18:06:14 PDT 2012

rfberry

@_lizzy_ there she is! haha hey Lizzy #hpm

Wed May 9 18:06:25 PDT 2012

rfberry

@_lizzy_ there she is! haha hey Lizzy #hpm

Wed May 9 18:06:25 PDT 2012

April918

I'm here! #HPM fellow from KC, putting the kiddo down, so may be in and out for a little bit
Wed May 9 18:07:22 PDT 2012

_lizzy_

@rfberry @aliciabloom I always want to be here, but Wednesday nights are touch and go. Glad to be here tonight! #hpm
Wed May 9 18:07:33 PDT 2012

aliciabloom

was thinking it was just going to be us, @rfberry...but then, @_lizzy_ arrived! hoping @ctsinclair joins us. oh! @April918 is here! #hpm
Wed May 9 18:08:12 PDT 2012

doctatum

RT @aliciabloom: topics from #hpm chat tonight are inspired by some great work from #AGS2012. join us at 9pm EST. #hpm
Wed May 9 18:08:46 PDT 2012

jfclearywisc

Jim Cleary UW Palliative Care physician & Dir PPSG (@painpolicy) joining #hospice & #palliative medicine tweetchat for next hr from Oz #hpm
Wed May 9 18:09:20 PDT 2012

rfberry

(sidenote as we're waiting for T1 & doing intros... threw out my back this week, found myself wishing I had a palliative care team!) #hpm
Wed May 9 18:09:31 PDT 2012

doctatum

checking in at #HPM chat from Columbia, MO. Interested to hear what folk thought of #ags12 but will be back and forth to kids too #hpm
Wed May 9 18:09:38 PDT 2012

_lizzy_

@doctatum Since I wasn't at #AGS2012 you'll have to catch us non-attendees up to date #hpm
Wed May 9 18:10:04 PDT 2012

nursecasestudy

Hello Everyone, Andrew Lopez, RN from #New Jersey #socmedchap #hospice #palliative #hpm
Wed May 9 18:10:18 PDT 2012

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aliciabloom

welcome @jfclearywisc! thanks for joining us, @doctatum. #hpm

Wed May 9 18:10:39 PDT 2012

_lizzy_

@nursecasestudy Awwww you made it! Glad you're here! #hpm

Wed May 9 18:10:49 PDT 2012

hollyby

Hi there! Holly Yang, #HPM doc from @SanDiegoHospice joining in the tweetchat for the next 50 min. All tweets are my own. #hpm
Wed May 9 18:11:19 PDT 2012

aliciabloom

before we get into topics...i did not attend #AGS2012, but saw some great news that i thought would be relevant to our chat. #hpm
Wed May 9 18:11:49 PDT 2012

hollyby

@rfberry I hope you are feeling better! #hpm

Wed May 9 18:12:01 PDT 2012

nursecasestudy

@nursefriendly is in #TwitterJail, using my alter ego tonight :) RT @_lizzy_: @nursecasestudy Awwww you made it! Glad you're here! #hpm
Wed May 9 18:12:26 PDT 2012

aliciabloom

thanks for joining, @hollyby! we're just getting started. welcome @nursecasestudy! #hpm
Wed May 9 18:12:30 PDT 2012

jfclearywisc

@aliciabloom Beautiful day here in Brisbane! #hpm http://t.co/Gx0d8Pyq

Wed May 9 18:12:35 PDT 2012

AnkurB_MD

Hi All! Checkin with #hpm tweetchat for the hr.

Wed May 9 18:13:21 PDT 2012

aliciabloom

T1: from #AGS2012, an interesting report on oncology patients referred to #hospice very, very late (http://t.co/j1mrVHDa) #hpm
Wed May 9 18:14:33 PDT 2012

aliciabloom

@jfclearywisc it sure looks like it :) #hpm

Wed May 9 18:15:09 PDT 2012

aliciabloom

thanks for checkin in @AnkurB_MD! #hpm

Wed May 9 18:15:29 PDT 2012

nursecasestudy

#thankyou :) RT @aliciabloom: thanks for joining, @hollyby! we're just getting started. welcome @nursecasestudy! #hpm
Wed May 9 18:15:37 PDT 2012

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KnowYourWishes

Hi #hpm. Sorry I'm late. Had to walk the dog! We're walked and Tweet Ready!
Wed May 9 18:15:46 PDT 2012

nursecasestudy

T1 Have too many of my #patient #oncologists telling #families, they can "beat" the #cancer :( #AGS2012 #hospice #hpm
Wed May 9 18:16:30 PDT 2012

aliciabloom

hey, @KnowYourWishes! glad you're here. i just sent out T1. #hpm
Wed May 9 18:16:45 PDT 2012

rfberry

@hollyby thanks, doing better today, hoping some rest over the next two weeks gets me back to normal #hpm
Wed May 9 18:17:28 PDT 2012

hollyby

T1: Having more comorbid conditions makes sense -> the more medical issues you have, the worse the prognosis. #hpm
Wed May 9 18:18:28 PDT 2012

nursecasestudy

T1 Makes me wonder if they are being influenced by #bigpharma to keep pushing #chemotherapy, collecting fees :( #AGS2012 #hospice #hpm
Wed May 9 18:18:44 PDT 2012

aliciabloom

T1: thoughts about the #AGS2012 report highlighting the demographics of cancer patients referred especially late to hospice? #hpm
Wed May 9 18:18:44 PDT 2012

aliciabloom

@rfberry that's such a bummer :( feel better! #hpm

Wed May 9 18:19:00 PDT 2012

rfberry

T1 It breaks my heart when people tell me they wish they had hospice sooner, yet it's the most frequent family feedback I hear #hpm
Wed May 9 18:19:09 PDT 2012

nursecasestudy

Feel better :) RT @rfberry: @hollyby thanks, doing better today, hoping some rest over the next two weeks gets me back to normal #hpm
Wed May 9 18:19:16 PDT 2012

KnowYourWishes

T1: Interesting study. Very large population studied.Wonder if the marriage thing has 2 do with not wanting 2 'give up hope' 4 spouse #hpm
Wed May 9 18:20:09 PDT 2012

hollyby

T1: Being married being linked to late hospice referral is interesting, maybe those with less support get attention/referral sooner? #hpm
Wed May 9 18:20:24 PDT 2012

nursecasestudy

T1 It would be very unusual to have a terminally ill #patient with #oncology or other #diseases without several comorbidities #hpm
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Wed May 9 18:20:35 PDT 2012

rfberry

T1 (any clinicians have thoughts on..) Do late referrals happen more often with cancer patients than other specialists? #hpm
Wed May 9 18:20:36 PDT 2012

doctatum

T1: small town vs >1 million ? if differences in relationships with Primary Care could impact timing of hospice? biased speculation #hpm
Wed May 9 18:21:02 PDT 2012

nursecasestudy

T1 The report doesn't make sense, when you're talking about #Urban areas where #patients have access to #hospice services #AGS2012 #hpm
Wed May 9 18:21:30 PDT 2012

_lizzy_

T1 Have a friend of a friend who has late stage Ca and will NEVER go to hospice. Not always educational issue...sometimes a moral one #hpm
Wed May 9 18:21:36 PDT 2012

KnowYourWishes

@rfberry I think late referrals come from NON-cancer diagnoses based on personal experienceex: COPD #hpm
Wed May 9 18:21:37 PDT 2012

hollyby

T1: Alternately, maybe what @KnowYourWishes said. Likely multifactorial #hpm

Wed May 9 18:21:43 PDT 2012

milhealth

@rfberry T1 is part of that because guidelines for hospice 'admission'? or has that changed (used to be fairly 'strict'...) #hpm
Wed May 9 18:21:45 PDT 2012

jfclearywisc

@hollyby But patients w comorbidities and advanced cancer should not get chemo!!! Big part of choosing wisely!!!! #hpm
Wed May 9 18:22:04 PDT 2012

KnowYourWishes

Certainly multifactorial :) MT @hollyby: T1: Alternately, maybe what @KnowYourWishes said. Likely multifactorial #hpm
Wed May 9 18:22:07 PDT 2012

aliciabloom

late referrals common among cancer patients-- decision for #hospice (unfortunately) requires active choice to stop disease directed tx #hpm
Wed May 9 18:22:13 PDT 2012

aliciabloom

RT @jfclearywisc: But patients w comorbidities and advanced cancer should not get chemo!!! Big part of choosing wisely!!!! #hpm
Wed May 9 18:22:34 PDT 2012

nursecasestudy

T1 In large #metropolitan areas, if #patients are not being referred, it points to #educational deficits or inherent #Bias #AGS2012 #hpm
Wed May 9 18:23:02 PDT 2012

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rfberry

@milhealth I would imagine it's more to do w/clinical understanding/lack of understanding of the guidelines than regs themselves #hpm
Wed May 9 18:23:29 PDT 2012

KnowYourWishes

I did study in 2010 showing increased comorbidities = less likely to have living will #hpm
Wed May 9 18:23:38 PDT 2012

jfclearywisc

@nursecasestudy But also #Urban #patients have much more access to cancer resoures competing with #hospice 4 ur $$$ #AGS2012 #hpm
Wed May 9 18:23:59 PDT 2012

SteveBednarski

@rfberry I think the issue is more costly palliative measures with oncology forces delays to hospuce #hpm
Wed May 9 18:24:12 PDT 2012

aliciabloom

i practice in a large metropolitan area & find that there are so many places for patients to get second opinion or additional treatment #hpm
Wed May 9 18:24:55 PDT 2012

rfberry

@KnowYourWishes interesting, I wonder if that's bc patients feel like they see MD's all the time w/specialists but no one takes lead #hpm
Wed May 9 18:24:55 PDT 2012

_lizzy_

T1 Perhaps it is clarifying the difference between "everything possible" and "everything possibly effective" #hpm
Wed May 9 18:24:57 PDT 2012

jfclearywisc

@SteveBednarski SO what if US hospice were not an either/or but an AND decision with cancer services? #hpm
Wed May 9 18:25:03 PDT 2012

KnowYourWishes

Ditto RT @aliciabloom: i practice in a large metropolitan area -many places for patients to get 2nd opinion or additional treatment #hpm
Wed May 9 18:25:45 PDT 2012

rfberry

RT @jfclearywisc: @SteveBednarski SO what if US hospice were not an either/or but an AND decision with cancer services? #hpm
Wed May 9 18:25:47 PDT 2012

aliciabloom

@doctatum i don't think that's just primary care bias-- it's true! a PCP is more likely to have the "big picture" than a specialist... #hpm
Wed May 9 18:26:11 PDT 2012

rfberry

@SteveBednarski could you expand on what you mean by more costly palliative measures? #hpm
Wed May 9 18:26:13 PDT 2012

http://hashtags.symplur.com/healthcare-hashtag-transcript.php?ha&smin=0&tdate=05-09-2012&thour=19&tmin=15&ssec=00&tsec=00&img=1

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milhealth

@rfberry #hpm that's why advanced directives/living will SO important. I have a very detailed one (adv. directive)
Wed May 9 18:26:14 PDT 2012

aliciabloom

RT @jfclearywisc: SO what if US hospice were not an either/or but an AND decision with cancer services? <-- i wish! #hpm
Wed May 9 18:26:32 PDT 2012

JasAWebb

RT @hastingscenter Aggressive end-of-life care for #Medicare dialysis patients is pervasive @amednews http://t.co/mYMXOw7B #bioethics #hpm
Wed May 9 18:26:40 PDT 2012

hollyby

T1: Concurrent care is definitely part of the answer in getting patients and families good support in a timely way. #hpm
Wed May 9 18:26:50 PDT 2012

nursecasestudy

RT @jfclearywisc: @hollyby But patients w comorbidities and advanced cancer should not get chemo!!! Big part of choosing wisely!!!! #hpm
Wed May 9 18:27:14 PDT 2012

AnkurB_MD

Late referrals 2 #Hospice in Metropolitans NOT surprising as we've seen More HC Access -> More Utilization -> Abrupt Transitions to EOL #hpm
Wed May 9 18:27:18 PDT 2012

aliciabloom

yes! RT @hollyby: T1: Concurrent care is definitely part of the answer in getting patients and families good support in a timely way. #hpm
Wed May 9 18:27:21 PDT 2012

rfberry

I'll RT this any day :) RT @milhealth thats why advanced directives/living will SO important. I have a very detailed AD #hpm
Wed May 9 18:27:26 PDT 2012

aliciabloom

marital status delayed #hospice referral in this large population of cancer patients...thoughts? #hpm
Wed May 9 18:27:56 PDT 2012

rfberry

@hollyby yes! And clear, timely (clinical & community directed) information about concurrent care #hpm
Wed May 9 18:28:05 PDT 2012

rfberry

RT @hollyby: T1: Concurrent care is definitely part of the answer in getting patients and families good support in a timely way. #hpm
Wed May 9 18:28:08 PDT 2012

milhealth

@rfberry #hpm there could also be cultural issues, for some cultures, you don't even 'talk' about Cancer or death/dying.
Wed May 9 18:28:15 PDT 2012

http://hashtags.symplur.com/healthcare-hashtag-transcript.php?ha&smin=0&tdate=05-09-2012&thour=19&tmin=15&ssec=00&tsec=00&img=1

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CarolynMcC

@AnkurB_MD I dream of the day we see palliative care consults at the initial diagnosis of a life threatening illness. #hpm
Wed May 9 18:28:29 PDT 2012

_lizzy_

T1 Doesn't it all go back to helping the patient understand the inevitable...that they are going 2 die? #hpm
Wed May 9 18:28:40 PDT 2012

milhealth

RT @CarolynMcC: @AnkurB_MD I dream of the day we see palliative care consults at initial diagnosis of life threatening illness. #hpm/yes~
Wed May 9 18:28:58 PDT 2012

SteveBednarski

@jfclearywisc @hollyby cancer pts may want blood transfsns, hydration, etc. All come with a higher cost that make it hard for hospices #hpm
Wed May 9 18:29:01 PDT 2012

KnowYourWishes

Gender of patient AND OF PROXY makes impact on EOL choices, thus would expect would make difference in hospice referral too #hpm
Wed May 9 18:29:09 PDT 2012

hollyby

@jfclearywisc Not all US hospices are an "either/or" with ongoing cancer care #hpm
Wed May 9 18:29:14 PDT 2012

AnkurB_MD

Good one! RT @_lizzy_ T1 Perhaps it is clarifying the difference between "everything possible" and "everything possibly effective" #hpm
Wed May 9 18:29:29 PDT 2012

milhealth

RT @_lizzy_: T1 Doesn't it all go back to helping the patient understand the inevitable that they are going 2 die? #hpm
Wed May 9 18:29:33 PDT 2012

KnowYourWishes

I'm interested to know if whether it was a female pt w/ husband or male pt w/ wife impacted the hospice referral #hpm (does that make sense?
Wed May 9 18:29:59 PDT 2012

colleen_young

How common is it for patients and families to request a referral to hospice? #hpm
Wed May 9 18:30:10 PDT 2012

doctatum

CMS talk at AGS didn't sound enthusiastic for hospice RT @rfberry: RT @hollyby: T1: Concurrent care is definitely part of the answer #hpm
Wed May 9 18:30:11 PDT 2012

aliciabloom

great, point @AnkurB_MD! more health care access -> more utilization => abrupt transitions to EoL care #hpm
Wed May 9 18:30:40 PDT 2012

hollyby

@SteveBednarski @jfclearywisc That is an issue for smaller hospices because of the

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reimbursement structure, but it is not impossible. #hpm

Wed May 9 18:30:58 PDT 2012

AnkurB_MD

Amen! RT @CarolynMcC @AnkurB_MD I dream of the day we c #palliative care consults at initial diagnosis of a life threatening illness. #hpm
Wed May 9 18:31:18 PDT 2012

KnowYourWishes

@colleen_young I don't have many patients say "i want hospice", but they say it in other ways. good clinician must be atuned to that #hpm
Wed May 9 18:31:19 PDT 2012

doctatum

cms = center for medicare medicaid services (nothing to do with geriatric folks who are enthusiastic about hospice) #hpm
Wed May 9 18:31:25 PDT 2012

SteveBednarski

@rfberry hydration, radiation, blood transfusions. Costly and often prevent hospice care until no longer beneficial. #hpm
Wed May 9 18:31:34 PDT 2012

milhealth

@SteveBednarski @rfberry Where my Mom was #hospice, ppl could bring the patient's dog (shots, current), #hpm
Wed May 9 18:31:44 PDT 2012

aliciabloom

@doctatum @hollyby that's a shame. concurrent care could improve quality of care & likely lower costs. #hpm
Wed May 9 18:31:46 PDT 2012

rfberry

right there w/ya! RT @CarolynMcC I dream of the day we see palliative care consults at initial diagnosis of a life threatening illness #hpm
Wed May 9 18:31:54 PDT 2012

nursecasestudy

Hospice more costly? RM @SteveBednarski: @rfberry I think the issue is more costly palliative measures with oncology forces delays #hpm
Wed May 9 18:31:58 PDT 2012

DeathwDignity

Psst, @mkow86 @DrBeckerSchutte @ShahinaLakhani @KathyKastner, have experience with #TherapyDogs in #hospice? Tell us more at #DWDchat. #hpm
Wed May 9 18:32:00 PDT 2012

hollyby

I hear it often, but I may have a biased view. RT @colleen_young: How common is it for pts & families to request a referral to hospice? #hpm
Wed May 9 18:32:38 PDT 2012

rfberry

Hoping it becomes more popular! RT @colleen_young How common is it for patients and families to request a referral to hospice? #hpm
Wed May 9 18:32:39 PDT 2012

aliciabloom

to me, it should be about helping people make decisions about how they want to live, not
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presenting them with impossible choices... #hpm

Wed May 9 18:33:29 PDT 2012

jfclearywisc

@hollyby Agree but seems the image that persists is still EITHER/OR #hpm
Wed May 9 18:33:31 PDT 2012

nursecasestudy

Skittish as everyone is about addressing #codestatus #DNRs, etc. Can see doctors passing the buck on #hospice @rfberry @KnowYourWishes #hpm
Wed May 9 18:33:36 PDT 2012

colleen_young

@KnowYourWishes @hollyby @rfberry Thank you. Was curious. #hpm

Wed May 9 18:33:51 PDT 2012

milhealth

RT @SteveBednarski: @rfberry hydration, radiation, blood transf $$often prevent hospice care...#hpm denial of inevitable, not good, no point
Wed May 9 18:34:01 PDT 2012

hollyby

@jfclearywisc Totally agree #hpm

Wed May 9 18:34:09 PDT 2012

_lizzy_

@colleen_young I think family referral requests fr previous hospice experience of someone in the family. They understand the benefits. #hpm
Wed May 9 18:34:13 PDT 2012

jess_jacobs

RT @Pallimed: 73 Cents by @ReginaHolliday a good short film for #HPM people to know and share http://t.co/6yQHZWHO
Wed May 9 18:34:15 PDT 2012

rfberry

@nursecasestudy hospice is not more costly than alternatives. A week on hospice is about $4k vs ICU $50k #hpm
Wed May 9 18:34:20 PDT 2012

GroundSwellAus

Please chk out our latest blog: "Funeral director + drama class = ?" http://t.co/XHuKiHgo #hpm #eol
Wed May 9 18:34:34 PDT 2012

SteveBednarski

@hollyby @jfclearywisc I work to get patiemts on as early as possible and am starting to see more push nack from even the large ones #hpm
Wed May 9 18:34:38 PDT 2012

aliciabloom

very lively responses to T1. thanks, everyone! please share final thoughts on T1 & we'll move on to talking about ICDs. #hpm
Wed May 9 18:35:12 PDT 2012

KnowYourWishes

My 2010 study also found more recent visits to PCP = more likely to have ADs. Encouraging! :) #hpm
Wed May 9 18:35:15 PDT 2012

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rfberry

that's why we keep tweeting #publicAwareness RT @jfclearywisc: @hollyby Agree but seems image persists is EITHER/OR #hpm
Wed May 9 18:35:24 PDT 2012

jfclearywisc

@hollyby I'm hearing request for palliative care much much more (gives me chance to introduce hospice as home based #palliative care! #hpm
Wed May 9 18:35:49 PDT 2012

KnowYourWishes

RT @rfberry: that's why we keep tweeting #publicAwareness RT @jfclearywisc: @hollyby Agree but seems image persists is EITHER/OR #hpm
Wed May 9 18:36:03 PDT 2012

aliciabloom

@rfberry @nursecasestudy unfortunately, some treatments (even though palliative in intent) are too costly for #hospice to cover. #hpm
Wed May 9 18:36:08 PDT 2012

nursecasestudy

#Denial, holding onto hope :( MT @aliciabloom: marital status delayed #hospice referral in this large population of cancer pati #hpm
Wed May 9 18:36:14 PDT 2012

nursecasestudy

RT @CarolynMcC: @AnkurB_MD I dream of the day we see palliative care consults at the initial diagnosis of a life threatening illness. #hpm
Wed May 9 18:36:45 PDT 2012

nursecasestudy

RT @_lizzy_: T1 Doesn't it all go back to helping the patient understand the inevitable...that they are going 2 die? #hpm
Wed May 9 18:36:59 PDT 2012

jfclearywisc

RT @GroundSwellAus: Please chk out our latest blog: "Funeral director + drama class = ?" http://t.co/A6Kqodss #hpm #eol
Wed May 9 18:37:01 PDT 2012

aliciabloom

MT @jfclearywisc: hearing request for palliative care much more, gives me chance to introduce hospice as home based #palliative care! #hpm
Wed May 9 18:37:01 PDT 2012

jess_jacobs

I'd 2nd that! If #AD's signed when you're healthy = easier. Culture shift needed - right now USA's scared of death @milhealth @rfberry #hpm
Wed May 9 18:37:03 PDT 2012

milhealth

@rfberry #hpm in ICU, my mom wasn't fed for days (hydr. only), 1st day in hospice-nurse asked us if ok, she ATE (was fed) an entire meal!
Wed May 9 18:37:07 PDT 2012

hollyby

I wonder if it has something to do with new recert rules? @SteveBednarski @jfclearywisc re: starting to see more push back #hpm
Wed May 9 18:37:23 PDT 2012

http://hashtags.symplur.com/healthcare-hashtag-transcript.php?h&smin=0&tdate=05-09-2012&thour=19&tmin=15&ssec=00&tsec=00&img=1

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KnowYourWishes

Happiness = chianti + lively #hpm chat + sleeping puppy :)

Wed May 9 18:37:26 PDT 2012

mkow86

@DeathwDignity I have had experience w therapy dogs! Very effective. Once brought an elderly man his old pup to the nursing home! #hpm
Wed May 9 18:37:45 PDT 2012

ctsinclair

RT @jfclearywisc: Im hearing request for palliative care much much more (chance to introduce hospice as home based #palliative care! #hpm
Wed May 9 18:37:59 PDT 2012

nursecasestudy

@_lizzy_ T1 Yes, they need to discuss the inevitable, yet many hesitate to. Often they wait till #patient is near #deaths door :( #hpm
Wed May 9 18:38:03 PDT 2012

rfberry

@milhealth surprising things can happen when people are comfortable & feel like themselves at home :) #hpm
Wed May 9 18:38:17 PDT 2012

milhealth

@jess_jacobs @rfberry #hpm my mom's hospice nurse told us it was gr8t 2 work w/family all of us on same pg, knew exactly what Mom wanted!
Wed May 9 18:38:23 PDT 2012

ctsinclair

@milhealth Sometimes just asking and trying are so simple to do. #hpm
Wed May 9 18:38:28 PDT 2012

KnowYourWishes

RT @milhealth: @jess_jacobs @rfberry #hpm my mom's hospice nurse told us it was gr8t 2 work w/family - all of us on same pg, knew exactly what Mom wanted!
Wed May 9 18:38:29 PDT 2012

SteveBednarski

@jfclearywisc @hollyby @rfberry What is/are the keys to create best bridge program to support pt's who don't want rehospitalization? #hpm
Wed May 9 18:39:07 PDT 2012

jfclearywisc

@hollyby UNfortunately rapid yet needed increase in hospice referrals is leading to increased scrutiny & #push back!! #hpm
Wed May 9 18:39:14 PDT 2012

aliciabloom

T2: also from #AGS2012- "Patients With ICDs Might Want Shut-Off in Some Scenarios" (http://t.co/UXETg5Bz) #hpm
Wed May 9 18:39:23 PDT 2012

ctsinclair

RT @rfberry: Hoping it becomes more popular! RT @colleen_young How common is it for patients/families to request a referral to hospice? #hpm
Wed May 9 18:39:23 PDT 2012

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_lizzy_

@milhealth That is a blessing that you were all together... so many times that isn't the case. #hpm
Wed May 9 18:39:33 PDT 2012

nursecasestudy

Not very common in my neck of the woods RT @colleen_young: How common is it for patients and families to request a referral to hospice? #hpm
Wed May 9 18:39:42 PDT 2012

KnowYourWishes

@SteveBednarski @jfclearywisc @hollyby @rfberry Would LOVE answer to that Q! #hpm Big problem!
Wed May 9 18:39:43 PDT 2012

PracticalWisdom

I love your work. Creativity + Function~ MT @GroundSwellAus "Funeral director + drama class = ?" http://t.co/10mCI5A6 #hpm #eol #dwdchat
Wed May 9 18:39:44 PDT 2012

rfberry

RT @aliciabloom: T2: also from #AGS2012- "Patients With ICDs Might Want Shut-Off in Some Scenarios" (http://t.co/UXETg5Bz) #hpm
Wed May 9 18:39:52 PDT 2012

jfclearywisc

@SteveBednarski No bridge. Unbundle Hospice medicare benefit and provide universal health care!!! #hpm
Wed May 9 18:40:08 PDT 2012

aliciabloom

@SteveBednarski your question about bridge programs would be great for a future chat! (@jfclearywisc @hollyby @rfberry) #hpm
Wed May 9 18:40:12 PDT 2012

ctsinclair

@rfberry @nursecasestudy a week on hospice at home or in nursing home is approximately under $1500 #hpm
Wed May 9 18:40:34 PDT 2012

jfclearywisc

@SteveBednarski No bridge. Unbundle Hospice medicare benefit and provide universal health care!!! ---> AS IF!!!! #hpm
Wed May 9 18:41:10 PDT 2012

rfberry

"frequently patients don't have conversations abt turning off defibrillators & they suffer a great deal" http://t.co/UVn2OaUj cc @NHDD #hpm
Wed May 9 18:41:12 PDT 2012

milhealth

@_lizzy_ thank U, it was! We were able to stay w/her until she passed away, hospice was wonderful! I'll always be grateful 2 them #hpm
Wed May 9 18:41:12 PDT 2012

aliciabloom

RT @jfclearywisc: No bridge. Unbundle hospice Medicare benefit and provide universal health care!!! #hpm
Wed May 9 18:41:27 PDT 2012

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ctsinclair

@jfclearywisc @SteveBednarski but bridge/transition programs are important until universal health care exists #hpm
Wed May 9 18:41:34 PDT 2012

nursecasestudy

That's what I thought. RT @rfberry: hospice is not more costly than alternatives. A week on hospice is about $4k vs ICU $50k #hpm
Wed May 9 18:41:36 PDT 2012

rfberry

RT @ctsinclair a week on hospice at home or in nursing home is approximately under $1500 #hpm
Wed May 9 18:41:49 PDT 2012

mkow86

@nursecasestudy @colleen_young not common around here either for family to request hospice referral UNLESS they want extra (free) care #hpm
Wed May 9 18:41:51 PDT 2012

aliciabloom

ICDs provide much benefit to patients, however at EoL offer much burden. important to educate patients on this reality & offer options. #hpm
Wed May 9 18:42:30 PDT 2012

KnowYourWishes

ICDs seem to be a 'forgotten' intervention. Myself included. #hpm

Wed May 9 18:42:39 PDT 2012

jfclearywisc

@aliciabloom T2 I really worry about consent process with ICDs. Wonder about similtaneous #palliative care consult to assist! #AGS2012 #hpm
Wed May 9 18:42:44 PDT 2012

milhealth

@rfberry #hpm I just think about my sons, I don't want them 2 ever be in position to not know what to do, they suffer!
Wed May 9 18:42:51 PDT 2012

ctsinclair

can someone repost T2? #hpm

Wed May 9 18:43:35 PDT 2012

jfclearywisc

@ctsinclair: I'll agree @jfclearywisc @SteveBednarski but bridge/transition programs are important until universal health care exists #hpm
Wed May 9 18:43:36 PDT 2012

hollyby

T2: IMHO the study shows that it is important to talk about when it may be appropriate to deactivate an AICD before it is put in. #hpm
Wed May 9 18:43:38 PDT 2012

April918

will see you guys/gals next week, kiddo is not wanting to go to bed! #HPM
Wed May 9 18:44:09 PDT 2012

nursecasestudy

@aliciabloom I often ask #patients if their #doctor has addressed #codestatus, if they "Want" us to do everything for them. #hpm
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Wed May 9 18:44:13 PDT 2012

mkow86

@nursecasestudy seeing trend of nursing homes sometimes using hospice for wrong reason//wanting the extra aide unfortunately #hpm
Wed May 9 18:44:16 PDT 2012

aliciabloom

@jfclearywisc we do that with LVAD evaluation process & it's been really beneficial. agree #palliative care would help with ICDs, too! #hpm
Wed May 9 18:44:27 PDT 2012

jfclearywisc

@ctsinclair @aliciabloom: T2: also from #AGS2012- "Patients With ICDs Might Want ShutOff in Some Scenarios" (http://t.co/iuMqVeH6) #hpm
Wed May 9 18:44:28 PDT 2012

rfberry

Advance Directives #NHDD RT @milhealth I think abt my sons, I dont want them 2 ever be in position to not know what to do, they suffer! #hpm
Wed May 9 18:44:40 PDT 2012

ctsinclair

@jfclearywisc ICD consent process is challenged by lucrative incentive to skew process (if we don't put it in, you could die suddenly) #hpm
Wed May 9 18:44:44 PDT 2012

KnowYourWishes

little off topic-hypothermia after cardiac arrest another intervention i wonder about re: informd consent.If ICD works, pt gets cooled! #hpm
Wed May 9 18:44:48 PDT 2012

nursecasestudy

@aliciabloom Once we've discussed it, and they know what we mean by "doing everything" often they say "I don't want all that" #hpm
Wed May 9 18:45:06 PDT 2012

rfberry

RT @aliciabloom: T2: also from #AGS2012- "Patients With ICDs Might Want Shut-Off in Some Scenarios" (http://t.co/UXETg5Bz) #hpm
Wed May 9 18:45:09 PDT 2012

aliciabloom

i think it is most beneficial to not use the word "everything" because if they don't choose that, it's like they're choosing "nothing" #hpm
Wed May 9 18:45:29 PDT 2012

AnkurB_MD

Agree! Like LVADs.. MT @jfclearywisc @aliciabloom T2 Wonder about simultaneous #palliative care consult w/ ICD plac to assist w/ convo! #hpm
Wed May 9 18:45:40 PDT 2012

SteveBednarski

@ctsinclair @jfclearywisc @rfberry @hollyby Ilove the chat, however need to step away. Looking forward to everyones input later. #hpm
Wed May 9 18:46:04 PDT 2012

rfberry

@SteveBednarski @jfclearywisc @hollyby I think early palliative care & clear goals of care discussions are key. #hpm

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Wed May 9 18:46:31 PDT 2012

aliciabloom

RT @ctsinclair: ICD consent process challenged by lucrative incentive to skew process (if we don't put it in, you could die suddenly) #hpm
Wed May 9 18:46:38 PDT 2012

aliciabloom

thanks for joining us, @SteveBednarski & @April918. hope to see you both next week! #hpm
Wed May 9 18:47:04 PDT 2012

hollyby

@SteveBednarski Thanks for joining in! #hpm

Wed May 9 18:47:20 PDT 2012

aliciabloom

for those of you working in #hospice...how do you address deactivation of ICDs? #hpm
Wed May 9 18:47:44 PDT 2012

ctsinclair

T2 question repost anyone? #hpm

Wed May 9 18:48:03 PDT 2012

AnkurB_MD

@ctsinclair @jfclearywisc T2: With ICDs the Q is not whether to Put It In BUT When To Turn It Off! #palliative care c/s may help! #hpm
Wed May 9 18:48:33 PDT 2012

hollyby

There are LOTS more ICDs put in than LVADs though. Important to work with the cardiologists about this issue. #hpm
Wed May 9 18:48:55 PDT 2012

aliciabloom

T2: also from #AGS2012- "Patients With ICDs Might Want Shut-Off in Some Scenarios" (http://t.co/UXETg5Bz) #hpm #hpm
Wed May 9 18:48:57 PDT 2012

KnowYourWishes

Yes! RT @AnkurB_MD: @ctsinclair @jfclearywisc T2: With ICDs the Q is not whether to Put It In BUT When To Turn It Off! #hpm
Wed May 9 18:49:09 PDT 2012

Pallimed

Implantable Cardiac Defibrillators - #Hospice Role in Deactivation? via @Pallimed #HPM http://t.co/eaneEuJh
Wed May 9 18:49:24 PDT 2012

nursecasestudy

There is and continues to be a tremendous #stigma surrounding death/dying, among #patients, #doctors @jess_jacobs @milhealth @rfberry #hpm
Wed May 9 18:49:29 PDT 2012

hollyby

@ctsinclair Not a particular question, I think, just comments on the article. #hpm
Wed May 9 18:49:35 PDT 2012

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aliciabloom

T2: how do we in #hospice & #palliative address ICDs given that they offer great benefit & much potential burden? #hpm
Wed May 9 18:49:46 PDT 2012

nursecasestudy

RT @milhealth: @rfberry #hpm in ICU, my mom wasn't fed for days (hydr. only), 1st day in hospice-nurse asked us if ok, she ATE (was fed) an entire meal!
Wed May 9 18:49:54 PDT 2012

aliciabloom

RT @Pallimed: Implantable Cardiac Defibrillators - #Hospice Role in Deactivation? via @Pallimed #HPM http://t.co/DjKU0GN3 #hpm
Wed May 9 18:49:59 PDT 2012

rfberry

RT @Pallimed: Implantable Cardiac Defibrillators - #Hospice Role in Deactivation? via @Pallimed #HPM http://t.co/eaneEuJh
Wed May 9 18:50:03 PDT 2012

hollyby

RT @Pallimed: Implantable Cardiac Defibrillators - #Hospice Role in Deactivation? via @Pallimed #HPM http://t.co/5A4sIysa #hpm
Wed May 9 18:50:08 PDT 2012

aliciabloom

@hollyby mostly comments, although i just threw out a question.... :) #hpm

Wed May 9 18:50:27 PDT 2012

KnowYourWishes

Impt to remember values change over time & with illness MT @jess_jacobs: I'd 2nd that! If #AD's signed when you're healthy = easier. #hpm
Wed May 9 18:50:40 PDT 2012

ctsinclair

Important to realize donut magnet for ICD's is meant to be a temporary way to turn off ICD , call the device rep to truly deactivate #hpm
Wed May 9 18:50:51 PDT 2012

nursecasestudy

RT @milhealth: @jess_jacobs @rfberry #hpm my mom's hospice nurse told us it was gr8t 2 work w/family - all of us on same pg, knew exactly what Mom wanted!
Wed May 9 18:50:51 PDT 2012

ggramels

@AnkurB_MD @CarolynMcC Rather than getting called after the nephrologist refuses to dialyze the dying patient? #hpm
Wed May 9 18:50:55 PDT 2012

aliciabloom

RT @aliciabloom: T2: how do we in #hospice & #palliative address ICDs given that they offer great benefit & much potential burden? #hpm
Wed May 9 18:51:02 PDT 2012

ctsinclair

@aliciabloom @hollyby thanks #hpm

Wed May 9 18:51:14 PDT 2012

ctsinclair

Also important to realize that a pacemaker and ICD may be contained in the same device but do not do the same thing to a heart. #hpm
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Wed May 9 18:52:16 PDT 2012

jess_jacobs

For sure - that's why a convo after #ICD implantation is so important. #hpm @KnowYourWishes
Wed May 9 18:53:28 PDT 2012

hollyby

T2: I include AICD deactivation in my goals of care discussions when talking about code status and discuss pros, cons, & pt wishes #hpm
Wed May 9 18:53:36 PDT 2012

jfclearywisc

@SteveBednarski A "do not hospitalize" order is very underused!!! But may struggle then to get non hospice home care! #hpm
Wed May 9 18:54:00 PDT 2012

aliciabloom

#AGS2012 study of patients w/ ICDs raised important point-- when patients knew benefit vs. burden & options, it impacted thinking. #hpm
Wed May 9 18:54:02 PDT 2012

hollyby

MT @ctsinclair: Also important to realize that a pacemaker & ICD may be contained in the same device but don't do the same thing... #hpm
Wed May 9 18:54:20 PDT 2012

ctsinclair

@hollyby Care to explain AICD vs ICD #hpm

Wed May 9 18:54:50 PDT 2012

jfclearywisc

RT @hollyby: T2: I incl AICD deactivation in goals of care discussions when talking abt code status & discuss pros, cons, & pt wishes #hpm
Wed May 9 18:54:54 PDT 2012

nursecasestudy

@hollyby T2 The main reason for an AICD is to improve quality of life, extend life. Not great time to discuss #Endoflife #hpm
Wed May 9 18:55:02 PDT 2012

AnkurB_MD

@aliciabloom Great chat! Gottu leave now.. will catch up later! thanks all.. #hpm
Wed May 9 18:55:03 PDT 2012

BillPfohl

Stupid question but I must ask ...does ICD offer Pts comfort care?#hpm
Wed May 9 18:55:04 PDT 2012

rfberry

I have to head out, thanks so much @aliciabloom, great topics tonight! #hpm
Wed May 9 18:56:07 PDT 2012

aliciabloom

just a few minutes left in tonight's #hpm chat...final thoughts?

Wed May 9 18:56:07 PDT 2012

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aliciabloom

thanks for joining us, @AnkurB_MD! #hpm

Wed May 9 18:56:24 PDT 2012

KnowYourWishes

Learned a lot about ICDs tonight! Thx #hpm

Wed May 9 18:56:34 PDT 2012

nursecasestudy

@jfclearywisc: @ctsinclair @aliciabloom: T2 When a #hospice referral is made, AICD maintenance should definitely be addressed. #hpm
Wed May 9 18:56:43 PDT 2012

ctsinclair

RT @BillPfohl: does ICD offer Pts comfort care? "No comfort, it hurts. Life prolonging only." #hpm
Wed May 9 18:56:49 PDT 2012

hollyby

@nursecasestudy I don't put them in, so I talk to patients who have them already. Preferable to discuss before and readdress l8r #hpm
Wed May 9 18:56:56 PDT 2012

aliciabloom

take it easy...feel better, @rfberry! #hpm

Wed May 9 18:56:59 PDT 2012

ctsinclair

@BillPfohl Never a dumb question here! #hpm

Wed May 9 18:57:00 PDT 2012

ctsinclair

@rfberry Goodnight RF! #hpm

Wed May 9 18:57:46 PDT 2012

hollyby

Sorry, same thing (A = automated), but they all are. RT @ctsinclair: @hollyby Care to explain AICD vs ICD #hpm
Wed May 9 18:57:48 PDT 2012

aliciabloom

@BillPfohl glad you asked! no stupid questions. it's all about learning & raising awareness around here. #hpm
Wed May 9 18:58:02 PDT 2012

ctsinclair

@hollyby :-) #hpm

Wed May 9 18:58:38 PDT 2012

jfclearywisc

@aliciabloom Ciao!! 12 noon here now!!! Beautiful day ahead.... #hpm

Wed May 9 18:58:59 PDT 2012

aliciabloom

here's hoping some of the chaplains from #socmedchap consider joining #hpm chat next week! we'd love your perspective.
Wed May 9 18:59:22 PDT 2012

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aliciabloom colleen_young

@jfclearywisc enjoy the beautiful day! it's almost bed time around here. #hpm
Wed May 9 18:59:53 PDT 2012

@mkow86 @nursecasestudy @ctsinclair @_lizzy_ Thanks all. #hpm

Wed May 9 19:00:16 PDT 2012

_lizzy_

Goodnight all! I think this is the quietest I have ever been. ICD codes are really outside of my area of knowledge. Good to learn. #hpm
Wed May 9 19:01:26 PDT 2012

aliciabloom

thank you all for a lively #hpm chat tonight! see you next week!
Wed May 9 19:01:27 PDT 2012

hollyby

@ctsinclair @BillPfohl Nuance... may help w/ comfort if symptomatic from a shockable arrhythmia, but packs a punch to do it. #hpm
Wed May 9 19:01:34 PDT 2012

KnowYourWishes

RT @aliciabloom: thank you all for a lively #hpm chat tonight! see you next week!
Wed May 9 19:02:08 PDT 2012

ctsinclair

Great chat as usual! Thanks @AliciaBloom #hpm

Wed May 9 19:02:10 PDT 2012

KnowYourWishes

RT @ctsinclair: Great chat as usual! Thanks @AliciaBloom #hpm

Wed May 9 19:02:19 PDT 2012

EWidera

RT @ssmithaahpm: AMA Wire - AMA CEO discusses future of the organization, medical profession http://t.co/gMUL8C6T #hpm #aamse
Wed May 9 19:02:27 PDT 2012

hollyby

@aliciabloom Thanks so much for moderating! Great job and great convo everyone! Hugs until next week! #hpm
Wed May 9 19:02:41 PDT 2012

ctsinclair

@hollyby @BillPfohl fair point #hpm

Wed May 9 19:02:43 PDT 2012

aliciabloom

@skypilotofhope #hpm = #hospice & #palliative medicine. lively group talking issues related to caring for those with serious illness.
Wed May 9 19:03:00 PDT 2012

aliciabloom

thanks, @hollyby & @ctsinclair! glad you were both here tonight. #hpm
Wed May 9 19:04:02 PDT 2012

nursecasestudy

#Thanks! 4 hosting :)RT @hollyby: @aliciabloom Thanks so much for moderating! Great job and great convo everyone! Hugs until next week! #hpm
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Wed May 9 19:04:28 PDT 2012

hollyby

Me too! :) RT @aliciabloom: thanks, @hollyby & @ctsinclair! glad you were both here tonight. #hpm
Wed May 9 19:05:58 PDT 2012

BillPfohl

Thank you all...interesting topics...Good evening! #hpm

Wed May 9 19:06:34 PDT 2012

apjonas

RT @Pallimed: Implantable Cardiac Defibrillators - #Hospice Role in Deactivation? via @Pallimed #HPM http://t.co/eaneEuJh
Wed May 9 19:13:30 PDT 2012

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