Palliative Pearls

The Dialysis Dilemma

The Dialysis Dilemma

For elderly and frail patients, hours of quality life saved by starting dialysis may not stack up well when compared to medical management of chronic kidney disease. Many studies show that for patients over 75, starting dialysis leads to poorer functional status and...

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I Can’t Catch My Breath

I Can’t Catch My Breath

Fear is a major component of the suffering patients feel when breathless. Consider our Breathlessness Action Plan to help palliative-care-minded patients and families with the anxiety. Stay calm: Quiet the room. Speak slowly in a calm voice. Reposition: Usually...

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How Long Do I Have, Doc?

How Long Do I Have, Doc?

There’s a helpful rule of thumb for prognosis near end-of-life, but first . . . It’s always a good idea to ask what’s behind the question.  Many patients who ask this may be hunting for something else.  We tend to follow up with a question like: “Could you tell me...

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Books Can Help

Books Can Help

The nice thing about books: you can take one home and it waits patiently for the right time. Open it when you’re ready. Close it when you like. Come back to it when it’s helpful. Hospice of the Northwest’s lending library is open to the public. We have over 1500...

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Comfort Feeding in Dementia

Comfort Feeding in Dementia

“What are we doing? He would never want to live like this!” For patients with advanced dementia, consider recommending feeding for comfort rather than medicalized nutrition. This means: Choosing foods that the patient responds to with pleasure Stopping feeding when...

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Encountering Loss

Encountering Loss

Supporting families (and ourselves) with loss may be some of the most difficult work in healthcare. Here are phrases we find helpful. “I am so sorry for your loss. As much as you can, give grief the reins. Give it all the time it needs.” “Many people experience anger,...

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Get Out of Jail Free Code: Z51.5

Get Out of Jail Free Code: Z51.5

Using ICD-10 code Z51.5 (Encounter for Palliative Care) as the first code in your documentation can help you care for your patients better. It can be used by any primary care provider or specialist. It alerts your partners that this patients goals are comfort...

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“I’d like to get Dad on hospice.”

“I’d like to get Dad on hospice.”

March 2022 - Patients and families can (and do!) refer themselves for hospice care. The percentage of referrals we receive from patients, families and caregivers (rather than from medical providers) has increased from 20% five years ago to 25% in 2021. Our community...

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Our old friend, propranolol

Our old friend, propranolol

February 2022 - Our old friend, propranolol Propranolol is effective in palliating panic/anxiety in elders who are sensitive to the sedation and delirium side effects of benzodiazepines. Consider Mrs. Li: She has moderate dementia and is struggling with the recent...

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