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Tolchin DW, Rushin C, Tolchin B, Slocum C, Meyerson JL, Havercamp SM, Keeney T, Schwartz AW, Schaefer K, Ross M, Stein MA, Jones CA, Rosa WE, Brooks FA. Top Ten Tips Palliative Care Clinicians Should Know About Providing Care for People With Disabilities. J Palliat Med 2024. [PMID: 38232708 DOI: 10.1089/jpm.2023.0662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Palliative care (PC) clinicians are well poised to help people with disabilities (PWD) live well in the context of serious illness. PC prioritizes person-centered care with a focus on function, autonomy, and quality of life. This approach aligns with principles of high-quality care for PWD. An understanding of the unique experiences and needs of PWD can advance the delivery of comprehensive, equitable PC for this population. In this article, we provide 10 tips to help PC clinicians develop an informed disability lens in their approach to care.
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Affiliation(s)
- Dorothy W Tolchin
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/MassGeneral Brigham/Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ben Tolchin
- Center for Clinical Ethics, Yale New Haven Health, New Haven, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chloe Slocum
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/MassGeneral Brigham/Harvard Medical School, Boston, Massachusetts, USA
| | - Jordana L Meyerson
- Harvard Medical School, Boston, Massachusetts, USA
- Section of Geriatrics and Palliative Care, Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | | | - Tamra Keeney
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea W Schwartz
- Harvard Medical School, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, Boston Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kristen Schaefer
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Care Dimensions Hospice, Danvers, Massachusetts, USA
| | - Melissa Ross
- Ross Psychotherapy, Arlington, Massachusetts, USA
| | - Michael A Stein
- Harvard Law School, Cambridge, Massachusetts, USA
- Harvard Law School Project on Disability, Cambridge, Massachusetts, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Forrest A Brooks
- Department of Medicine, Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Skarf LM, Jones KF, Meyerson JL, Abrahm JL. Pharmacologic Pain Management: What Radiation Oncologists Should Know. Semin Radiat Oncol 2023; 33:93-103. [PMID: 36990640 DOI: 10.1016/j.semradonc.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Individuals with cancer experience a host of symptoms, especially when the malignancy is advanced. Pain occurs from the cancer itself or related treatments. Undertreated pain contributes to patient suffering and lack of engagement in cancer-directed therapies. Adequate pain management includes thorough assessment; treatment by radiotherapists or anesthesia pain specialists; anti-inflammatory medications, oral or intravenous opioid analgesics, and topical agents; and attention to the emotional and functional effects of pain, which may involve social workers, psychologists, speech therapists, nutritionists, physiatrists and palliative medicine providers. This review discusses typical pain syndromes arising in cancer patients undergoing radiotherapy and provides concrete recommendations for pain assessment and pharmacologic treatment.
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Affiliation(s)
- Lara Michal Skarf
- Section of Palliative Care, VA Boston Healthcare System, Harvard Medical School, Boston, MA.
| | - Katie Fitzgerald Jones
- Boston College William F. Connell School of Nursing and VA Boston Health Care System, Boston, MA
| | - Jordana L Meyerson
- Section of Palliative Care, VA Boston Healthcare System, Harvard Medical School, Boston, MA
| | - Janet L Abrahm
- Department of Psychosocial Oncology and Palliative Care, Division of Adult Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Meyerson JL, O'Malley KA, Obas CE, Hinrichs KLM. Lived Experience: A Case-Based Review of Trauma-Informed Hospice and Palliative Care at a Veterans Affairs Medical Center. Am J Hosp Palliat Care 2023; 40:329-336. [PMID: 35848682 DOI: 10.1177/10499091221116098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Many individuals who present for hospice or palliative care might have experienced trauma during their lives, with some progressing to post-traumatic stress disorder. As these individuals face life-limiting illness, trauma might resurface. Consequently, physical and emotional health might suffer due to exacerbation of trauma-related symptoms, such as anxiety, irritability, or flashbacks. Providing trauma-informed care can help mitigate the effects of trauma for those facing life-limiting illness who might not be able to tolerate formal trauma treatment due to limited prognosis, fatigue, or lack of willingness to engage in treatment. The goal of this narrative review is to describe how aging and the end-of-life experience can lead to a re-engagement with previous traumatic experiences and, using case-based examples, provide recommendations for all members of the interprofessional hospice or palliative care team on how to elicit and respond to a history of trauma to minimize the potential negative impact of trauma at end-of-life.
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Affiliation(s)
- Jordana L Meyerson
- Medical Service, Section of Palliative Care, 20026Veterans Affairs Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kelly A O'Malley
- Mental Health Service, RinggoldID:20026Veterans Affairs Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christelle E Obas
- Department of Nursing, 20026Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Kate L M Hinrichs
- Mental Health Service, RinggoldID:20026Veterans Affairs Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Meyerson JL. Screened In. J Pain Symptom Manage 2022; 63:e134-e135. [PMID: 32926964 PMCID: PMC7485550 DOI: 10.1016/j.jpainsymman.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jordana L Meyerson
- Veterans Affairs Boston Healthcare System, Brockton, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Boston University School of Medicine, Boston, Massachusetts, USA.
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Meyerson JL, McNamara LA, Nathan SN, Skarf LM. Complexities of Corona Virus Disease-19: The Role of Palliative Care at a Veterans Affairs Hospital. J Palliat Med 2021; 24:1375-1378. [PMID: 33956526 DOI: 10.1089/jpm.2021.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Corona Virus Disease-19 (COVID-19) pandemic accentuated the need for delivery of quality palliative care. We share the experience of our acute care hospital palliative care team in caring for veteran patients who died from COVID-19 and provide recommendations for palliative care teams caring for older adult populations. We conducted a retrospective chart review on 33 patients to gather characteristics data and delineate palliative care team involvement in their clinical courses. Our palliative care team participated in the care of 87.9% of patients who died from COVID-19. They were medically and psychosocially complex with 75.8% carrying at least four medical comorbidities, 87.8% presenting from an institutional facility, and 39.4% diagnosed with at least one psychiatric condition. Our results emphasize the impact of this pandemic on vulnerable populations and highlight the benefits of palliative care for support of patients, their loved ones, and the clinical teams caring for them.
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Affiliation(s)
- Jordana L Meyerson
- Department of Medicine, Section of Geriatrics and Palliative Care, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Laura A McNamara
- Department of Medicine, Section of Geriatrics and Palliative Care, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Susan N Nathan
- Department of Medicine, Section of Geriatrics and Palliative Care, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lara Michal Skarf
- Department of Medicine, Section of Geriatrics and Palliative Care, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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Hinrichs KLM, Woolverton CB, Meyerson JL. Help Me Understand: Providing Palliative Care to Individuals With Serious Mental Illness. Am J Hosp Palliat Care 2021; 39:250-257. [PMID: 33874784 DOI: 10.1177/10499091211010722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Individuals with serious mental illness (SMI) have shortened life expectancy with increased risk of developing comorbid medical illnesses. They might have difficulty accessing care and can be lost to follow-up due to complex socioeconomic factors, placing them at greater risk of dying from chronic or undiagnosed conditions. This, in combination with stigma associated with SMI, can result in lower quality end-of-life care. Interdisciplinary palliative care teams are in a unique position to lend assistance to those with SMI given their expertise in serious illness communication, values-based care, and psychosocial support. However, palliative care teams might be unfamiliar with the hallmark features of the various SMI diagnoses. Consequently, recognizing and managing exacerbations of SMI while delivering concurrent palliative or end-of-life care can feel challenging. The goal of this narrative review is to describe the benefits of providing palliative care to individuals with SMI with concrete suggestions for communication and use of recovery-oriented language in the treatment of individuals with SMI. The salient features of 3 SMI diagnoses-Bipolar Disorders, Major Depressive Disorder, and Schizophrenia-are outlined through case examples. Recommendations for working with individuals who have SMI and other life-limiting illness are provided, including strategies to effectively manage SMI exacerbations.
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Affiliation(s)
- Kate L M Hinrichs
- Mental Health Service, 20026VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Cindy B Woolverton
- Mental Health Service, 20026VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Jordana L Meyerson
- Department of Medicine, 20026VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Meyerson JL. "I Lost My Best Buddy Yesterday". J Palliat Care 2020; 36:5-6. [PMID: 32830590 DOI: 10.1177/0825859720951359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jordana L Meyerson
- 8267Veterans Affairs Boston Healthcare System, Brockton, MA, USA.,Harvard Medical School, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
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Hinrichs KLM, Steadman-Wood P, Meyerson JL. ACT Now: The Intersection of Acceptance and Commitment Therapy with Palliative Care in a Veteran with Chronic Suicidal Ideation. Clin Gerontol 2020; 43:126-131. [PMID: 31322060 DOI: 10.1080/07317115.2019.1642974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Suicide rates are increasing in the United States and groups at elevated risk include older adults, veterans, and those with life-limiting illnesses. However, the treatment of suicidality at end-of-life has been little studied. There is emerging evidence that palliative care itself may be protective against suicide and there is some support for the use of Acceptance and Commitment Therapy (ACT) at end-of-life. The overlapping mechanisms of palliative care and ACT are especially well-suited for individuals struggling with suicidality in the context of life-limiting illness.A case from a Veterans Affairs Home-Based Primary Care (HBPC) team is used to illustrate the challenges and opportunities when providing end-of-life care to an older veteran with chronic suicidal ideation. Prior mental health treatment had limited impact on his suicidality. However, with an integrated ACT and palliative care approach, the HBPC team was better able to focus on the veteran's goals. This approach was helpful in reducing suicidal ideation and engaging him in end-of-life decision-making discussions. This case highlights the valuable role of palliative care in suicide prevention and how the addition of ACT can aid in the effective treatment of chronic suicidal ideation at the end-of-life.
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Affiliation(s)
| | - Pamela Steadman-Wood
- Providence VA Medical Center, Providence, USA.,Alpert Medical School Brown University
| | - Jordana L Meyerson
- VA Boston Healthcare System, Boston, USA.,Harvard Medical School.,Boston University School of Medicine, Boston, USA
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Meyerson JL, McKinell KJ, Skarf LM, Nathan SN, Hinrichs KL. Rally the Troops: Interdisciplinary Response to a Veteran Who Attempted Suicide on a Veterans Affairs Hospice Unit. J Palliat Med 2019; 22:870-872. [DOI: 10.1089/jpm.2018.0171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jordana L. Meyerson
- Veterans Affairs Boston Healthcare System, Brockton, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Lara Michal Skarf
- Veterans Affairs Boston Healthcare System, Brockton, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Susan N. Nathan
- Veterans Affairs Boston Healthcare System, Brockton, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Kate L.M. Hinrichs
- Veterans Affairs Boston Healthcare System, Brockton, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Cam JA, Meyerson JL, Ng D, Frangione B, Ghiso J, Rostagno A. P4–060: Oligomeric assemblies of the Aβ Dutch mutant induce the formation of nucleosomes in primary human cerebral endothelial cells. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.1798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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