#Hpm Tweet Chat 5:9:12

7/31/2019 #Hpm Tweet Chat 5:9:12

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6/27/12 1:hpm - Healthcare Social Media Transcript

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#hpm transcript

Healthcare Social Media TranscriptFrom: Wed May 09 18:00:00 PDT 2012

To: Wed May 09 19:15:00 PDT 2012

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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 introduceyourself #hpmWed May 9 18:03:43 PDT 2012

rfberry Renee Berry in Menlo Park, CA, early palliative care advocate, started as a hospicevolunteer. Hello! #hpmWed May 9 18:04:09 PDT 2012

aliciabloom hello @rfberry! glad you're here. #hpmWed May 9 18:04:51 PDT 2012

_lizzy_ Lizzy Miles, thanatologist, hospice volunteer, social worker and passionate advocate abouend-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://www.twitter.com/_lizzy_http://twitter.com/24399366/status/200390913938309121http://www.twitter.com/rfberryhttp://www.symplur.com/healthcare-hashtags/hpm/http://www.symplur.com/healthcare-social-media/http://www.symplur.com/healthcare-hashtags/conferences/http://www.symplur.com/healthcare-hashtags/conferences/http://www.symplur.com/healthcare-hashtags/conferences/http://www.symplur.com/healthcare-hashtags/tweet-chats/http://www.symplur.com/healthcare-hashtags/diseases/http://www.symplur.com/healthcare-hashtags/diseases/http://twitter.com/24399366/status/200391142217486336http://www.symplur.com/healthcare-hashtags/s4pm/http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/KnowYourWisheshttp://www.twitter.com/aliciabloomhttp://twitter.com/15739043/status/200391130263728128http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/_lizzy_http://twitter.com/24399366/status/200390913938309121http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/rfberryhttp://www.twitter.com/aliciabloomhttp://twitter.com/121558178/status/200390735369998337http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/rfberryhttp://twitter.com/121558178/status/200390627219865601http://www.symplur.com/healthcare-hashtags/hpm/http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/aliciabloomhttp://www.twitter.com/rfberryhttp://twitter.com/24399366/status/200390030160695296http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/aliciabloomhttp://www.symplur.com/healthcare-hashtags/http://www.symplur.com/healthcare-hashtags/hpm/http://www.symplur.com/healthcare-hashtags/diseases/http://www.symplur.com/healthcare-hashtags/tweet-chats/http://www.symplur.com/healthcare-hashtags/conferences/http://www.symplur.com/healthcare-social-media/http://www.symplur.com/healthcare-hashtags/hpm/analytics/?hashtag=hpm&fdate=05-09-2012&shour=18&smin=0&tdate=05-09-2012&thour=19&tmin=15&ssec=00&tsec=00&img=1http://www.symplur.com/healthcare-hashtags/hpm/?hashtag=hpm&fdate=05-09-2012&shour=18&smin=0&tdate=05-09-2012&thour=19&tmin=15&ssec=00&tsec=00&img=1http://www.symplur.com/healthcare-social-media/

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rfberry @aliciabloom is it just us tonight? haha I thought @ctsinclair said he was coming, & saw atweet from @_lizzy_ not too long ago :) #hpm

Wed May 9 18:06:04 PDT 2012

aliciabloom @_lizzy_ ! welcome. glad you're here. #hpmWed May 9 18:06:14 PDT 2012

rfberry @_lizzy_ there she is! haha hey Lizzy #hpmWed May 9 18:06:25 PDT 2012

rfberry @_lizzy_ there she is! haha hey Lizzy #hpmWed 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 bitWed 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! #hpmWed 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 #hpmWed May 9 18:09:20 PDT 2012

rfberry (sidenote as we're waiting for T1 & doing intros... threw out my back this week, foundmyself 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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7/31/2019 #Hpm Tweet Chat 5:9:12

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aliciabloom welcome @jfclearywisc! thanks for joining us, @doctatum. #hpmWed May 9 18:10:39 PDT 2012

_lizzy_ @nursecasestudy Awwww you made it! Glad you're here! #hpmWed May 9 18:10:49 PDT 2012

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

aliciabloom before we get into topics...i did not attend #AGS2012, but saw some great news that ithought would be relevant to our chat. #hpm

Wed May 9 18:11:49 PDT 2012

hollyby @rfberry I hope you are feeling better! #hpmWed 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! #hpmWed May 9 18:12:30 PDT 2012

jfclearywisc @aliciabloom Beautiful day here in Brisbane! #hpmhttp://t.co/Gx0d8PyqWed 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 :) #hpmWed May 9 18:15:09 PDT 2012

aliciabloom thanks for checkin in @AnkurB_MD! #hpmWed 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
http://twitter.com/422176685/status/200393622921805827http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/nursecasestudyhttp://www.twitter.com/hollybyhttp://www.twitter.com/aliciabloomhttp://www.symplur.com/healthcare-hashtags/thankyou/http://www.twitter.com/nursecasestudyhttp://twitter.com/24399366/status/200393588033601537http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/AnkurB_MDhttp://www.twitter.com/aliciabloomhttp://twitter.com/24399366/status/200393505166737408http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/jfclearywischttp://www.twitter.com/aliciabloomhttp://twitter.com/24399366/status/200393354612178944http://www.symplur.com/healthcare-hashtags/hpm/http://www.symplur.com/healthcare-hashtags/hospice/http://www.symplur.com/healthcare-hashtags/AGS2012/http://www.twitter.com/aliciabloomhttp://twitter.com/55394837/status/200393051263348736http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/AnkurB_MDhttp://twitter.com/27231379/status/200392857582977024http://t.co/Gx0d8Pyqhttp://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/aliciabloomhttp://www.twitter.com/jfclearywischttp://twitter.com/24399366/status/200392837840379904http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/nursecasestudyhttp://www.twitter.com/hollybyhttp://www.twitter.com/aliciabloomhttp://twitter.com/422176685/status/200392819796488192http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/nursecasestudyhttp://www.twitter.com/_lizzy_http://www.symplur.com/healthcare-hashtags/TwitterJail/http://www.twitter.com/nursefriendlyhttp://www.twitter.com/nursecasestudyhttp://twitter.com/32316055/status/200392717543538688http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/rfberryhttp://www.twitter.com/hollybyhttp://twitter.com/24399366/status/200392666951852032http://www.symplur.com/healthcare-hashtags/hpm/http://www.symplur.com/healthcare-hashtags/AGS2012/http://www.twitter.com/aliciabloomhttp://twitter.com/32316055/status/200392541391167489http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/SanDiegoHospicehttp://www.symplur.com/healthcare-hashtags/HPM/http://www.twitter.com/hollybyhttp://twitter.com/15739043/status/200392414140178432http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/nursecasestudyhttp://www.twitter.com/_lizzy_http://twitter.com/24399366/status/200392373547700225http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/doctatumhttp://www.twitter.com/jfclearywischttp://www.twitter.com/aliciabloom

7/31/2019 #Hpm Tweet Chat 5:9:12

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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. #hpmWed May 9 18:16:45 PDT 2012

rfberry @hollyby thanks, doing better today, hoping some rest over the next two weeks gets meback 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#hpmWed May 9 18:18:44 PDT 2012

aliciabloom T1: thoughts about the #AGS2012 report highlighting the demographics of cancer patientsreferred especially late to hospice? #hpm

Wed May 9 18:18:44 PDT 2012

aliciabloom @rfberry that's such a bummer :( feel better! #hpmWed 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 themost 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 thenext 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 dowith 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 lessupport 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 cancerpatients 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 impac

timing of hospice? biased speculation #hpmWed 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. Notalways educational issue...sometimes a moral one #hpmWed May 9 18:21:36 PDT 2012

KnowYourWishes @rfberry I think late referrals come from NON-cancer diagnoses based on personalexperienceex: COPD #hpm

Wed May 9 18:21:37 PDT 2012

hollyby T1: Alternately, maybe what @KnowYourWishes said. Likely multifactorial #hpmWed May 9 18:21:43 PDT 2012

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

jfclearywisc @hollyby But patients w comorbidities and advanced cancer should not get chemo!!! Bigpart of choosing wisely!!!! #hpm

Wed May 9 18:22:04 PDT 2012

KnowYourWishes Certainly multifactorial :) MT @hollyby: T1: Alternately, maybe what @KnowYourWishessaid. Likely multifactorial #hpmWed 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 getchemo!!! 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 #educationadeficits or inherent #Bias#AGS2012#hpm

Wed May 9 18:23:02 PDT 2012
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7/31/2019 #Hpm Tweet Chat 5:9:12

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

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

jfclearywisc @nursecasestudy But also #Urban#patients have much more access to cancer resourescompeting 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 tohospuce #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 toget 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 thetime w/specialists but no one takes lead #hpmWed May 9 18:24:55 PDT 2012

_lizzy_ T1 Perhaps it is clarifying the difference between "everything possible" and "everythingpossibly 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 withcancer 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 toget 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 anAND 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 havethe "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 palliativemeasures? #hpm

Wed May 9 18:26:13 PDT 2012
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milhealth @rfberry#hpm that's why advanced directives/living will SO important. I have a verydetailed 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 withcancer services?

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CarolynMcC @AnkurB_MD I dream of the day we see palliative care consults at the initial diagnosis of 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 aregoing 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 atinitial 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 wita higher cost that make it hard for hospices #hpmWed May 9 18:29:01 PDT 2012

KnowYourWishes Gender of patient AND OF PROXY makes impact on EOL choices, thus would expectwould 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 #hpmWed May 9 18:29:14 PDT 2012

AnkurB_MD Good one! RT @_lizzy_ T1 Perhaps it is clarifying the difference between "everythingpossible" 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 thatthey 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 impactethe 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? #hpmWed May 9 18:30:10 PDT 2012

doctatumCMS talk at AGS didn't sound enthusiastic for hospice RT @rfberry: RT @hollyby: T1:

Concurrent care is definitely part of the answer #hpmWed May 9 18:30:11 PDT 2012

aliciabloom great, point @AnkurB_MD! more health care access -> more utilization => abrupttransitions 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 consultsat 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 otherways. good clinician must be atuned to that #hpmWed May 9 18:31:19 PDT 2012

doctatum cms = center for medicare medicaid services (nothing to do with geriatric folks who areenthusiastic about hospice) #hpmWed May 9 18:31:25 PDT 2012

SteveBednarski @rfberry hydration, radiation, blood transfusions. Costly and often prevent hospice careuntil 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'sdog (shots, current), #hpmWed May 9 18:31:44 PDT 2012

aliciabloom @doctatum@hollyby that's a shame. concurrent care could improve quality of care & likelower 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 atinitial 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 costlypalliative measures with oncology forces delays #hpm

Wed May 9 18:31:58 PDT 2012

DeathwDignity Psst, @mkow86@DrBeckerSchutte@ShahinaLakhani@KathyKastner, have experiencewith #TherapyDogs in #hospice? Tell us more at #DWDchat. #hpm

Wed May 9 18:32:00 PDT 2012

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

rfberry Hoping it becomes more popular! RT @colleen_young How common is it for patients andfamilies 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 #hpmWed 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#hpmWed May 9 18:33:36 PDT 2012

colleen_young @KnowYourWishes@hollyby@rfberry Thank you. Was curious. #hpmWed May 9 18:33:51 PDT 2012

milhealth RT @SteveBednarski: @rfberry hydration, radiation, blood transf $$often prevent hospicecare...#hpm denial of inevitable, not good, no point

Wed May 9 18:34:01 PDT 2012

hollyby @jfclearywisc Totally agree #hpmWed May 9 18:34:09 PDT 2012

_lizzy_ @colleen_young I think family referral requests fr previous hospice experience of someonin 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 knowand 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 abou$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#eolWed May 9 18:34:34 PDT 2012

SteveBednarski @hollyby@jfclearywisc I work to get patiemts on as early as possible and am starting tosee 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'llmove on to talking about ICDs. #hpmWed 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 butseems 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 tointroduce 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: @hollybyAgree but seems image persists is EITHER/OR #hpmWed May 9 18:36:03 PDT 2012

aliciabloom @rfberry@nursecasestudy unfortunately, some treatments (even though palliative inintent) 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 #hpmWed May 9 18:36:14 PDT 2012

nursecasestudy RT @CarolynMcC: @AnkurB_MD I dream of the day we see palliative care consults at theinitial 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 theinevitable...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 tointroduce 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 nowUSA's scared of death @milhealth@rfberry#hpmWed 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-nurseasked 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@jfclearywiscre: starting to see more push back #hpmWed May 9 18:37:23 PDT 2012
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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 anelderly man his old pup to the nursing home! #hpmWed May 9 18:37:45 PDT 2012

ctsinclair RT @jfclearywisc: Im hearing request for palliative care much much more (chance tointroduce 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 watill #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 likethemselves 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. #hpmWed May 9 18:38:28 PDT 2012

KnowYourWishes RT @milhealth: @jess_jacobs@rfberry#hpm my mom's hospice nurse told us it was gr8t2 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 tosupport 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 toincreased 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) #hpmWed May 9 18:39:23 PDT 2012

ctsinclair RT @rfberry: Hoping it becomes more popular! RT @colleen_young How common is it forpatients/families to request a referral to hospice? #hpmWed May 9 18:39:23 PDT 2012
http://twitter.com/17206739/status/200399605798666244http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/colleen_younghttp://www.twitter.com/rfberryhttp://www.twitter.com/ctsinclairhttp://twitter.com/24399366/status/200399604427128832http://www.symplur.com/healthcare-hashtags/hpm/http://www.symplur.com/healthcare-hashtags/AGS2012/http://www.twitter.com/aliciabloomhttp://twitter.com/27231379/status/200399566644842499http://www.symplur.com/healthcare-hashtags/hpm/http://www.symplur.com/healthcare-hashtags/push/http://www.twitter.com/hollybyhttp://www.twitter.com/jfclearywischttp://twitter.com/386315695/status/200399536982732801http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/rfberryhttp://www.twitter.com/hollybyhttp://www.twitter.com/jfclearywischttp://www.twitter.com/SteveBednarskihttp://twitter.com/262368526/status/200399376777101312http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/rfberryhttp://www.twitter.com/jess_jacobshttp://www.twitter.com/milhealthhttp://www.twitter.com/KnowYourWisheshttp://twitter.com/17206739/status/200399374294073345http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/milhealthhttp://www.twitter.com/ctsinclairhttp://twitter.com/27807159/status/200399351057629184http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/rfberryhttp://www.twitter.com/jess_jacobshttp://www.twitter.com/milhealthhttp://twitter.com/121558178/status/200399327095566336http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/milhealthhttp://www.twitter.com/rfberryhttp://twitter.com/422176685/status/200399266986991616http://www.symplur.com/healthcare-hashtags/hpm/http://www.symplur.com/healthcare-hashtags/deaths/http://www.symplur.com/healthcare-hashtags/patient/http://www.twitter.com/_lizzy_http://www.twitter.com/nursecasestudyhttp://twitter.com/17206739/status/200399250285277185http://www.symplur.com/healthcare-hashtags/hpm/http://www.symplur.com/healthcare-hashtags/palliative/http://www.twitter.com/jfclearywischttp://www.twitter.com/ctsinclairhttp://twitter.com/23881118/status/200399194438115329http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/DeathwDignityhttp://www.twitter.com/mkow86http://twitter.com/262368526/status/200399112460435456http://www.symplur.com/healthcare-hashtags/hpm/http://www.twitter.com/KnowYourWishes

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_lizzy_ @milhealth That is a blessing that you were all together... so many times that isn't thecase. #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 forpatients 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! #hpmBig problem!Wed May 9 18:39:43 PDT 2012

PracticalWisdom I love your work. Creativity + Function~ MT @GroundSwellAus "Funeral director + dramaclass = ?" 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 inSome Scenarios" (http://t.co/UXETg5Bz)#hpmWed May 9 18:39:52 PDT 2012

jfclearywisc @SteveBednarski No bridge. Unbundle Hospice medicare benefit and provide universalhealth 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 #hpmWed May 9 18:40:34 PDT 2012

jfclearywisc @SteveBednarski No bridge. Unbundle Hospice medicare benefit and provide universalhealth 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 agreat deal" http://t.co/UVn2OaUj cc @NHDD#hpmWed 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 waswonderful! 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 universalhealth care!!! #hpmWed May 9 18:41:27 PDT 2012
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Wed May 9 18:44:13 PDT 2012

mkow86 @nursecasestudy seeing trend of nursing homes sometimes using hospice for wrongreason//wanting the extra aide unfortunately #hpmWed 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 ShuOff 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 bin 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 (iwe don't put it in, you could die suddenly) #hpmWed 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! #hpmWed May 9 18:44:48 PDT 2012

nursecasestudy @aliciabloom Once we've discussed it, and they know what we mean by "doingeverything" 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 inSome 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 choosethat, 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. #hpmWed May 9 18:46:04 PDT 2012

rfberry @SteveBednarski@jfclearywisc@hollyby I think early palliative care & clear goals of carediscussions 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 (ifwe 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!

#hpmWed May 9 18:47:04 PDT 2012

hollyby @SteveBednarski Thanks for joining in! #hpmWed May 9 18:47:20 PDT 2012

aliciabloom for those of you working in #hospice...how do you address deactivation of ICDs? #hpmWed 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 ToTurn It Off! #palliative care c/s may help! #hpmWed May 9 18:48:33 PDT 2012

hollyby There are LOTS more ICDs put in than LVADs though. Important to work with thecardiologists about this issue. #hpm

Wed May 9 18:48:55 PDT 2012

aliciabloomT2: also from #AGS2012- "Patients With ICDs Might Want Shut-Off in Some Scenarios"(http://t.co/UXETg5Bz) #hpm#hpmWed May 9 18:48:57 PDT 2012

KnowYourWishes Yes! RT @AnkurB_MD: @ctsinclair@jfclearywisc T2: With ICDs the Q is not whether toPut 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#HPMhttp://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. #hpmWed 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 inhospice-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#HPMhttp://t.co/DjKU0GN3#hpm

Wed May 9 18:49:59 PDT 2012

rfberry RT @Pallimed: Implantable Cardiac Defibrillators - #Hospice Role in Deactivation? via@Pallimed#HPMhttp://t.co/eaneEuJhWed May 9 18:50:03 PDT 2012

hollyby RT @Pallimed: Implantable Cardiac Defibrillators - #Hospice Role in Deactivation? via@Pallimed#HPMhttp://t.co/5A4sIysa#hpm

Wed May 9 18:50:08 PDT 2012

aliciabloom @hollyby mostly comments, although i just threw out a question.... :) #hpmWed May 9 18:50:27 PDT 2012

KnowYourWishes Impt to remember values change over time & with illness MT @jess_jacobs: I'd 2nd that! I#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 gr8t2 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 todialyze the dying patient? #hpm

Wed May 9 18:50:55 PDT 2012

aliciabloomRT @aliciabloom: T2: how do we in #hospice & #palliative address ICDs given that theyoffer great benefit & much potential burden? #hpmWed May 9 18:51:02 PDT 2012

ctsinclair @aliciabloom@hollyby thanks #hpmWed May 9 18:51:14 PDT 2012

ctsinclair Also important to realize that a pacemaker and ICD may be contained in the same devicebut 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 codestatus and discuss pros, cons, & pt wishes #hpmWed May 9 18:53:36 PDT 2012

jfclearywisc @SteveBednarski A "do not hospitalize" order is very underused!!! But may struggle thento 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 benefitvs. 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 thesame device but don't do the same thing... #hpmWed May 9 18:54:20 PDT 2012

ctsinclair @hollyby Care to explain AICD vs ICD #hpmWed May 9 18:54:50 PDT 2012

jfclearywisc RT @hollyby: T2: I incl AICD deactivation in goals of care discussions when talking abtcode 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. Notgreat 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.. #hpmWed May 9 18:55:03 PDT 2012

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

rfberry I have to head out, thanks so much @aliciabloom, great topics tonight! #hpmWed 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! #hpmWed May 9 18:56:24 PDT 2012

KnowYourWishes Learned a lot about ICDs tonight! Thx #hpmWed May 9 18:56:34 PDT 2012

nursecasestudy @jfclearywisc: @ctsinclair@aliciabloom: T2 When a #hospice referral is made, AICDmaintenance should definitely be addressed. #hpmWed May 9 18:56:43 PDT 2012

ctsinclair RT @BillPfohl: does ICD offer Pts comfort care? "No comfort, it hurts. Life prolonging only#hpmWed 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! #hpmWed May 9 18:56:59 PDT 2012

ctsinclair @BillPfohl Never a dumb question here! #hpmWed May 9 18:57:00 PDT 2012

ctsinclair @rfberry Goodnight RF! #hpmWed May 9 18:57:46 PDT 2012

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

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

ctsinclair @hollyby :-) #hpmWed May 9 18:58:38 PDT 2012

jfclearywisc @aliciabloom Ciao!! 12 noon here now!!! Beautiful day ahead.... #hpmWed May 9 18:58:59 PDT 2012

aliciabloom here's hoping some of the chaplains from #socmedchap consider joining #hpm chat nextweek! we'd love your perspective.Wed May 9 18:59:22 PDT 2012
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aliciabloom @jfclearywisc enjoy the beautiful day! it's almost bed time around here. #hpmWed May 9 18:59:53 PDT 2012

colleen_young @mkow86@nursecasestudy@ctsinclair@_lizzy_ Thanks all. #hpmWed 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 ofmy 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 shockablearrhythmia, but packs a punch to do it. #hpmWed 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#hpmWed May 9 19:02:10 PDT 2012

KnowYourWishes RT @ctsinclair: Great chat as usual! Thanks @AliciaBloom#hpmWed May 9 19:02:19 PDT 2012

EWidera RT @ssmithaahpm: AMA Wire - AMA CEO discusses future of the organization, medicalprofession 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! Hugsuntil next week! #hpm

Wed May 9 19:02:41 PDT 2012

ctsinclair @hollyby@BillPfohl fair point #hpmWed May 9 19:02:43 PDT 2012

aliciabloom @skypilotofhope#hpm = #hospice & #palliative medicine. lively group talking issuesrelated 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. #hpmWed May 9 19:04:02 PDT 2012

nursecasestudy #Thanks! 4 hosting :)RT @hollyby: @aliciabloom Thanks so much for moderating! Greatjob 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 heretonight. #hpmWed May 9 19:05:58 PDT 2012

BillPfohl Thank you all...interesting topics...Good evening! #hpmWed May 9 19:06:34 PDT 2012

apjonas RT @Pallimed: Implantable Cardiac Defibrillators - #Hospice Role in Deactivation? via@Pallimed#HPMhttp://t.co/eaneEuJh

Wed May 9 19:13:30 PDT 2012
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#Hpm Tweet Chat 5:9:12