Thyme Care’s Post

"There is an urgent and unmet need to normalize the use of palliative care from the moment of serious illness diagnosis. For that to happen, we need to take a long, hard look at how we can help patients and clinicians overcome pervasive myths." Thyme Care's Dr. Julia Frydman, Medical Director for Palliative Care, recently collaborated with Dr. Fred Divers, American Oncology Network's Chief Medical Officer, for a recent article in Oncology News Central. In the article, the two discussed the stigmas around palliative care, and highlighted how a "sooner, rather than later" protocol can reduce pain, hospitalization, and financial strain on many patients. Check out the link below to learn more. #palliativecare #healthcare #transforminghealthcare

Sharing another excellent article published as part of the special article series "Hospitalization and Parkinson’s Disease: Safety, Quality and Outcomes" in the journal Frontiers Journal of Neurology & Neuroscience. This article took a deeper look at a subset of the data pulled for the research project I've been working on with Cleveland Clinic, touching on inpatient palliative care for end of life Parkinson’s patients. Great work by Benjamin Walter, MD, MBA and team! Here's the section that most stood out to me: “Earlier involvement of palliative-oriented care may have facilitated an earlier discussion of advance care planning. A Parkinson Disease Quality Measurement Set, published by the American Academy of Neurology in 2016, recommended an annual review of advance directives, but it is unclear how widely this is implemented. Estimated rates of advance directives completion among PwP were reported to vary from 68 to 95% (Kwak et al., 2014; Tuck et al., 2015; Kluger et al., 2018; Lum and Kluger, 2020). The present study did not assess this directly though the rate is postulated to be lower given that the majority of patients at EOL had a full/presumed full code status upon last admission. Similar findings were seen in another study which described that advanced care planning for many patients with PD started as a response to a crisis event like a hospitalization (Nimmons et al., 2020). Our patients who were discharged to hospice had received a PC consultation more frequently. On the other hand, the patients who expired in the hospital, with higher rates of ICU transfers and invasive procedures, were observed to have less frequent interactions with PC services. While the sample was not felt to be powered enough to assess for correlations, previous research had shown that in-hospital PC involvement influenced discharge disposition and improved quality of life (Brody et al., 2010).”

Excited to share insights from our Clinical Advisory Board member, Dr. Areej El-Jawahri, about why she joined Tuesday Health and her vision for transforming serious illness and end-of-life care. Q: What inspired you to join Tuesday Health's Clinical Advisory Board? A: Tuesday Health is tackling the most pressing problem facing the American health care system, how to help patients cope most effectively and live as well as possible with their serious illness and how to ensure they receiving high-quality care across the continuum of serious illness and at the end of life. As an oncologist caring for patients living with cancer, I have seen too often the unnecessary suffering that patients and families endure during the course of their serious illness. I have seen too often the failure of our health care system to address the immense supportive care needs of these patients such as optimally managing their physical and psychological symptoms, and helping them cope most effectively to living with cancer, maximizing their quality of life and care throughout their illness course. The work that Tuesday Health does will hopefully change the paradigm of how we deliver serious illness care to patients and families across the United States and perhaps the globe. Q: How do you envision your expertise contributing to the transformation of serious illness and end-of-life care? A: I am an oncologist and a palliative care researcher focused on improving the quality of life and care for patients with cancer. Over the past two decades, we have learned from numerous clinical trials about the immense benefits of integrating a team of clinicians with specific expertise in addressing complex physical and psychological symptoms and helping patients and families cope most effectively with their serious illness for improving a wide range of patient and family centered outcomes including quality of life, caregiving burden, psychological distress, and also end-of-life care. These team of specialists are called palliative care or supportive care clinicians. Supportive care is appropriate for patients living with serious illness at any stage of disease and even when receiving potentially curative therapy as the goal of supportive care is to improve the lived experience of patients throughout their illness trajectory. Despite the benefits of supportive care for patients with serious illness, it is not appropriately implemented or readily available for millions of Americans living with serious illness. My hope is that my expertise will help us translate the knowledge from these studies to developing an effective and scalable care model that can reach patients with serious illness across the United States to improve their quality of life and care. Tuesday Health is honored to have Dr. El-Jawahri on board. Join us in our mission to revolutionize supportive care and empower the lives of patients and caregivers!

I met with a good friend last week who is a doctor with specialties in infectious disease and oncology. I needed to talk through my experience when my dad was in the hospital. I wanted to understand what could have looked different if we had had different information. I want to gather this information to share with others and hopefully improve patient (and their families') experience.   I was left with two main points: 1. Patients and their families are clients. They can make requests (especially when it comes to communication). 2. You can request a Family Meeting where all of the specialists/services treating the patient are in the same room with the patient and family making sure everyone understands the treatment options and the risks involved.   Both of these blew my mind! They sound simple, but when you are in a frantic, fast-paced hospital environment with specialists coming in and out of the patient room at all hours of the day, it definitely feels like you are working on their terms not vice versa. Remember, you are the client, and they are there to serve you!   One consistent story that I hear from patients and families who have been through hospital stays is that they receive very different information from different specialties, leaving untrained families to make sense of the discrepancies. We my dad checked in to the hospital the main goal was to get the tumor out of his brain. While we waited for surgery, my dad developed pneumonia, high blood pressure became a concern, and an irregular heartbeat was discovered. New variables (and risks) were introduced, which also meant new specialties with different goals were at play. We never took a pause to talk all together talk about what this meant for potential outcomes. A Family Meeting would have been sooooo helpful!   Use your voice, ensure understanding, and make sure that the specialties clarify their differing views! This simple step will hopefully allow you to be present with your loved one as much as possible in a challenging situation. https://lnkd.in/g6EKaAkA

When we think of palliative care, many of us imagine end-of-life scenarios. However, palliative care is much more than that—it’s a holistic approach to enhancing the quality of life for patients from the moment of diagnosis. Here’s why palliative care is crucial throughout the journey: 1. Diminishing or Preventing Side Effects of Oncological Treatment: Palliative care works hand-in-hand with curative treatments, helping to manage and mitigate the often debilitating side effects of chemotherapy, radiation, and other cancer therapies. This ensures patients can tolerate treatments better and maintain a higher quality of life. 2. Alleviating and Preventing Symptoms of the Disease: Palliative care provides comprehensive symptom relief, from pain management to addressing symptoms like nausea, fatigue, and breathlessness. This proactive approach prevents complications and reduces the physical and emotional burden on patients and their families. 3. Providing Orientation and Reducing Uncertainty: A diagnosis can bring a whirlwind of emotions and uncertainties. Palliative care teams offer guidance, education, and support to help patients and families understand what to expect, make informed decisions, and navigate the complexities of their healthcare journey. By integrating palliative care early in the treatment process, we can transform the experience for patients and their loved ones, focusing on comfort, dignity, and comprehensive support. Let's continue to spread awareness about the full spectrum of palliative care and its invaluable role in improving lives from diagnosis to beyond.

Polypharmacy causes greater symptom burden, confusion and overwhelm for the patient and caregiver, and reduced quality of life. Picture Mrs. B, an 86 yo African-American female with metastatic breast cancer with brain metastases who has declined further cancer-directed treatment, not quite yet ready for hospice care, with a chief presenting complaint today of “I’m so confused.” Once I quickly realized she was in fact oriented, alert, and with good insight, I realized she was confused about her medications. She pulled out 3 plastic bags - 1 for all of her meds from her primary care, 1 with her supplements, 1 with her supportive care meds (for pain, nausea, etc.). I have patients like her that BEG me to please take them off some of their medications every clinic day and guess what…I oblige. Deprescribing is one of my favorite and most underrated skills. Starting with a comprehensive medication reconciliation (including those supplements!), deprescribing is an intentional skill to assess and prioritize a patient’s health conditions, values and goals of care, drug interactions and side effects, quality of life, pill burden, caregiver burden weighed in light of their prognosis and….you guessed it DEPRESCRIBE the low value medications. For example, my patient above who has declined any more cancer-directed treatment, not quite yet ready for hospice care, does not need a statin. She’s also had profound weight loss and her hypertension has resolved and she no longer needs her antihypertensives. We were able to cut down Mrs. B’s medications down to 2 bags. This was a small but significant win, and most importantly, it met HER goal for today. Deprescribing is a low cost, high value, often overlooked intervention that I love to utilize often in my palliative care practice.

PALLIATIVE CARE THROUGH ART: S#6 🚀 Hope is not a strategy in palliative care 🚀 Dr. Christian Ntizimira, a dedicated palliative care physician, and Bazongere Rosine, a talented artist, recently engaged in a profound conversation highlighting the contrasting perceptions of palliative care in two different worlds. Both driven by compassion and humanity, their discussion shed light on the importance of proactive action in this critical field. In their exchange, Dr. Ntizimira emphasized the need for a strategic approach in palliative care. While hope remains an integral part of the human experience, it cannot be the sole foundation for providing comfort and support to those in need. Palliative care goes beyond just hoping for better days; it requires a comprehensive and proactive strategy that addresses patients' physical, emotional, and spiritual well-being. Bazongere Rosine, with her unique perspective as an artist, added a creative touch to the conversation. She emphasized the role of art in capturing the essence of palliative care, allowing society to grasp the complex emotions and challenges faced by both patients and caregivers. Through art, she believes, we can bridge the gap between the two worlds and promote a deeper understanding of the importance of compassionate end-of-life care. Palliative care is a critical field that demands thoughtful and deliberate action. It is not enough to hope for a better outcome; we must actively work towards providing the support and comfort that individuals in need deserve. By recognizing the importance of a strategic approach and embracing the power of art, we can create a more compassionate and empathetic society. Join the conversation, and let's break down barriers together! How can we further enhance palliative care and ensure it remains at the forefront of compassionate healthcare? Union for International Cancer Control (UICC) Ophira Ginsburg Danny Burke Maria Castrillo Gil Zainab Shinkafi-Bagudu Nazik Hammad Diane Andrea NDOLI Christian Rusangwa Christina Thompson Lively AORTIC- Africa Palliative Care WA African Palliative Care Association Members Walther Center in Global Palliative Care and Supportive Oncology Palli Verse Palliative Care South Australia Elisabeth Kübler Ross Foundation International Association for Hospice and Palliative Care (IAHPC) WHPCA

So much good news to highlight from the last 2 weeks in the kidney [space]. 1️⃣ Strive Health announced a multi-year partnership with Oak Street Health in 21 states to help manage care for patients with CKD. 📣 Strive's co-founder and CSO Will Stokes said "We focus on delivering compassionate kidney care and Oak Street Health offers the best clinical care model for older adults, so bringing the organizations together in collaboration is a natural fit." 🧩 Context: CVS Health acquired Oak Street earlier this year for ~$10.6B. CVS CEO Karen S. Lynch said "We will also open new Oak Street clinics co-located with CVS Pharmacies this year and have already identified additional locations for 2024. We now expect to build 50-60 clinics next year." 2️⃣ Interwell Health announced their expanded relationship with Humana to provide integrated and coordinated care for members living with #CKD and ESKD across 13 states. 📣 In the press release, Interwell's CMO Dr. George Hart said "Our success is due in large part to our ability to fully activate a passionate, multidisciplinary care team that works in partnership with our network of high performing nephrologists across the country." 🧩 Context: Last week Interwell celebrated one-year since its inception and three-way merger. In that time the company has grown the number of patients under management to 125,000 and its provider network to 1,700 nephrologists. 3️⃣ Fresenius Medical Care North America announced FDA clearance for Versi®HD with GuideMe Software. The upgrade is designed to improve patient training time, ease the transition to home, and make the training experience easier for new users. 📣 FMC's SVP and Medical Officer of Home Therapies Brigitte Schiller, MD said "As a result of this software upgrade, patients and their care partners will have additional support to be confident with the therapy at home. VersiHD with GuideMe Software will support Fresenius Medical Care’s mission of advancing access to home therapies to more patients." 🧩 Context: NxStage Medical, Inc. has delivered over 30 million patient treatments over nearly two decades. Over 95% of HHD patients in the U.S. use the NxStage HHD system. 4️⃣ A new study from the National Kidney Foundation and NCQA reveals alarming disparities in CKD testing and highlights a path to equitable care for Americans living with diabetes. The study shows that less than 40% of patients with #diabetes have been recommended at least annual #kidney health screening tests. NKF and NCQA also found concerning disparities in even lower fulfillment of recommended testing among Black/African Americans and socioeconomically disadvantaged groups. 📣 NKF's CMO Joseph Vassalotti said "Kidney health testing is pivotal to ensuring timely diagnosis and equitable treatment of CKD." 🧩 Context: Approximately 90% of people with CKD in the United States don't even know they have it. -- What are you seeing, celebrating & following in the kidney [space]? 👇🏼

For Healthcare Professionals #HCPs Conversation Openers: Practical advice for healthcare professionals on ‘how’ to have open conversations on mental health with patients - https://lnkd.in/eY_N-Jf2 UKONS (UK Oncology Nursing Society) EONS Cancer Nursing Nursing Times

ELDERLY HbA1c COMPLICATIONS Managing HbA1c levels among the elderly is a pressing concern due to the prevalence of diabetes in this population and the complexities associated with their care. Diabetes affects a substantial portion of individuals aged 65 to 99 worldwide, with higher rates observed in North America and the Caribbean. Elderly patients with diabetes often have multiple coexisting health conditions, necessitating various medications. Age-related factors also make achieving glycemic control challenging. Uncontrolled diabetes can lead to a range of complications, both microvascular and macrovascular. These include peripheral artery disease, coronary artery disease, stroke, and heart failure, among others. While effective management can mitigate these complications, aggressive glycemic treatment can result in severe hypoglycemia, which can lead to falls, cognitive decline, and even increased mortality rates. The balance between managing hyperglycemia and avoiding hypoglycemia becomes crucial. Current American Diabetes Association (ADA) guidelines recommend individualized HbA1c targets based on cognitive function and comorbidities. However, putting these recommendations into practice can be challenging for both patients and healthcare providers. Many elderly patients may receive excessive treatment, often with inappropriate glycemic goals that don't suit their unique needs. Complications associated with strict glycemic targets include: Hypoglycemia: Intensive glucose-lowering therapy can lead to severe hypoglycemia, especially in older individuals. Research shows a higher prevalence of hypoglycemic events among elderly patients with lower HbA1c levels. Those on insulin and multiple therapies are at higher risk. Falls: Rigorous glucose control increases the risk of hypoglycemia-related falls, which are particularly concerning for the elderly due to their frailty. Some studies suggest that elderly diabetic patients with lower HbA1c levels are more likely to experience falls. Macrovascular Cardiac Incidents: Poorly controlled HbA1c levels are associated with increased rates of cardiovascular events like coronary artery disease, peripheral artery disease, and stroke. Microvascular Cardiac Incidents: The impact of intensive glucose control on preventing microvascular complications is debated. Some studies show benefits, while others find no significant reduction in events like retinopathy, nephropathy, and neuropathy. Cost and Lifestyle: The burden of treatment cost and intensity affects the quality of life of elderly patients. Some studies indicate that intensive treatment might not lead to substantial improvements in outcomes. Mortality: Mortality rates exhibit a U-shaped curve, implying increased mortality risk for both very low and very high HbA1c levels. Studies show conflicting results regarding the impact of intensive glucose control on mortality rates among elderly patients.