Phone: 651.917.4616 / 800.214.9597

Resources for care and support

For Learners

Conference session materials are now available. Please note that presentations are subject to change and may NOT represent the most current version. Materials will continue to be updated. All final versions will be posted and available on the site for several weeks after the conference. Please keep in mind that not all presenters will choose to make their presentations available. In an effort to reduce paper waste, MNHPC will NOT be providing hard copies of the presentations or handouts. If you would like a hard copy for notes, please print them off prior to arriving at the conference.

SUNDAY

Pre-Conference | Sunday, April 2nd, 2017 | 1:00-5:00 pm | Veranda 1-8

Making the Difficult Conversation Simple(r) | Jeff Cohn, MD

Pre-Conference Cohn PPT

This half-day workshop will focus on the role of conversation leading to advance care planning and person-centered care for individuals with advancing serious illness. The event will include new information about advancing serious illness, knowledge and communication gaps being faced by patients with advancing serious illness, how patients vary by underlying conditions, creating conditions for psychological safety, enabling communication about sensitive information comfortably and safely. In addition, this workshop will include an experience with an evidence-based communication tool, My Gift of Grace and interactive activities that will lead to participants leaving the workshop with personal commitments to action regarding enhanced conversation with their patients with advancing serious illness.

Upon completion of the activity, learners will be able to:
Objective1: Recognize different clinical archetypes of advancing serious illness and the communication challenges being faced across those archetypes.
Objective 2: Understand the concept of psychological safety and how to apply that to conversations that surface people’s values, beliefs, and priorities, leading to person- centered care.
Objective 3: Practice communication that makes one vulnerable in ways that are comfortable and safe and can be applied with the patients and families you/your organization work with.

MONDAY

Keynote Address | Monday, April 3rd, 2017 | 8:45-10:15 am | Ballroom

The Human Side of Healthcare | Dale Larson, PhD

Larson and Tobin 2000 Keynote
Larson 2002 Keynote
Larson 2001 Keynote

As end-of-life care enters its second wave, hospice and palliative care services continue to expand, bringing better quality of life to growing numbers of dying persons and their families through better symptom management, clearer communication about the patient’s condition, greater sensitivity to spiritual and cultural issues, and increased control over the site of death.

Best outcomes in all these areas are achieved through meticulous and courageous person-centered care—care that requires empathically engaging with distressed patients and families, negotiating ethical conflicts, integrating cumulative losses, leading difficult curative to palliative conversations, and communicating openly with colleagues.

Recent studies tell us that burnout, compassion fatigue, and moral distress are ongoing risks in this intensely emotional work, and also that finding meaning in it keeps the spark alive, inspiring renewed commitment. We will explore both these sides of end-of-life care and their place in our collective efforts to provide hope in a world in which loss is inescapable.

Upon completion of the activity, learners will be able to:
Objective 1: Identify challenges and rewards of person-centered end-of-life care
Objective 2: Identify frequency and causes of burnout and compassion fatigue, and antidotes to them
Objective 3: Identify role of internal stressors in burnout
Objective 4: Identify common concealed work-related experiences of end-of-life

Breakout Session 1 | Monday, April 3rd, 2017 | 10:45-12:00 pm 

1A: Secrets at the End of Life | Dale Larson, PhD | Atrium 4

1A Larson Handout

Working with people facing life-threatening illness and grief ushers us into a world of secrets. Family secrets, traumatic life events, and disenfranchised grief are just some of the many painful and often stigmatized experiences patients and family members confide to us.

Secret keeping can strongly impact end-of-life care, blocking the transitional conversations needed to move from curative to palliative goals of care. Health professionals also keep secrets—self-doubts and other embarrassing and distressing thoughts and experiences that can act as invisible stressors. Navigating this world of secrets sensitively and ethically is a hallmark of the effective end-of-life professional.

To address these issues, we will draw upon recent work on self-concealment and health, emotion regulation, helper secrets, family secrets, the experimental disclosure paradigm, client secrets and lying in psychotherapy, attachment styles, and end-of-life conversations.

Upon completion of the activity, learners will be able to:
Objective 1: Identify key factors in the psychology of secrets and the effects of secrets and secret keeping on health and end-of-life care
Objective 2: Identify the most commonly reported secrets of patients
Objective 3: Identify common themes in work-related secrets of end-of-life professionals
Objective 4: Identify strategies for facilitating safe and potentially healing discussions of secrets

1B | Regulatory Issues for Hospice and Palliative Care: The Latest from Washington | Judi Lund Person, MPH | Bloomington

1B Lund Person

The current environment for health care, for Medicare, and for hospice and palliative care has never been more uncertain. What will happen with the Affordable Care Act? What regulations will be eliminated as the new administration looks at regulatory burden? What will happen with Medicaid? How will this impact hospice and palliative care? All of these questions are at the forefront of our minds as we watch the changes in government and anticipate more.

This session will provide an “up to the minute” update on happenings in Washington, discussions at CMS, and changes that are expected or underway. There has never been a time where it is more important to stay “in the know.” Be a part of the discussion that could position your hospice or palliative care program for the future.

Upon completion of the activity, learners will be able to:
Objective 1: List three changes that have been announced that impact provisions of the Affordable Care Act and their impact on hospice and palliative care.
Objective 2: Describe changes to the Medicaid program and plans that could reshape Medicaid policy.
Objective 3: List three regulatory changes that could be considered regulatory burden and could be reduced or eliminated.

1C: Threshold Conversations: Diagnosis, Dying, Death and Bereavement | Ted Bowman, Mdiv | Edina

1C Bowman PPT

Caring work with individuals and families facing diagnosis, dying, death or bereavement requires attention to sacred spaces, sometimes called thin or hinge places between one reality and another. Talking respectfully and honestly about this continuum requires courage, self-awareness, empathy, and compassion. Doing it well requires care of self, colleagues, and families and a commitment to enter the threshold.

In this session, participants will consider the thresholds of living, dying and death for individuals and families WITH special attention to perspectives and tools for communicating about these matters with all involved.

Upon completion of the activity, learners will be able to:
Objective 1: By the end of the session, participants will be to name and discuss key components for effective conversations at threshold moments
Objective 2: to name and discuss challenges for their interactions with families at threshold moments
Objective 3: Prepare a plan for improving the quality of conversations with families
facing threshold moments

1D | A Conversation about Prognostication | Maggie O’Connor, MD, BC-PC | Atrium 7

1D O’Connor Handout

Prognostication is part and parcel of medical practice when the expectation is a good outcome, recovery from an appendectomy, for example. But when the prognosis is one of lost function or death, both foreseeing and foretelling the outcome is one of the most difficult skills to master, and is often avoided altogether. Last year Maggie spoke about the Art and Science of Prognostication.

This year’s workshop will delve into the nitty gritty through a conversation between the presenter and the participants based on a thread in Paul Kalanthi’s book, When Breath Becomes Air. In this memoir, Dr. Kalanthi notes a series of conversations with his oncologist that offer a perfect vehicle to discuss the nuances of prognostication and reflect on how we can do this difficult task better. While reading the book is recommended, there is no need to do so before attending the session.

Upon completion of the activity, learners will be able to:
Objective 1: articulate their own values and beliefs about the practice of prognostication
Objective 2: create ways for volunteers to serve the pediatric population, whether it be a patient, sibling, or a child living in a hospice patient’s home.
Objective 3: define hope in richer terms than simply prolonging life or meeting a goal

1E | Hospice & Palliative Care Case Conference: What We do When Surrogacy Fails, the Baby Doesn’t Die, and the New Definition of ‘Maximum Life-Support’ | Drew Rosielle, MD, FAAHPM; Allison Feldman, MD; Elena Wahmhoff, MD | Atrium 2

1E Rosielle.Feldman.Wahmhoff PPT

This case conference will explore challenging situations in contemporary hospice & palliative care. For each case, we will discuss the case details, review relevant medical research literature, and engage the audience in discussion.

We will discuss the challenges of surrogate decision-making, including the research literature on the limited accuracy of surrogacy, involving a case where a patient woke up and was able to identify his surrogates made the wrong decision. We will discuss caring for infants with trisomy 18, a syndrome which has been inaccurately characterized as uniformly fatal, and what happens when the palliative care team advocates for more aggressive treatments than others. Finally, we will discuss extra-corporeal mechanical oxygenation (“ECMO”) a life-support technology which is rapidly changing medical care for the critically ill patients in the ICU, and how palliative care teams can help care for these patients and their families.

Upon completion of the activity, learners will be able to:
Objective 1: define the gap between the normative conception of surrogate decision- making and the reality of how decisions are more commonly made.
Objective 2: guide parents and other professionals to make better informed decisions for infants with severe chromosomal syndromes.
Objective 3: expertly provide palliative care for patients and their families on extra- corporeal mechanical oxygenation in the intensive care unit.

1F | Strengthening your Hospice Roots: Enhancing Productivity and Cost Containment Efforts | Lisa Abicht-Swensen, MHA, LNHA | Veranda 7-8

1F Abicht-Swensen PPT

Issues of cost containment have become particularly relevant with federal health reform demanding the delivery of cost efficient care across all health care settings. As hospice providers seek to securely anchor their operational and financial roots and expand their reach into the communities they serve, it is imperative that their strategic initiatives address productivity expectations and cost containment strategies that focus on reducing costs without compromising excellent patient- and family-centered care.

Upon completion of the activity, learners will be able to:
Objective 1: Understand the factors influencing hospice productivity and caseload determinations
Objective 2: Identify strategies toward more efficient staffing and management of ancillary expenses
Objective 3: Identify various data metrics and benchmarks used for improving and maximizing clinical and financial performance

1G | What’s Important? Eliciting Deep Insights from Patients and Families: A Workshop for Opening Doors to Important Conversations | Sandra Schellinger, MSN, NP-C; Eric Anderson, MD; Judi Blomberg, BA, JD | Atrium 6

1G Schellinger.Anderson.Blomberg PPT
1G Schellinger.Anderson.Blomberg Handout 1
1G Schellinger.Anderson.Blomberg Handout 2
1G Schellinger.Anderson.Blomberg Handout 3

Patient and family goals are complex, involving all aspects of personhood and evolving during the serious illness experience. This workshop allows participants to practice two techniques for understanding patient and caregiver needs that are readily translatable to a variety of care settings.

The presenters will share the results of in-depth analysis of 1,000 goals as described by patients several years prior to death. This analysis illustrates the dynamic nature of both medical and nonmedical goals that patients identify, and the timing of whole person issues along the illness trajectory.

Participants will understand the need for ongoing goals of care discussions and the turning points that may alert the care team to decision making, advance care planning and supportive care needs. In addition, the results of interviews with patients and their caregivers will shed light on the priorities, not just of caregivers, but of families as self-identified care teams.

Upon completion of the activity, learners will be able to:
Objective 1: identify common themes of goals as defined by patients and families.
Objective 2: name two common turning points of the serious illness experience that would proactively identify the need for a goals of care discussion.
Objective 3: partner with patients and families to identify their support network and potential gaps.

1H | Integrative Healing Therapies for Hospice Care | Sandra McGurran, MSW, LISW | Plaza 2

1H McGurran PPT

Integrative Healing Therapies for Hospice Care will discuss the definition of integrative healing vs alternative therapy; review the use of integrative healing therapies across the continuum of care; provide education on aromatherapy and evidence- based outcomes on the use of aromatherapy for symptom management of anxiety, nausea, pain and sleep; and review other modalities of integrative therapies such as healing touch, Reiki, guided imagery, breathing, AND music. The integrative therapies discussed will have an experiential component for attendee learning.

Upon completion of the activity, learners will be able to:
Objective 1: Define Integrative Healing Therapies vs Alternative Therapies
Objective 2: Explain 2 integrative healing therapies that can be used for symptom management of anxiety, nausea, pain and sleep.
Objective 3: Incorporate 3 integrative healing therapy modalities into care providers routine to support well-being and resiliency.

1I | Teaching Communication Skills-Professional Development | Annette Nijjar, MD; Elizabeth Uchitelle, MD; Beth Jeffrey, MD | Atrium 8

1I Nijjar.Uchitelle.Jeffrey PPT
1I Nijjar.Uchitelle.Jeffrey Handout 1
1I Nijjar.Uchitelle.Jeffrey Handout 2

This train-the-trainer session will focus on teaching communication skills using small-group role plays. We will introduce the roadmap of a typical session, discussing the evidence base for this approach. Participants will learn how to set up small group work to achieve focused, time efficient learning in a supportive and safe environment. We will address feedback. We will also discuss how to apply this in one-on-one teaching. During this workshop, the participants will have the chance to practice above skills in small-groups and develop ways of using the skills learned in their own work environment.

Upon completion of the activity, learners will be able to:
Objective 1: guide a small group through a communication role play and have practiced that at least once during this workshop.
Objective 2: identify a learner’s needs and help them develop a take-home point.
Objective 3: develop an outline and commit to the first steps for a communication teaching format adapted to their work environment.

1J | Thorazine in Terminal Delerium: Allowing a Husband to Say Goodbye | Jennifer Kuyava, MD | Veranda 1-2

1J Kuyava PPT

Terminal delirium can be incredibly distressing to family and friends. This session will evaluate a case of a 59-year-old female who originally presented to the hospital with dizziness and confusion. Investigation revealed widely metastatic breast cancer.

Her hospitalization became incredibly complicated and she suffered from complex pain and delirium. Despite appropriate management, delirium persisted. The Palliative team worked closely with the Hospitalist and Oncologist to thoroughly investigate causes for the delirium. Unfortunately, no treatable cause was discovered. During this hospitalization, the patient’s complex delirium was not only distressing for her husband, but also the nursing staff. Diligent efforts to improve symptoms continued and relief was finally achieved with use of chlorpromazine (Thorazine). Additionally, during this time, the patient’s husband became overwhelmed and required much support from the Palliative team in order to engage in the decision-making process for his wife.

Upon completion of the activity, learners will be able to:
Objective 1: Recognize situations in Palliative Care that may benefit from use of chlorpromazine compared to other neuroleptics.
Objective 2: Describe how to work within a multi-specialty team of providers when a patient’s decision-maker is overwhelmed and unable to engage in the decision-making process.
Objective 3: Identify ways to best work with nursing and other specialists to give patients and their families the best care possible when faced with terminal delerium.

1K | Best Practices in Palliative Care for Immigrants and Refugees: A Family Systems and Cultural Humility Perspective | Miguel Ruiz, MD; Cristina Plaza, MAEd, LAMFT | Atrium 1

1K Ruiz.Plaza Ruiz PPT

The immigration experience shapes conversations that patients, families, and health care providers hold regarding the decisions that take place during advanced illness and end of life.

Family systems theoretical perspective and praxis can add to the dialogue and family dynamics surrounding these important issues with the immigrant community. It is important to also frame these conversations moving from cultural competence as the “arrival” to the understanding of other minority groups, towards a lifelong journey of learning about others, cultural growth and humility.

End-of-life conversations and decision-making are difficult for all individuals, but they often come with additional burdens for those belonging to displaced and frequently undeserved immigrant populations. The practice of culturally appropriate Palliative Care through a family systems lens not only aligns with best practices but also has the potential to reduce existing care disparities in advance care planning and end-of-life care.

Upon completion of the activity, learners will be able to:
Objective 1: Enhance understanding of the added burdens for displaced populations during advanced illness and end of life
Objective 2: Learn the key elements of how the Family Systems theory can be applied to Palliative Care
Objective 3: Understand how the tenants of Cultural Humility can be applied to advanced illness and end of life

Breakout Session 2 | Monday, April 3rd, 2017 | 1:15 – 2:15 pm

2A | Story as Method: Introducing Companion Narratives as an Invitation for Patient Explorations of Spiritual Self | Dee Dee Haines, D Min, Mdiv | Bloomington

2A Haines PPT

Spiritual identity is grounded in a system of connectedness. Who am I in relationship to myself? My illness? My family, community, environment? Do I feel connected to Something More? Is my spiritual identity a resource in times of crisis?

Life review is complex and grief narratives can be multi-layered, making dialogue surrounding these reflective questions painful for patients, and families. The introduction of companion narratives, or stories, sourced from everyday life, novels, poetry, films, hymns/songs and imaginative life review can function like case study models. Intentional story-telling invites patients and families to speak about wounded relationship, celebrate affirmations, consider possibilities for reconciliation, explore feelings and emotions, increasing comfort and a sense of reconciliation.

In this guided discussion registrants will learn how to introduce and use “story” as a method for engaging self, patients and families in the exploration of spiritual identity and connectedness.

Upon completion of the activity, learners will be able to:
Objective 1: Describe ways in which companion narratives can be used in work
Objective 2: Describe 3-4 ways of responding to or initiating discussions based on companion narratives
Objective 3: Illustrate 2-3 potential uses and misuses of companion narratives

2B | Hospice Levels of Care | Jeannie Vestrum, RN, BSN, CHPN | Veranda 1-2

2B Vestrum PPT
2B Vestrum Handout

This presentation would review the four levels of care in hospice which are; Routine, Respite, Continuous and General Inpatient (GIP).

Each level of care will be discussed presenting the CMS regulatory requirements, documentation expectations and the roles of each hospice staff member during a level of care change. We will explore potential barriers in delivering the appropriate level of care and ways to overcome those. CMS is collecting data via the PEPPER Reports on how often GIP and Continuous Care are being provided. It is important to understand the appropriate use of each level of care and assess any potential areas of improvement for your agency.

Upon completion of the activity, learners will be able to:
Objective 1: Upon completion, participant will be able to describe the CMS requirements for each of the hospice levels of care.
Objective 2: Upon completion, participants will be able to identify staff educational needs regarding their roles in providing the appropriate use of levels of care.
Objective 3: Upon completion, participant will be able to recognize areas of improvement regarding level of care delivery for hospice patients.

2C | Opiods for Chronic Pain in Palliative Care Populations. Looking Back on What Has Changed the Last 10 Years | Drew Rosielle, MD, FAAHPM | Edina

2C Rosielle PPT

When I entered palliative medicine in 2005 I used opioids, including high dose chronic opioid therapy, liberally, even for my patients who weren’t close to the end-of-life. In the last decade, along with much of the rest of our professional community inside and outside of palliative care, I have had to painfully re-evaluate how I approach chronic opioid therapy for my patients, and have learned a lot from the last 10 years of research literature, and my own mistakes.

As palliative care becomes more integrated into the mainstream of US medicine, we are seeing more and more patients well before they die, and the cultural and regulatory environment around opioid prescribing is changing rapidly. This session will tell this story via several cases of patients I have both helped and harmed, will review the current evidence base on chronic pain, and the emerging regulatory climate we live in.

Upon completion of the activity, learners will be able to:
Objective 1: describe patient characteristics and diagnoses that are most likely to be helped or harmed by chronic opioid therapy, even when nearing the end-of-life.
Objective 2: ask patients evidence-based questions to help stratify their risk of opioid dependence or misuse.
Objective 3: instruct patients and colleagues about the changing regulatory issues with opioid prescribing.

2D | What are you Bringing to the Bedside? Mindful Presence & Self-Awareness | Carolyn O’Bryan Cochran, CT, MA, LPC | Atrium 4

2D OBryan-Cochran PPT
2D OBryan-Cochran Handout

Carl Jung once said, “Please remember, it is what you are that heals, not what you know.” The congruence of a practitioner facilitates the therapeutic relationship and contributes to patient healing. Doing one’s own inner work develops the congruency essential when working with patients at the end of life. Practitioner self-awareness is key to being fully present and open to patients’ experience.

Through experiential exercises, participants will begin to identify personal experiences and/or biases that may affect patient care leading to a growth in self-awareness and a greater ability to be mindfully present.

Upon completion of the activity, learners will be able to:
Objective 1: Describe the importance of self-awareness for the practitioner.
Objective 2: Explore personal history and begin to identify personal experiences and/or biases that can affect mindful presence during patient care.
Objective 3: Identify strategies for future growth in self-awareness.

2E | In sha allah: Somali End-of-Life Care | Intisar Hussein, MSW | Atrium 6

2E Hussein PPT

This presentation will help health care professionals understand and provide culturally specific care when working with the Somali Muslim community.

The presentation covers the history of Somalia and the immigration to the United States and Minnesota. It will cover culturally appropriate communication including what to say when hearing of someone’s death, code status and difficult conversations in hospice. We will discuss funeral preparation including how the body is prepared for burial and bereavement. After attending this session participants will have a deeper understanding of caring for the Somali Muslim population.

Upon completion of the activity, learners will be able to:
Objective 1: Upon completion, participants will be able to describe the stance in Somali/ Oromo regarding DNR DNI code status
Objective 2: Upon completion, participants will be able to describe the importance’s of faith at end of life in Somali/Oromo Muslims culture.
Objective 3: Upon completion, participants will be able to outline the time restrictions in regards to grief in the Somali/ Oromo Muslim community.

2F | What’s New in Community-Based Palliative Care | Lyn Ceronsky, DNP, GNP, FPCN, CHPCA | Veranda 7-8

2F Ceronsky PPT
2F Ceronsky Handout

This session will describe models of community-based palliative care, including program structure and characteristics. Outpatient palliative care clinics and home based palliative care programs will be highlighted. The importance of a needs assessment, considerations for choosing a clinical model, and metrics will be discussed. Key principles to follow when beginning or developing a community-based program will be explored.

Upon completion of the activity, learners will be able to:
Objective 1: Describe two models of community based palliative care.
Objective 2: Identify steps in designing a community based palliative care program, including components of a needs assessment.
Objective 3: Describe metrics to evaluate impact of a community based palliative care program.

2G | I Love my Volunteer Buddy!: How Volunteers can Serve our Pediatric Population | Claire Vandrovec; Jody Chrastek, DNP, CHPN | Atrium 1

2G Vandrovec.Chrastek PPT
2G Vandrovec.Chrastek Handout

When it comes to end-of-life care, the pediatric population has often been overlooked. Over the years, there have been advancements in the availability and quality of end-of-life care for children. We see every day how our patients and their families benefit from the care and support of the interdisciplinary team, including volunteers! So, why not give the same experience to our pediatric patients? Listeners will learn how their volunteers can serve our pediatric patients, their siblings, and children who live with a hospice patient. We will explore the various roles Fairview Home Care and Hospice’s volunteers take on while working with our pediatric population, with the hope that other programs will be inspired to use their volunteers to serve this special population! We will also talk about children’s concepts of death/dying based on their developmental and chronological age.

Upon completion of the activity, learners will be able to:
Objective 1: Recognize the benefits of volunteers serving both the pediatric patient and their sibling
Objective 2: Create ways for volunteers to serve the pediatric population, whether it be a patient, sibling, or a child living in a hospice patient’s home.
Objective 3: Describe the different ways in which children conceive death and dying, based on their developmental and chronological age

2H | Physician-Assisted Dying Today: Progress or Peril? | Don Postema, PhD, MPhil, MTS | Atrium 7

2H Postema PPT

Currently, more than 1 in 6 US residents has legal access to physician assistance in dying (PAD). Legislation has been introduced in Minnesota to do the same. Recent polls show a majority of Americans favor legalized physician-assisted suicide. The Canadian Parliament, prompted by their Supreme Court, last year legalized physician-assisted dying for all Canadians. However, the British House of Commons rejected a bill legalizing PAD. How are we to understand these changes from an ethical perspective? What are the ethical arguments supporting and opposing these changes? Will these changes amount to progress in end-of-life care, or do they signal a dangerous turn?

Upon completion of the activity, learners will be able to:
Objective 1: To understand recent developments related to physician-assisted dying.
Objective 2: To review the ethical and social backgrounds to these changes.
Objective 3: To critically reflect on the ethical frameworks used to support and oppose these changes.

2I | Advance Care Planning and the Nursing Student | Nancy Hall, DNP, RN | Atrium 8

2I Hall PPT

As highly trusted health care professionals across the continuum of care, nurses are in a unique position to recommend and support effective advance care planning (ACP) processes. The interpersonal and communication skills essential to ACP are useful in many areas of nursing practice; learning these skills during their pre-licensure nursing education is beneficial to nursing students and their future patients. In order to achieve the goal of making ACP a normal part of standard patient care delivery, early exposure to ACP processes is important.

This session will address some of the core skills required for effective ACP conversations and methods to introduce and provide practice of those skills in basic nursing education programs. Ideas re: collaboration between nursing programs and agencies providing ACP will be discussed.

Upon completion of the activity, learners will be able to:
Objective 1: list interpersonal and communication skills essential to an effective advance care planning process.
Objective 2: describe methods of introducing and providing for practice of these skills in basic nursing education programs.
Objective 3: discuss ideas re: collaboration between nursing programs and agencies providing advance care planning services

2J | Collaborating to Increase Access to LifeCourse, a Late Life Supportive Care Approach | Vivian Anugwom, MS, CHES; Paul Erickson, MD, MPH | Atrium 2

2J Anugwom.Erickson

LifeCourse is collaborating with NorthPoint Health & Wellness Center to spread LifeCourse beyond the mainstream healthcare system in which it was developed. NorthPoint is a community-based clinic and is uniquely positioned to serve individuals living with serious illness in North Minneapolis and to address disparities in late-life care affecting communities of color.

Built on core tenets of palliative care, LifeCourse was created to address medical and non-medical needs and challenges during the time between advanced illness diagnosis and end of life. LifeCourse features lay healthcare workers who help individuals and families navigate the challenges and ensure that their values are honored. LifeCourse implementation staff provide program training, implementation support, evaluation tools and technical assistance. Program materials and processes were adapted collaboratively to ensure that the program supports the clinic and community’s needs. This collaboration provides experience and shared learning that continues to inform LifeCourse spread locally and nationally.

Upon completion of the activity, learners will be able to:
Objective 1: understand common late life care needs of NorthPoint Health & Wellness Center’s patient population and the ability of the LifeCourse program to support those needs.
Objective 2: understand the adaptations made to LifeCourse for successful program spread.
Objective 3: Know how to collaborate with LifeCourse to adopt a late life supportive care approach.

Breakout Session 3 | Monday, April 3rd, 2017 | 2:45 – 3:45 pm

3A | DNR Does Not Mean Do Not Treat: Why POLST (Physician Orders for Life Sustaining Treatment) Works | Nancy Joyner, MS, APRN-CNS, ACHPN | Atrium 8

3A Joyner PPT

Currently, choices within medical treatment in the U.S. are vast. The POLST (Physician Orders for Life Sustaining Treatment) paradigm is a national approach utilizing advance care planning conversations between health care professionals, patients and families. POLST is designed for individuals facing serious illnesses or frailty. It determines what treatments patients do and do not want based on their personal beliefs and current state of health. POLST was developed to improve the quality of patient care by identifying those preferences for medical treatment and translating them into medical orders. The POLST Form is completed as a result of informed, shared decision-making. The POLST Form is action driven, preventing initiation of unwanted, non-beneficial and burdensome treatment. The POLST form is voluntary, recognized by emergency medical personnel and goes into effect at the time of signature, just as with other medical orders. The POLST form can be changed at any time.

Upon completion of the activity, learners will be able to:
Objective 1: Describe three principles of the POLST paradigm.
Objective 2: Identify how POLST clarifies medical wishes and intent.
Objective 3: Discuss why POLST benefits both patients and healthcare professionals.

3B | Educating the Public about Hospice through Collaborative Programming | Mary Hostetler, BSN, MBA, MAN; Christi Young, LPN; Amy Stelpflug, CTRS, CDP, CDCM; Susan Siegle, BA | Atrium 6

3B Hostetler.Young.Stelpflug.Siegle PPT

Learn from the experience of the Greater Rochester Area Providers of Hospice (GRAPH) who have been working together since August 2015. GRAPH is a consortium of four area hospice agencies including Heartland Hospice, Mayo Clinic Hospice, Seasons Hospice and St. Croix Hospice. Our mission is to educate the public and professional community about the advantages of utilizing hospice services.

Upon completion of the activity, learners will be able to:
Objective 1: Upon completion, participant will be given techniques and suggestions on how to promote education of hospice services within their community.
Objective 2: Upon completion, participant will learn how to partner with other hospice agencies in a shared service area to work collaboratively to educate the community about the benefits of hospice services

3C | The Patient Environment: My Workplace or Her Home?  Julie Szmaocki, MEd, MT-BC | Atrium 1

3C Szamocki PPT

This session will paint a detailed picture of the hospice patient’s environment and examine how it interacts with their changing needs and conditions. Special attention will be paid to the sound environment, and the effects of noise on the well-being of patients and staff members, e.g., sleep disturbance, agitation, fear, depressive mood, aggression, and intrusion into privacy. This session will share research and case examples to illuminate best practices, and will teach assessment of the patient environment. Attendees will be encouraged to self-monitor their contribution to the patient’s sensory environment and to intervene appropriately to reduce stress in the patient environment. Attendees will be invited to share their own best practices for the benefit of the group.

Upon completion of the activity, learners will be able to:
Objective 1: Recognize the components of the hospice patient’s sensory environment and identify stress producers in the environment.
Objective 2: Identify four potential non-auditory effects of noise on the vulnerable person (person with dementia, pain, anxiety, heart condition)
Objective 3: Assess the patient’s sensory environment prior to contributing to it, and intervene appropriately to reduce stress.

3D | Comfortableness with the Discomfort of Surveys | Lores Vlaminck, MA, BSN, RN, CHPN | Veranda 1-2

3D Vlaminck PPT
3D Vlaminck Handout 1
3D Vlaminck Handout 2
3D Vlaminck Handout 3

Oversight by regulatory bodies is a given, but developing the confidence and assurance of compliance is an intentional investment of time and methodolgies. This will include on-going internal agency audits, scrutiny, and pursuit of best practices. Consider attending this learning session if you are interested in survey preparedness tools, the survey process, and common survey deficiencies. The audience will be encouraged to share best practices for survey experiences.

Upon completion of the activity, learners will be able to:
Objective 1: Identify the source of regulations and compliance tools
Objective 2: Understand the survey process and prepare through mock surveys
Objective 3: Describe the common deficiencies in surveys

3E | “I Can’t Pull the Plug!”: Supporting Surrogate Decision-Makers in the Medical Setting | Florence Wright, MSW, LGSW | Atrium 7

3E Wright PPT
3E Wright Handout

Surrogate decision-makers are often placed in the position of making what can be life or death decisions, which can ultimately lead to lasting distress. Surrogates often enter into the decision-making role without medical knowledge, preparation, or an understanding of what the role fully entails. In the medical setting, surrogates may encounter conflicting information from various medical teams involved in the patient’s care, disagreement among family members, distressing emotions, and pressure to make critical decisions under time constraints. Without needed support, many surrogates who have communicated medical decisions on behalf of others are left with lasting distress, complicated grief, and/or PTSD. This presentation will explore the experience of surrogate decision-makers and will highlight interventions that can ameliorate surrogate distress. This presentation will also include a description of a patient/family educational booklet that was created in order to provide support to surrogates in the medical setting.

Upon completion of the activity, learners will be able to:
Objective 1: Participants will be able to identify common emotions experienced by surrogate decision-makers
Objective 2: Participants will be able to identify common challenges of surrogate decision-making in the medical setting
Objective 3: Participants will be able to name 3 strategies for supporting surrogates in decision-making

3F | Working with “Barriered” Populations to Access Community Services at End of Life | Leigh Hartenberg, LGSW, APSW | Veranda 7-8

3F Hartenberg PPT
3F Hartenberg Handout

It is well known throughout the industry that working with “barriered” populations can be ethically challenging due to the high level of associated needs and risks when accessing end of life community resources. Utilizing discussions and case examples, this session will describe and provide strategies to assist patients and their medical providers in overcoming “barriers” including undocumented immigration status, felony offenses, chemical health and homelessness.  While the examples and case studies in this session will be from a hospital setting, the goal of the session is to provide universally applicable strategies for any and all levels of medical professionals.

Upon completion of the activity, learners will be able to:
Objective 1: Upon completion participants will be able to identify and describe at least three unique characteristics of “barriered” populations and how these characteristics prevent access to end of life care in the community.
Objective 2: Upon completion participants will be able to identify and describe at least two methods for effective interviewing and collaborating with “barriered” patients to assist them with accessing community end of life services.
Objective 3: Upon completion participants will be able to identify and describe at least two ways they can incorporate more accessibility of end of life cares to “barriered” populations in their own practices.

3G | CANCELLED
3H | Physician-Assisted Dying Today: Progress or Peril? | Don Postema, PhD, MPhil, MTS | Bloomington

3H Postema PPT

Currently, more than 1 in 6 US residents has legal access to physician assistance in dying (PAD). Legislation has been introduced in Minnesota to do the same. Recent polls show a majority of Americans favor legalized physician-assisted suicide. The Canadian Parliament, prompted by their Supreme Court, last year legalized physician-assisted dying for all Canadians. However, the British House of Commons rejected a bill legalizing PAD. How are we to understand these changes from an ethical perspective? What are the ethical arguments supporting and opposing these changes? Will these changes amount to progress in end-of-life care, or do they signal a dangerous turn?

Upon completion of the activity, learners will be able to:
Objective 1: To understand recent developments related to physician-assisted dying.
Objective 2: To review the ethical and social backgrounds to these changes.
Objective 3: To critically reflect on the ethical frameworks used to support and oppose these changes.

3I | Pain-Staking Truths: How to Plug into Patients in Pain Without Shorting Out | Vicki Rackner, MD | Edina

Participants will leave with the 7 steps of the “Connection Prescription” that offers a system for making a positive difference to a patient in pain. Further, hospice staff can share this system with family caregivers. Develop a working knowledge about how the brain processes pain. •Replace the myths about how to respond to loved ones in pain with reality. •Acquire the 3 habits and 6 qualities of effective family leaders. •Immediately be able to apply the Connection Prescription to get and stay connected to loved ones in pain.

Upon completion of the activity, learners will be able to:
Objective 1: Develop a working knowledge about how the brain processes pain.
Objective 2: Acquire the 3 habits and 6 qualities of effective family leaders.
Objective 3: Immediately be able to apply the Connection Prescription to get and stay connected to patients and loved ones in pain.

3J | What are you Bringing to the Bedside? Mindful Presence & Self-Awareness | Carolyn O’Bryan Cochran, CT, MA, LPC | Atrium 4

3J OBryan-Cochran PPT
3J OBryan-Cochran Handout

Carl Jung once said, “Please remember, it is what you are that heals, not what you know.” The congruence of a practitioner facilitates the therapeutic relationship and contributes to patient healing. Doing one’s own inner work develops the congruency essential when working with patients at the end of life. Practitioner self-awareness is key to being fully present and open to patients’ experience. Through experiential exercises, participants will begin to identify personal experiences and/or biases that may affect patient care leading to a growth in self-awareness and a greater ability to be mindfully present.

Upon completion of the activity, learners will be able to:
Objective 1: Describe the importance of self-awareness for the practitioner.
Objective 2: Explore personal history and begin to identify personal experiences and/or biases that can affect mindful presence during patient care.
Objective 3: Identify strategies for future growth in self-awareness.

Closing Session | Monday, April 3rd, 2017 | 4:00-5:00 pm | Ballroom

Importance of Good Communication Skills in Healthcare | Darryl Chutka, MD 

This presentation describes the benefits of good communication skills between the healthcare provider and the patient. A variety of simple tools will be shown to the audience which can be used to improve communication skills. These will include how to take a patient-centered interview, agenda-setting, relationship-building and how to give bad or unexpected news to patients. The importance of empathy will also be discussed and the various techniques of non-verbal communication in conveying empathy. A variety of examples of provider-patient interactions will be demonstrated using a standardized patient.

Upon completion of the activity, learners will be able to:
Objective 1: Describe proven benefits of good communication skills between the healthcare provider and the patient
Objective 2: List several tools which can be used to provide good communication
Objective 3: Describe the importance of non-verbal communication both from a patient’s point of view as well as the provider’s.

TUESDAY

Keynote Session |Tuesday, April 4th, 2017 | 8:45 – 10:15 am | Ballroom

Compassionate Communication: Conversations about Spirituality | Betty Ferrell, RN, PhD, MA, FAAN, FPCN, CHPN

Ferrell Keynote PPT

This session will describe the opportunity for all members of the interdisciplinary team to communicate with patients and family caregivers about spirituality in serious illness.

Upon completion of the activity, learners will be able to:
Objective 1: Define Spirituality and special issues in serious illness and at the end of life
Objective 2: Identify opportunities for team members to address spiritual concerns through compassionate presence and expert communication

Breakout Session 1 | Tuesday, April 4th, 2017 | 10:45-12:00 pm

4A | Supporting Family Caregivers | Betty Ferrell, RN, PhD, MA, FAAN, FPCN, CHPN | Atrium 4

4A Ferrell PPT

This session will describe the available evidence about the needs of family caregivers in serious illness and interventions that can offer support.

Upon completion of the activity, learners will be able to:
Objective 1: Describe a synthesis of literature about the needs of family caregivers in the care of patients with serious illness
Objective 2: Describe a model of support for family caregivers including assessment of caregiver needs and teaching based on a model of Family Caregiver QOL

4B | Avoiding Costly Medicare Mistakes | Corrinne Ball, RN, CPC, CAC, CACO | Edina

4B Ball PPT

With increasing legislative and regulatory requirements changes, it is important to stay abreast of Medicare regulation requirements. Failure to meet Medicare regulations could be costly to your agency. During this session we will look at a variety of areas where your agency could be losing money, and identify ways to prevent payment denial.

Upon completion of the activity, learners will be able to:
Objective 1: Identify the top three return to providers, rejection and medical denial reason codes.
Objective 2: Knowledge of medical review process and provide tips for responding to an ADR.

4C | Failure to Die: When Graduation isn’t a Celebration | Sara Lassig, PhD, LISW; Kristopher Hartwig, MD, MPhil; Robin Schafer, RN, BSW | Bloomington

4C Lassig.Hartwig.Schafer PPT

While the “live” hospice discharge or “graduation” from hospice can sometimes be a celebratory or positive transition for a hospice enrolled individual and his/her support system, the change of course can also be a source of significant stress, suffering, confusion, and complication for all involved. This presentation will highlight the limited research in this domain, as well as discuss potential patient populations where this unexpected transition may be more likely to occur. Case examples will be utilized to highlight the significant emotional, psychosocial, financial, and physical complications and obstacles that an individual and his/her support systems may face when the once assumed dying trajectory does not go as “expected.” In addition, tools and techniques for best supporting these individuals will be offered and discussed in this interdisciplinary setting.

Upon completion of the activity, learners will be able to:
Objective 1: Discuss three potentially challenging outcomes that may occur from a “live” hospice discharge.
Objective 2: Recognize three patient populations (diagnosis based) that may lend themselves to a higher likelihood of “live” hospice discharges
Objective 3: Apply three tools to assist in navigating patients and families through complex transitions in status

4D | Who Should I Call: Palliative Care and Ethics Consults-Differences and Similarities | Lyn Ceronsky, DNP, GNP, FPCN, CHPCA | Atrium 2

4D Ceronsky PPT

Although many hospitals and hospices have both palliative care teams and ethics committees, questions often arise about the differences and similarities in function, skills and focus. This session will explore complementary roles, characteristics of effective relationships between the two specialties, and communicating indications for consultation. Case studies and audience discussion are included.

Upon completion of the activity, learners will be able to:
Objective 1: Distinguish indications for consultation to ethics committees and/or palliative care teams.
Objective 2: Describe characteristics of collaborative relationships between palliative care programs and ethics committees.
Objective 3: Identify key knowledge and skills needed by palliative care clinicians to address ethical questions common to palliative care.

4E | Starting Where you Are and Knowing Where You’re Going: Palliative Care Program Development | Thomas Klemond, MD | Atrium 7

4E Klemond PPT

Palliative care has experienced explosive growth in hospital settings across the U.S., despite less than favorable financial attributes in the fee for service model. Hospice care has also grown substantially. However, there are fundamental gaps in access to palliative and hospice care. Further growth and development is often talked about and affirmed as valuable, but a clear vision for ideal palliative care in health systems and communities is not yet mature. Full continuum access to palliative care is a sought after ideal, but creativity in development and relationship building is necessary as the reimbursement model for palliative care is not defined or stable in a broad sense. I will present models of palliative program development, describe proposed future states, and discuss common barriers to outpatient/community palliative care development along with successful models.

Upon completion of the activity, learners will be able to:
Objective 1: Identify basic attributes and infrastructure of successful hospital based palliative care models
Objective 2: Identify goals of outpatient/community palliative care and describe basic opportunities and barriers to development
Objective 3: Develop a personally relevant strategy to further palliative or hospice program development in the learner’s health system

4F | Honing your Palliative Care Communication Skills: At the Bedside or in the Clinic | Susan Hunt, MD, FACP | Plaza 4

4F Hunt PPT

As Palliative Care providers, our communication with patients should not only be an opportunity to give pertinent medical information, but also should be therapeutic conversations in themselves. How we talk with patients matters, since therapeutic communication is at the heart of Palliative Care. Many validated tools exist in the medical and nursing literature which help develop and hone Palliative Care communication skills. We will review the pertinent literature, then practice, using audience participation and role play, specific communication skills that are integral to the practice of Palliative Care. Specifically, we will address the following patient-centered Palliative Care communication skills: Basic Verbal and Non-verbal Communication, Determining Capacity, Shared Decision Making, Breaking Bad News, Facilitating a Family Conference, and Discussing Goals of Care. Everyone will receive a bibliography.

Upon completion of the activity, learners will be able to:
Objective 1: Upon completion, participants will be able to define and use the SPIKES protocol in breaking bad news with patients.
Objective 2: Upon completion, participants will be able to identify and use the components involved determining a patient’s capacity.
Objective 3: Upon completion, participants will have acquired and practiced approaches to Facilitating a Family Meeting, and to discussing Goals of Care.

4G | Ready to Serve: Meeting the Needs of LGBT Older Adults | Marsha Berry, MA, CAED; Nate Cannon, BA, CDP | | Atrium 1

4G Berry.Cannon PPT
4G Berry.Cannon Handout

Whether you know it or not, you serve lesbian, gay, bisexual and transgender (LGBT) older adults. Learn the unique issues facing these populations and how they affect their willingness to seek out services and interact with the medical community. This session will outline LGBT aging, describe the diversity of sexual orientations and gender identities, present findings from a recent needs assessment, and identify actions you can take to make your practice more LGBT culturally competent.

Upon completion of the activity, learners will be able to:
Objective 1: Explain biological sex, sexual orientation, gender identity and gender expression.
Objective 2: Explain the barrier and health disparities LGBT older adults face as they seek to interact with formal health care and social services
Objective 3: Identify ways to support welcoming services for LGBT older adults

4H | Osteopathic Manipulation Therapy: Take Home Techniques for the Hospice & Palliative Care Provider | Todd Dalberg, DO, MCR; Meghan Young, DO | Veranda 1-2

4H Dalberg.Young PPT
4H Dalberg Handout

When managing distressing symptoms within the field of hospice and palliative medicine, the role of integrative medicine is integral to optimizing patient outcomes.  This presentation will focus on the role of Osteopathic Manipulative Medicine (OMM) and its applications specific to patients with chronic, complex, conditions as well as those nearing the end-of-life period.  OMM is a holistic approach to treating a variety of symptoms including pain, anxiety, headaches, respiratory insufficiency, constipation, as well as promoting overall health and well-being.  This session will allow each attendee to actively participate in a variety of techniques aimed at treating these distressing symptoms.

Upon completion of the activity, learners will be able to:
Objective 1: List 3-4 principles and practices of Osteopathic Manipulation Therapy (OMT)
Objective 2: Perform 3-4 techniques that can be used in your daily practice.
Objective 3: Identify community D.O.’s throughout the state of Minnesota who also practice OMT.

4I | Fido the Facilitator: Conversations with a Therapy Dog at End-of-Life | Molly Johnson, BS, KPA, CTP, CHES; Deb Van Buren, MA; Mary Seifert, MS | Atrium 8

4I Johnson.Van Buren.Seifert PPT

An effective hospice therapy dog program can trigger meaningful conversations between therapy dog and patient about a dying person’s hopes, dreams, and challenges. This dialogue often takes both patient and volunteer down a winding path of life review and ultimately adds richness and depth to one’s end-of-life care experience. Participants will hear first-hand audio accounts of these conversations from the patients themselves and experience the positive, powerful impact a therapy dog program can have on quality of life. Registered therapy dog, Fitzgerald William, will be on hand to demonstrate the unequalled power of a calm, polite, non-judgmental listener.

Upon completion of the activity, learners will be able to:
Objective 1: Describe the types of unique conversations a therapy dog visits triggers and the positive impact on quality of life.
Objective 2: Discuss the psychosocial and palliative benefits of therapy dogs visits.
Objective 3: Describe the qualities of an effective hospice therapy dog.

4J | Community Partners Working Together to Reduce Hospital Readmissions by Increasing Advance Care Planning | Janelle Shearer, BSN, MA, CPHQ; Nancy Stratman, BA, MS, NAR; Brenda Iverson | Veranda 7-8

4J Shearer.Stratman.Iverson

Evidence-based research demonstrates that repeated hospitalizations are frequent toward the end of life. Stratis Health is leading a community-based initiative to improve care coordination within and between care settings in order to reduce readmissions. In this session you will hear directly from two community teams how their readmission root cause analyses led them to implement community-wide strategies to increase advance care planning among community partners and across the continuum of care.

Upon completion of the activity, learners will be able to:
Objective 1: Describe an approach to collaborate with a community partnership to identify barriers and solutions to hospital readmissions
Objective 2: Identify how to initiate a community-wide method to advance care planning
Objective 3: Discuss strategies to promote advance care planning throughout a community

4K | Prognosis at the Bedside: Can we Do Better? | William Downey, MD; Joseph Amberg, MD | Atrium 6

4K Downey PPT
4K Amberg.Downey PPT

Most hospital discharged patients have a very short stay due to late referral. The purpose of this talk is to enlighten hospitalists about prognosis for various typical diagnoses. The presentation will include discussion of tips to identify patients appropriate for hospice referral further upstream rather than at the last days of their lives, discussion of our own internal biases, presenting a more hopeful prognosis then we actually believe, introduction of the “elephant in the room” concept regarding our uncomfortable feelings of talking with the patient and their family about the person’s disease and likely prognosis, and introduction with distribution check list of how to begin difficult conversations at the bedside.

Upon completion of the activity, learners will be able to:
Objective 1: The learner will come to understand typical prognosis for various disease processes.
Objective 2: The learner through interactive learning will possess tools useful for improving their prognostic abilities.
Objective 3: The learner will begin to have the words and phrases to open those difficult conversations regarding a patient’s prognosis and goals of care.

Breakout Session 2 | Tuesday, April 4th, 2017 | 1:15 – 2:15 pm

5A | Living with Limited Time: Exploring Feelings | Lores Vlaminck, MA, BSN, RN, CHPN | Atrium 4

5A Vlaminck

Everyone’s experience in facing a serious illness is unique and yet similar. It may not be easy for our patients to talk about their fears and anxiety and the hesitancy may inhibit healthy dialogues. Normalizing uncertainty and anxiety may be the most important theme for the hospice team. Plan to attend this learning session to discuss commonly expressed and felt expressed thoughts and questions.

Upon completion of the activity, learners will be able to:
Objective 1: Increase awareness of expressed or unexpressed questions and anxieties when facing a serious illness
Objective 2: Develop increased confidence in responding to expressed feelings and anxieties
Objective 3: Consider open-ended questions with responses that portray confidence and acceptance of expressed fears

5B | Key Drivers and Best Practices for Improving your CAHPS Results | Lisa Abicht-Swensen, MHA, LNHA | Plaza 4

5B Abicht-Swensen PPT

Since the requirement that Hospice providers participate in the CAHPS survey in 2016, the impact and consequence for performing poorly on CAHPS measures has begun to emerge. Future Annual Payment Updates (APU) will be determined, in part by how a hospice performs on their CAHPS surveys. And with the advent of Hospice Compare, Hospices are now accountable for their performance on quality of care and patient experience outcomes in a public and increasingly competitive manner. This session will focus on the major drivers of patient satisfaction as measured by the CAHPS survey tool and the best practices that Hospices can engage in to assure they survive and thrive.

Upon completion of the activity, learners will be able to:
Objective 1: Understand the components of the CAHPS survey reported on Hospice Compare
Objective 2: Determine the major drivers of satisfaction as measured by the Hospice CAHPS survey tool
Objective 3: Gain an awareness of best practices that are common to the highest performers on the CAHPS survey

5C | Pain-Staking Truths: How to Plug into Patients in Pain without Shorting Out | Vicki Rackner, MD | Atrium 1

Participants will leave with the 7 steps of the “Connection Prescription” that offers a system for making a positive difference to a patient in pain. Further, hospice staff can share this system with family caregivers. Develop a working knowledge about how the brain processes pain. •Replace the myths about how to respond to loved ones in pain with reality. •Acquire the 3 habits and 6 qualities of effective family leaders. •Immediately be able to apply the Connection Prescription to get and stay connected to loved ones in pain.

Upon completion of the activity, learners will be able to:
Objective 1: Develop a working knowledge about how the brain processes pain.
Objective 2: Acquire the 3 habits and 6 qualities of effective family leaders.
Objective 3: Immediately be able to apply the Connection Prescription to get and stay connected to patients and loved ones in pain.

5D | Compassion Fatigue & Moral Distress: What does ‘Doing Everything’ do to the Care Team? | Thomas Klemond, MD | Atrium 6

5D Klemond PPT

There is a well-established pattern in U.S. healthcare of providing aggressive life sustaining treatment at nearly all phases of care, irrespective of likelihood of meaningfully successful outcomes, and often with significant suffering to patients. Healthcare spending continues to increase unsustainably, and continuation of the current pattern jeopardizes the future of our society. Palliative Care and other hospital teams at the front lines participate in the decisions that perpetuate this unsustainable scenario, and often must provide medical care that violates their sense of what is right, humane and socially just. In this session we will share perspectives on both the effects of prolonged exposure to patients facing catastrophic illness (compassion fatigue), and the hazard of deterioration of integrity and clinical energy presented by forced participation in providing medical treatments that are ethically unsound to those providing them (moral distress).

Upon completion of the activity, learners will be able to:
Objective 1: Define compassion fatigue and moral distress
Objective 2: Determine degree to which these phenomena are present in themselves in in their teams
Objective 3: Describe strategies to reduce compassion fatigue and moral distress and develop a positive and sustainable work life balance

5E | Implementation of a Serious Illness Communication Program Using a Systemic Approach to Facilitate Conversations about Patient Goals and Values | Sara Revier, RN, MSN, ACNS-BC, ACHPN | Atrium 8

5E Revier PPT
5E Revier Handout

Education to improve the primary palliative care skills of all providers is an essential part of population based palliative care and is especially important in disseminating interventions. A conversation guide has been developed by Ariande Labs to provide a systematic way for primary care providers and specialty providers to carry out goals of care conversations with seriously ill patients. The proposed session would review the development and implementation process of a Serious Illness Communication Program throughout a large organization (Centracare Health), which involves training non palliative care providers utilizing the Serious Illness Conversation Guide to provide better, more, and earlier conversations with seriously ill patients. The goal is to ensure broader access to primary palliative care and free up the speciality palliative care team for more complex patient/family needs. Session would include review of outcomes from implementation in several specialty departments.

Upon completion of the activity, learners will be able to:
Objective 1: Summarize the rationale for a systematic approach to improving conversations about patient values and priorities in serious illness.
Objective 2: Describe an approach to facilitate more, better, and earlier conversations about serious illness by collaborating with primary and specialty care providers.
Objective 3: List opportunities and challenges associated with implementing a program focusing on facilitating conversations about serious illness earlier in the disease trajectory.

5F | The Hospice Information Visit: Setting the Stage for Hospice Admission | Amy Widmark, RN, BSN | Edina

5F Widmark PPT

A strong Hospice Information Visit can be a crucial step toward family/patient engagement in end-of-life and goals-of-care discussions. Equipping patients with all the information they need to make treatment decisions includes teaching them the treatment option of hospice care. Frequently, patients end up enrolling in hospice in the last few days or weeks of life when physical symptoms may spiral downward. The vision behind an early Hospice Information Visit (that is done well), is to equip patients to embrace the full hospice care they are entitled to — before that last minute spiral to end of life.

Upon completion of the activity, learners will be able to:
Objective 1: define three strategies to connect with patient during the hospice information visit.
Objective 2: describe the difference between a “Communicator” and a “Public Speaker” , as it relates to the hospice info visit
Objective 3: list the common “Myths of Hospice” that need to be addressed in the hospice information visit

5G | Involving Acute Care Hospital Social Workers in End-of-Life Discussions | Leigh Hartenberg, LGSW, APSW | Atrium 2

5G Hartenberg PPT
5G Hartenberg Handout 1
5G Hartenberg Handout 2

Acute Care Hospital Social Workers are able to provide unique insights when discussing end-of-life care options with patients. Using a case example and handouts, this presentation will discuss how, in a hospital setting, social workers can start discussions regarding discharge options (i.e. continuing treatment or hospice) with non-crisis patients and their families. This session is targeted to beginning social workers and other treatment team members who are either looking for a refresher on hospice discussions or wanting to learn about how social workers can be utilized in the end-of-life discussion process. There are two main goals of the session. The first is to provide a basic overview of the skills necessary to discuss palliative care and hospice. The second is to give insight into conversations that may assist in lowering hospital readmission rates.

Upon completion of the activity, learners will be able to:
Objective 1: Upon completion, participants will be able to describe two ways to start the palliative and hospice discussion with non-acute care patients and their families in a hospital setting.
Objective 2: Upon completion, participants will be able to describe and use at least one visual tool with patients and families to assist in the discussion of hospice versus palliative care.
Objective 3: Upon completion, participants will be able to describe and use at least one tool to prepare themselves and their surroundings for the palliative versus hospice discussion.

5H | The New and Improved POLST 2016 and Understanding its Important but Limited Scope in Serious Illness Care | Victor Sandler, MD | Atrium 7

5H Sandler PPT

This talk will review the changes in the POLST form. The rationale for the changes will be explained. The planned future for the POLST in Minnesota in the context of the national POLST movement will be elaborated. Most important, the POLST will be explained as part of serious illness care. This means having health systems that identify patients with serious illness and poor prognosis, training providers to undertake timely discussions of goals of care and plans of care, and completing these discussions with completion of a POLST – when appropriate.

5I | Opioids for Chronic Pain in Palliative Care Populations. Looking Back on What Has Changed the Last 10 Years | Drew Rosielle, MD, FAAHPM | Bloomington

5I Rosielle PPT

When I entered palliative medicine in 2005 I used opioids, including high dose chronic opioid therapy, liberally, even for my patients who weren’t close to the end-of-life. In the last decade, along with much of the rest of our professional community inside and outside of palliative care, I have had to painfully re-evaluate how I approach chronic opioid therapy for my patients, and have learned a lot from the last 10 years of research literature, and my own mistakes. As palliative care becomes more integrated into the mainstream of US medicine, we are seeing more and more patients well before they die, and the cultural and regulatory environment around opioid prescribing is changing rapidly. This session will tell this story via several cases of patients I have both helped and harmed, will review the current evidence base on chronic pain, and the emerging regulatory climate we live in.

Upon completion of the activity, learners will be able to:
Objective 1: describe patient characteristics and diagnoses that are most likely to be helped or harmed by chronic opioid therapy, even when nearing the end-of-life.
Objective 2: ask patients evidence-based questions to help stratify their risk of opioid dependence or misuse.
Objective 3: instruct patients and colleagues about the changing regulatory issues with opioid prescribing.

Breakout Session 3 | Tuesday, April 4th, 2017 | 2:45 – 3:45 pm

6A | Effective Communication between Patients, their Surrogates, Loved Ones, & Medical Professionals | Deborah Laxson, PMP | Atrium 6

6A Laxson PPT

According to an article published by JAMA – Internal Medicine, April 2015(1), the top 7 barriers to care goal communications with seriously ill patients and their families basically distill down to a lack of understanding, acceptance, and agreement of the patient’s medical status by the patient, agent, and loved ones. As a non-medically trained individual, Deborah uses her personal experience navigating the complexities of modern medicine when faced with making end-of-life decisions for a loved one in ICU and cautions that what is clear to one person may not be clear to others. Deborah provides tools to help patients, health care age, surrogate, loved ones, and medical professionals communicate clearly and consistently with each other during the medical event of a seriously ill patient. (1)You, John J., MD, MSc . (2015). Barriers to Goals of Care Discussion with Seriously Ill Hospitalized Patients and Their Families. JAMA – Internal Medicine. 175(4), 549-556.

Upon completion of the activity, learners will be able to:
Objective 1: Describe challenges faced by the health care agent during a loved one’s medical event.
Objective 2: Recognize why non-medically trained individuals may not recognize when their loved one is on life support.
Objective 3: Explain why some health care agents may suffer a form of PTSD when their loved one dies.

6B | The “We Honor Veterans” Program and the Vietnam Veteran: A Personal Story | John Thomas, MD; Edward Curtiss | Edina

6B Thomas.Curtiss

How can we better serve those who courageously served us? One out of every four deaths is a Veteran. Minnesota has 360,000 Veterans. Many of these men and women will be served by our hospice teams. What are the special needs of these patients and their families at the end of life? How best can we respond? Former (Navy) Swift Boat Captain and current VA Hospital Volunteer, Edward Curtiss, will share his story and photographs taken while in Vietnam. Additionally, he will offer his thoughts about effectively communicating with Veterans about their experiences and needs. Dr. John Thomas will discuss how the “We Honor Veterans” program, a VA and NHPCO collaboration, enhances the care delivered by all hospice disciplines to Veterans at the end of life. He will present two cases: 1) the Veteran as caregiver; and 2) a non-verbal dementia patient sings during her “pinning” ceremony.

Upon completion of the activity, learners will be able to:
Objective 1: Better understand how an active We Honor Veterans Program enhances a hospice program’s ability to care for Veterans at the end of life.
Objective 2: Better serve Vietnam Veterans at the end of life with a deeper understanding of their experience including PTSD, Agent Orange exposure, and the disrespectful treatment they received upon returning home.
Objective 3: Better be able to communicate in a comfortable and meaningful way with Veterans about their military experience.

6C | Earning Palliative Care Extra Credit: Coaching Palliative Care to Nonspecialists | James Risser, MD | Atrium 8

6C Risser PPT

Session on how to coach development of primary palliative care skills in nonspecialists. Make the case for why we need to lift up primary palliative care education. Major goals is to break down the fundamentals of a good palliative care conversation, so it can be taught to trainers–and demonstrate how case based learning can drive home major teaching points of communication and conveying of prognosis.

Upon completion of the activity, learners will be able to:
Objective 1: Understand the need to develop palliative care skills amongst nonspecialists.
Objective 2: Review the basics of a good palliative care conversation and provide this as a template for teaching others.
Objective 3: Understand how case based learning can be the most effective way to convey the major teaching points of the approach and timing of a good palliative care conversation.

6D | Hospice 101.5 | Lores Vlaminck, MA, BSN, RN, CHPN | Plaza 4

6D Vlaminck PPT
6D Vlaminck Handout 1

This learning session will provide information and education for the staff that have recently joined a hospice agency and want to know more about the nuances of provision of hospice services in different settings, the role of each team member in contributing to the best possible care for the patient and family. Hospice scenarios will be shared to demonstrate the uniqueness of the hospice benefit through different levels of care needs.

Upon completion of the activity, learners will be able to:
Objective 1: Describe the Medicare hospice benefit that include admission, discharge, revocation, bereavement and levels of care.
Objective 2: Identify the unique role and responsibility each team member plays in contributing to the patient’s quality of life
Objective 3: Articulate the fundamentals of the hospice benefit that includes the philosophy, services and team members

6E | How to Navigate and Understand Regulations around Abuse | Brenda Fischer, RN | Atrium 7

6F Fischer PPT

We will review the current regulations associated with Abuse, and Neglect and what is required by the facility to sustain compliance in these areas.  This has been one of the top 5 deficiencies cited for the past two years in Minnesota. We will review the regulations associated with this topic, discuss what is required for policy, procedures, and staff training. We will review who to contact, what time frames are required, and components to include for a thorough investigation to meet the requirements of this regulation. Completing this session will provide more insight and knowledge of how to maintain compliance with this Medicare standard.

Upon completion of the activity, learners will be able to:
Objective 1: Upon Completion, participants will be able to identify which regulations are associated with abuse and neglect, and what components are required to meet these requirements.
Objective 2: Participants will be able to identify definition of abuse, neglect, injuries of unknown origin and misappropriation of property.
Objective 3: Upon Completion, participants will be able to identify specific time frames of when and whom to contact for allegations of abuse and neglect, and how to complete a thorough investigation.

6F | Introduction to Strategies for Trauma Awareness & Resilience for Patients’ End-of-Life Care | Crixell Shell, MS | Veranda 1-2

6F Shell PPT

Crixell Shell will introduce the basic concepts and models of the Strategies for Trauma Awareness and Resilience (STAR) Training and it application to hospice and palliative care settings. STAR is designed to increase the capacity of caregivers, leaders, and organizations to address psychological trauma, break cycles of victimhood and violence, and build resilience. Via experiential activities, workshop participants will apply STAR models to discover practical productive strategies to assist hospice and palliative care patients and their families address and heal from unresolved psychological trauma. STAR is a research and practice-supported approach with a 14 year reputation of national and international success that integrates neuropsychology, systems theory, restorative justice, nonviolent conflict transformation, and broadly defined spirituality setting the stage for reconciliation between individuals, families, and communities.

Upon completion of the activity, learners will be able to:
Objective 1: List 3-4 types of psychological trauma impacting diverse populations and the common responses to psychological trauma.
Objective 2: Describe the links between unhealed psychological trauma and cycles of victimhood, harm, and violence.
Objective 3: Describe how STAR’s trauma awareness and resilience strategies may assist patients and families faced with end of life care issues

6G | Revitalize your Resiliency | Andrea Tatley, M.Div. | Atrium 4

Statistics show that 60% of interdisciplinary providers in hospice and palliative care are in or nearing “burn-out.” If you are feeling tired or stressed, (or work with those who are) and would like to improve your resiliency skills, join us. Bring healing to your mind-body and soul in this experiential workshop. Discover how your body responds to both stress and peace. Learn simple strategies to increase your resiliency skills and bring calm to your daily life.

Upon completion of the activity, learners will be able to:
Objective 1: Understand the impact of stress on your mind, body and spirit.
Objective 2: Discover what are your greatest gateways to well-being.
Objective 3: Learn simple strategies to increase resiliency and bring calm into their daily life.

6H | Self-Reported Experience & Barriers to the Use of Intrathecal Drug Delivery Systems: Results of a State-Wide Survey of Hospice Clinicians | Jacob Strand, MD; Lindsay Warner, MD; Susan Moeschler, MD | Atrium 2

6H Strand.Warner.Moeschler PPT

Pain is one of the most commonly experienced symptoms faced by patients with a serious illness. While effective use of systemic analgesic therapies can control pain in most settings, a substantial minority of patients will have inadequate analgesia or intolerable side effects with systemic therapies. For these patients, intrathecal drug delivery can deliver pain medications with greater potency and/or few systemic side effects and are associated with significant patient benefit. However, despite these benefits, the integration and management of IDDS for patients receiving hospice care has not been previous studied. In this interactive presentation we will present the results of a statewide survey of hospice clinicians on the self-reported experience with, and barriers to, the use of intrathecal drug delivery systems for patients receiving hospice care as well as implications for future practice.

Upon completion of the activity, learners will be able to:
Objective 1: Identify intrathecal drug delivery system approaches to pain control and understand the gap that currently exists in managing these devices in the hospice setting.
Objective 2: Describe practice barriers to the integration of intrathecal drug delivery systems in hospice settings and how to address them.

6I | Medical Futility | Victor Sandler, MD; Thaddeus Pope, JD, PhD | Bloomington

6I Sandler PPT
6I Pope PPT

One of the most common types of bioethical issues confronting clinicians, especially though not only in the hospital, is a medical futility conflict. These patients almost never have decision making capacity. But their surrogates want aggressive, curative directed treatment that the patient’s clinicians judge to be non-beneficial or even cruel. Starting with a case presentation, this session will examine model mechanisms and policies for resolving these disputes.

Upon completion of the activity, learners will be able to:
Objective 1: Discuss the concept of Futile Care
Objective 2: Identify best institutional practices for situations when a family insists on harmful, non-beneficial, or futile care

6J | LifeCourse: An Innovative Approach to Late Life Care | Eric Anderson, MD; Karl Fernstrom | Atrium 1

6J Anderson. Fernstrom

Built on tenets of palliative care, LifeCourse provides supportive “whole person” care. It asks patients what matters most and helps them chart and experience a care journey that respects their goals. At its core is a lay healthcare worker who visits patients monthly in their homes, communicates across care settings and organizations, and works with primary and specialty care teams and social service partners. It’s unique in that it’s long-term – most care coordination lasts 30 to 90 days and tends to follow an acute episode – and in its reliance on affordable lay care guides as navigators. Measures include utilization, quality of life (QOL), and experience. We found a positive impact compared to usual care. Results indicate LifeCourse participants maintain QOL and experience are more likely to use palliative care and hospice, experience fewer inpatient days, are more likely to complete an advanced directive, and have lower cost.

Upon completion of the activity, learners will be able to:
Objective 1: recognize and describe the key components of an upstream palliative care intervention.
Objective 2: assess the impact of a new intervention on patient quality of life, patient experience, utilization, and cost outcomes.

Closing Session | Tuesday, April 4th, 2017 | 4:00 – 5:00 pm |  Ballroom

The Gift of GAB: Goals, Attitude, Behavior | Conor Cunneen

In a highly informative, fun and interactive program, Conor Cunneen puts a different spin on “It Starts with a Conversation” demonstrating how everyone can have the Gift of GAB and how the Gift of GAB can impact your workplace, colleagues and patients in a positive manner. GAB is an acronym for Goals, Attitude, Behavior. Participants will learn through powerful examples, storytelling and more than a dash of humor that will leave them with a smile on the face, a spring in the step AND memorable, actionable ideas to take back to patients, care givers, colleagues and family.

Upon completion of the activity, learners will be able to:
Objective 1: Appreciate that Goals (even “micro” Goals) impact work, life and colleagues in a positive manner
Objective 2: Understand that good Attitude provides the oxygen for a good environment
Objective 3: Know THE most important question to ask when things go wrong
Objective 4: Discover your Behavior creates Your Brand

 

 

 

 

back to top