BROADCASTS.com

Often podcasts meet clinical reality.\xa0 That\u2019s why we do this podcast- to address real world issues in palliative care, geriatrics, and bioethics.\xa0 But rarely does the podcast and clinical reality meet in the same day.

Within hours of recording this podcast, I joined a family meeting of an older patient who had multiple medical problems including cancer, and a slow but inexorable decline in function, weight, and cognition.\xa0 Physical therapy had walked with him that day and noted improvement compared to previous walks, suggesting that he should be discharged to a skilled nursing facility for rehabilitation on discharge.\xa0 The patient's capacity to make decisions was marginal, and his sons were shouldering much of the responsibility. The sons were very focused on rehabilitation, and the patient gave his assent. In the meeting, I used the language suggested by Sarguni Singh, \u201cI worry that going to SNF for rehab may not result in your being independent.\u201d\xa0 We additionally discussed hospice care as an option for care that might follow the trial of rehabilitation.

Today we talk with Sarguni Singh, hospitalist-researcher at the University of Colorado, Ann Henshaw, Occupational Therapist who teaches at George Washington and works clinically at Georgetown, and Tamra Keeney, Physical Therapist-researcher at Mass General Hospital and Harvard Medical School.\xa0 Lynn Flint, author of the NEJM perspective titled, \u201cRehabbed to Death,\u201d joins Eric and I as co-host.

We cover a lot of ground in this podcast, including an evidence based toolkit to promote collaboration between therapy fields and palliative care, outcomes of rehabilitation for people with advanced cancer (hint: not much hospice, lots of re-hospitalization), and a JAGS study on use of post-acute care among patients with heart failure.\xa0 We also heard from Tamra about her opinion piece in which she laments, \u201cThe role of rehabilitation is often myopically constrained to facilitation of efficient discharge planning.\u201d\xa0 Therapists are so much more.

At the end of the day, I lamented that physical, occupational, and speech therapists aren\u2019t more tightly integrated with palliative care teams.\xa0 As Lynn says at the end of the podcast, to paraphrase, \u201cPhysical therapy, occupational therapy, speech therapy - all this therapy for older frail patients is a core part of good palliative care.\u201d

And our guests sing along with \u201cSweet Caroline\u201d - so good, so good, so good!

-@AlexSmithMD

\xa0

This episode of the GeriPal Podcast is sponsored by\xa0UCSF\u2019s Division of Palliative Medicine, an amazing group doing world class palliative care.\xa0 They are looking for physician faculty to join them in the inpatient and outpatient setting. \xa0To learn more about job opportunities, please click here:\xa0https://palliativemedicine.ucsf.edu/job-openings