Palliative Care and Hospice – Creating Quality Living

 Here is what I learned last week….

There are three things that stood out to me from last week’s California Hospice and Palliative Care Association annual conference:

  • a distinct benefit of the RN on a palliative care team
  • the beneficial uses of Cannabis
  • early outcomes from CA’ s End of Life Option Act


RN role shines through in the data-

Steven Pantilat, MD, Director of UCSF’s Palliative Care Program and the Director of Palliative Care Quality Network (includes 93 programs nationwide) presented trends from his own UCSF team experiences and from 92 other teams.

  1. Their most recent significant finding:    If an RN is on the palliative care team, patient’s pain management outcomes are drastically improved; they are not sure why.        Yea, the distinct knowledge and unique caring of nurses…. strikes again!
  2. This is a LOL funny insight from Pantilat who is someone who presents data often to high-brow audiences.  He says that there is a  parallel between an audience’s response to receiving data … and the stages of grief

Denial – Anger – Bargaining – Depression – Acceptance

  1. They are finding that functional status is emerging as a useful predictor for appropriateness for palliative care. I was surprised and DAH! at the same time!   One problem is that EMRs don’t collect reliable data related to function.  They are working to resolve the EMR issue.


Who’s teaching whom about Cannabis?

Wow, nurses shined through here as well!  A nice young physician from an LA hospice company who is also a UCLA faculty member gave an in-depth presentation on the history of marijuana uses, laws, legislative attempts to change it from a schedule I drug, research and the difficulties in doing good research related to the lack of standardization of dosing and combinations of CBD and THC (cannabinoids). This was good info.

It was when he started talking about the legalization of cannabis and the difficulties of access and dosing, when the tides turned in who was educating whom. There was a group of nurses whose working knowledge of dosing, interactions and uses of cannabis way surpassed his. It was a lively conversation and enlightening. Much to his credit, he surrendered quickly and listened intently. Afterwards, he bee-lined it over to the nurses and started taking notes.

These hospice and holistic care nurses are being increasingly called upon to coach physicians, patients, families and the medical cannabis dispensaries for dosing and interactions with sick patients.  It’s easy to see how the demand is growing for clinicians who can assess and manage the big picture for patients who are turning to cannabis.    These nurses had so much practical knowledge and so much to say.  I could have listened to their wisdom for much longer. Fascinating.    For more information ….

Did you know that there is an American Cannabis Nurses Association that has a core-curriculum and certification? Here’s the link. The ingenuity of nurses is in full swing here.

This is what I learned about Cannabis:

  • Best evidence for traditional uses of cannabis are for nausea and vomiting, pain, neuropathy.
  • The CBD component (non-psychoactive) of cannabis has highly promising anti-inflammatory effects with significantly fewer side effects than traditional meds. More on their website.
  • Cannabis use as an opioid substitute show promising research. One study reported 97% of patients found success in withdrawing from opioid addiction.   More research on website.
  • Addiction trends:     9% – Cannabis, if started using before age 18 ;   15% – Alcohol ; 23% – Opioid ; 26% – Tobacco


The impact of EOLOA – CA passed the End of Life Options Act 18 months ago.

Hospice By The Bay is the 2nd oldest hospice in the country, the largest in CA and is affiliated with UCSF.

They engaged early and cautiously with patients in this Aid in Dying law. They presented their initial findings from patients, families and staff.  They interviewed 50% of families and 100% of their 90 staff who were involved in the cases. This is their experience to date:

  • 30 patients who took the dying meds
  • most had cancer – 77% for them; 59% for state of CA
  • all had higher education and were affluent
  • 44% atheist, 15% Catholic; 15% spiritual
  • CA law requires that patients must self ingest, which means that they must do it before they lose their independence.
  • This hospice has the policy that the nurse cannot be in the room during the ingestion process, although they can help with the set up of process.
  • There is no set dying medication protocol in CA’s law. Oregon uses Seconal exclusively, which is expensive (~ $3000.).  Standardization among those pharmacies in CA who participate is underway; less costly and safe meds are available.
  • Deaths went well – sleep in 1/2 hour; death in 1-2 hours
  • Families – 94% felt loved one died with dignity; 97% felt they had less grief r/t to the good death.
    • Biggest concern is feelings of isolation among the families because of the negative response from the public, friends, etc.  These families would love to help other families through the process.
  • Because of the high cost of the meds they are not typically purchased until anticipated death date is set.
  • All staff reported that this is a unique experience.  There is not the steady patient decline to prepare them for the sudden death.  It was strange for the staff to have a patient up walking and talking and then die.   All staff did well if the families did well, and as reported 94% of families did well.

For complete analysis, access the Care and Choice at End of Life.   Here is the link:

As a nurse, I believe that hospice and palliative care is one specialty that can create quality living at the most vulnerable times, save families’ souls and save everybody money.   Who and What else can do that?  

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