Meeting Report Annual Assembly of the American Academy of Hospice and Palliative Medicine

Report from the Annual Assembly of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association held in Austin, Texas, March 25-28, 2009.

By Emese Somogyi-Zalud, MD

This year’s Annual Assembly of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association was held in Austin, Texas, from March 25-28. Austin is a progressive university town with a rich cultural scene. As such, it was a wonderful place to host this national event with over 2,000 attendees including nurses, physicians, social workers and other professionals.

Its success builds on a decade of rapid advancement in the field of palliative care and hospice, including clinical care, research, service delivery, and education. More information about this premier educational event for those caring for people with serious and life limiting illness can be found on the Academy’s website.

Some of the meeting’s highlights

Nearly 40 years ago, Dr. Eric Cassell published his seminal work on suffering and medicine. At the opening of the conference, he spoke about the professional responsibility to prevent and treat suffering. “The meaning of distress is as important as the symptoms themselves,” Cassell said. Suffering is a type of distress that happens when patients feel their illness has taken away their sense of wholeness and is typically marked by self-conflict, loss of purpose, and loneliness. When their feeling of wholeness, or intactness, is taken away, patients feel vulnerable and often fear they will never achieve good health again. Because suffering is personal and unique to each individual, the easiest way to find out if a patient is suffering is to just to ask them. Symptoms may be relieved but suffering often continues.”

A special presentation by Wall Street Journal columnist Jeffrey Zaslow generated a lot of interest. In 2007, Randy Pausch, a happily married father of three young children, developed terminal pancreatic cancer. The Carnegie Mellon University professor had an opportunity to give a “last lecture” before leaving his position to spend his final months enjoying life with his family. A video of the lecture reached millions online, and Pausch’s and Zaslow’s book, The Last Lecture, became an instant bestseller. Zaslow spoke of his brief but unforgettable friendship with Pausch, whose story of living life to the fullest affected so many people around the world. Randy Paush Homepage.

A presentation by Dr. Andy Billings from Harvard Medical School indicates a major shift in thinking about patient autonomy, advance care planning, and end-of-life decision making. There is a growing realization that leaving burdensome medical decisions to ill people and their families is not the most effective way to support autonomy. Instead, decision making needs to be a shared responsibility of the physician, and the patient and family. Health professionals are under the obligation to provide more than information. Our duty is to present realistic treatment options that reflect the goals of care, and to provide guidance with decision making. We need to support people in dealing with the emotional impact of illness, and we need to educate them about the disease process. With optimal support, people can truly exercise autonomy and make optimal decisions their medical care.

Dr. Alessandra E. Strada (Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York; stoppain.org) gave a talk about the often overlooked issue of professional self care. Hospice and palliative care providers invest a great deal of themselves in caring for others. The repetitive losses, the emotional and physical demands of relieving someone’s suffering can take a toll, sometimes even before we realize it. Self awareness is a key first step in the prevention of burnout. We should explore our vulnerabilities, grieving styles, sources of meaning, and the strength of our social support. We need to find productive ways to manage stress, emotions, and grief. Very importantly, instead of the currently prevailing practice of informal or nonexistent support, we need structured organizational support for professional caregivers.

This year’s conference had special importance for Hawaii’s palliative care and hospice community. Dr. Daniel Fischberg, the medical director of the Queen’s Medical Center Pain and Palliative Care Program served as Program Co-Chair. It was a year-long job to organize such a large event. The success of the meeting reflects his hard work and commitment.

We would also like to acknowledge Dr. Ritabelle Fernandes of Kokua Kalihi Health Center who presented on the success of her home-based palliative care program for seriously ill residents of Kalihi Valley.

A record number of more than 20 health professionals from Hawai‘i attended the conference. We got reminded that our state’s community of hospice and palliative care professionals is unique in more than one way. Crucial to our success is having Kokua Mau, a state-wide organization providing a platform for professional advancement, collaboration, and community service.

The 2010 AAHPM & HPNA Annual Assembly will be held in Boston, MA, March 3-6, 2010. Dr. Fischberg will again serve as Program Co-Chair. The city of Boston provides an exciting mix of historic culture, prestigious colleges, universities, hospitals, and museums. It will be another great conference in another great city and another much needed opportunity to build connections, get re-energized, and become up to date in the field of hospice and palliative medicine.