Time for Geriatric Assessments in Cancer Care: William Dale, Mazie Tsang, and John Simmons
GeriPal - A Geriatrics and Palliative Medicine Podcast
Release Date: 09/07/2023
Is Attending to Clinician Distress Our Job? Sara Johnson, Yael Schenker, & Anne Kelly
GeriPal - A Geriatrics and Palliative Medicine Podcast
Have you had one of those consults in which you’re thinking, huh, sounds like the patient’s goals are clear, it’s really that the clinician consulting us disagrees with those goals? To what extent is it our job as consultants to navigate, manage, or attend to clinician distress? What happens when that clinician distress leads eventually to conflict between the consulting clinician and the palliative care team? Today our guests Sara Johnson, Yael Schenker, & Anne Kelly discuss these issues, including: A recent paper first authored by Yael asking if attending to clinician...
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Rehab and Death in Skilled Nursing Facilities: Sarguni Singh, Christian Furman, and Lynn Flint
GeriPal - A Geriatrics and Palliative Medicine Podcast
In this week's podcast, we sit down with Drs. Sarguni Singh, Christian Furman, and Lynn Flint, three authors of the recent The authors dive into the challenges facing seriously ill older adults discharged to Skilled Nursing Facilities (SNFs), where fragmented care transitions, misaligned Medicare policies, and inadequate access to palliative care often result in burdensome hospitalizations and goal-discordant care. The discussion highlights key barriers in Medicare’s SNF and hospice benefits, including the inability to access concurrent hospice and SNF care, and explores...
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Inflammaging: Brian Andonian, Sara LaHue, Joe Hippensteel
GeriPal - A Geriatrics and Palliative Medicine Podcast
Six years ago we had John Newman on GeriPal to talk about (Song choice Who Wants to Live Forever by Queen, perfect selection). John explained the basics of geroscience, what is it, what are the key theories in geroscience, what is senescence, why people who provide clinical care for older adults should care about geroscience, and potential therapeutics like metformin and rapamycin. Today we bring on three rising stars in Geroscience, Brian Andonian, Sara LaHue, Joe Hippensteel, to talk about one of the key pillars of Geroscience: inflammaging. We use this terrific paper they...
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The Chaplain and the Doctor: A Podcast with Betty Clark and Jessica Zitter
GeriPal - A Geriatrics and Palliative Medicine Podcast
In this week’s episode, we delve into the powerful documentary with two extraordinary guests: Betty Clark, the chaplain at the heart of the film, and Dr. Jessica Zitter, the physician and filmmaker who brought this story to the screen. The film provides a deeply moving look into the ways personal stories and biases shape our interactions in healthcare. Through our conversation with Betty and Jessica, I gained a valuable insight: the narratives we carry within ourselves—whether conscious or unconscious—act as invisible forces that influence how we engage with patients and...
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A Strategic Path Forward for Hospice & Palliative Care: Ira Byock, Kristi Newport, Brynn Bowman
GeriPal - A Geriatrics and Palliative Medicine Podcast
In June of 2025, hospice and palliative care pioneer Ira Byock . In a nutshell, he expressed concerns that the quality of hospice care in the United States has become highly variable, with disturbing frequency of unethical practices and avaricious owners. He also raised concern that the rapid increase in palliative care program growth during the first two decades of this century has stalled, leaving us with understaffed programs that are often inadequately trained. Along with Ira, we’ve invited Kristi Newport, a palliative care doctor and Chief Medical Officer of the , and Brynn...
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Palliative Care in Sickle Cell: Craig Blinderman, Stephanie Kiser, Eberechi Nwogu-Onyemkpa
GeriPal - A Geriatrics and Palliative Medicine Podcast
Today’s topic on palliative care for sickle cell disease may raise eyebrows with some of you. You might think, wait, now we’re doing sickle cell? On top of , , and ? Where does it end? Do we have staff for all of this? Well I implore you, dear listeners, to keep an open mind and listen to this podcast. Our guests do a fabulous job of stating the case for palliative care in sickle cell disease, to the point that we ask: why haven’t we been doing this all along? Our guests today are Craig Blinderman, Stephanie Kiser, Eberechi Nwogu-Onyemkpa, three palliative...
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Medical Billing and Coding in Geriatrics: Peter Hollmann, Ken Koncilja, and Audrey Chun
GeriPal - A Geriatrics and Palliative Medicine Podcast
Last month, the “Billing Boys”—Chris Jones and Phil Rodgers—joined the GeriPal podcast to . This month, we’re back with part two, shifting the focus to geriatrics. While billing and coding may not be the most exciting topic, they’re essential for ensuring fair reimbursement for the complex care we provide and for supporting the work of our interprofessional teams, many of whom can’t bill directly for their services. When we underbill or leave money on the table, we not only shortchange ourselves but also devalue the critical role of geriatrics in the healthcare system. This time,...
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Rethinking Slow Codes: Gina Piscitello, Parker Crutchfield, Jason Wasserman
GeriPal - A Geriatrics and Palliative Medicine Podcast
I’m going to begin with a wonderful quote from a recent editorial in by our guests Parker Crutchfield & Jason Wasserman. This quote illustrates the tension between the widely held view in bioethics that slow codes are unethical, and the complexity of real world hospital practice: “Decisive moral positions are easy to come by when sitting in the cheap seats of academic journals, but a troubling ambivalence is naturally characteristic of live dilemmas.” Gina Piscitello, our third guest, recently surveyed doctors, nurses and others at 2 academic medical centers about slow codes. ...
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GeriPal Live! at NPCRC Foley Retreat: Dio Kavalieratos, Prasanna Ananth, Alexi Wright
GeriPal - A Geriatrics and Palliative Medicine Podcast
This is the second GeriPal podcast we’ve recorded live using this format, see this to our prior podcast at the Center to Advance Palliative Care (CAPC) meeting in Philadelphia. Also look for our upcoming podcast recorded live from the . Today we join you from beautiful Banff, Alberta, Canada at the National Palliative Care Research Center () annual Kathleen Foley retreat. This meeting was bittersweet. I’ve been fortunate to attend every meeting in one capacity or another since 2006. The made an enormous impact on the growth and capacity for palliative care...
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GeriPal Live! at CAPC: Karen Bullock, Kim Curseen, Matt Gonzales
GeriPal - A Geriatrics and Palliative Medicine Podcast
Eric and I had the pleasure of doing a GeriPal Live! Podcast as the closing keynote for the recent in Philadelphia PA. For this podcast, we invited 3 guests to each select an article of interest to them, and engage in a discussion about the article, including questions from the CAPC attendees in the audience. Our guests chose the following articles (in the order discussed) Matt Gonzales used AI to select an article by Ravi Parikh on , published in JAMA Network Open, finding 44% in the intervention arm received palliative care consults, vs 8% in the control arm. We discussed use of AI...
info_outlineThe comprehensive geriatric assessment is one of the cornerstones of geriatrics. But does the geriatric assessment do anything? Does it improve outcomes that patients, caregivers, and clinicians care about?
Evidence has been mounting about the importance of the geriatric assessment for older adults with cancer, the subject of today’s podcast. The geriatric assessment has been shown in two landmark studies (Lancet and JAMA Oncology) to reduce high grade toxicity, improve patient and caregiver satisfaction, and improve completion of advance directives (can listen to our prior podcast on this issue here).
Based on this surge in evidence, the American Society of Clinical Oncologists recently updated their guidelines for care of older adults to state that all older adults receiving systemic therapy (including chemo, immuno, targeted, hormonal therapy) should receive geriatric assessment guided care.
We talk about these new guidelines today with William Dale, a geriatrician at City of Hope and lead author of the guideline update in the Journal of Clinical Oncology, Mazie Tsang, palliative care/heme/onc physician-researcher at Mayo Clinic Arizona who authored a study of geriatric and palliative conditions in older adults with poor prognosis cancers published in JAGS, and John Simmons, a retired heme/onc doctor, cancer survivor, and patient advocate. We talk about:
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What is a practical geriatric assessment and how can busy oncologists actually do one? (hint: 80% can be done in advance by patients or caregivers)
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Why is it that some oncologists are resistant to conducting a geriatric assessment, yet have no problem ordering tests that cost thousands of dollars?
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What can you do with the results of a geriatric assessment?
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How does the geriatric assessment lead to improved completion of advance directives, when the assessment doesn’t address advance care planning/directives at all?
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How does palliative care fit into all this? Precision medicine?
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What groups are being left out of trials?
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What are the incentives to get oncologists and health systems to adopt the geriatric assessment?
And Mazie, who is from Hawaii, requested the song Hawaii Aloha in honor of the victims of the wildfire disaster on Maui. You can donate to the Hawaii Red Cross here.
Aloha,
-@AlexSmithMD
Additional Links:
Brief ASCO Video of how to conduct a practical geriatrics assessment
Brief ASCO Video of how to use the results of a practical geriatrics assessment
Time to stop saying the geriatric assessment is too time consuming