Time for Geriatric Assessments in Cancer Care: William Dale, Mazie Tsang, and John Simmons
GeriPal - A Geriatrics and Palliative Care Podcast
Release Date: 09/07/2023
How Pharma Invents Diseases: A Podcast with Adriane Fugh-Berman
GeriPal - A Geriatrics and Palliative Care Podcast
Who gets to decide on what it means to have a disease? I posed this question a while . I’ll save you from reading the article, but the main headline is that corporations are very much the “who” in who gets to define the nature of disease. They do this either through the invention of disease states or, more often, by redrawing the boundaries of what is considered a disease (think pre-diabetes). On today's podcast, we invite Adriane Fugh-Berman to discuss the influence of industry, whether it be pharma or device manufacturers, on healthcare. Adriane founded , a Georgetown University...
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Public Facing Education via Social Media: A Podcast with Julie McFadden, Matt Tyler, Sammy Winemaker and Hsien Seow
GeriPal - A Geriatrics and Palliative Care Podcast
On today’s podcast, we’ve invited four hospice and palliative care social media influencers (yes, that’s a thing!), all of whom focus their efforts on educating the general public about living and dying with a serious illness. Their work is pretty impressive in both reach (some of their posts are seen by millions of viewers) and breadth of work. We’ve invited: Julie McFadden (aka ): Julie is a social media superstar, with 1.5 million , another 400,000 subscribers on her l, and another . She covers topics on death, dying, and hospice from a hospice nurse perspective, and she...
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Palliative Care Nursing: Podcast with Betty Ferrell about ELNEC
GeriPal - A Geriatrics and Palliative Care Podcast
As Betty Ferrell says on our podcast today, nurses play an essential role in care of people with serious illness. Who spends the most time with the patient in the infusion center? Doing home care? Hospice visits? In the ICU at the bedside? Nurses. (End-of-Life Nursing Education Consortium) celebrates it’s 25th anniversary in 2025. We talk today with Betty Ferrell, who has been a nurse for 47 years, and is the founder and PI of ELNEC. As I argue on the podcast, has likely done more to lift the primary palliative care skills of clinicians than any other initiative. ...
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The Promise and Pitfalls of AI in Medicine: Bob Wachter
GeriPal - A Geriatrics and Palliative Care Podcast
Eric asks the question that is on many of our minds - is the future of AI more Skynet from Terminator, in which AI takes over the world and drives humanity to the brink of extinction, or Wall-E, in which a benevolent and empathetic AI restores our humanity? Our guest today is Bob Wachter, Chair of Medicine at UCSF and author of the . Bob recently wrote an essay in and delivered a s on the same topic. We discuss, among other things: Findings that in several studies AI was rated by patients as more empathetic than human clinicians (not less, that isn’t a typo). Turns my concern...
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Ambivalence in Decision-Making: A Podcast with Joshua Briscoe, Bryanna Moore, Jennifer Blumenthal-Barby & Olubukunola Dwyer
GeriPal - A Geriatrics and Palliative Care Podcast
Ambivalence is a tough concept when it comes to decision-making. On the one hand, when people have ambivalence but haven't explored why they are ambivalent, they are prone to bad, value-incongruent decisions. On the other hand, acknowledging and exploring ambivalence may lead to better, more ethical, and less biased decisions. On today's podcast, Joshua Briscoe, Bryanna Moore, Jennifer Blumenthal-Barby, and Olubukunola Dwyer discuss the challenges of ambivalence and ways to address them. This podcast was initially sparked by Josh’s “Note From a Family Meeting” Substack post titled...
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Surrogate Decision Making: Bernie Lo and Laurie Dornbrand
GeriPal - A Geriatrics and Palliative Care Podcast
In 1983, a 25 year old Nancy Cruzan was thrown from her car while driving home in Missouri, landing in a water filled ditch. She was resuscitated by EMS, but did not regain higher brain function, and was eventually diagnosed as being in a persistent vegetative . In 1988, Cruzan’s parents requested that her feeding tube be removed, arguing that she would not want to continue in this state. The hospital refused without a court order, and the case eventually made its way to the Supreme Court. Arguing for the state of Missouri against the Cruzan’s was who would later be assigned the...
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PC Trials at State of Science: Tom LeBlanc, Kate Courtright, & Corita Grudzen
GeriPal - A Geriatrics and Palliative Care Podcast
One marker of the distance we’ve traveled in palliative care is the blossoming evidence base for the field. Ten years ago we would have been hard pressed to find 3 clinical trial abstracts submitted to the annual meeting, much less high quality randomized trials with robust measures, sample sizes, and analytics plans. Well, as a kick off to this year’s first in-person plenary, held in conjunction with the closing Saturday session of the AAHPM/HPNA Annual Assembly, 3 randomized clinical trials were presented. Today we interview the authors of these 3 abstracts about their findings: ...
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Electronic Frailty Indexes: Kate Callahan, Ariela Orkaby, & Dae Kim
GeriPal - A Geriatrics and Palliative Care Podcast
What is frailty? Kate Callahan relates a clear metaphor on today’s podcast. A frail person is like an origami boat: fine in still water, but can’t withstand a breeze, or waves. Fundamentally, frailty is about vulnerability to stress. In 2021 we talked with . Today we talk with Kate Callahan, Ariela Orkaby, & Dae Kim about deficit accumulation frailty. What is the difference, you ask? George Kushel probably explained it in graphical terms (in JAGS), using the iconic golden gate bridge as a metaphor (Eric and I get to see the bridge daily driving or biking...
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Dysphagia Revisited: A Podcast with Raele Donetha Robison and Nicole Rogus-Pulia
GeriPal - A Geriatrics and Palliative Care Podcast
Almost a decade ago, our hospice and palliative care team decided to do a “Thickened Liquid Challenge.” This simple challenge was focused on putting ourselves in the shoes of our patients with dysphagia who are prescribed thickened liquids. The rules of the challenge were simple: fluids must be thickened to “honey consistency” using a beverage thickener for a 12-hour contiguous period. All of us failed the challenge. We then decided to challenge others and asked them to post their videos online using the hashtag #thickenedliquidchallenge. Here are some of the results...
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End-of-Life Doulas: A Podcast with Jane Euler, Beth Klint, and John Loughnane
GeriPal - A Geriatrics and Palliative Care Podcast
In the last several years, I’ve seen more and more articles about end-of-life doulas (). Despite this, in my 20-year career as a palliative care physician, I have yet to see a death doula in the wild. I’m unsure what they do, how often they’re used, and who pays for their work. So, on today’s podcast, we try to get to the bottom of what exactly is an end-of-life doula. We’ve invited two death doulas, Jane Euler and John Loughnane (who is also a family doc and palliative care physician), to talk about the role of a doula at the end of life. We also invited Beth Klint to speak...
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