Ambivalence in Decision-Making: A Podcast with Joshua Briscoe, Bryanna Moore, Jennifer Blumenthal-Barby & Olubukunola Dwyer
GeriPal - A Geriatrics and Palliative Care Podcast
Release Date: 04/11/2024
Coping with Serious Illness: Danielle Chammas and Amanda Moment
GeriPal - A Geriatrics and Palliative Care Podcast
Denial. Substance use. Venting. Positive reframing. Humor. Acceptance. All of these are ways we cope with stressful situations. Some we may consider healthy or unhealthy coping strategies, but are they really that easy to categorize? Isn’t it more important to ask whether a particular coping behavior is adaptive or not for a particular person,in a particular time or situation? We are going to tackle this question and so many more about coping on this week's podcast with , a recurring GeriPal guest, psychiatrist, and palliative care doc at UCSF, and , a Palliative Care Social Worker at...
info_outline
Falls and Fractures: A Podcast with Sarah Berry
GeriPal - A Geriatrics and Palliative Care Podcast
Falls are very common among older adults but often go unreported or untreated by healthcare providers. There may be lots of reasons behind this. Patients may feel like falls are just part of normal aging. Providers may feel a sense of nihilism, that there just isn't anything they can do to decrease the risk of falling. On this week's podcast, we try to blow up this nihilism with our guest Sarah Berry. Sarah is a geriatrician at Hebrew SeniorLife in Boston where she does research on falls, fractures, and osteoporosis in older adults. We pepper Sarah with questions ranging from: Why...
info_outline
Dialysis vs Conservative Management for Older Adults: Manju Kurella Tamura, Susan Wong, & Maria Montez-Rath
GeriPal - A Geriatrics and Palliative Care Podcast
We recently published a podcast on palliative care for kidney failure, focusing on conservative kidney management. Today we’re going to focus upstream on the decision to initiate dialysis vs conservative kidney management. As background, we discuss Manju Kurella Tamura’s landmark that found, contrary to expectations, that function declines precipitously for nursing home residents who initiate dialysis. If the purpose of initiating dialysis is improving function - our complex, frail, older patients are likely to be disappointed. We also briefly mention Susan Wong’s terrific studies...
info_outline
COVID Updates: A Podcast with Peter Chin-Hong and Lona Mody
GeriPal - A Geriatrics and Palliative Care Podcast
In March 2020, we launched our first podcast on COVID-19. Over the past four years, we’ve seen many changes—some positive, some negative. While many of us are eager to move past COVID (myself included), it’s clear that COVID is here to stay. This week, we sit down with infectious disease experts and to discuss living with COVID-19. Our conversation covers: The current state of COVID Evidence for COVID boosters, who should get them, and preferences between Novavax and mRNA vaccines COVID treatments like Molnupiravir and Paxlovid Differences in COVID impact on nursing home...
info_outline
Medical Cannabis Revisited: A Podcast with David Casarett and Eloise Theisen
GeriPal - A Geriatrics and Palliative Care Podcast
Cannabis is complicated. It can mean many things, including a specific type of plant, the chemicals in the plant, synthetic analogs, or products that have these components. The doses of the most widely discussed pharmacologically active ingredients, THC and CBD, vary by product, and the onset and bioavailability vary by how it is delivered. If you believe the evidence for efficacy to manage symptoms like neuropathic pain, how do you even start to think about recommending these products to patients? On today’s podcast, we answer that question with our guests, David Casarett and Eloise...
info_outline
Guidelines or Goals in Heart Failure: Parag Goyal, Nicole Superville, and Matthew Shuster
GeriPal - A Geriatrics and Palliative Care Podcast
When treating heart failure, how do we distinguish between the expanding list of medications recommended for “Guideline Directed Medical Therapy” (GDMT) and what might be considered runaway polypharmacy? In this week’s podcast, we’ll tackle this crucial question, thanks to a fantastic suggestion from GeriPal listener Matthew Shuster, who will join us as a guest host. We’ve also invited two amazing cardiologists, Parag Goyal and Nicole Superville, to join us about GDMT in heart failure with reduced ejection fraction (HFrEF) and in Heart Failure with preserved EF (HFpEF). We talk...
info_outline
Intentionally Interprofessional Care: DorAnne Donesky, Michelle Milic, Naomi Saks, & Cara Wallace
GeriPal - A Geriatrics and Palliative Care Podcast
In fellowship, one of the leaders at MGH used to quote Balfour Mount as saying, “You say you’ve worked on teams? Show me your scars.” Scars, really? Yes. I’ve been there. You probably have too. On the one hand, I don’t think interprofessional teamwork needs to be scarring. On the other hand, though it goes against my middle-child “can’t we all get along” nature, disagreement is a key aspect of high functioning teams. The key is to foster an environment of curiosity and humility that welcomes and even encourages a diversity of perspectives, including direct...
info_outline
Images of the Dying: A Podcast with Wendy MacNaughton, Lingsheng Li, and Frank Ostaseski
GeriPal - A Geriatrics and Palliative Care Podcast
Can death be portrayed as beautiful? In this episode, we share the joy of talking with (artist, author, graphic journalist) and (Buddhist teacher, author, founder of the and Zen Hospice Project) about using drawings and images as tools for creating human connections and processing death and dying. You may know Wendy as the talented artist behind or . Our focus today, however, was on her most recently published book titled . This beautiful book began as a very personal project for Wendy while she was the artist-in-residence at Zen Hospice. As BJ MIller writes in the foreword, “May this...
info_outline
Stepped Palliative Care: A Podcast with Jennifer Temel, Chris Jones, and Pallavi Kumar
GeriPal - A Geriatrics and Palliative Care Podcast
If palliative care was a drug, one question we would want to know before prescribing it is what dose we should give. Give too little - it may not work. Give too much, it may cause harm (even if the higher dose had no significant side effects, it would require patients to take a lot of unnecessary additional pills as well as increase the cost.) So, what is the effective dose of palliative care? On today’s podcast, we talk about finding an evidence-based answer to this dosing question with three leaders in palliative care: , , and . All three of our guests were co-authors of...
info_outline
Well-being and Resilience: a Podcast with Jane Thomas, Naomi Saks, Ishwaria Subbiah
GeriPal - A Geriatrics and Palliative Care Podcast
Well-being and resilience are so hot right now. We have an endless supply of CME courses on decreasing burnout through self-care strategies. Well-being committees are popping up at every level of an organization. And C-suites now have chief wellness officers sitting at the table. I must admit, though, sometimes it just feels off… inauthentic, as if it's not a genuine desire to improve our lives as health care providers, but rather a metric to check off or a desire to improve productivity and billing by making the plight of workers a little less miserable. On today’s podcast, we talk with ,...
info_outlineAmbivalence 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 “Ambivalence in Clinical Decision-Making,” which discussed Bryanna’s and Jenny’s 2022 article titled “Two Minds, One Patient: Clearing up Confusion About Ambivalence."
Bryanna’s and Jenny’s article is particularly unique as it discusses these “ambivalent-related phenomena” and that these different kinds of “ambivalence” may call for different approaches with patients, surrogates (and health care providers):
In addition to defining these “ambivalent related phenomena” we ask our guests to cover some of these topics:
-
Is ambivalence good, bad, or just a normal part of decision-making?
-
Does being ambivalent mean you don’t care about the decision?
-
What should we be more worried about in decision-making, ambivalence or the lack thereof?
-
The concern about resolving ambivalence too quickly, as it might rush past important work that needs to be done to make a good decision.
-
What about ambivalence on the part of the provider? How should we think about that?
-
How do you resolve ambivalence?
Lastly, the one takeaway point from this podcast is that the next time I see ambiguity (or have it myself), I should ask the following question: “I see you are struggling with this decision. Tell me how you are feeling about it.”