Opioids remain the cornerstone of symptom relief in hospice and palliative care, especially for pain and dyspnea. However, navigating reported "allergies" to opioids—particularly morphine and codeine—can pose significant challenges. In an already complex clinical landscape, these allergy labels can lead to under-treatment of distressing symptoms, unnecessary
As palliative care continues to evolve with an emphasis on quality of life, comfort, and symptom control, the incorporation of precision medicine tools like pharmacogenomics (PGx) offers promising benefits. Pharmacogenomics, the study of how a patient’s genetic makeup influences their response to medications, can serve as a powerful ally
In palliative medicine, attention to genitourinary symptoms is often overshadowed by more pressing issues such as pain, dyspnea, or existential distress. Yet lower urinary tract dysfunction—particularly the confusing coexistence of overactive bladder (OAB) symptoms and urinary retention—is both common and under-recognized, especially in older adults with complex comorbidities.
March is Kidney Awareness Month, a time often focused on prevention, early detection, and life-sustaining treatments like dialysis. These conversations are important—and incomplete. Missing too often is space for an equally valid, deeply human decision: the decision to stop dialysis. For many people living with advanced kidney disease, dialysis
March is Kidney Awareness Month, a time often focused on prevention, early detection, and life-sustaining treatments like dialysis. These conversations are important—and incomplete. Missing too often is space for an equally valid, deeply human decision: the decision to stop dialysis. For many people living with advanced kidney disease, dialysis
We spend a great deal of time helping patients in maintaining stability—physically, emotionally, and socially. For individuals living with dementia, stability is more than a comfort; it is a lifeline. Disrupting it—especially through relocation—can carry significant clinical and emotional risks. Whether moving from home to a facility,
In palliative and hospice medicine, opioids remain the cornerstone of pain and symptom management. Morphine, codeine, hydromorphone, oxycodone, and other agents provide profound relief from pain, dyspnea, and certain distressing symptoms at the end of life. Yet, many patients arrive with their medical record littered with “opioid allergy” labels. These
As the hospice community deepens its commitment to equity and trauma-informed care, clinicians are increasingly caring for individuals who have experienced incarceration. These patients bring with them a lifetime of medical, psychological, and existential burdens shaped not only by disease, but by the enduring imprint of trauma, stigma, and institutionalization.
Prescription Drug Monitoring Programs (PDMPs) are state-run electronic databases that track controlled substance prescribing and dispensing. While they were originally designed as a tool to combat the opioid epidemic, PDMPs are now an expected part of safe, compliant medical practice in nearly every setting—including palliative care and hospice. For
For patients, caregivers, and clinicians walking the palliative and hospice journey In palliative care and hospice, we are often surrounded by urgency—symptoms to manage, decisions to make, emotions to hold, lives to honor. And yet, amid all of this motion, one of the most therapeutic interventions available to us
Smiling is one of the most basic human expressions, universally recognized and deeply tied to emotion, social connection, and quality of life. In the palliative and hospice setting, providers often witness the gradual fading of a patient’s ability to smile. While at first glance this may seem like a
Introduction For many people—especially women, older adults, and those with chronic health conditions—recurrent urinary tract infections (UTIs) can feel like an endless cycle. Antibiotics may clear the infection temporarily, but the relief is often short-lived. Over time, repeated antibiotic exposure can lead to resistance, side effects, and a
When we think of aging, most people imagine wrinkles, thinning hair, or skin changes. Yet the most insidious change is less visible: the gradual loss of muscle mass, strength, and function known as sarcopenia. Beginning as early as age 30, we lose 3–8% of muscle mass per decade, accelerating
Sleep disturbance is one of the most pervasive and distressing symptoms in patients living with advanced illness. Families worry when their loved one is awake at night, clinicians search for safe non-opioid strategies to settle nighttime agitation, and patients often ask for something “natural” to help them sleep. For many
The holidays arrive every year whether we feel ready or not. They come with lights and music, rituals and expectations—tables set the way they’ve always been set, recipes made the way they’ve always been made. And yet, for many, something essential is missing. A chair is empty.
My late husband, Bob, was a hospice and palliative medicine physician. Early in our relationship, as we shared family histories, I told him about my brother David. When David was 13 (I was 18), he was in an accident and remained in a coma for 21 days. For years I
If you are a healthcare professional and feel put upon, underappreciated, overlooked, and taken for granted by administration, it is entirely valid. Many administrators on both the provider and payer side of healthcare fail to recognize that without the talent, the show simply cannot go on. Unlike Broadway and Hollywood,
In palliative care, we have a front-row seat to love in action. We watch adult children pour themselves into caregiving for aging parents—managing appointments, medications, decisions, grief. But increasingly, those same caregivers are also raising children or supporting young adults at the very same time. They are “the sandwich
Every October, we do something bizarre. We cover our houses in skeletons, ghosts, and gravestones. We dress up as zombies. We tell creepy stories. We watch movies about death… for fun. And yet, bring up real death at the dinner table and suddenly everyone needs to “go check the laundry.
Trauma is not just an emotional experience—it is a physiological and neurological event that leaves lasting imprints on the brain. For palliative care providers, understanding these changes is vital. Patients in our care may carry a history of trauma, whether from childhood adversity, war, intimate partner violence, medical interventions,
In Buddhism, there is a powerful teaching story often referred to as “the bird on your shoulder.” A monk asks his students, “If a bird sat on your shoulder and whispered, ‘Today could be the day you die,’ how would you live?” The question is not meant to frighten—but
October is Down Syndrome Awareness Month—a time to celebrate the lives, stories, and strengths of individuals with Down syndrome and the families who love and support them. It's a moment to pause, learn, and reflect on what it truly means to be inclusive, to embrace diversity in
In hospice and palliative care, we often stand at the intersection of life’s most profound questions. Patients and families ask us what truly matters at the end of life and what makes life meaningful. Remarkably, one of the longest-running studies in the world gives us answers that echo what
Alzheimer’s disease disproportionately affects women. Nearly two-thirds of all patients living with Alzheimer’s are female, and while increased life expectancy explains part of this difference, it does not tell the full story. Emerging research suggests that biological factors—including differences in brain lipid metabolism—play a critical role