FINAL PROGRAM - California State Hospice Association

6-P. Pain? Yes. Substance Abuse? Yes.
What Next...
Brian W. Murphy, MD, MBA, Chief Medical Officer,
Nathan Adelson Hospice, Las Vegas, NV.
Patients in both hospice and palliative care can exhibit
the challenging combination of need for pain management
in the setting of known or suspected substance abuse. This
can create much angst for care giving staff and potential for
liability. A brief history of selected clinical cases and publicized
examples will help illustrate the problem. Recommendations
for clinical care and helpful resources will be
reviewed, including contracts, urine testing, pill counts, dispensing
practices and the like.
Learning Objectives: Enhance one's knowledge and confidence
in techniques used to provide pain management in
the setting of substance abuse. Improve one's knowledge
and understanding of the risks of inadequate pain management
for or improper dispensing of opioids to patients.
7-P. Methadone for Severe Pain Pros & Cons
Jim Joyner, Pharm.D., Director of Clinical Operations,
Outcome Resources, Rocklin, CA.
The role of methadone in the treatment of chronic severe
pain will be explored. A thorough and balanced review of the
advantages and potential risks of methadone use in hospice
patients will be presented. Methadone dosing and opioid
conversion methods will be discussed in detail. An effective
method for converting patients from other opioids to methadone
will be demonstrated.
Learning Objectives: List 3 risks or potential pitfalls associated
with the use of methadone for severe chronic pain.
Demonstrate ability to work through a series of case study
problems about converting from other opioids to methadone.
List at least 3 potential advantages of methadone over
other long-acting opioids in managing severe chronic pain.
9-P. Circles of Trust
Arlene Stepputat, M.A., Manager of Volunteers, Visiting
Nurse and Hospice Care, Santa Barbara, CA.
Based on the work of Parker Palmer in A Hidden Wholeness,
a circle of trust follows a unique set of touchstones that
allow each member of the group to be part of a safe container
for deep reflection and sharing. Often in the course of our
careers or aspects of our lives there is a separation between
soul and role. Using Circles of Trust, group members have a
way of being in community and yet able to hear one’s own
inner voice. Authentic revelations shared result in a connection
that unifies a group and reminds each member of what
is truly important to that person. Healing and the chance to
truly hear and be heard is a rare gift that is sorely needed in
our busy lives. Learn and experience it for yourself.
Learning Objectives: Participants will understand the
Touchstones for meetings and how they create group safety.
Participants will have an opportunity to experience firsthand
how a circle of trust works. Participants will learn ways to
apply this to volunteer programs.
8-P. Meaning-Centered and Values-Guided
Approach to Enhance the Patient Experience
Meghan A. Marty, Ph.D., Postdoctoral Fellow, Julia
Kasl-Godley, Ph.D., Staff Psychologist, Palo Alto Veterans
Affairs Health Care System, Palo Alto, CA; Kimberly
E. Hiroto, Ph.D., Staff Psychologist, Santa Rosa Veterans
Affairs Community Based Outpatient Clinic, Santa Rosa, CA.
People with advanced or life-limiting illness often experience
multiple forms of suffering. Sources of this emotional
distress often include questions about their purpose or
meaning in life and concerns for how they will be remembered.
Their illness experience can often affect their view of
themselves and their life. This presentation will address specific
therapeutic approaches and techniques to highlight the
patient’s sense of meaning and recognition that their sense
of self can continue in the presence of their illness.
Learning Objectives: Identify types of suffering commonly
experienced by persons at end-of-life. Describe three
approaches that can assist with different types of suffering
and determine the appropriate intervention to use depending
on the type of suffering. Practice specific techniques consistent
with these therapeutic approaches.
18 PROGRAM BY DAY—FRIDAY, OCTOBER 5, 2012