Updates in Palliative Care 2024

Seattle, WA US

May 1, 2024 to May 4, 2024

This course offers Live (in-person) and Livestream (virtual) attendance options.

Course Directors: Frank (Andy) A. Bock, D.O., Molly A. Feely, M.D., and Jacob J. Strand, M.D.

Mayo Clinic's Updates in Palliative Care is a multidisciplinary CME course designed to build and enhance your palliative care knowledge. Experts from the Mayo Clinic Center for Palliative Care provide clinically relevant pearls for palliative care providers and clinicians from primary care, hematology/oncology, hospital medicine, critical care and related specialties. If you care for patients with serious illness and are looking to broaden your skills beyond the basics, this is the course for you.

Registration	Dates/Time	Fee
Update in Palliative Care (Live and Livestream)	May 2 - 4, 2024	$895
Update in Pediatric Palliative Care	May 1, 2024 7:00 a.m. - 4:30 p.m.	$495
Sign up for both to receive a $100 discount		$1290
It Takes a Village* *You must sign up for the General Session to take this course	May 2, 2024 1:30 - 3:00 p.m.	$250
Palliative Care KSA - Live (in-person) Only* *You must sign up for the General Session to take this course	May 2, 2024 1:00 - 5:00 p.m.	$250
Buprenorphine & Palliative Care* *You must sign up for the General Session to take this course	May 2, 2024 1:30 - 4:45 p.m.	$250

Target Audience

Targeted clinician specialties (MD, NP, PA-C) including clinicians from general internal medicine, family medicine, hospital medicine, oncology, hospice and palliative care, critical care, geriatrics, nephrology and cardiology.

Learning Objectives

Upon completion of this activity, participants should be able to:

Develop treatment strategies for common symptoms in patients with serious illness.
Utilize the Serious Illness Conversation Guide to assess patients' goals and values.
Define adaptive coping and apply intervention strategies to improve patient and family coping.

Attendance at any Mayo Clinic course does not indicate or guarantee competence or proficiency in the skills, knowledge or performance of any care or procedure(s) which may be discussed or taught in this course.

Course summary

Available credit:

28.25 AAPA Category 1
28.25 AMA PRA Category 1 Credit™
28.25 Attendance
28.25 IPCE

Event starts:

05/01/2024 - 7:00am

Event ends:

05/04/2024 - 12:00pm

PDF / Printable Version

Mayo Clinic Updates in Pediatric Palliative Care 2024 Fairmont Olympic Hotel Seattle, Washington
Wednesday, May 1, 2024 (PDT) Optional Add-on - $495.00 Ped’s Only on May 1 or $395.00 with purchase of General Session
7:00 a.m.	Breakfast Meet the Professors (Live only)
7:45 a.m.	Welcome & Introductions
8:00 a.m.	Assessment and Management of Pain in Children with Significant Neurologic Impairment Lezlie Andersen, M.D. Review clinical guidelines of pain assessment in neurologically impaired children. Describe the unique aspects of managing pain in children with neurologic impairments.
8:30 a.m.	Management of Chemotherapy-Induced Nausea & Vomiting in Children Megan Thorvilson, M.D., MDiv Consider as stepwise approach for management of chemotherapy-induced nausea and vomiting in children. Describe a clinical rationale for selecting antiemetic agents in children.
9:00 a.m.	Pediatric Palliative Care Pharmaceutical Updates Christopher Collura, M.D., MA Identify new medication(s) or breaking evidence that have had the greatest impact on the pediatric palliative care practice in recent years. Identify recent pharmaceutical agents across the care continuum that may benefit the holistic care considerations for the pediatric palliative care provider.
9:30 a.m.	Beyond the Pain Ladder: Indications for Methadone, Ketamine, and Duloxetine Lezlie Andersen, M.D. Consider the safety of these drugs safe in infants and children? Describe the absolute and relative contraindications to prescribing these medications in children. What are counseling considerations with parents when starting these medications.
10:00 a.m.	Break
10:30 a.m.	Screening for Psychosocial Distress in Children and Adolescents with Cancer Sarah McCarthy, Ph.D., MPH LP Describe how psychosocial distress presents in different developmental stages. Identify clinical tools useful for screening for psychosocial distress that have been validated in this population.
11:00 a.m.	Supportive Care for Patients and Parents of Children with Complex Chronic Conditions Jori Bogetz, M.D. Review the care trajectory for children with complex chronic conditions and psychosocial challenges for their families. Define palliative care needs for children with complex chronic conditions and their families.
11:30 a.m.	The Role of Pediatric Palliative Care in Grief and Bereavement Support Carolyn Mueller, LICSW MSW, Aubrey J. Manahan, R.N., CHPPN Explore ways that a pediatric palliative care program can approach grief and bereavement. Discuss coordination of grief and bereavement efforts with hospice bereavement teams.
12:00 p.m.	Lunch Break
12:30 p.m.	Keynote: Pediatric Palliative Care State of the Field Jeff Klick, M.D. Review the history of pediatric palliative care from early program development to evolution of training programs to current state. Discuss the current prevalence and availability of pediatric palliative care nationwide. Consider shifting priorities for the field of pediatric palliative care and the impact on the next generation of providers’ education, training, and clinical practice.
1:15 p.m.	Break
1:30 p.m.	Navigating Potentially Non-Beneficial Treatment in Children with Life-Limiting Illness Robert Macauley, M.D. What are some important pitfalls to avoid when discussing potentially non-beneficial care with parents? Outline approaches that are most likely to foster a therapeutically successful interaction with parents and pediatric patients.

2:00 p.m.	What is the Value Proposition for Pediatric Palliative Care? Lindsay Ragsdale, M.D. Define and explore value as it pertains to pediatric palliative care. Compare and contrast cost effective, cost savings and cost avoidance. Consider strategies to approach interdisciplinary program growth with institutional leadership.
2:30 p.m.	Outpatient Integration of Pediatric Palliative Care in Oncology Melissa Smith, APRN CNP MS, Aubrey J. Manahan, R.N., CHPPN Describe the current state of pediatric palliative oncology care. Explore potential benefits for integration of pediatric palliative care in outpatient oncology.
3:00 p.m.	Break
3:15 p.m.	The Role of Perinatal Palliative Care in Maternal Fetal Care Christopher Collura, M.D., MA Describe the role of perinatal/pediatric palliative care in maternal fetal care centers. Identify patient populations that would most benefit from involvement of perinatal/pediatric palliative care.
3:30 p.m.	Adolescent Medical Decision-Making Robert Macauley, M.D. Consider ethical challenges in medical decision-making and assent when caring for adolescents with serious illness. Describe strategies to consider prognostic disclosure when parents request withholding of information from their adolescent child.
3:45 p.m.	Palliative Sedation in the Pediatric Patient Megan Thorvilson, M.D., MDiv Consider ethical challenges to consider when proposing palliative sedation in pediatric patients. Review drug selection and management approaches in palliative sedation.
4:00 p.m.	Medical Cannabinoids in Children and Adolescents Christopher Collura, M.D., MA Describe the evidence-based indications for medical cannabinoids in children and adolescents. Outline the potential benefits and known risks of medical cannabinoids in children and adolescents.
4:15 p.m.	Wrap-Up
4:30 p.m.	Adjourn

Updates in Palliative Care Thursday, May 2-4, 2024 Fairmont Seattle *All times listed are in Pacific Time Zone*
General Session Thursday May 2, 2024
6:30 a.m.	Registration & Breakfast
6:55 a.m.	Welcome
7:00 a.m.	Buprenorphine Basics for Pain in Geriatrics and Palliative Care Katie Fitzgerald Jones, MSN, APRN, Ph.D. Describe the history and basic pharmacology of buprenorphine. Differentiate between buprenorphine formulations FDA approved for pain vs. addiction. In which ways is buprenorphine safer than full opioid agonists? How do you overcome insurance barriers in prescribing buprenorphine pain products?
7:30 a.m.	Interventional Pain Procedures – When to Refer Patients with Serious Illness Susan M. Moeschler, M.D. Are interventional procedures really an option for palliative patients? Who is the ideal palliative patient for interventional pain procedures? When should I think about referring to a pain interventionalist? (Early? Late?) What do you wish palliative clinicians knew or did differently around pain interventions of any kind?
8:00 a.m.	Neuropathic Pain – Beyond Gabapentinoids and Duloxetine Dare O. Olatoye, M.D. What drugs should I consider when first line agents fail? What are some tips for when and how to prescribe tricyclics for neuropathic pain? Are there procedures for neuropathic pain that work (scrambler? Nerve stimulator?
8:30 a.m.	Worries About Anxiety in Palliative Care Jason Webb, M.D. When is worry normal and when does it need to be treated in palliative care patients? Aren’t all patients with a serious illness worried? When is pharmacologic treatment of anxiety indicated? What screening methods work for anxiety in patients with serious illness? When is it reasonable to use benzodiazepines in palliative care for anxiety? And when not? Is Buspirone ever helpful? What about hydroxyzine?
9:00 a.m.	Break
9:15 a.m.	Cases in Refractory Symptoms – What to Do When the Usual Meds Don’t Work Sara E. Wordingham, M.D. What are the pathophysiologic causes of dyspnea (e.g., muscle weakness, lung parenchymal disease, airway disease, catabolic drive etc.)? What is total dyspnea? Which non-pharmacologic interventions have evidence basis to support their use for dyspnea? Is pulmonary rehabilitation effective in the HPM population? How should opioids be used to manage dyspnea (getting at the concept that low dose opioids are effective and safe but that increasing beyond 30 OME is neither effective nor safe)?
9:45 a.m.	Niche Anti-Emetics: Uncommon Anti-Emetics for Unique Situations – Expanding Your Nausea Toolkit Megan Brandeland, M.D. When might you consider using the granisetron patch for nausea? When is promethazine the ideal antiemetic? What antiemetics should I think about in patients with very prolonged QTc? What is the role of NK-1 inhibitors? Is there any role outside of chemo?
10:15 a.m.	Contemplative Medicine --- Good for You, Good for Me. Deirdre R. Pachman, M.D. What is contemplative medicine? How do I apply principles of contemplative medicine to my daily clinical practice? How does contemplative medicine help me find meaning in my daily work?
10:45 a.m.	Break
11:00 a.m.	Controversies in Advance Care Planning. Can We Just Stop Doing ACP Now? Molly A. Feely, M.D. Is advance care planning effective or not? If not, can I stop talking to patients about advance care planning?
11:30 a.m.	Tips for Negotiating Goals of Care When the Patient Lacks Capacity Megan J. Thorvilson, M.D. What are some strategies for negotiating GOC with surrogates? What do I do when surrogates still want the patient do decide when I know the patient lacks capacity? How do I manage a situation where the surrogate heard the patient say something out of context when the patient lacks capacity? Which GOC decisions require only minimal decisional capacity?
12:00 p.m.	Waiting for a Miracle…. The Family Who Wants Everything Done Christopher A. Collura, M.D. How do I respond to a family that says, “Do everything?” What are strategies for negotiating with family who request care that is highly unlikely to be beneficial? How do I construct an effective time limited trial? Why do some patients/families persist with unrealistic expectations/GOC?
12:30 p.m.	Adjourn

Friday May 3, 2024
6:15 a.m.	Breakfast Meet the Professors (live participants only) Molly A. Feely, M.D., Sara E. Wordingham, M.D., Megan Brandeland, M.D., Christopher A. Collura, M.D.
6:55 a.m.	Welcome
7:00 a.m.	Methadone as a Workhorse in Hospice and Palliative Care Kelly WU, M.D. What makes methadone special? Describe the pharmacology of methadone and why it is so tricky to use. What is the evidence (or lack thereof) that methadone is really more effective on neuropathic pain than other opioids? What are the down sides of methadone? (OD deaths, QT prolongation, drug interactions etc.)
7:30 a.m.	Nuts & Bolts of Methadone Prescribing: Practical Tips in the Outpatient Management of Methadone Mashele M. Huschka, APRN, C.N.P., D.N.P. Who is an ideal patient for methadone? In whom would you avoid methadone? How do you start methadone in the outpatient setting? How do you titrate methadone in the outpatient setting? How do you follow patients requiring methadone?
8:00 a.m.	Everything You Ever Wanted to Know About Ketamine for Pain Management Jacob J. Strand, M.D. Which types of pain is ketamine effective in treating? How do you dose ketamine? IV? Oral? Inpatient? Outpatient? How is it supplied? What are the risks of ketamine I need to watch for?
8:30 a.m.	The Poop on Treating Diarrhea in Palliative Care Teresa J. Goddard, P.A.-C What can I use to treat diarrhea when Imodium doesn’t work? How does one use tincture of opium? When should I consider using bile acid salts? What about diarrhea in patients on tube feeds or high output ileostomy?
9:00 a.m.	Break
9:15 a.m.	Open Up and Say “Ahhhh.” Mucositis, Xerostomia and Secretion Management Jordan C. Karow, APRN, C.N.P., D.N.P. What is your algorithm for treating mucositis? What works for xerostomia? What works for secretion management at EOL and for those not EOL? When should I consider botulinum injections for excess secretions?
9:45 a.m.	Palliating ALS --- What Does the Non-Neurologist Need to Know About Management Claudia Z. Chou, M.D. What is new in voice assistance for ALS patients? How is nutrition assistance the same or different for ALS patients? What do we need to know about ventilatory assistance for ALS patients? How can I help my ALS patients obtain equipment
10:15 a.m.	“I Itch So Bad, I Want to Die” Kelly Wu, M.D What are some common causes of generalized pruritus in palliative care patients? Is there a common pathway for the symptom of pruritus? How should we treat various types of pruritus (uremic? Cholestatic? Hematologic/malignant? Opioid induced? Etc)?
10:45 a.m.	Break
11:00 a.m.	Why Do Different Hospices Have Different Answers About the Same Patient: Hospice Variations in the US and the Reasons Why Molly Feely, M.D. How are hospices paid? What are MACs and how do they influence hospice behavior? How did what happen to San Diego Hospice impact hospice behavior? Where are we now and what can we expect going forward?

11:30 a.m.	Practical Tips for Assessing Hospice Eligibility Suzanne S. Bundrick, APRN, C.N.P., M.S.N. How do I know if a patient is hospice eligible or not? Aren’t there some published criteria somewhere? What if my patient doesn’t fit the criteria perfectly but I still think they have a life expectancy less than 6 months? What are general markers of life expectancy less than 6 months?
12:00 p.m.	Tips for Effective Palliative Care in the Nursing Home When You DON’T Have a Dedicated SNF Palliative Team – A Case-Based Adventure Natalie F. Mohammad, APRN, C.N.P How can I use neuroleptics for symptom management (e.g. nausea) in the setting of SNF regulations around these medications? What are tips and tricks to achieve good symptom control in under sourced SNF settings (e.g. prn vs scheduled meds, patches vs pills, etc)? How can I address the demoralization in patients who want to go home but are not able? How can I create an “IDT-like team” in the SNF? Why do so many of my patients from the SNF lack advance care planning and how can we do better?
12:30 p.m.	Adjourn

Buprenorphine & Palliative Care 1:30 p.m. to 4:45 p.m. (Optional add-on $250.00)
Katie Fitzgerald Jones, MSN, APRN, Ph.D., Zachary S. Sager, M.D., Laura S. Rhee, D.O. What are the nuances of prescribing buprenorphine? What do I do when my stable buprenorphine patient gets admitted with pain crisis? How do I set up my clinic to manage patients on buprenorphine? How do I partner with addiction medicine? Or do I?

Saturday May 4, 2024
6:15 a.m.	Breakfast Meet the Professors: Mashele Huschka, APRN, C.N.P., D.N.P., Claudia Z. Chou, M.D., Teresa J. Goddard, PAC, Jacob J. Strand, M.D., Kelly Wu M.D., Jordan C. Karow, APRN, C.N.P., D.N.P. (Live only)
6:55 a.m.	Welcome
7:00 a.m.	Case Based Conundrums in Palliative Care Ethics Megan Brandeland, M.D. 3-5 cases that illustrate ethical dilemmas common or specific to palliative care that you wish all palliative clinicians understood better. Potential examples might include but are not limited to, requests to withdraw life-sustaining measures after suicide attempt, decision making for patients who are unrepresented, the futility of the concept of futility etc.
7:30 a.m.	Case Based Conundrums in Hepatology Palliative Care Wil Santivasi, M.D. 3-5 cases that illustrate palliative principles specific to hepatology that you wish all palliative clinicians understood better. Potential examples might include, but are not limited to, prognosticating in decompensated cirrhosis, management of hepatic encephalopathy at the EOL, and evidence-based risks for indwelling PleurX catheters etc.
8:00 a.m.	Case Based Conundrums in Neuro Palliative Care Claudia Z. Chou, M.D. 3-5 cases that illustrate palliative principles specific to neuro palliative care that you wish all palliative clinicians understood better. Potential examples might include, but are not limited to; modern prognostication of anoxic brain injury, seizure management in hospice patients, and which patients with stroke might improve to independence etc?
8:30 a.m.	Case Based Conundrums in Geriatric Palliative Care Gregory J. Hanson, M.D. 3-5 cases that illustrate palliative principles specific to geriatrics that you wish all palliative clinicians understood better. Potential examples might include but are not limited to; why recognizing frailty phenotype is important to HP, and what do palliative clinicians need to know about meds for dementia (deprescribing tips, etc.)?
9:00 a.m.	Break
9:15 a.m.	Addiction in Patients with Serious Illness Zachary S. Sager, M.D. I thought we didn’t have to worry about addiction in patients with serious illness. What is the risk of developing or re-developing addiction in this population? How do I talk to my palliative patient that I think might be developing a substance use disorder? What are treatment options for SUD in patient who are too ill to attend traditional inpatient or intensive outpatient treatment programs? How do I engage my addiction colleagues in helping manage non-traditional patients with SUD?
9:45 a.m.	Health Disparities: A Toolkit for Clinicians Rahma Warsame, M.D. Appreciate larger system sources of health disparities (see previous talk for details). Name three changes you can make in your own approach to patients that can help alleviate some health disparities for your practice. Name three changes your practice can make that can help alleviate health disparities for your practice?
10:15 a.m.	Creating Holding Space in Ambulatory Palliative Care: Supporting Coping and Sitting with Prognostic Uncertainty Jason Webb, M.D. What is resiliency training? What is dignity therapy? How do they support adaptive coping? How can I get them at my work?
10:45 a.m.	Break
11:00 a.m.	Home Palliative Care Gregory J. Hanson, M.D. When should I consider referring my patient to home palliative care? How do I evaluate the home palliative programs in my area? What does a good home? palliative program look like? Should I start a home palliative program. in my area? How do I even consider starting? When should I consider referring my patient to home palliative care? How do I evaluate the home palliative programs in my area? What does a good home palliative program look like? Should I start a home palliative program in my area? How do I even consider starting?

11:30 a.m.

The Future of Integrated Palliative & Cancer Care

Wil Santivasi, M.D.

What is early integrated palliative care (EIPC), why consider it and how does it differ in solid organ tumor and hematologic malignancies?
How have targeted therapies changed early integration of palliative care and co-management?
Is there an ideal integrated practice model?
What are the pitfalls (need to comment on nationwide FTE shortage)?

12:00 p.m.

Grief for Clinicians Who Are Not Mental Health Trained: How Can I Help My Patients & Their Survivors?

Jill Lovell, LICSW

How do I recognize grief vs depression?
How do I recognize complicated grief?
What should I do about grief and complicated grief?

12:30 p.m.

Adjourn

Fairmont Olympic Hotel

411 University Street

Seattle, WA 98101

United States

Reservations

A block of guest rooms has been reserved for attendees and their guests with special course rates at the Fairmont Olympic, Seattle, WA. To receive the special rate of $299.00 Deluxe Room (plus applicable taxes and fees) for a standard room, reservations must be made before the room block is filled or before the expiration date of April 9, 2024, whichever comes first. After April 9, 2024, reservations will be taken based on space and rate availability.

Please identify yourself as a participant of the Mayo Clinic Palliative course when making your reservation. You may call (949) 240-2000 to make your reservation or click on the link to make a online reservations.

All travel and lodging expenses are the sole responsibility of the individual registrant.

Course Directors

Frank (Andy) A. Bock, D.O.
Dr. F. Andrew (Andy) Bock is a Mayo Clinic Palliative Medicine Consultant with the Division of Community Internal Medicine, Geriatrics and Palliative Care and an Assistant Professor with the Mayo Clinic Alix School of Medicine. He has been board certified in Hospice and Palliative Medicine since 2004 and is a Hospice Medical Director with Mayo Hospice. He currently serves as the Palliative Care Fellowship Hospice Rotation Director and previously served as chair of the Palliative Medicine Clinical Practice Committee. Andy has an interest in physician communication and complex medical decision making including advanced care planning and end of life shared decision making. He continues to practice palliative care in the hospital, subacute and community settings

Molly A. Feely, M.D.
Dr. Feely is triple boarded in family medicine, internal medicine, and palliative medicine. Her clinical interests lie in palliative care for patients with end stage renal disease and pain management for patients with dual diagnoses of cancer and substance use disorder. She has been very active in education throughout her career, is a former program director for the hospice palliative medicine fellowship at Mayo and current education chair for palliative medicine. She has been member of the executive leadership team for the section of palliative medicine at Mayo Clinic Rochester for 10 years.

Jacob J. Strand, M.D.
Dr. Strand is currently Chair, Enterprise Center for Palliative Medicine and Assistant Professor of Medicine, Mayo Clinic College of Medicine and Sciences. He sees hospitalized patients with complex symptom needs on the inpatient palliative care services and works closely with patients and their caregivers to manage complications of serious illness, particularly patients with cancer and advanced heart failure in the outpatient Symptom Management, Pain and Quality of Life Clinic at Mayo Clinic in Rochester. Dr. Strand's clinical research interests center around the integration of palliative medicine into the care of patients with cancer and advanced cardiac disease, management of complex cancer-related pain and barriers to cancer pain management. He participates in several active national research protocols and lectures nationally and internationally on these topics.

Accreditation Statement
In support of improving patient care, Mayo Clinic College of Medicine and Science is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

Credit Statement(s):

AMA
Mayo Clinic College of Medicine and Science designates this live activity for a maximum of 28.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAFP
Application for CME credit has been filed with the American Academy of Family Physicians. Determination of credit is pending.

AAPA

Mayo Clinic College of Medicine and Science has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 28.25.

IPCE
This activity was planned by and for the healthcare team, and learners will receive 28.25 Interprofessional Continuing Education (IPCE) credit for learning and change. AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.

Other Healthcare Professionals:
A record of attendance will be provided to all registrants for requesting credits in accordance with state nursing boards, specialty societies or other professional associations.

Sessions	Date / Time	Credits
Updates in Pediatric Palliative Care	May 1, 2024 7:00 a.m. - 4:30 p.m.	8.00
Updates in Palliative Care	Thursday, May 2, 6:30 a.m. - 12:30 p.m.	4.75
	Friday, May 3, 6:15 a.m. - 12:30 p.m.	5.75
	Saturday, May 4, 6:15 a.m. - 12:30 p.m.	5.75
Optional Workshops
It Takes a Village	May 2, 2024 1:30 - 3:00 p.m.	1.50
Palliative Care KSA - Live (in-person) Only	May 2, 2024 1:00 - 5:00 p.m.	4.00
Buprenorphine & Palliative Care	May 2, 2024 1:30 - 4:45 p.m.	3.25

For disclosure information regarding Mayo Clinic School of Continuous Professional Development accreditation review committee member(s) and staff, please go here to review disclosures.

Available Credit

28.25 AAPA Category 1
28.25 AMA PRA Category 1 Credit™
28.25 Attendance
28.25 IPCE

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Updates in Palliative Care 2024