Palliative care provides an extra layer of support to patients and families living with serious or advanced illness. Palliative care providers tend to the physical, psychological, spiritual and social needs of patients and their loved ones. All hospice is considered palliative care, but all palliative care is not hospice. This presentation differentiates between the two, describes eligibility criteria for each, payment models, and services rendered. Data substantiating the impact of palliative care will be covered, as well as primary, secondary, and tertiary palliative care models.

Comprehensive pain assessment allows practitioners to determine the most likely pathogenesis of pain, which helps guide selection of appropriate therapy. This is a two-part presentation. In Part 1, Pain Assessment, participants will discuss the importance of pain assessment, learn to assess a patient’s pain complaint using the “PQRSTU” approach, perform pain assessments using single- and multidimensional pain assessment tools, and identify common barriers to pain assessment and strategies to mitigate them. In Part 2, Pathogenesis of Pain, participants will learn about the various components of pain signaling (including the role of A-delta and C-fibers), define terms such as hyperalgesia, allodynia, and wind up, and differentiate between visceral, somatic, and neuropathic pain.

Opioids are an essential component of treating moderate to severe pain in patients with serious or advanced illness. In this presentation learners will understand opioid nomenclature, and the pharmacologic differences between opioids. The appropriate use of opioids in palliative care, and specific pain syndromes will be addressed. Participants will also learn about opioid-related adverse effects and management of such. This session will also address opioid myths and misconceptions and address how to dispel these misunderstandings with patients, families and other health care providers.

Patients with a serious or advanced illness often need to be switched (or rotated) from one opioid to a different opioid, or between dosage formulations or routes of administration. Participants in this presentation will learn about the concept of equianalgesia, and how to switch from one dosage formulation or route of administration to a different one using the same opioid, and how to switch entirely from one opioid to a different opioid, using a variety of dosage formulations and routes of administration. Timing of switches, dosing analgesics for breakthrough pain, and monitoring suggestions will also be addressed.

Adjuvant analgesics, also known as co-analgesics, are defined as “drugs with a primary indication other than pain that have analgesic properties in some painful conditions.” Participants in this presentation will learn where adjuvant analgesics act within the pain pathway, how to select an appropriate adjuvant analgesic, and how to monitor for both efficacy and toxicity, including identification of common adverse effects associated with these various medication classes.

Methadone is a strong opioid used to treat moderate to severe pain in patients with serious or advanced illness. Methadone is pharmacologically different from many opioids, and it is essential that providers understand the pharmacodynamic and pharmacokinetic differences between methadone and more customary opioids. This presentation will cover those pharmacologic differences, and address methadone dosing in opioid-naïve and opioid-tolerant patients. Participants will learn how to monitor and titrate methadone therapy, and manage adverse effects.

Palliative care practitioners are able to capably manage pain in serious or advanced illness in the majority of patients using a critical thinking process of drug therapy selection (along with non-pharmacologic intervention). However, in some cases the situation is more complicated. Participants in this presentation will learn about the evidence that guides the management of tenesmus pain, local or topical pain (e.g., wound care pain), pain associated with hyperalgesia, and complicated neuropathic pain. Complicated pain management is definitely not “one size fits all!”

Recommending or prescribing drug therapy is step 1 in the therapeutic relationship. Monitoring the patient’s response is a critical part of the process. Participants will learn how to select discriminating monitoring parameters for therapeutic effectiveness and potential toxicity for analgesic therapy. We will also review the “5 A’s” of analgesia that should be included when monitoring an analgesic regimen. Last, participants will learn how to adjust therapy based on monitoring data collected.

Patients receiving palliative or hospice care frequently experience nausea and/or vomiting, dysphagia, gastrointestinal obstruction, and fluctuating levels of consciousness that make oral administration challenging. In this presentation, participants will learn to identify alternate routes of medication administration commonly utilized in this patient population, such as transmucosal, transdermal, topical, and rectal, and the benefits and limitations associated with these routes. The use of compounded topical medications will also be addressed, including a discussion of the available evidence either supporting of refuting their use.

A majority of palliative care patients will experience nausea and vomiting at some point following their diagnosis. These symptoms can be an enormous source of suffering for patients, and if inadequately treated can result in numerous complications. Participants in this presentation will learn to identify potential causes of nausea/vomiting, recognize signs that a patient may be suffering from total nausea, and design an appropriate treatment regimen, including both pharmacologic and non-pharmacologic treatment to manage a given patient’s nausea/vomiting based on etiology.

Cardiopulmonary symptom are very common in serious or advanced illness. Participants will learn how to assess cardiopulmonary symptoms such as cough, hiccups, dyspnea and oral/pulmonary secretion. We will also address non-pharmacologic and pharmacologic treatments, how to monitor the patient’s response to therapy, and recommendations for adjusting the regimen as required.

Neurologic and psychiatric symptoms are very common in serious and advanced illness. Participants in this session will learn how to detect and assess neuropsychiatric symptoms such as anxiety, depression, confusion, delirium, and insomnia. Non-pharmacologic and pharmacologic management strategies will be addressed. Best practices for monitoring the therapeutic regimen will also be addressed. Case examples will be used to illustrate the process of non-drug and drug therapy selection.

If left untreated, genitourinary symptoms can lead to significant distress. In this presentation, participants will identify symptoms associated with bladder spasms, overactive bladder, and urinary tract infections, and recommend appropriate treatment options. Pruritis is a symptom that is often difficult to treat and can also have a detrimental impact on patients’ quality of life. In the second part of this presentation, participants will summarize the pathogenesis, etiologies, and potential treatment options for itching.

Everyone is familiar with the process of prescribing medications, which includes carefully consideration of patient- and drug-related variables. However, drug therapy is not meant to be continued forever, but adjusted or discontinued as the patient’s clinical situation changes. Participants in this presentation will learn about the process of “deprescribing” – stopping medications when they no longer meet the patient’s goals of care, they are medically futile, or the burden exceeds the benefit of drug therapy. Learners will also gain valuable pointers on how to have those conversations with patients, families and other health care providers in the process of deprescribing.