Harvard Medical SchoolCenter for Palliative Care




J. Andrew Billings, MD
Susan D. Block MD
Eva H. Chittenden, MD
Kristen G. Schaefer, MD


September 4-6, 2014


Royal Sonesta Hotel
Cambridge, MA




$850 physicians
$700 nurses, psychologists, allied health professionals
$575 social workers, chaplains, others


A maximum of 18
Social Work Continuing Education hours for relicensure, in accordance with Massachusetts 258 CMR


Earn up to 19.75 AMA PRA Category 1 Credits™

In Massachusetts
Opioid Education/Pain Management Credits: A maximum of 5.0
End-of-Life Care Credits: A maximum of 18.75


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PAPC Schedule

Please note: program changes/substitutions may be made without notice

Thursday       Friday       Saturday

Topic Tracks

S - Symptom Management
E - Ethical Aspects of End-of-Life Care
P - Psychosocial and Spiritual Aspects of End-of-Life Care
Q - Quality Assurance
O - Original Research-based Presentation
* - Qualifies in Massachusetts for Risk Management in Opioid and Pain Management
All sessions qualify in Massachusetts for Risk Management in End-of-Life Care (except for overviews of the day).


Thursday - September 4, 2014




Session Name


7:15-8:00   Registration and Breakfast  
8:00-8:30   Welcome, Introduction, and Overview of the Course and Day Kristen G. Schaefer, MD
Eva H. Chittenden, MD
8:30-9:45 PL1 Plenary: Prognostication in Serious Illness Alexander K. Smith, MD, MPH
9:45-10:00   Break  
10:00-11:15   Breakout Session 1  
  1A Care of Patients with Advanced Cardiac Disease Akshay Desai, MD, MPH
  1B Talking about Serious News Jane deLima Thomas, MD
Amanda Moment, LICSW
  1C Pharmacotherapy of Pain* Mihir M. Kamdar, MD
Elizabeth Rickerson, MD
  1D Identifying Opportunities for Collaboration between Oncology and Palliative Care Tracy Balboni, MD, PhD
Kathy Selvaggi, MD, MS
  1E Mind/Body Medicine in Palliative Care Ann Webster, PhD
11:15-11:30   Break  
11:30-12:45   Breakout Session 2  
  2A Opioid Misuse and Addiction in Palliative Care* Lida Nabati, MD
Joji Suzuki, MD
  2B Decoding Code Status Discussions Eva H. Chittenden, MD
  2C Managing Neuropathic Pain* Mihir M. Kamdar, MD
  2D Cultural Issues in Palliative Care Alexander K. Smith, MD, MPH
  2E Depression and Anxiety in Palliative Care Marshall Forstein, MD
12:45-1:45   Lunch on Your Own  
1:45-3:00 PL2 Plenary: A Randomized Controlled Trial of a Structured Tool to Elicit Goals and Values: The Serious Illness Care Program Rachelle E. Bernacki, MD, MS
3:00-3:15   Break  
3:15-4:30   Breakout Session 3  
  3A Delirium at the End of Life: Impact on Patients and Caregivers Mary K. Buss, MD, MPH
  3B Management of Common Non-Pain Symptoms in Palliative Care (Repeated at 4B) Erica Wilson, MD
Kathleen P. Doyle, MD
  3C Psychological Challenges in the Care of Young Adults Karen Fasciano, PsyD
  3D A Comprehensive Review of Methadone* Mihir M. Kamdar, MD
Elizabeth Rickerson, MD
  3E Using the Serious Illness Care Guide Rachelle E. Bernacki, MD, MS
Kristen G. Schaefer, MD
4:30-4:45   Break  
4:45-6:00   Breakout Session 4  
  4A Palliative Care Emergencies Mary K. Buss, MD, MPH
  4B Management of Common Non-Pain Symptoms in Palliative Care (Repeated at 3B) Erica Wilson, MD
Kathleen P. Doyle, MD
  4C Case-based Ethical Dilemmas Nicholas Sadovnikoff, MD
  4D Palliative Care in the Homeless Population James J. O’Connell, MD
  4E Outpatient Palliative Care Corinne Alexander, MD
Simone P. Rinaldi, MSN, APRN-BC, AHPN-BC


Friday - September 5, 2014






7:15-8:00   Breakfast  
8:00-8:15   Overview of the Day Kristen G. Schaefer, MD
Eva H. Chittenden, MD
8:15-9:30 PL3 Learning the Hard Way (but with Great People): The Harvard Palliative Care Experience Susan D. Block, MD
Vicki A. Jackson, MD, MPH
Kathy Selvaggi, MD
Mary K. Buss, MD, MPH
9:30-9:45   Break  
9:45-11:00   Breakout Session 5  
  5A Part 1 of 2. Misunderstandings about Prognosis: An Approach for Palliative Care Consultants When the Patient Does Not Seem to Understand What Was Said (must take both parts, 5A and 6A) Vicki A. Jackson, MD, MPH
Juliet Jacobsen, MD
Jane deLima Thomas, MD
  5B "Difficult" Families Guy Maytal, MD
  5C Practical Aspects of Pediatric Palliative Care Shih-Ning Liaw, MD
  5D Legal Aspects at the End of Life, Especially Withholding and Withdrawing Life Sustaining Treatments Rebecca Brendel, MD, JD
  5E Interventional Approaches to Pain Management* Elizabeth Rickerson, MD
11:00-11:15   Break  
11:15-12:30   Breakout Session 6  
  6A Part 2 of 2. Misunderstandings about Prognosis: An Approach for Palliative Care Consultants When the Patient Does Not Seem to Understand What Was Said (must take both parts, 5A and 6A) Vicki A. Jackson, MD, MPH
Juliet Jacobsen, MD
Jane deLima Thomas, MD
  6B "Difficult" Patients Guy Maytal, MD
  6C ABCs of Hospice Stephanie Patel, MD
  6D Hypercoagulable Syndromes and the New Anticoagulants in End-Stage Diseases Rachel P. Rosovsky, MD, MPH
  6E Advanced Care: Bringing Palliative Care to Home and Community Brad Stuart, MD
12:30-1:30   Lunch on Your Own  
1:30-2:45 PL4 Plenary: Advanced Illness Management: Where Are We Now and Where Are We Going? Brad Stuart, MD
2:45-3:00   Break  
3:00-4:15   Breakout Session 7  
  7A Palliative Care and End-stage Renal Disease Robert A. Cohen, MD
  7B Medical Marijuana: What Clinicians Need to Know Ilana M. Braun, MD
Joshua Abrams, JD
Lida Nabati, MD
  7C Reflecting on End of Life through Poetry Amy Ship, MD
  7D Conflictual Family Meetings in the ICU Kristen G. Schaefer, MD
Philip Higgins, LICSW
  7E Cognitive Assessment as a Sixth Vital Sign Marshall Forstein, MD
4:15-4:30   Break  
4:30-5:45   Breakout Session 8  
  8A Palliative Care in the ICU Eva H. Chittenden, MD
  8B Challenges in Management of Advanced Dementia Helen Chen, MD
  8C When Your Patient Asks: How Do I Talk with My Kids? Cynthia W. Moore, PhD
  8D Patient Requests to Hasten Death: Assessment and Management Susan D. Block, MD
  8E Sexuality Issues in Palliative Care Patients and Their Families Sharon L. Bober, PhD


Saturday - September 6, 2014






7:15-8:00   Breakfast  
8:00-8:15   Overview of the Day Kristen G. Schaefer, MD
Eva H. Chittenden, MD
8:15-9:30 PL5 Plenary: Bereavement

8:15-9:00 Interview
9:00-9:15 Structured Debrief

Susan D. Block, MD
9:30-9:45   Break  
9:45-11:00   Breakout Session 9  
  9A Conflict Resolution in the Interdisciplinary Team Corinne Alexander, MD
Todd Hultman, PhD, ACNP, ACHPN
Todd Rinehart, LICSW, ACHP-SW
  9B Best Practices in Bereavement Care Sue Morris, MCP
  9C Psychiatric Issues in Patients with Advanced Disease David Yuppa, MD
  9D Spiritual Care of Patients with Advanced Illness: Associations with Quality of Death and Medical Care at the End of Life Tracy Balboni, MD, PhD
Katrina M. Scott, MDiv, BCC-HPCC
  9E Making Work Sustainable Heidi Blake, MD
Amanda Moment, LICSW
11:00-11:15   Break  
11:15-12:30 PL6 Closing Plenary: Evidence-Based Palliative Care: Important Scientific Advances in the Last Year Kristen G. Schaefer, MD
Eva H. Chittenden, MD
9E: Creating a sustainable work-life balance is an ongoing, iterative process that requires self-reflection and monitoring. In this interactive workshop, we will explore ways in which we can work toward greater sustainability in our work and in our lives.
9D: This session will explore the impact of religion/ spirituality in serious illness, including quality of life, end-of-life outcomes, and end-of-life medical decision making. It will also address the basics of spiritual assessment and spiritual care provision by multidisciplinary team and the role of chaplaincy in spiritual care provision.
9C: This presentation will focus on the common themes, symptom clusters, and medical-psychiatric pathology that are often seen in individuals with advanced disease. It will also broach the broader topic of existential distress and how clinicians may best help individuals and their families cope with the dying process.
9B: This session will provide a summary of normal grief reactions and risk factors for poor bereavement outcomes; practical strategies for caring for the bereaved before and after the death of the patient; and guidelines for hospital-based bereavement programs.
9A: A hallmark of palliative care is the interdisciplinary team process. Given the challenges of developing a plan of care for patients with serious illness, there are times when conflict may arise within the palliative care team or across teams providing care to the patient. A model of conflict resolution based on shared values and ethics across disciplines can help to constructively resolve such conflicts.
8E: This session will look at this vital quality of life issue for patients and partners that is often under-addressed in a palliative care context.
8D: In this session, participants will learn to: describe key domains that require evaluation for a patient requesting hastened death; describe three counter-transference issues that may have an impact on clinician behavior in assessing and managing requests for aid in dying; and identify major risk factors for requests to hasten death and describe approaches to addressing them.
8C: When patients with dependent children are faced with a life-threatening illness, worries about the impact on their children are frequently at the forefront of their concerns. In this session, we will discuss a model for providing parent guidance consultations to patients, focused on assessing and addressing parents' concerns about their children's responses to the illness.
8B: Dementia ranked second in non-cancer primary diagnoses for patients admitted to hospice in 2012. This session will review evidence and provide practical strategies for the care of this challenging patient population.
8A: In this session, we will first review and discuss different models of palliative care collaboration in the ICU setting. Second, we will review the literature on patient and family mental health outcomes after an ICU stay, as well as communication interventions that can improve these outcomes.
7E: This workshop will review the domains of brain function that are commonly impaired in medically ill patients. Assessing cognitive function is important for informed consent, treatment adherence, and ability to manage psychological issues in medically ill patients.
7D: In this interactive session, participants will explore and practice a nuanced approach to communication with surrogates and families in the ICU when there is family conflict regarding goals of care. A case of a woman with metastatic pancreatic cancer and acute respiratory failure will be presented, and participants will be given strategies to pursue end-of-life discussions and decision-making with the family.
7C: During this interactive workshop, together we'll read several poems that address death and dying to explore how literature can "open up" discussions of challenging issues in palliative care.
7B: In this session, participants will learn the fundamentals of: Medical Marijuana regulation in Massachusetts; the cannabinoid system; the product offered at registered marijuana dispensaries; and the evidence base in support of the product.
7A: End-stage kidney disease is associated with heightened morbidity and mortality. This session is designed to highlight which patients have the greatest likelihood of doing poorly on dialysis and provide tools to assist with decision-making about dialysis in frail individuals. In addition, the session will address end-of-life care for patients with advanced chronic kidney disease.
6E: Palliative care is now widely available in most major hospitals across the U.S. This session will explore how Advanced Care brings a comprehensive blend of disease-modifying treatment and palliation into patients' homes and communities.
6C: In this session we will review the basic services that all hospice providers must deliver, including a discussion of the different levels of hospice care, common misunderstandings that are associated with hospice services, as well as basic eligibility criteria for enrollment in hospice, including reviewing the Hospice Medicare Benefit.
6B: A novel approach to thinking about and interacting more effectively with patients that we experience as "difficult."
6A: Part 2 of session 5A. Please see above.
5E: This session will help participants understand the background and rationale for pain interventions in palliative care and cancer pain patients. We will focus on the importance of a pain diagnosis and discuss the risk/ benefit ratio for interventions in a population that is generally much sicker than the typical chronic pain population.
5D: The major course of law and its hierarchy/ interaction will be addressed. A discussion and analysis of case law will be presented.
5B: An interactive presentation on how to think about and interrelate effectively with families that we experience as challenging.
5A: Called in after discussions about prognosis, palliative care consultants sometimes find that the patient and referring clinician have different reports about what was said. In these situations, palliative care consultants need to sort through the many potential sources of confusion from both referring clinician and patient and have a framework for approaching these challenging cases while aligning with the referring clinician to jointly form a plan of care.
4E: In this session, we'll discuss the challenges of building successful outpatient clinics--changing culture, building infrastructure, and managing growth--using insights gained over a decade of managing palliative care clinics, both embedded in a large cancer center, and co-located within a primary care setting.
4D: This session will review the literature on palliative and end-of-life care for homeless persons and explore interventions that have been tried in Boston with a goal of beginning a discussion on best practices.
4C: This session will focus on several ethical dilemmas that arise in palliative care, including the relevance of the doctrine of double effect and whether there is an ethical distinction between treatments that may be withheld versus withdrawn.
4B: This session will review the differential diagnoses and treatment of common non-pain symptoms frequently seen in palliative care.
3E: In this interactive session, you will have an opportunity to practice using the Serious Illness Conversation Guide.
3D: This session will provide an in-depth review of the properties of methadone that make it an attractive yet complicated opioid to manage.
3C: Palliative care for young adults requires an understanding of the developmental issues faced by this population and the unique life disruptions due to serious illness. Understanding the psychological issues for young adults can assist clinicians with important aspects of care including: adherence, decision making, advanced care planning and emotional distress. This session will provide an overview of development and research, but also incorporate case examples to discuss this special population.
3B: This session will review the differential diagnoses and treatment of common non-pain symptoms frequently seen in palliative care.
2E: This workshop will discuss the epidemiology, assessment, and treatment of depression and anxiety in Palliative Care. Specific recommendations for pharmacologic and psychosocial supportive treatments will be discussed.
2D: Culture has a profound influence on the attitudes, beliefs, and behaviors of patients and families facing serious illness and death. In this highly interactive session we will explore these influences, and how to optimally approach cultural issues without falling into the trap of stereotyping.
2B: In this session, we will briefly review the historic context of resuscitation and code status discussions, followed by a review of current survival statistics. We will then discuss challenges and best practices in code status conversations, based on the health care setting, the type of clinician leading the conversation, and the patient/ family's readiness for the discussion.
2A: In this session, a palliative medicine specialist and an addiction psychiatrist will help you understand how to better care for palliative care patients with a spectrum of misuse and addiction. Whether practicing in the inpatient or outpatient setting, you will learn how to manage and assess risk of opioid misuse, identify and stratify aberrant drug taking behaviors, treat pain in patients on opioid maintenance therapy and understand unique needs of patients with addiction at the end of life.
1E: Topics that will be covered include: The role of stress in health illness; specific physical, emotional, and behavioral stress symptoms; relaxation techniques for improved comfort, sleep, peacefulness and well-being; and research studies supporting mind-body techniques and their use in palliative care.
1D: Case studies will be presented to highlight: The role of palliative cancer therapies in patients with advanced malignancies; the goals of care and quality of life; and using effective communication strategies between oncology providers and palliative care to assure continuity of care.
1C: Basic introduction to the assessment and management of pain. This session will review pharmacological management of pain focusing on both opioid and non-opioid medications.
1B: This session aims to define and provide guidelines for discussing serious news. Participants will be able to understand the importance of engaging in these discussions and practice using tools.