💬
Conversations
20
ConversationsKey
Goals-of-Care Meeting
REMAP — the conversation that determines everything
ConversationsKey
"Am I Dying?"
The question physicians dread most — and what the patient is really asking
ConversationsKey
Family Won’t Accept the Prognosis
De-escalating conflict and redirecting toward the patient
ConversationsKey
Delivering a Prognosis
The ‘how long’ conversation — done with skill and honest compassion
ConversationsKey
Explaining Hospice
Without it sounding like giving up
ConversationsKey
Withdrawing Life-Sustaining Treatment
Preparing families for what they’re about to witness — and what it means
Conversations
Pediatric & Young Adult Death
Different family dynamics, different language, completely different emotional landscape
Conversations
African American Patients & Families
Navigating historical medical distrust and faith-centered decision-making
Conversations
Hispanic & Latino Frameworks
Familismo, designated spokesperson, and the role of spiritual support
Conversations
Asian & Pacific Islander Frameworks
Filial piety, indirect communication, non-disclosure practices
Conversations
Muslim Patients at End of Life
Islamic frameworks around suffering, death rites, and comfort care
Conversations
Jewish Frameworks at End of Life
Pikuach nefesh, sanctity of life, and variation across denominations
Conversations
Patient Refuses Hospice
The capacitated patient choosing the ICU — honoring autonomy without abandonment
Conversations
Artificial Nutrition & Hydration
The question families ask most — ‘Are we starving them?’
Conversations
Sudden Prognosis Change
Re-opening a conversation that was closed
Conversations
Device Deactivation Conversation
The talk that must happen before the order is written
Conversations
Discussing Palliative Sedation with Family
What it is, what it isn’t, and the fears they carry into the room
Conversations
Jehovah’s Witnesses at End of Life
Blood products, sincere faith, and what hospice can still offer
Conversations
The Patient Who Has No One
When there is no family, no proxy, no one coming
Conversations
When the Clinician Is Grieving
Your grief is not unprofessional — it is evidence that you were present
📊
Prognostication
14
PrognosticationKey
Prognostication Tools Overview
Which tool for which patient — and what the evidence says about accuracy
PrognosticationKey
Palliative Performance Scale (PPS)
Full 11-row bedside scoring table — ambulation, activity, self-care, intake, consciousness
PrognosticationKey
FAST Scale for Dementia
Full 7-stage staging table with Medicare hospice threshold
PrognosticationKey
Active Dying Clinical Checklist
Hui et al. 2014 — 12 validated signs of imminent death with specificity data
PrognosticationKey
Disease Trajectory Curves
Lunney’s three patterns — cancer, organ failure, and dementia
Prognostication
Cancer Trajectory
Rapid terminal decline — clinical markers and conversation timing
Prognostication
Heart Failure Trajectory
Recognizing the final admission in peaks-and-valleys disease
Prognostication
Renal & CKD Trajectory
Dialysis discontinuation, conservative management, uremic timeline
PrognosticationKey
The Surprise Question
‘Would I be surprised if this patient died in the next 12 months?’
Prognostication
ECOG & Karnofsky Scale
Side-by-side comparison with clinical anchors and survival correlations
Prognostication
Palliative Prognostic Score (PaP)
30-day survival probability using clinical signs, labs, and function
Prognostication
Cachexia as Prognostic Marker
Cancer cachexia stages, weight loss thresholds, and the anorexia-cachexia trajectory
Prognostication
Lab Markers in Prognosis
Albumin, lymphocytes, CRP, bilirubin — what the labs say about trajectory
Prognostication
Pediatric Prognostication
Perinatal, neonatal, and pediatric-specific frameworks
📋
Protocols
20
ProtocolsKey
Opioid Initiation
Starting opioids in the opioid-naive hospice patient
ProtocolsKey
Opioid Rotation & Equianalgesic Conversion
When to rotate, how to calculate — full conversion table
Protocols
Opioid-Induced Neurotoxicity (OIN)
Myoclonus, hyperalgesia, delirium — recognize it, stop it, rotate
ProtocolsKey
Palliative Sedation Protocol
Proportionate vs. continuous deep sedation — consent, dosing, documentation
ProtocolsKey
Refractory Dyspnea
Physician-level management — opioid titration, anxiolytics, oxygen decision
Protocols
Hypercalcemia of Malignancy
Most common reversible emergency in hospice — full management protocol
Protocols
Malignant Bowel Obstruction
Octreotide, dexamethasone, hyoscine — the medical pathway without surgery
ProtocolsKey
Hemorrhagic Crisis Protocol
Dark linen, midazolam rescue sedation, physician role
Protocols
Steroid Use at End of Life
Dexamethasone by indication — dose matrix and taper guidance
Protocols
Spinal Cord Compression
Oncologic emergency — dexamethasone loading, radiation window, functional prognosis
ProtocolsKey
Comfort Kit / Crisis Medications
What to pre-prescribe, what to teach families, when to use each
Protocols
Ketamine for Refractory Pain
Sub-anesthetic dosing, NMDA mechanism, opioid-sparing protocol
Protocols
Hospice Eligibility Overview
The clinical certification decision — what the law requires, what surveyors look for
Protocols
Seizures at End of Life
Acute management, anti-epileptic selection, and prophylaxis in brain disease
Protocols
Superior Vena Cava Syndrome
Dexamethasone, radiation window, stenting decision, and comfort management
Protocols
Anticoagulation at End of Life
DVT/PE management, bleed risk, when to stop — clinical decision framework
Protocols
Device Deactivation — Clinical Protocol
ICD, pacemaker, LVAD, neurostimulator — step-by-step deactivation procedures
Protocols
Malignant Ascites
Paracentesis timing, diuretics, comfort-focused drainage
Protocols
Ventilator Withdrawal Protocol
Medication sequencing, family prep, nursing checklist — dying after extubation
Protocols
Refractory Nausea & Vomiting
Etiology-matched antiemetics — stepwise protocol for the hospice setting
📝
Documentation
19
Documentation
Hospice Certification Note
Required elements, fill-in template, common surveyor deficiencies
DocumentationKey
Goals-of-Care Note Template
What to document to protect the patient, family, and yourself
Documentation
Capacity Assessment Documentation
Four-prong note — legally defensible, clinically complete
DocumentationKey
Pronouncement of Death Note
Required elements — legally complete, clinically compassionate
DocumentationKey
Comfort Order Set Template
Complete standing orders — pain, dyspnea, secretions, agitation, nausea, seizure, hemorrhage
DocumentationKey
POLST — Completing & Interpreting
Medical Orders for Life-Sustaining Treatment — field guide
DocumentationKey
Recertification Note
What surveyors look for — beyond copying the last certification
DocumentationKey
Death Certificate Completion
Cause of death, contributing conditions, manner — common errors and how to avoid them
DocumentationKey
Face-to-Face Encounter Note
CMS §418.22(a)(4) — required for 3rd benefit period and all subsequent
Documentation
Functional Decline Documentation
Capturing the clinical trajectory that supports certification
Documentation
Significant Change Documentation
When to document, what to include, IDT obligations
Documentation
MAID Awareness & Documentation
Where it’s legal, how to respond to requests, documentation requirements
Documentation
Family Meeting Note
Who attended, what was said, what was decided — legally protective documentation
Documentation
IDT Meeting Documentation
CMS-required interdisciplinary team notes — standards and templates
Documentation
Advance Directive Review
Ensuring the document reflects current goals — what to look for and document
Documentation
Attending Physician Letter of Medical Necessity
Supporting SNF, DME, home health, and hospice level-of-care decisions
Documentation
Bereavement Documentation
13-month post-death follow-up — CMS requirements and clinical practice
Documentation
Transfer Note — Hospice to Hospital
Information that must travel with the patient for safe transitions
Documentation
Quality & Performance Documentation
QAPI requirements, outcome measures, and documentation for hospice accreditation
⚖️
Ethics
10
EthicsKey
Medical Futility
Physiological vs. normative — clinical framework and ethics committee trigger
EthicsKey
Surrogate Decision-Making
Hierarchy, substituted judgment, best interests, and conflict resolution
EthicsKey
Capacity Assessment Framework
Four-prong test, decision-specific capacity, when to consult psychiatry
Ethics
Ethics Consultation
When to call, what to expect, and how to document the process
Ethics
Conscientious Objection
When providers can object and when they cannot — the ethical and legal framework
Ethics
MAID — Ethical Framework
Autonomy, dignity, distinction from euthanasia — the core ethical arguments
Ethics
Pediatric Ethics at End of Life
Parental authority, child assent, Baby Doe regulations, and the unbearable decision
Ethics
Cultural Ethics at End of Life
When culture and autonomy conflict — the ethical navigation
Ethics
Moral Distress in Hospice Teams
What it is, how it accumulates, and what teams can do
Ethics
Resource Allocation at End of Life
Triage, ventilator allocation, and the ethics of scarce resources
🌿
Naturopathic
10
Naturopathic
CAM Evidence Framework
How to evaluate, integrate, and document complementary therapies
Naturopathic
Aromatherapy
Lavender for anxiety and agitation, peppermint for nausea — evidence and application
Naturopathic
Music Therapy
Level I Cochrane evidence for agitation, pain, and anxiety in palliative care
Naturopathic
Herbal Supplements — Hospice Safety
Common herbs, their evidence, and drug interactions with hospice medications
Naturopathic
Massage Therapy
Evidence-based application in hospice — anxiety, pain, edema, touch as comfort
Naturopathic
Acupuncture at End of Life
Evidence-based points, nausea and pain protocols, practical integration
Naturopathic
Mindfulness & Meditation
MBSR, dignity therapy, brief breathing practices — evidence in advanced illness
Naturopathic
Reiki & Energy Therapies
Evidence, appropriate framing, and integration alongside conventional care
Naturopathic
Animal-Assisted Therapy
Evidence for AAT in hospice — reducing isolation, anxiety, and improving wellbeing
Naturopathic
Nutrition at End of Life
Evidence-based guidance on when to eat, what helps, and how to counsel families
🌱
Cannabis
2
Cannabis
CBD Dosing Guide
Evidence-based CBD in hospice — dosing, forms, indications, interactions
Cannabis
THC & Medical Cannabis
Physician guide to medical cannabis in palliative care — indications, dosing, routes, adverse effects
🔬
Assessment Tools
11
Assessment ToolsKey
ESAS-r: Edmonton Symptom Assessment System
Daily symptom burden tracking — validated across palliative populations
Assessment ToolsKey
PHQ-9 Depression Screening
Validated in palliative populations — detecting and acting on treatable depression
Assessment Tools
CAGE-AID Substance Use Screening
Admission screening for substance use — hospice-specific considerations
Assessment Tools
Clinical Frailty Scale (CFS)
Prognosis and care intensity decisions across all diagnoses
Assessment ToolsKey
PPS Reference Card
Quick bedside scoring guide with clinical anchors
Assessment ToolsKey
FAST Reference Card
Dementia staging quick reference with hospice threshold
Assessment Tools
PaP Score Reference Card
30-day survival calculation — quick scoring reference
Assessment Tools
Palliative Prognostic Index (PPI)
Weeks-prognosis calculator validated in non-cancer and cancer patients
Assessment Tools
PAINAD Scale
Pain Assessment in Advanced Dementia — behavioral pain tool for non-verbal patients
Assessment Tools
AUDIT-C Alcohol Screening
3-item alcohol screening validated in primary care and palliative settings
Assessment Tools
GAD-7 Anxiety Screening
7-item generalized anxiety screener validated in advanced illness
💉
Med Routes
7
Med RoutesKey
Medication Routes at End of Life
When and why — subcutaneous, sublingual, transdermal, rectal, buccal
Med RoutesKey
Equianalgesic Conversion — Clinical Calculator
Step-by-step conversion with full table and Methadone warning
Med Routes
CSCI / Syringe Driver
Setup, drug compatibility, site care, troubleshooting
Med Routes
SQ Injection Technique
Nurse teaching guide and printable patient/family handout
Med Routes
Off-Label Use Justification at EOL
Documenting clinical rationale for non-standard prescribing at end of life
Med Routes
Rectal Medication Administration
When to use, what drugs work, and how to teach families
Med Routes
Controlled Substance Documentation
DEA requirements, hospice-specific rules, and preventing diversion
📜
Regulatory
6
RegulatoryKey
Hospice Eligibility by Diagnosis
Complete Medicare LCD criteria for 8 major diagnosis groups
RegulatoryKey
Levels of Care
RHC, CHC, GIP, Respite — criteria, documentation, billing triggers
Regulatory
Face-to-Face Regulatory Guide
Timeline, documentation standards, and audit-proofing your F2F encounters
Regulatory
Recertification Regulatory Guide
What surveyors look for — interval, narrative, and attestation requirements
Regulatory
Hospice Discharge Protocols
Patient rights, revocation, improvement, and safe discharge planning
Regulatory
Voluntarily Stopping Eating & Drinking (VSED)
Clinical management, ethical framework, legal landscape, AAHPM position
🤲
Special Populations
9
Special Populations
Pediatric Palliative Care
Weight-based dosing, age-appropriate communication, family systems
Special Populations
Veterans in Hospice
Moral injury, PTSD at EOL, VA/hospice dual enrollment, cultural scripts
Special Populations
Substance Use Disorder in Hospice
Opioid-tolerant dosing, MOUD continuation, harm reduction at EOL
Special Populations
Intellectual & Developmental Disabilities
Pain assessment without verbal report, capacity, behavioral indicators
Special Populations
Incarcerated Patients
Correctional hospice, legal rights, and care inside prison walls
Special Populations
LGBTQ+ Patients at End of Life
Legal protections, relationship recognition, and affirming care
Special Populations
Homeless & Housing-Unstable Patients
Respite beds, care coordination, and dying without a home
Special Populations
Infection Management at End of Life
When to treat, when not to treat — decision trees for UTI, pneumonia, wound infections
Special Populations
Wound Care at End of Life
Malignant wounds, fungating tumors, pressure ulcers — comfort-focused protocols
🗣️
Communication
10
CommunicationKey
SPIKES: Breaking Bad News
6-step evidence-based framework — validated across specialties
CommunicationKey
Responding to
Honest, compassionate, useful — without false certainty
CommunicationKey
Family Meeting Framework
Structure, facilitation, and documentation for high-stakes family conversations
Communication
Telephone Death Notification
Scripted, evidence-based — how to tell someone their person has died by phone
Communication
Responding to Miracle Requests & Faith-Based Demands to Continue Treatment
One of the most common and most avoided conversations
CommunicationKey
Nothing More
Reframing this question — what the patient is really asking
Communication
Working With Angry Families
De-escalation, active listening, and maintaining your own equilibrium
Communication
Cultural Broaching
Asking about cultural and religious preferences without assumption or stereotyping
Communication
Working With Medical Interpreters
Best practices, avoid family interpreters, and EOL-specific vocabulary challenges
Communication
MAID Conversation — Responding to Requests
States where legal and where not — scripted, evidence-based responses
End-of-Life
Withdrawal & Detachment in the Dying Patient
Distinguishing normal dying from treatable conditions — knowing when not to intervene