For more information about the author, click to view their website: VITAS Healthcare
By Dr. Lauren Loftis, Regional Medical Director, VITAS Healthcare
Pain and discomfort can be under-recognized and under-treated in patients with serious illness. At the end of life, 81% of patients cite being pain free as an important factor in dying a “good death.” 1 Along with the physiological pain associated with a patient’s terminal illness, anxiety and depression may contribute to their “total pain.” Social, emotional, and spiritual dimensions of total pain increase the patient’s suffering beyond their physical discomfort.
A holistic approach to targeting pain at the end of life enables physicians to provide relief and comfort care that improve the patient’s quality of life.
To illustrate, a patient I’ll call Bob Jones is a 65-year-old male with stage IV colon cancer and extensive metastases to the bone, liver, and brain. Mr. Jones’ wife is his caretaker, and he is estranged from his son who lives out of state. His son does not accept his terminal diagnosis. Despite surgery, chemotherapy, and radiation, Mr. Jones’ disease has progressed.
As I meet Mr. Jones for an initial hospice encounter, I ask open-ended questions, especially what matters most to him at this point in his disease progression, to determine his goals of care. I learn he is a Vietnam Veteran with signs of undiagnosed PTSD. He is constipated and desires to return home and spend time with his wife. He wishes to go to Hawaii but fears that this can no longer happen. His son does not want him to take morphine.
As physicians, when we ask about pain, we keep in mind that it is defined by the patient. Hospice clinicians manage pain based on the needs and expectations of the patient and family, not our own.
Getting an accurate measure of the pain level is necessary for appropriate treatment. The patient may be reluctant to report pain for fear of being a “complainer” or a desire to avoid opioids. Asking open-ended questions may help you gauge pain more effectively:
Other indicators of pain and suffering can be viewed or discussed. Dryness of the eyes can lead to painful keratitis as well as infections. Patients on long-term oxygen therapy may have skin breaks around the nares, dryness, and episodes of epistaxis, which can be distressing. Patients who have been using noninvasive modes of ventilation may have pressure ulcers at the nasal bridge and cheeks. Pooling oral secretions and lack of oral care can lead to oral ulcers and dental issues.
Signs of malnutrition include temporal wasting, supra, infra-clavicular wasting, scaphoid abdomen, and skin dryness. Loss of muscle mass can create an increased risk of skin breakdown. Dehydration signs include dryness of mucosal surfaces, loss of skin turgor, and dry skin. Abdominal fullness can point towards constipation or urinary retention, which can cause significant distress to the patient. Lastly, a hygiene assessment and well-being focused on maintaining the patient's dignity are essential.
For Mr. Jones, our VITAS team contacted his son to discuss his hesitation to provide pain medication for his father. Using a calm and thoughtful approach, we explored where his beliefs came from and if they were simply based on a common misconception about the use of morphine in hospice patients.
Mr. Jones had agreed to hospice services “to get out of this place,” meaning the hospital, and go home to sleep in his own bed, with his wife and dogs nearby, his stated goals for end of life. He received Continuous Care to help manage his symptoms at home. The VITAS hospice physician evaluated him at admission and after transport to his home. Clinicians profiled his medications, which we arranged to be delivered to the home along with a bedside commode, walker, oxygen, and briefs.
Once in hospice, the interdisciplinary team—a team manager, primary nurse, hospice aide, physician, chaplain, social worker, team physician, and volunteer—collaborates to address the patient’s total pain beyond opioids alone. VITAS also has an in-house pharmacy team with Pharm Ds on call to assist with symptom management consultations, medication selection, and dose conversions.
After Mr. Jones arrived home, the home health aide gave Mr. Jones the first true bath he had had in weeks. The team addressed his constipation. We consulted our VITAS social worker and chaplain to help him and his family. The VITAS Pharm D assisted with a methadone titration regimen and pharmacologic selection.
With these interventions, Mr. Jones “felt so much better he couldn’t believe it” and “wished he’d called us months ago.” He was able to live at home for nearly six months after his hospitalization. His course of symptom management allowed him to make meaningful memories with his family. He also achieved resolution to his estrangement with his son, which was not only significant to him but also the rest of the family, even beyond Mr. Jones’ death.
A total pain approach to comfort care minimizes any medication side effects—even those not related to the terminal illness—while enhancing the patient’s:
This includes empowering the patient to participate in decision-making, which helps them retain dignity and a sense of control.
The emphasis of comfort care is to improve the patient’s quality of life in their remaining months, weeks, and days. The outcomes of the hospice interdisciplinary care team’s efforts are evident—in the photos we receive and the kind words of family members and even patients themselves who entrusted their care to us. Like Mr. Jones, many tell us: “We wish we knew about hospice sooner.”
Questions about total pain management? Ready to refer a patient? Contact your VITAS representative.
1Meier, Emily, et al. (2016). “Defining a Good Death (Successful Dying): Literature Review and a Call for Research and Public Dialogue.” American Journal of Geriatric Psychiatry. Retrieved Sept. 16, 2024
Alzheon has reported encouraging results from its Phase 2 trial of ALZ-801, an oral treatment for early Alzheimers disease. The study showed cognitive benefits, a 28% reduction in hippocampal atrophy, and a strong safety profile, particularly for individuals with two copies of the APOE4 gene. With the Phase 3 trial now fully enrolled, topline results are expected in the near future. If successful, ALZ-801 could become the first oral anti-amyloid therapy for high-risk patients. Aqualane is proud to be part of this groundbreaking research and extend our deepest gratitude to all participants whose contributions are shaping the future of Alzheimers treatment.
At The Dubin Center, we often see the strength that blooms when families come together to care for a loved one. One such inspiring duo is Sally and her daughter, Jenna multigenerational caregiving team who have supported each other and grown together through the challenges of dementia caregiving.Sally has been a caregiver for at least four years, navigating the evolving needs of her husband with quiet strength and a fierce commitment to showing up each day. Two years ago, her daughter Jenn moved to Florida to be closerand to help. Since then, the two have become a team, blending perspectives, experiences, and love as they walk the caregiving journey together.When asked what they would say to someone who is unsure about joining a support group or getting involved with The Dubin Center, both women spoke with heartfelt conviction."Definitely come, Sally said. Anyone dealing with this sort of stuff needs support. It saved me.Jenn echoed her mothers words, adding, You are not alone. The support groups can help lift you out of the misery. You can give advice and get advice. Its a safe spaceand comforting knowing others understand.Caregiving across generations isnt always easy, but it opens the door for powerful lessons.When asked what younger and older generations can learn from each other, Sally emphasized patiencenoting that age often brings the ability to let go of the small things and focus on what really matters. Jenn reflected on the importance of respect, independence, and dignity, which shes seen modeled by her mom.So, what advice do they have for other families navigating caregiving across generations?Find support, and dont do it alone, Sally advised. Let your family know whats going on and ask for help when you need it.Jenn added, Being open, honest, patient, and kind are the most important. Dont judge, and find a middle ground to work together.Thank you, Sally and Jenn, for your inspiring words! Whether you have family to lean on or not, their words are a reminder that caregiving doesnt have to be a solitary journey. If you or someone you know is caregiving across generations or by themself, reach out. Whether it's joining a support group or simply asking questions, The Dubin Center is here for you!
As we mark Womens History Month 2025, TravelPulse is once again taking a moment to acknowledge the substantial contributions and innovations of women in the travel industry.Its hardly an overstatement to say that women play a critical role in travel and tourism, both locally and globally.The latest available data from the World Travel & Tourism Council shows that women make up nearly 40 percent of the industry. That translates to about 48 million women working in what is now the worlds ninth largest industry.Among these women are scores of trailblazers, visionaries and fearless go-getters who have set their sights on making a difference for others or for the world (or both) and are doing so in their own unique way. They are entrepreneurs, they are corporate titans, they are passionate environmentalists and they are leaders of some of the travel industrys largest brands, businesses and trade groups.This is TravelPulses fifth annual list of influential women in travel, and each year, it is a privilege reviewing the bold things that women in travel are accomplishing. The 2025 class of influential leaders makes clear that women continue to be a force to be reckoned with, even during this fraught time in our history.Women continue to bring unique approaches to addressing and resolving many of the daunting challenges facing the industry and the world at large, including finding ways to make travel more sustainable, inclusive, accessible, thoughtful, and beneficial for stakeholders at all levels.At TravelPulses request, each of the 20 women being honored this year (who were all nominated by industry peers) shared a few career accomplishments theyre most proud of, as well as thoughts on what motivates them. Their answers are a compelling and inspirational read.Heres a closer look at each of the 2025 winners and the forces that drive them.Kerri Johnson, Founder, GOMO TravelAs the founder of GOMO Travel, Kerri Johnson is transforming the way people with mobility challenges, medical conditions, or other travel limitations experience the world. A medical travel assistance agency, GOMOs medical travel companions ensure that travelers get where they need to go with safety.The assistance of GOMO companions is available whether someone has mobility issues, suffers from anxiety, or requires medical assistance.Johnsons efforts through GOMO prioritize inclusivity, ensuring every traveler no matter their circumstances receives personalized support, from booking accessible accommodations to navigating unexpected disruptions.Q: What motivates you to do what you do each day?I have a nursing background and have always been sensitive to peoples feelings and needs, says Johnson. As I have grown and matured, I have become a staunch advocate for those less fortunate. I start my day with my alarm of Andy Williams song The Impossible Dream.This is a daily reminder to accomplish my goal of alleviating fear, isolationism, andexclusion experienced by many would-be travelers, says Johnson. At GOMO Travel, we strive to make their dreams possible.Q: What are your hopes and goals related to your specific area of work and the impact youd like to have on the travel industry?We feel everyone should be free to travel on their own terms, whatever that individuallymeans for them, says Johnson. Our hope is to normalize assisted travel across the globe so they will know that resources like ours exist. Uber did not happen overnight, and we utilize every day to build our network to achieve our goal of one day becoming the Uber of assisted travel.
Hospice Care in Southwest Florida: Collier, Lee, Glades, and Hendry countyThe VITAS Healthcare team visits patients wherever they call home, including but not limited to: private homes, senior living communities, and long term care facilities in Southwest Florida. We have offices located in Collier and Lee County and an Inpatient Unit in Naples. Coming soon, VITAS Inpatient Unit in Lee County.VITAS provides 24/7 support whenever our patients and families need it.At VITAS, we prioritize our patients and their families above all else. By concentrating on enhancing quality of life, managing symptoms and pain effectively, and minimizing 911 calls and hospital readmissions, we ensure our patients' comfort and well-being. VITAS distinguishes itself from traditional hospice providers through a personalized approach to care planning, transparent medication management, and a comprehensive range of specialized modalities tailored to meet diverse patient needs. These include physical therapy, occupational therapy, speech therapy, respiratory therapy, wound care, palliative oncology therapy, palliative dialysis, and more. Office Locations:Fort Myers VITAS Hospice Office12751 Westlinks Dr. Fort Myers, 33913 Vitas Inpatient Unit at Solaris Healthcare Imperial900 Imperial Golf Course Blvd. Naples, 34110 Naples VITAS Hospice Office4980 N. Tamiami Trail, Suite 102, Naples 34103 Our Care ServicesAt VITAS we care for patients with an interdisciplinary team comprising a nurse, physician, aide, social worker and chaplain. Our teams design personalized care plans to ensure comfort, dignity and quality of life. Hospice Care at Home Condition-Specific Care 24/7 Telecare Intensive Comfort Care Veterans Care Inpatient Hospice Care Music Therapy Paw Pals Pet Visits Grief and Bereavement Support
Hospice Care in Southwest Florida: Collier, Lee, Glades, and Hendry countyThe VITAS Healthcare team visits patients wherever they call home, including but not limited to: private homes, senior living communities, and long term care facilities in Southwest Florida. We have offices located in Collier and Lee County and an Inpatient Unit in Naples. Coming soon, VITAS Inpatient Unit in Lee County.VITAS provides 24/7 support whenever our patients and families need it.At VITAS, we prioritize our patients and their families above all else. By concentrating on enhancing quality of life, managing symptoms and pain effectively, and minimizing 911 calls and hospital readmissions, we ensure our patients' comfort and well-being. VITAS distinguishes itself from traditional hospice providers through a personalized approach to care planning, transparent medication management, and a comprehensive range of specialized modalities tailored to meet diverse patient needs. These include physical therapy, occupational therapy, speech therapy, respiratory therapy, wound care, palliative oncology therapy, palliative dialysis, and more.Office Locations:Fort Myers VITAS Hospice Office12751 Westlinks Dr. Fort Myers, 33913 Vitas Inpatient Unit at Solaris Healthcare Imperial900 Imperial Golf Course Blvd. Naples, 34110 Naples VITAS Hospice Office4980 N Tamiami Trail, Suite 102, Naples 34103Our Care ServicesAt VITAS we care for patients with an interdisciplinary team comprising a nurse, physician, aide, social worker and chaplain. Our teams design personalized care plans to ensure comfort, dignity and quality of life. Hospice Care at Home Condition-Specific Care 24/7 Telecare Intensive Comfort Care Veterans Care Inpatient Hospice Care Music Therapy Paw Pals Pet Visits Grief and Bereavement Support
Hospice Care in Southwest Florida: Collier, Lee, Glades, and Hendry countyThe VITAS Healthcare team visits patients wherever they call home, including but not limited to: private homes, senior living communities, and long term care facilities in Southwest Florida. We have offices located in Collier and Lee County and an Inpatient Unit in Naples. Coming soon, VITAS Inpatient Unit in Lee County.VITAS provides 24/7 support whenever our patients and families need it.At VITAS, we prioritize our patients and their families above all else. By concentrating on enhancing quality of life, managing symptoms and pain effectively, and minimizing 911 calls and hospital readmissions, we ensure our patients' comfort and well-being. VITAS distinguishes itself from traditional hospice providers through a personalized approach to care planning, transparent medication management, and a comprehensive range of specialized modalities tailored to meet diverse patient needs. These include physical therapy, occupational therapy, speech therapy, respiratory therapy, wound care, palliative oncology therapy, palliative dialysis, and more.Office Locations:Fort Myers VITAS Hospice Office12751 Westlinks Dr. Fort Myers, 33913 Vitas Inpatient Unit at Solaris Healthcare Imperial900 Imperial Golf Course Blvd. Naples, 34110 Naples VITAS Hospice Office4980 N Tamiami Trail, Suite 102, Naples 34103Our Care ServicesAt VITAS we care for patients with an interdisciplinary team comprising a nurse, physician, aide, social worker and chaplain. Our teams design personalized care plans to ensure comfort, dignity and quality of life. Hospice Care at Home Condition-Specific Care 24/7 Telecare Intensive Comfort Care Veterans Care Inpatient Hospice Care Music Therapy Paw Pals Pet Visits Grief and Bereavement Support