Time to Remove Feeding Tubes from POLST: Podcast with Susan Tolle and Elizabeth Eckstrom

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GeriPal - A Geriatrics and Palliative Medicine Podcast 38 min 4 speakers 8 chapters transcribed 3 days ago

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Transcript generated automatically by AI and may contain errors.

What is the podcast’s main focus and who are the guests?

Eric Widera 0:00

Welcome to the Jerry Pell Podcast. This is Eric Widera. This is Alex Smith.

Lynn Flint 0:10

This is Lynn Flint.

Eric Widera 0:12

And Alex, who are our Skype guests on today?

Alex Smith 0:15

Today we have some wonderful guests from up north. We have Susan Toll, who is the director of the Center for Ethics and Healthcare at OHSU in Portland, Oregon, and also is the chair of the Oregon Pulse Association. and a founding member of POLST from back in the 1990s. Welcome to the GeriPel podcast, Susan.

Susan Tolle 0:37

It's a pleasure to be here.

Alex Smith 0:38

And we also have Elizabeth Ekstrom, who is chief of geriatrics at OHSU. Welcome to the GeriPel podcast, Elizabeth.

Elizabeth Eckstrom 0:47

Thank you for having us today.

Eric Widera 0:49

And Elizabeth, if I'm remembering correctly, you are also an Okapi, is that right?

0:54

Yes.

Elizabeth Eckstrom 0:56

You're the only one who remembers that, Eric.

Eric Widera 0:58

So Elizabeth has fame because in a New York Times article, she was referenced as being an okapi, or geriatrics as a whole was. Do you remember the line, Elizabeth?

Elizabeth Eckstrom 1:13

Something like, as rare and endangered as an okapi.

Eric Widera 1:17

What is an okapi? It's an African antelope, is that right?

Elizabeth Eckstrom 1:22

I'm not sure it's an antelope, but it's a strange animal that I have never seen before and probably will never see again, even in photos.

Eric Widera 1:34

And your name is now forever linked, thanks to that New York Times article in my brain,

Lynn Flint 1:39

to the okapi. Isn't there a picture of an okapi in the fellows' room? I think there is. Yes, there is.

Eric Widera 1:46

Well, we're going to be talking about your recent Journal of American Geriatrics or JAGS article titled, It's Time to Remove Feeding Tubes from Pulse Forms. But before we do, we always start off with a song request. Do either of you have a song request for Alex?

Elizabeth Eckstrom 2:05

Well, in the spirit of trying to ensure that all of our older patients are allowed to eat the way they want to, we chose the song Eat It.

Eric Widera 2:15

Alex, can you give us a little bit of Eat It?

2:25

Eat It

Alex Smith 2:32

eat it get yourself an egg and beat it have some more chicken have some more pie it doesn't matter if it's boiled or it's fried just eat it eat it

Alex Smith 2:56

Something

Unknown 2:56

like that. Nicely

Eric Widera 3:01

done,

Unknown 3:03

Alex. You

Eric Widera 3:03

were up until the late night working on that one. Well, clearly it

Alex Smith 3:07

wasn't late enough.

Lynn Flint 3:12

But you get the idea. I never heard the words enunciated so clearly.

Alex Smith 3:18

They were a little bit of a tongue twister. It doesn't matter if it's broiled or fried.

Eric Widera 3:24

It is a perfect song for our topic today, which is feeding tubes and pulse forms. Before we go into the topic at hand, maybe we can just take, again, a step back like we usually do on this podcast. How did you both get interested in this as a topic?

Susan Tolle 3:50

Well, For a very long time, we've tried to be sure that whatever is on a pulse form is going to make a difference for patients and is going to result in them receiving the care they want and avoiding treatments they don't want. And sometimes science tells us that changes are needed in the pulse form. And as we learn more and more about the problems with feeding tubes and advanced dementia,

Why did the hosts choose the song “Eat It” for a feeding‑tube discussion?

Susan Tolle 4:21

it became clear that we needed to really rethink the original thinking in the 90s when we put it on the post form and obviously other states followed. And it's widely used, but its effectiveness may now outweigh the problems it's causing.

Eric Widera 4:42

Yeah, it always seemed like the outlier of the group because it was one of those interventions which is usually not an urgent thing, like something we have to figure out in the emergency room. It's something that we usually have to figure out in the hospital or the nursing home, but it didn't feel like an emergent issue like the other things on the pulse did.

Lynn Flint 5:05

I totally agree. In my clinical experience, I feel like I always have described this as an extra or accessory option on the pulse form because I could never imagine the first responders showing up and saying, stat! Get a peg! Get a peg in this person! Does somebody have the peg kit? Yeah,

Elizabeth Eckstrom 5:26

right, exactly. Yeah, I feel the same way. I think that most of the time it feels like a little different conversation. You're talking about what would happen in an emergency and then you have to say, and would you want artificial nutrition? And even the patient kind of says, well, that doesn't have to happen right in the emergency, does it?