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Interprofessional Webinar Series:
An 83-year-old woman with dementia and weight loss

This webinar is presented in collaboration with the
National Hospice and Palliative Care Organization.

Funding Disclosure: No commercial funding has been accepted for the activity.

Date and Time: November 30, 2017, 12:30 PM – 1:30 PM ET (Live)

Location: Online at

Speaker Name and Title:
Russell K. Portenoy, MD 
Moderator, Executive Director,
MJHS Institute for Innovation in Palliative Care 
Chief Medical Officer, MJHS Hospice and Palliative Care 

Mara Lugassy, MD 
Senior Hospice Medical Director

Joyce Palmieri, RN, MS, CHPN
Vice President, Clinical Services 

Linda Stertz, LCSW-R
Social Work Manager

Timothy W. Kirk, PhD
Ethics Consultant

Purpose: This webinar will describe the interdisciplinary assessment and management of a complex patient with advanced dementia and weight loss, who is facing a decision to withdraw or withdraw and restart artificial nutrition.

Participants will be able to:

  1. Describe the clinical indications and potential complications of tube feeding in patients with advanced dementia
  2. Perform a benefit-to-risk analysis of the specific case relative to the existing literature and published guidelines
  3. Describe the ethical considerations pertinent to withdrawing or withholding artificial nutrition
  4. Develop a plan of care from the perspective of an interdisciplinary palliative care team that can address the preferences and concerns about artificial nutrition on the part of family members and nursing home staff
Why Do I Need to Know This?
Nursing home patients commonly receive placement of feeding tubes in the hope of achieving benefits, such as reduced aspiration, weight gain and improved survival.  However, evidence in the literature and expert consensus highlight the potential for harms if this approach is used broadly in the population with advanced dementia.  The potential for conflict between the nursing home providers and family caregivers exist because both the medical and ethical considerations involved in withdrawing or withholding artificial nutrition can be complex.  The plan of care should be based on careful medical evaluation, excellent communication, and an ethical analysis.  Specialists in palliative care may be asked to clarify the clinical and ethical considerations and assist in the resolution of conflicts when they occur. 

Target Audience: palliative care specialists, pain specialists, primary care providers, nurse practitioners, registered nurses, advanced practice nurses, registered nurses with a specialty in palliative care/hospice, pharmacists, allied health professionals, fellows, residents, and medical students.

Criteria for Successful Completion:
    1. Attendance at entire session (mandatory for nurses, social workers, and pharmacists)
    2. Submission of completed evaluation form (mandatory to receive CE/CME credit for MDs, nurses, 
        social workers)
    3. Successful completion of a posttest; 80% passing grade (mandatory to receive CE credit for social 

Continuing Education Credits: 1.0

Continuing Education Accreditation:

Physicians: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the National Hospice and Palliative Care Organization (NHPCO) and MJHS. NHPCO is accredited by the ACCME to provide continuing medical education for physicians.

NHPCO designates this live activity for a maximum of 1.0 AMA PRA Category 1 credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses: NHPCO is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation.

NHPCO designates this live activity for a maximum of 1.0 contact hour. Nurses should claim only the contact hours commensurate with the extent of their participation in the activity. Accredited status by ANCC refers only to continuing nursing education and does not imply endorsement of any commercial product discussed in conjunction with this activity.

Social Workers: NHPCO is an approved provider of continuing education contact hours by the National Association of Social Workers (Provider #886414158).

This program is Approved by the National Association of Social Workers (Approval #886414158-2923) for 1 continuing education contact hour.

MJHS Institute for Innovation in Palliative Care SW CPE is recognized by the New York State Education Department’s State Board for Social Work as an approved provider of continuing education for licensed social workers #0242.

Individual: $25 (includes CME/CE certificate)
Group: $95 + $5 per CME/CE certificate

System Requirements for Computers and Mobile Devices:

Russell K. Portenoy, MD, Planner, has indicated a relationship with AstraZeneca Pharmaceuticals LP and Tabula Rasa for research support.  

Mara Lugassy, MD, Joyce Palmieri, RN, Linda Stertz, LCSW, and Timothy W. Kirk, PhD, have no financial arrangements or affiliations with any commercial entities whose products, research or services may be discussed in these materials. Any discussion of investigational or unlabeled uses of a product will be identified.

No other Planning Committee Member has any disclosures. 

Planning Committee Members
Barbara Bouton, MA, FT
Colleen Fleming-Damon, PhDc, APRN-BC, ACHPN-BC, C.T.
Steven R. Gardner, MPA, PAHM
Myra Glajchen, DSW
Jennifer Kennedy, RN, MA, BSN, CHC
Russell K. Portenoy, MD
Karen Richards, PhD, EdS
Judith A. Skretny