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Clinical Programs in the Department of Supportive Care - Palliative Care
- 1. The Palliative Care Program at University Health Network ELLICSR Summer Student Program BreELLICSR Summer Student Program Ernie Mak MD CCFP Palliative Care Physician Princess Margaret Cancer Centre 10th June 2016 MB BAO Palliative Care Physician Princess Margaret Cancer Centre 12th June 2015
- 2. Objectives • Understand the concept of palliative care and how this has evolved over time • Recognize some of the triggers which may prompt a referral to the palliative care team • Feel confident describing what the palliative care team does!
- 3. • What is your understanding of the term Palliative Care?
- 5. • “Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual…” World Health Organization
- 7. Palliative Care Program at UHN • Consultation service – Outpatient consultations - at PM (cancer), TGH (transplant, cardiac) and TWH (movement disorders) – Inpatient consultations • Inpatient Palliative Care Unit at the Princess Margaret, TRI (Bickle) • Aim to provide high quality care throughout the disease course
- 8. Palliative Care Outpatient Clinic End of Life Care Palliative Care Unit Hospital Home Hospital-based Care Community-based Care Palliative Care Clinic
- 9. Referral to Oncology Palliative Care Clinic Oncology Palliative Care Clinic Consultation Home Palliative Care Lederman Palliative Care Centre Community PCU/ Residential Hospice Longitudinal follow-up in tandem with oncology, primary and community care for • symptom control • psychosocial care • referral to community services • advance care planning Early Palliative Care Transitional and end of life care Typical pathways of palliative care upon referral to the Oncology Palliative Care Clinic
- 10. PM Outpatient Clinic • 30 half-day clinics weekly • Staffed by palliative care physician, nurse, social worker • Referrals to other disciplines as necessary • Completed at every visit: – Edmonton Symptom Assessment Scale – Assessment of performance status
- 11. Typical referrals made from the clinic 1 Community Care Access Centre services include nursing, personal support, physical therapy, occupational therapy, and equipment such as hospital bed, walker, wheelchair. 2 Medical/surgical specialists may include neurosurgery, ophthalmology, dentistry, etc. Abbreviations: CCAC, Community Care Access Centre. Figure modified from Hannon B et al, Supportive Care in Cancer 2014
- 14. • Early palliative care at our centre shown to improve: - patient quality of life - Satisfaction with care - Symptom management Compared with standard oncology care alone Lancet. 2014;383(9930):1721-30
- 15. Palliative Care Program at UHN • Consultation service – Outpatient consultations – Inpatient consultations • Inpatient Palliative Care Unit
- 16. Inpatient Consultations • Available at all UHN sites • Provide palliative care support for inpatients with malignant and non- malignant diseases • Reasons for referral: -Symptom management - Advance Care Planning - Discharge planning - End-of-life care
- 17. Palliative Care Program at UHN • Consultation service – Inpatient consultations – Outpatient consultations • Inpatient Palliative Care Unit
- 19. Palliative Care Unit statistics • 12 beds • Approx. 400 admissions/year • Average length of stay 11 days • Acute PCU: admit patients for active management of acute symptom issues or to facilitate transition to a longer-term PCU
- 21. Reason for admission 69% 14% 17% Symptom control Terminal care Transition Numbers based on quarterly data Jan-Aug 2015
- 22. Destination at discharge 4% 50% 29% 17% Death Home Community PCU Other hospitals Numbers based on quarterly data Jan-Aug 2015
- 24. Education • More than 50 trainees yearly, including palliative care residents/fellows, residents from other specialties, medical students, nurses, spiritual care providers, social workers... • Educational rounds, including Psychosocial Oncology and Palliative Care Grand Rounds, Pain and Symptom Management Rounds, Journal Club, etc. • U of T interdisciplinary graduate program in Palliative and Supportive Care
Editor's Notes
- Housed within a larger department of psychosocial oncology and palliative care, which has representation at the executive level. PMH organized into depts of med onc, rad onc, surg onc and dept of psychosocial onc and pall care.
- One of the purposes of our palliative care clinic is to provide a link between hospital-based care and community-based care from early in the disease trajectory, once a diagnosis of advanced, incurable illness has been established. We manage symptoms such as pain, nausea, constipation, breathlessness, and also refer patients to appropriate community-based resources such as CCAC or home visiting palliative care physicians. We also discuss Advance care planning from early on, to establish what the patient and their family’s goals of care are, and to document these in a timely fashion
- Note: Referrals to other services by Oncology Palliative Care Clinic staff are not included in this figure. Longitudinal follow-up is usually weeks to months, but may be days to years. Transfers of care to community PCUs, hospices or home palliative care are for transitional and end-of-life care; transfers to the Lederman centre may be for end-of-life care or symptom control.
- Housed within a larger department of psychosocial oncology and palliative care, which has representation at the executive level. PMH organized into depts of med onc, rad onc, surg onc and dept of psychosocial onc and pall care.
- Housed within a larger department of psychosocial oncology and palliative care, which has representation at the executive level. PMH organized into depts of med onc, rad onc, surg onc and dept of psychosocial onc and pall care.