2021 Program

Implementing the National Framework. Where are the Gaps and How do we Address Them?

Thursday, February 25

Speaker bios

Note: all times are Eastern Standard Time

12:00-13:00 OPENING KEYNOTE – Carlos Centeno
Global Experiences and International Good Practices to Develop a Palliative Care National Framework
It is urgent to study how palliative care can be integrated at all levels of a health system and even in the society considering that to develop of palliative care specialized services is only a link of the chain of a good palliative care practice. Some indicators new have been proved useful to draw the European perspective of the integration of palliative care in pediatric, primary care, oncology, cardiology, long term facilities, and in a societal level. Through research performed in Europe and also in Low- and Middle-Income Countries (LMIC) and presented in the format of Palliative Care Atlas, it is possible to identify experiences and good practices in Palliative Care that could inspire more integration and improvements in the Framework on Palliative Care in Canada.12:45-13:00 interaction with audience (Q&A, discussion)
13:00-14:00 Congestive Heart Failure: A Palliative Medicine Review of the Disease, its Therapies and Drug Interactions
Kirsten Wentlandt
This talk will review HF and current targeted therapies including their effects on symptoms, hospital admission rates, exercise performance, HRQL, and survival. Pharmacological interactions with, and precautions related to commonly used palliative care medications are also reviewed. The goal of this review is to equip palliative care clinicians with information to make evidence-based decisions while managing the balance between optimal disease management and patient quality of life.13:45-14:00 interaction with audience (Q&A, discussion)
14:00-14:15 Break
14:15-15:15 Cannabis and the Palliative Care Patient
Erynn Shaw
Cannabis has a long history of therapeutic applications, and with legalization patients receiving palliative care have demonstrated a growing interested in its potential for symptom management. It is becoming increasingly important to understand the available evidence and balance this with management of refractory symptoms, patient preferences, and palliative patient’s rights to access experimental treatments. This workshop will provide an overview of medical cannabis for symptom management in palliative care patients, with a focus on oncology.15:00-15:15 interaction with audience (Q&A, discussion)
15:15-16:15 Choice of three concurrent workshops
Workshop 1 Pediatric Palliative Care in Practice
Dave Lysecki, Gregorio Zunia-Villanueva
The Framework establishes that all Canadians, regardless of age, require equitable access to palliative care. And yet, there are a limited number of practitioners and institutions with experience in comfort in delivering a palliative approach to children. This workshop is for individuals looking to explore or deepen their understanding of the provision of palliative care to children. The workshop will use cases to demonstrate how we all have a role to play in supporting children with palliative needs.
Workshop 2 Improving the quality of life and death in Long Term Care (LTC): A palliative care collaboration within LTC
Allison Crombeen, Glen Maddison
Residents in LTC homes are frail and have comorbid conditions that render them to be at risk for death; however, access to palliative care in LTC can be inconsistent. The need to have detailed advanced care planning discussions is critical in this population to ensure the care they receive aligns with their goals. In this workshop, we will describe our year long collaboration with a LTC home wherein we provided consultation to residents, education to the nursing staff and collaboration with the LTC nurse practitioners with the goal of improving palliative care in LTC and reducing transfers to hospital at EOL. Our consultations included a detailed advanced care planning discussion during which we described common scenarios that could lead to death for LTC residents, such as acute respiratory illnesses, swallowing difficulties and hip fractures, as well as possible management choices, such as transfer to hospital or management in LTC. We provided end of life care for residents who requested not to be hospitalized, including patients who chose non-operative management of hip fractures. We supported the nursing staff by providing 24/7 access to our team to ensure proper symptom management as a means of knowledge translation. We will present data that demonstrates that our project reduced transfers to acute care, increased the quality of death in LTC and lead to improved staff satisfaction. This intervention has the potential to improve access to palliative care in LTC, while also improving the ability of frontline LTC providers to provide comprehensive palliative care.
Workshop 3 Love in the Time of COVID-19 – Lessons Learned Using Clinical Guidelines and Protocols
Anne Boyle, Anne Bhéreur
A session to discuss experiences gained from the end of life care of patients with COVID-19 in different parts of Canada. Many guidelines and protocols have emerged during the pandemic, but how useful are they? What lessons can be derived from the lived experience?16:00-16:15 Interaction with audience (Q&A, discussion)

Friday, February 26

12:00-13:00 Early Palliative Care Everywhere: How to Move the Mountain
Hsien Seow
Increased access to palliative care is everyone’s business, but how do we succeed in achieving this goal? The Canadian Society of Palliative Care Physicians has been a national champion for increased access to palliative care. However, by some measures, the progress for change has been slow; at times it can feel like trying to move a mountain. We need to focus on strategies to overcome inertia in the system in order to have access to palliative care at the population-level. Dr. Hsien Seow, Canada Research Chair in Palliative Care and Health System Innovation, will explore potential strategies and the roles palliative care specialists can play in helping to build a better system. He will look at who needs to be engaged and discuss engagement strategies to help move the mountain that is adopting a palliative care approach.12:45-13:00 interaction with audience (Q&A, discussion)
13:00-14:00 Clinical Pearls for Symptom Management in Advanced Parkinsonism
Barbara Connolly, Teneille Gofton
Parkinsonism is a common feature of neurodegenerative disease. People living with both typical (idiopathic Parkinson disease) and atypical forms of parkinsonism (ie. multiple system atrophy, progressive supranuclear palsy) have complex palliative care needs that vary throughout the disease trajectory. This interactive workshop will provide an overview of the recently published Canadian Guideline for Parkinson disease as it pertains to symptom management in the advanced stages of Parkinson disease, will discuss the differences and similarities between typical and atypical parkinsonism and will explore time points along the disease trajectory amenable to palliative care intervention.13:45-14:00 interaction with audience (Q&A, discussion)
14:00-14:15 Break
14:15-15:15 CSPCP Members’ Showcase A

Evaluation of a Project ECHO on Pediatric Palliative Care Targeting Health Professionals in South Asia
Jennifer Rowe
Project ECHO Pediatric Palliative Care (PPC) is an online educational program developed to train health care professionals in South Asia to provide palliative care for seriously ill children in their communities. Regular ECHO sessions are hosted every 2 weeks over multipoint videoconference providing didactic and case-based teaching. Launched in March 2018, this is the first global ECHO program to specifically provide training in pediatric palliative care. The goal of this study is to provide a descriptive review of the ECHO program, including the characteristics of participants and sessions and the satisfaction and perceived strengths and weaknesses of the program.

Exploring Learners’ Perspectives of a Pediatric Palliative Care Tele-mentoring and Education Program
Jennifer Rowe
More than 98% of children who need palliative care live in low- or middle-income countries where access to palliative care is extremely limited. A lack of palliative care education for health care providers has been identified as a significant barrier to improving access to palliative care. Project ECHO (Extension of Community Healthcare Outcomes) is a tele-mentoring educational platform developed to improve access to specialist care in underserved areas. Our objective is to explore the learning experiences of participants in a Project ECHO on pediatric palliative care (ECHO PPC) in South Asia and explore considerations to improve ECHO to cater to the unique learning needs and challenges for healthcare professionals in resource-limited settings.

Implementing a Tele-Teaching and Mentorship Program (Project ECHO) to Build Pediatric Palliative Care Capacity
Jennifer Rowe
Globally, pediatric palliative care services are largely unavailable in low- and middle-income countries (LMIC), where98% of children needing palliative care reside. The Extension of Community Health Care Outcomes (ECHO) project uses web-based videoconference sessions to train healthcare professionals in remote or under-served areas, connecting them with specialists to create virtual learning communities. We developed an ECHO project for Pediatric Palliative Care (ECHO PPC) to increase the knowledge and skills of health professionals of pediatric palliative care in South Asia. Our objective is to describe the key considerations from our experiences in the design, implementation and modification our Project ECHO.

Developing a Canadian Atlas of Palliative Care: Methodological Learnings to Date
Christopher Klinger
Significant variation exists across Canadian jurisdictions in many palliative care-related domains, including the integration of the palliative care approach, access to specialist-level services, inclusion into the curricula of the health professions, and community engagement. A Canadian Atlas of Palliative Care, based on existing work in e.g., Africa, Europe and South America, is set to map the current state.

15:00-15:15 interaction with audience (Q&A, discussion)

15:15-16:15 Choice of three concurrent workshops
Workshop 1 Our Place in Public Health Palliative Care; The Role for Physician Leaders and Advocates
Denise Marshall, Erin Gallagher
Public Health Palliative Care has gained traction internationally as more than a “movement”. It is now seen as one of the most important levers to shift societal care closer to the goal of “a good death for all”. In this workshop we will update one another on the core concepts underpinning a PHPC approach, and review the emerging theories, outcomes and research surrounding various aspects of PHPC programs, initiatives and activities around Canada and the world. Most importantly, we will, both individually and collectively, move forward as physician leaders and advocates in ‘next step” , logical, practical application of PHPC in our work and our lives.
Workshop 2 How can we implement early, systematic integrated palliative care for advanced cancer patients? Learning from the PaCES project
Jessica Simon, Aynharan Sinnarajah
A key role for advanced palliative care providers is to improve the quality of care and patient/family experience but implementing best evidence into practice is not easy. The American Society of Clinical Oncology guidelines recommend palliative care involvement within 8 weeks of advanced cancer diagnosis, but commonly patients only access palliative care in the final few months of life. The Palliative Care Early and Systematic (PaCES) knowledge translation project has adapted and implemented evidence-based practices for delivering early and systematic Palliative Care (PC) at the health system level for patients with advanced colorectal cancer. Using the PaCES project as a case study, this hands-on workshop will walk you through the “Knowledge-to-Action cycle” and you’ll learn how this framework can guide your own projects to implement evidence into practice. We will explore key steps and challenges in developing clinical improvement, like securing project funding, engaging stakeholders, developing an implementation plan adapted to local contexts, assessing readiness and avoiding change fatigue, evaluating and sustaining change. You will be encouraged to share your own challenges and successes in implementing change. We aim to leave you with renewed enthusiasm in your role as a change agent for “Implementing the Framework on Palliative Care in Canada”.
Workshop 3 Talking the Talk: Enhancing Communication in the Care of Children with Serious illnesses
Megan Doherty, Stephanie Van Zanten
For children with serious illnesses, exploring a family’s values, priorities and goals of care and incorporating these into treatment plans and recommendations. This session will present a systematic approach to conversations in the setting of serious illness or complex health conditions. There will be a focus on practical tools, approaches and principles that can be integrated into routine palliative care practice, using the Pediatric Adaptation of the Serious Illness Conversation Guide.16:00-16:15 Interaction with audience (Q&A, discussion)

Saturday, February 27

12:00-13:00 Taking Care of Yourself, While You Care for Others
Joanna Humphreys
Taking care of yourself while practicing palliative medicine is more of a struggle than ever.Through openness, vulnerability and introspection, I hope to lead participants to consider what impacts their own well-being. As a group, we can think through ways that we can support ourselves, others in our team, our community and organizations through our own personal work and advocacy within our greater system.12:45-13:00 interaction with audience (Q&A, discussion)
13:00-14:00 Top Palliative Care Articles from 2019
Jose Pereira, Hun Je Park
13:45-14:00 interaction with audience (Q&A, discussion)
14:00-14:15 Break
14:15-15:15 CSPCP Members’ Showcase B

An Educational Intervention to Improve Medical Resident Communication In Goals Of Care And End-Of-Life Discussions
Laura Albak
A significant number of Canadians die in teaching hospitals. Although death is often anticipated, frequently end-of-life (EOL) discussions do not occur. Residents are often the direct care providers, to whom the EOL discussions are delegated. The literature suggests Residents have difficulty with these discussions because of lack of training. Our objective was to develop an educational intervention in a single-center internal medicine residency program, aimed at improving communication skills with goals of care (GOC) discussions. To assess the efficacy of this intervention and explore the standardized patient (SP) and Resident satisfaction.

Always Life to Honour: A Three-year, Mixed-methods Study of Palliative Care in International Humanitarian Action
Kevin Bezanson
The need and space for palliative care in humanitarian response is increasingly recognized as integral by international actors, but with limited experiential guidance1,2. We aimed to: 1) Gather existing evidence from lived experiences of palliative care provision in humanitarian crises. 2) Help inform humanitarian healthcare organizations for providing ethically and contextually appropriate care.

Developing a Problem-based Palliative Care Learning Module for Medical Students During Family Medicine Clerkship
Karen Leung
While the survival rates for life-limiting illnesses such as cancer and cardiovascular disease have improved, patients are also experiencing greater frailty and burden of symptoms.1 Early-career physicians and medical educators have identified a need for increased palliative care training, including managing symptoms for both cancer and non-cancer illnesses and navigating supportive services for patients and their families.2,3 Therefore, a novel palliative learning module was developed for medical students during their family medicine rotation.

15:00-15:15 interaction with audience (Q&A, discussion)

15:15-16:15 Choice of three concurrent workshops
Workshop 1 Narrative Medicine in Palliative Care: Allowing Ourselves to be Moved By Patients’ Stories
Catherine Courteau, Laurence Laneuville
During the 2018 Columbia University Narrative Palliative Care: A Basic Narrative Medicine Workshop, Dr. Charon reminded us that narrative medicine and palliative care share a lot in common, namely an openness to be moved by patients’ stories. Our own experiences have confirmed the many parallels between the two fields. Our workshop is divided into three parts. First, we briefly review what is narrative medicine and possible applications in palliative care, namely the use of patients’ personal narratives in care such as dignity therapy. We follow by presenting narrative medicine experiences we were actively involved in the last few years such as the creation of a reading club and reading module as part of the Physician Apprenticeship Course for medical students at McGill University, the development of writing workshops with health care professionals in a Montreal hospital and the participation in writing series for cancer patients in Vancouver. We have found death and dying to be a common theme in reading choices and writing topics in all our initiatives, reflecting an unmet need for a space to discuss this topic among medical trainees, physicians and patients. Our goal here is to discuss how narrative medicine can bridge this gap. Lastly, we go into action by exploring different techniques of narrative medicine with the participants. By allowing participants to experience projects we have developed and implemented, we hope to facilitate the integration of narrative medicine into participants’ own practices.
Workshop 2 Aging in Place: Development of a Shared Care Consultative Model of Palliative care in Long-Term Care Facilities
Amit Arya, Aveksha Ellaurie
The proportion of Canadian deaths occurring in long-term care (LTC) facilities has been increasing in the past 2 decades and is expected to reach 39% of residents per year by 2020. These are individuals frequently facing advanced life-limiting illnesses including dementia, heart failure, lung disease and cancer. Yet as of 2018, it is estimated that only 6% of Canadian LTC residents received formalized palliative care in the last year of life. A recent study found that only 25% of LTC residents had completed an advanced directive prior to their most recent hospital admission, and 38% had recurrent hospital visits. Alarmingly, 21% of LTC residents who died in acute care were hospitalized primarily for palliative care. There is reasonable evidence in the literature to suggest that specialist palliative care services for patients in LTC improve health outcomes and reduce system costs. Hence, in 2018, the William Osler Health System and the Central West Palliative Care Network initiated a shared care, consultative palliative care in LTC pilot program which to date has provided 111 visits to over 90 patients with life-limiting illness. The program has focused on patients with complex symptoms, existential distress, and undifferentiated goals of care. This interactive workshop will examine relevant literature and involve multiple small group case discussions, highlighting the challenges and benefits of working in the LTC setting. The workshop will aid participants in development of a palliative care consult service in LTC, including a discussion on the successes and lessons learned from the ongoing pilot project.
Workshop 3 CSPCP Staffing Model – How does this thing work?
Dave Henderson, Leonie Herx
This workshop will explore a model to help develop a staffing plan for a specialist palliative care program. It is recommended that core competencies and understanding of a palliative approach to care be developed in all practice settings for all disciplines. In order to improve access to high quality palliative care, the National Framework for Palliative Care in Canada outlines the need for an integrated model of specialist and primary palliative care. However, we know that <15% of Canadians have access to specialist palliative care. Our staffing model serves as a tool to enable communities to both plan and advocate for the necessary resources to staff specialist palliative care teams. Calculating staffing needs for specialist palliative care services is complex, and there is little published evidence to suggest best practice. Staffing needs are often dependent on factors such as patient demographics, access to primary care, competency levels, models of care, and geography, to name a few. Recognizing these challenges, the CSPCP has developed a model based on a review of international literature, expert opinion from Canadian palliative care medical directors and feedback from key stakeholder groups. The model theorizes as a standard, a specialist palliative care team that provides care in an advisory-consultant-educational-coaching role alongside shared care with all primary care clinicians. The model embraces a team approach to care and recognizes that the numbers of palliative care physicians, nurses and social workers are all interdependent. In this workshop we will describe the CSPCP staffing model. Participants will then work to use the model in a practical, interactive experience to calculate the staffing needs for various communities. We will also facilitate discussion on how to use this as an advocacy tool for developing/maintaining programs in the participants own regions.16:00-16:15 Interaction with audience (Q&A, discussion)