2022 Program

Thursday, May 5

Note: all times are Eastern Time

12:00-12:10 Welcome and Housekeeping
12:10-13:10 Physician Wellness: From the Individual to the System
Charlie Chen

Stemming from ​a personal journey of healing and ongoing recovery, I am committed to the cultivation of a culture of wellness for the palliative medicine community. The COVID-19 pandemic has demonstrated that a shift in culture toward better supports for physician wellness and the prevention of burnout has never been more important. Let’s come together in a process of discovery and walk through the elements – from what the individual can do to what the responsibilities are for an organization or system – that promote resilience and well-being. 12:55-13:10 interaction with audience (Q&A, discussion)
13:15-14:15 2021 Top Papers
Vincent Fruci, Wendy Yeomans
We will review the top 10 published studies in palliative medicine from 2021… and have fun while doing it! (Q&A, discussion)
14:00-14:15 interaction with audience (Q&A, discussion)
14:15-14:35 Break
14:35-15:35 Members Showcase
15:20-15:35 Interaction with audience (Q&A, discussion)
Clinical Milestones in atypical parkinsonism as triggers for initiation of palliative care
Teneille Gofton, Robin Bessemer
Progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) are forms of atypical parkinsonism with complex symptom burden and unpredictable illness trajectories. The timing for initiation of neuropalliative care is uncertain. The objective of this scoping review was to summarize the available literature pertaining to survival in PSP and MSA, with a focus on: 1) clinical milestones, 2) illness trajectory, and 3) other predictors of mortality as they relate to neuropalliative care in this population.
Implementing a novel interprofessional Caregiver Support Clinic: A palliative care and social work collaboration
Harleen Toor
High levels of burden and, in more severe instances, burnout represents a significant issue for caregivers of patients with advanced cancer. Early identification and management of caregiver distress and cultivating caregiver resiliency are seldom considered elements of routine care. The objectives of this quality improvement (QI) initiative are to 1) leverage the complementary expertise of palliative medicine and social work using an integrated model of care to assess and manage caregiver needs and 2) evaluate its impact on caregivers and clinicians.
Improving Advance Care Planning for Patients Admitted to Cardiology with Congestive Heart Failure Exacerbations
Jalal Ebrahim
Congestive heart failure exacerbations (CHFe) are common and carry enormous symptom burden. Hospital admission portends a poor prognosis, however, literature demonstrates low rates of inpatient Advance Care Planning (ACP). We designed a simple, cost-effective intervention to enhance ACP documentation for patients admitted with CHFe. Our objectives were to examine if this improved rates of: 1) Documented ACP discussions, or 2) Documented code status.
15:40-16:40 Choice of four concurrent workshops
16:25-16:40 interaction with audience (Q&A, discussion)
Workshop 1 Interventional management of cancer pain
Jordi Perez
Description of indications, contraindications, risks and benefits of interventional procedures to control cancer related pain including nerve blocks, neurolysis, cement augmentation techniques and continuous intraspinal drug administration.
Workshop 2 Socially Accountable Palliative Care: Supporting the needs of structurally vulnerable populations
Naheed Dosani, Alissa Tedesco
Structurally vulnerable populations face significant barriers to accessing quality palliative care. This workshop will provide participants with tools to practice more socially accountable care, aimed at reducing inequities in palliative care provision and better meeting the needs of structurally vulnerable populations. Through an evidence-based review, case-based narratives and interactive discussion, participants will have the opportunity to reflect on their practices and programs through an equity-oriented lens.
Workshop 3 Reconceptualising palliative care conversations with seriously ill Asian patients
Zhimeng Jia, Rashmi Sharma
Asian Canadians and Asian Americans represent the largest and fastest growing ethnic minority group in North America.  Accompanying the rapid growth is the increasing number of Asian individuals facing serious illness and experiencing end-of-life (EOL) care. Unfortunately, Asians in North America are at high risk of experiencing inequities in care at the end-of-life including receiving care that is not aligned with patient values and goals, and experiencing a lack of respect for cultural traditions and religious and spiritual beliefs. These inequities have been attributed to multiple factors including differential access to and engagement with palliative care services, culturally discordant communication interventions, and inherent structural racism. This workshop will provide participants with an understanding of the historical and social context that contributes to these inequities and provide a culturally-sensitive framework for facilitating serious illness communication with Asian Canadians and Asian Americans. The workshop will be carried out in three phases. In the first phase, the presenters will contextualize and compare the Asian Canadian and Asian American healthcare experience in terms of historical relevance, cultural diversity, and emerging sociodemographic trends. In the second phase, the presenters will walk through a case study that illustrates the challenges with using conventional tools to navigate a goals-of-care discussion with a Korean Canadian family. In the third phase, the presenters will draw on recent empirical data to provide additional domains and themes to help clinicians more effectively discuss goals of care with Asian American/Canadian patients and families, including assessment of acculturation, temporal framing, linguistic and paralinguistic cues, traditional philosophy, familial ethics, and spirituality.
Workshop 4 Pain management in the palliative patient with addiction history
Katrin Conen, Leslie Martin
Pain is a leading symptom in many patients presenting with life-limiting illness. While we are trying to apply a palliative approach to care early in advanced disease trajectories, we face new challenges in prescribing opioids for our patients in the scope of the nation-wide opioid crisis and, when patients present or show signs of a opioid addiction history. While we want to assure excellent care including providing the pain management the patient needs, we need to follow measures protecting society and the healthcare system and make sure we do what we can to counteract diversification and abuse. This workshop will be led by a palliative care physician with an expertise in managing complex cancer pain, and an addictive medicine specialist with an expertise in chronic pain, addiction, and it`s management. The goal of this workshop is to bring two specialists’ side by side together and discuss with participants knowledge and issues about each others approaches. We would like to achieve a gain in understanding differences and similarities about the focus of care in palliative and addiction management of pain. The workshop will provide opportunities for case-based discussions. At the end of this workshop, participants should be able to gain knowledge and confidence in: Understanding and managing chronic complex pain in the context of addiction medicine. Evaluate palliative cancer pain in a patient with an addiction history, it`s management, challenges, and opportunities and reflection about clinic practice in the context of the national opioid crisis.

Friday, May 6

12:00-12:10 Welcome and Housekeeping
12:10-13:10 Choice of two concurrent workshops
12:55-13:10 interaction with audience (Q&A, discussion)
Workshop 1 The First Oxford Textbook of Public Health Palliative Care – A New Dimension
Julian Abel
The publication of the first Oxford Textbook of Public Health Palliative Care marks a new dimension in providing population approaches to end of life. Death, dying, loss and care giving is everyone’s business, as it is something we experience multiple times in our life until our own final one. It is a social and cultural experience of what matters most to us and is so much more than a medical condition to manage.
Workshop 2 A Cross Country Comparison of the Quality of Death and Dying, 2021
Eric Finkelstein
Few efforts have attempted to comparatively measure how well countries deliver end-of-life (EOL) care. Results from prior studies, which were largely based on proxy measures, are now outdated. This presentation presents results of an effort to systematically rank and grade countries (and Hong Kong and Taiwan) on the quality of EOL care using a novel preference-based score, termed the Quality of Death and Dying Index (QODDI) 2021. We fielded a survey among country experts around the world, asking them to rate the performance of their country on 13 key indicators of EOL care. Ratings were combined with preference weights from caregiver-proxies of recently deceased patients to generate a weighted summary score that ranked and graded (from A to F) countries based on overall EOL care. The final sample includes responses from 181 experts representing 81 countries with 2 or more experts reporting. This presentation presents the results and highlights the large disparities in the quality of EOL care across countries, and especially between the highest income countries and others.
13:15-14:15 Choice of two concurrent workshops
14:00-14:15 interaction with audience (Q&A, discussion)
Workshop 1 Palliative care for adolescent and young adult (AYA) cancer patients: a new and integrated approach
Mohamed Abdelaal, Pamela Mosher
Adolescent and Young Adults (AYA) with cancer experience a high level of symptom burden, both physically and emotionally. Given their broad developmental range, AYA patients, aged 15 to 39 years, have unique and multiple needs that require specialized care from oncology, palliative, rehabilitation and mental health specialists. Globally, cancer treatment centres have developed specific AYA programs to address these needs. However, the question of the best method(s) to care for these patients, including the role of palliative care, remains unanswered. Despite the evidence base that recommends palliative care, most cancer centres do not include palliative support in standard oncological care for AYA patients. There is a paucity of research on the palliative and supportive care needs of AYA, and the extant literature demonstrates different needs and gaps compared with older cancer patients. Our team created a developmentally-focused, integrated palliative and psychiatric clinic dedicated to address the palliative and psychosocial care needs of AYA cancer patients and their caregivers. In this workshop, we will invite participants to consider the specific palliative care needs for this vulnerable population and brainstorm how their own centres and clinics might improve care for AYA locally. We will describe the findings from our clinic, discuss the development and current structure of this integrated palliative care/psychiatry clinic, and will present our outcome data.
Workshop 2 Narrative medicine in palliative care: Allowing ourselves to be moved by patient’s stories (part 1)
Catherine Courteau, Laurence Laneuville
***Given the positive response to our narrative medicine workshop at the 2021 ALPM, we offer a repeat of this workshop this year (part 1). Participants who attended our ALPM narrative medicine session last year might prefer attending part 2 only, for new content.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 professional experiences have confirmed the many parallels between the two fields. In our journeys towards palliative care and psychiatry practices, we have also found an unmet need for a space to discuss death and dying in medicine.In this first session, we will start by laying out the basis of narrative medicine as ‘’medicine practiced with the narrative skills of recognizing, absorbing, interpreting, and being moved by the stories of illness’’ (Charon, 2016). We will then review possible applications of narrative medicine in palliative care, including in medical education and in patient care. We will focus our attention on the use of personal narrative interventions, such as dignity therapy. Finally, we will introduce narrative medicine techniques with a short writing exercise. We will reflect on this exercise using the concept of narrative wreckage in relation to trajectories of illness (Frank, 1995).
14:15-14:35 Break
14:35-15:35 Choice of three concurrent workshops
15:20-15:35 Interaction with audience (Q&A, discussion)
Workshop 1 The Canadian Interdisciplinary Palliative Care Competency Framework: Enhancing Physicians’ Palliative Care Competencies
Deborah Dudgeon, José Pereira
Canadians want highly skilled providers who can address their palliative care needs, whenever and wherever those skills are required. However, many Canadians do not receive high-quality palliative care. The Canadian Interdisciplinary Palliative Care Competency Framework (the Framework) directs the consistent implementation and measurement of palliative care competencies in practice that nurses, general physicians, social workers, personal support workers, and volunteers must demonstrate to meet the minimum national standard for palliative care competency. Physician competencies in the Framework were developed in partnership with CSPCP Board members, who helped to align these competencies with existing national palliative competencies, such as the EFPPEC competencies for undergraduate medical education and the PACE competencies for postgraduate learners. A corresponding set of skills self-assessments were developed as well to allow individual physicians to assess their level of competency in twelve domains of palliative care, and to guide continuing education and professional development plans. Equity considerations and culturally safe approaches to caring for specific populations, including First Nations, Inuit, and Métis, were built into the competencies and skills self-assessments. Workshop participants will hear examples of how partners across the country are actioning the Framework to contribute to continuous improvement in palliative care. Participants will learn about and complete a mini-skills self-assessment for physicians on an innovative digital self-assessment tool hosted on Pallium’s Learner Journey webapp.
Workshop 2 Towards a More Equitable Palliative Care: (Re)envisioning the Palliative Care Model for Patients with Non-malignant Illness and Multimorbidity
Kyra Harris-Schulz
Canadian data continues to demonstrate massive inequities in access to Palliative Care (PC) services for patients with non-malignant illness and multi-morbidity across care settings despite research demonstrating that such patients have significant palliative needs. The numerous barriers to non-malignant PC illuminated in literature and our clinical work with non-malignant patients point to a number of key questions to guide a way forward: • How do the needs of patients with cancer and non-cancer diagnoses differ? • How is our current model of PC inherently cancer-focused? • What does a non-malignant model of PC look like? • What are the affordances and limitations of a non-malignant model of PC in our current healthcare systems? In this workshop we will explore the above questions and call on the experiences of participants to help collaboratively (re)envision a non-malignant model of PC. A literature review of current access and barriers to PC for patients with non-cancer diagnoses will be shared. Cases from our diverse work in the tertiary inpatient setting will be integrated to illuminate the complexities and successes of early PC for patients with multimorbidity and organ failure. Participants will exchange ideas and innovations through the sharing of their own local and regional initiatives to support patients with non-cancer diagnoses. In terms of relevance, this workshop will provide an opportunity for PC physicians to better characterize the problem of inequitable access to PC based on diagnosis and begin to work towards a shared conceptualization of how our individual and collective practices can change to improve care.
Workshop 3 Narrative medicine in palliative care: Stories for self-care (part 2)
Catherine Courteau, Laurence Laneuville
***This workshop will not cover narrative medicine fundamentals. We recommend that participants new to narrative medicine attend part 1 prior to this session.
Apart from mindfulness and yoga classes, how can we, clinicians, find some ways to practice palliative care with self-care as an imperative? In his ‘’ethics of self-care’’ (2009), Craig Irvine highlights how our current application of ethics is almost exclusively targeted towards patients, namely through the principles of biomedical ethics (autonomy, non-maleficence, beneficence and justice). He argues that clinicians should give just as much importance to the ethics of self-care and proposes narratives as a way to integrate salient clinical experiences.In this second workshop, we will explore the applications of narrative medicine for self-care, specifically the use of stories for deeper introspection. As writer Clarissa Pinkola Estés puts it: “stories set the inner life into motion, and this is particularly important where the inner life is frightened, wedged, or cornered”. Stories allow us to reveal truer versions of ourselves, to ourselves and others.We will use Virginia Woolf’s concept of “moments of being” as a theoretical basis for our experimentation with story making. In A sketch from the past, Woolf revisits childhood memories, including about her mother who passed away when she was thirteen years old. We will invite participants to apply narrative medicine techniques with: 1) a close reading exercise from an excerpt of Woolf’s memoirs around her mother’s death and 2) a prompted short writing exercise, followed by sharing and discussion.
15:40-17:00 Members Showcase
16:40-17:00 Interaction with audience (Q&A, discussion)
ABC’s of Serious Illness Communication: A hybrid of resources and training experiences
Jeff Myers
The problem this project addresses is the current state of seriously ill people and their substitute decision makers (SDMs) being inadequately prepared for both advancing illness and decision-making. There are gaps within existing communication skills frameworks and training experiences designed to address this problem as essential elements of content, structure or education modality are either missing or underemphasized. The ABC’s of Serious Illness Communication Project (All clinicians, Better Communication) is a program of resources and training experiences aiming to fill these gaps. The program is a hybrid drawing from strengths of several existing serious illness communication frameworks but with clarified terminology, a focus on specific communication skills and a fundamental approach and structure that can be applied to different contexts.
Palliative Care Medication Alternatives during 2012 Injectable Drug Shortage
Carmen Johnson
In 2012, Sandoz, the only Canadian manufacturer of generic injectable drugs experienced manufacturing issues.  This caused a Canada-wide injectable drug shortage. This presentation discusses the alternative medications and routes used for symptom management.  It also outlines the effect alternative medications had on drug costs and nursing drug administration time.
Symptom management & palliative care consultation for COVID-19 patients: A multi-site retrospective chart review
Jennifer Guan, Madelaine Baetz-Dougan
COVID-19 is associated with high rates of morbidity and mortality (1). Previous work has described symptom management provided by specialists in palliative care for COVID-19 patients (2). However, there is a paucity of literature describing the primary palliative care provided by general internal medicine and hospitalist teams. Our aim with this research and subsequent learning objectives are: 1) to describe and compare symptom management by acute care providers and palliative care specialists, and 2) to describe patterns of palliative care consultation across institutions.
Exploring Residents’ Experiences of Palliative Care Training in a Family Medicine Residency Program
Stephanie Cheon
Residents in our family medicine residency program are expected at the end of their training, to demonstrate the skills and competencies that enable them to provide primary-level palliative care. Our program thus has a responsibility to offer residents adequate learning opportunities in palliative care. However, exposure to palliative care training varies across the different teaching sites in our program. Through a survey of our graduating residents, we explore their perspectives on their site-specific palliative care experiences. We aim to understand the impact of our current curriculum on their comfort level in each of our program’s established palliative care objectives and whether it prepares them to deliver primary-level palliative care in their future practice.

Saturday, May 7

12:00-12:10 Welcome and Housekeeping
12:10-13:10 Opioid safety in palliative care
Jenny Lau, Paolo Mazzotta
Opioids are essential medications for palliative care but they can be harmful to patients and their caregivers. In collaboration with CSPCP, expert consensus recommendations about opioid safety in palliative care were developed. In this workshop, attendees will learn about the high priority recommendations and explore strategies to begin to incorporate and implement these recommendations into their practices. 12:55-13:10 interaction with audience (Q&A, discussion)
13:15-14:15
Palliative Care in Rheumatic Diseases: When Does the End Begin and Why Does It Matter?
Alexandra Saltman
This session will employ a case-based learning approach to examine the role of palliative care for patients with life-limiting rheumatologic diseases and patients with advanced malignancies who develop de novo rheumatologic conditions secondary to immunotherapy. We will review the preliminary data on the needs of this patient population and the level of knowledge and comfort of providers in caring for this population as they approach the end of life. We will consider areas for future clinical, research and teaching opportunities at the intersection of these two disciplines, and how a collaborative model of care may provide a template both for the provision of palliative care for patients with other non-malignant illnesses, for teaching trainees about the benefits of early, interdisciplinary, integrated palliative care.
14:15-14:35 Break
14:35-15:35 Choice of two concurrent workshops
15:20-15:35 Interaction with audience (Q&A, discussion)
Workshop 1 Inspiring Compassionate Palliative Care Advocacy through Equity, Diversity & Inclusion
Amit Arya, Trevor Morley
Everyone who dies has a right to access high quality palliative care as a human right, yet inequity is built into palliative care as a system. We all know the statistics: just 1 in 6 Canadians receives home palliative care at end-of-life. In a world driven by inequity, the practice of palliative medicine should be considered social justice work. Yet, palliative care physicians commonly have little understanding, training or exposure to this. Working in a world driven by inequity, palliative care physicians must expand the scope of their relationship with patients with life-limiting illness as beyond the purely clinical. Consideration should be provided to the social causes of suffering at the level of the individual (micro level) and beyond. Our gaze must extend from our patients and their families to their neighbourhood and community (meso level) and to the society in which we all live (macro level). This workshop will examine relevant literature and discuss important concepts such as social justice and social accountability from a palliative care perspective. Through discussion and real life examples, we will discuss the meaning of socially accountable practice and real life macro-level advocacy, and the importance of putting an equity, diversity and inclusion lens on all our work. Practical tools, along with real life examples, will be shared to guide advocacy and inspire attendees. We will also provide a critical analysis of the current state of advocacy in palliative care in Canada.
Workshop 2 Evidence-Guided Management of Delirium in Palliative Care
Peter Lawlor
This talk will involve a brief presentation of a clinical vignette. This will serve as a framework for some of the presentation. although most aspects of delirium in palliative care settings will be covered, the focus will be on management, particularly symptomatic management. Recent study findings and associated controversies surrounding antipsychotic use in the symptomatic management of delirium will be addressed.
15:40-16:40 Members Showcase
16:25-16:40 Interaction with audience (Q&A, discussion)
Virtual Palliative Care intervention: Pain and Symptom Management through Relief app
Jehanara Chagani, Martin Chasen
Many patients with palliative care needs not only prefer to receive care at home but also prefer end of life care at home. Patients are less likely to visit emergency departments when their symptoms are well managed. However, assessing patient’s symptoms and providing care and support in real-time can be a challenge. It is with this challenge in mind an app was developed to allow patients with palliative care needs to self-report their symptoms on a regular basis, using electronic assessment tools, in their homes.
What About Empathy? Exploring a Podcast Teaching Tool
Irene Ying
There is evidence that erosion of empathy occurs through medical training. Concurrently, online educational resources, including podcasts, are gaining traction among medical learners. The convergence of these two phenomena has led to the development of an empathy themed podcast, which intends to share patient, caregiver, and healthcare practitioner stories to promote empathy and compassionate care among medical learners. This study used qualitative phenomenological approaches to understand the role of the podcast in teaching empathy. Local ethics committee approval was obtained. Participants were recruited through voluntary response sampling via email sent to medical students, family medicine residents, and faculty involved in Undergraduate Medical Education, Department of Family and Community Medicine, and Division of Palliative Care. Participants included 9 faculty and 15 learners. Virtual focus groups were conducted after participants listened to select podcast episodes. A thematic analysis of focus group transcripts identified emergent themes.
Fighting Fires and Battling the Clock: Theorizing resident approaches to advance care planning in primary care
Tavis Apramian
Patients with serious illness engaging in advance care planning (ACP) benefit from better survival, mood, quality of life, positive family outcomes, and goal-concordant care; unfortunately, few family physicians (less than 40% in Ontario) report regularly initiating conversations with their sick patients about their values. We asked how family medicine residents learn to engage in ACP to better understand the role of medical education in creating this clinical gap.
16:40-16:45 Wrap-up