clinical programs in the department of supportive care - palliative care
TRANSCRIPT
The Palliative Care Program at University Health Network
ELLICSR Summer Student ProgramBreELLICSR Summer Student Program
Ernie Mak MD CCFPPalliative Care Physician
Princess Margaret Cancer Centre10th June 2016
MB BAOPalliative Care Physician
Princess Margaret Cancer Centre12th June 2015
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!
• What is your understanding of the term Palliative Care?
• “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
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
Palliative Care Outpatient Clinic
End of Life Care
Palliative Care Unit
Hospital Home
Hospital-based Care
Community-based CarePalliative Care Clinic
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
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
Typical referrals made from the clinic
1Community Care Access Centre services include nursing, personal support, physical therapy, occupational therapy, and equipment such as hospital bed, walker, wheelchair.
2Medical/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
• 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
Palliative Care Program at UHN• Consultation service
– Outpatient consultations – Inpatient consultations
• Inpatient Palliative Care Unit
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
Palliative Care Program at UHN• Consultation service
– Inpatient consultations – Outpatient consultations
• Inpatient Palliative Care Unit
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
Reason for admission
69%
14%
17%
Symptom controlTerminal careTransition
Numbers based on quarterly data Jan-Aug 2015
Destination at discharge
4%
50%
29%
17%DeathHomeCommunity PCUOther hospitals
Numbers based on quarterly data Jan-Aug 2015
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
