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Medical Assistance in Dying (MAID)

Health care professionals, administrators, clinicians and leaders from all health sectors – please join us for this (complimentary) opportunity to learn more about Medical Assistance in Dying (MAiD) and participate in discussions about:

  • Patient and family perspective on MAiD
  • Overview of current and emerging MAiD legislation
  • Intake, assessment and clinical processes
  • Clinical issues, including: Resiliency, assessments and process for MAiD, issues in clinical care, and unique considerations in smaller communities.

For full agenda – please contact Wendy at wendy.scharf@champlain.ccac-ont.ca

REGISTER

DATE AND TIME

Sat, April 22, 2017

8:00 AM – 4:30 PM EDT

Add to Calendar

LOCATION

Ottawa Conference and Event Centre

200 Coventry Road

Ottawa, ON K1K 4S3

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Palliative Prescription Tips for Physicians

pillsImprove efficiency and reduce treatment delays by collaborating with the Pharmacy providing Palliative Medication. They can provide guidance with:

  • formulating medication orders
  • current availability of medications
  • the list and concentrations of the Facilitated Access Palliative Care Drugs covered by ODB
  • coverage and LU requirements for additional Medications

A list of Facilitated Access Palliative Care Drugs covered by ODB can be found on the MOHLTC website at: http://www.health.gov.on.ca/en/pro/programs/drugs/edition_42.aspx (go to Part VI-B)

Palliative Care Facilitated Access Registration

Physicians should consider registering on the Palliative Care Facilitated Access List with OMA as it greatly reduces paperwork for ODB clients. This requires a Physician Declaration form found here.

Pharmacists and Nurse Practitioners will contact physicians to order, renew, or adapt these medications as only physicians are approved prescribers in the Facilitated Access Program.

For those physicians not registered on the Palliative Care Facilitated Access program, the physician must call the EAP Telephone Request Service (TRS) at 1-866-811-9893 or 416-327-8109 to request coverage of any medication on the Facilitated Access Palliative Care Drug List for ODB clients.

On Prescriptions for Palliative patients, please write either “P.C.F.A.” or “Palliative” and your CPSO number.


Article written by: Steve Coulas BSc Pharm,
Petawawa Centennial Family Health Centre

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Advance Care Planning Day: Don’t Take Chances

Speak UpApril 16th is National Advance Care Planning Day, a day for you and others to reflect on decisions made at the end of life. This is a day to begin a conversation with a loved one or a patient about their wishes for end of life care – or it might remind you to review your own plan.

Visit advancecareplanning.ca to start the conversation about end-of-life care.

Health care professionals will also find extensive resources to help others make a plan, including a short workbook for patients and families to create an Advanced Care Plan.


Don’t Take Chances, Share Your Wishes

Five Steps of Advance Care Planning

Advance care planning cartoonToo many Canadians don’t have a plan for their future healthcare. But Advance Care Planning is easy!

Speak to your patients about the five easy steps outlined in the video below.

A short workbook for patients and families to create an Advance Care Plan is also available in English and French on the Speak Up website.


Where is Your Parachute?

It’s never too early to plan for end-of-life care! View this short video from Pallium Canada, then learn more about advanced care planning at www.advancecareplanning.ca.

 

More information

Palliative Care: Better Early Than Late

It’s better to be early than late. Research shows that patients who receive early palliative care:

  • have less depression
  • have better quality of life
  • live longer!

This Pallium Canada video explains why palliative care EARLY is BETTER than palliative care LATE.

More information

The New England Journal of Medicine:

The “Surprise Question”

When caring for someone with advanced disease, many physicians and other health professionals ask the question “Is this patient palliative yet?”. This is the wrong question to ask, especially since most health professionals and the public continue to unfortunately equate palliative care with only the last days or weeks of life — terminal or EOL phase. (See article: Palliative Care: Early is Better than Late).

A much more appropriate question is “Could this patient benefit from a palliative care approach?” Such an approach could be done earlier and alongside treatments to control the disease, such as chemotherapy or treatments to control advanced heart failure or COPD. Palliative care could therefore already start when a patient still has many months and even longer to live, particularly if they are experiencing issues, such as uncontrolled symptoms or psychological distress, that affect their quality of life.

The “surprise question” was developed by researchers in the United States to bring to clinicians’ attention the need to activate palliative care earlier. Clinicians are encouraged to ask the following question when they have a patient with a progressive incurable illness: “Will I be surprised if this patient dies in the next 6 to 12 months?” If the answer is “No, I will not be surprised”, then a palliative care approach needs to be activated in that patient. A palliative care approach refers to some basic interventions that do not necessarily require a specialist palliative care team and includes goals of care discussions, symptom assessment and management, assessment of needs across the four domains (physical, psychological, social, spiritual/religious/existential), assessment of functional status, an assessment of overall quality of life and advance care planning.

Some prognostic indicator guidelines are available. One of the most commonly used is the GSF Prognostic Indicators Guide from the Gold Standards Framework Program based in the United Kingdom. The GSF Indicator guide provides general indicators and disease specific indicators that help answer the surprise question. In a recent publication in the CMAJ, You and colleagues provide another useful framework first developed by Walter et al. Readers are encouraged to read this¹.

The surprise question has been used successfully in family medicine clinics in the Niagara region² and is used in over 1200 clinics in the United Kingdom as part of the Gold Standards Framework Program³. In the GSF framework, family medicine clinics also create a registry of patients who could benefit from a palliative care approach (i.e. when the answer to the question is “No, I will not be surprised if this patient dies in the next 6 to 12 months”).

Note that answering “No, I will not be surprised” does not mean that a family physician or other specialist has to refer the patient or transfer the patient’s care to a specialist palliative care team. This may only be required if there are very complex needs or if the family physician or specialist wishes to confirm or discuss a care plan. In most cases, the family physician or specialist may provide palliative care alongside other treatments to control the disease as best possible.

The surprise question is not meant to restrict palliative care to the last year of life, but promotes activating palliative care earlier than only the last days or weeks. It does not mean that clinicians are accurate at predicting life expectancy, but it does bring to the clinician’s attention the need for increased vigilance, ensuring that palliative care needs are addressed earlier and that we are not waiting for the last days or weeks.

Dr. José Pereira
Head and Professor, Division of Palliative Care, Department of Medicine, University of Calgary.
Medical Chief, Department of Palliative Medicine, Bruyère Continuing Care.
Medical Chief, Division of Palliative Care, Department of Medicine, The Ottawa Hospital.
Medical Lead, Champlain Regional Hospice Palliative Care Program.

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¹ You JJ, et al. Just ask: discussing goals of care with patients in hospital with serious illness. CMAJ 2013 July 2013 DOI:10.1503/cmaj.121274
² Marshal D, et al. Enhancing family physician capacity to deliver quality palliative home care: An end-of-life, shared-care model Can Fam Physician 2008;54:1703.e1-7
³ Dale J, et al. A national facilitation project to improve primary palliative care: impact of the Gold Standards Framework on process and self-ratings of quality. Qual Saf Health Care 2009;18:174-180. Doc10.1136/qshc.2007.024836

Palliative Care: Early is Better than Late

Many physicians and other health professionals, as well as patients and the public at large, think of death and dying when they hear the word “palliative”. They equate it with the last days or weeks of life; also referred to as the terminal phase or end-of-life (EOL). This has many negative consequences.

Opportunities are lost, in patients whose disease is life limiting and progressing (whether it be cancer or an illness such as end-stage heart or lung disease), to improve symptom control, improve quality of life and engage in goals of care discussions and advance care planning in a timely manner. Lack of preparation in turn results in inappropriate treatment choices and poor use of health care resources. In Ontario, for example, Cancer Care Ontario reports that a very high proportion (42%) of cancer patients visit emergency departments in the last two weeks of life¹. In a recent retrospective audit at The Ottawa Hospital of patients who visited the TOH Emergency Department in the last two weeks of life, only about 1 in 10 had a “do not resuscitate” (DNR) order in place.

There is the concern that initiating palliative care early will increase psychological distress for patients and even shorten their lives. Evidence shows otherwise. “Late” palliative care (i.e. only in the EOL phase) versus “early” palliative (at the time of diagnosis) were compared in a recent randomized study involving patients with newly diagnosed metastatic lung cancer². In the “late” model, which is what usually happens, patients were first referred to medical and radiation oncology. They were referred for palliative care only in the last days or weeks when they entered the terminal (or EOL) phase. Patients randomized to the “early” model started palliation at the same time that they were referred for chemotherapy and/or radiotherapy treatments. Those who received early palliative care experienced significantly better symptom control, reported better quality of life and actually lived almost three months longer than those who received late palliative care.

Other studies have found similar results. In a large US study of almost 4,500 Medicare patients who died of congestive heart failure or cancer, palliative care was associated with increased survival³. In a study involving patients with lung cancer, hospice care was not associated with increased mortality and chemotherapy use in last 2 weeks of life did not improve survival4.

In 2002, the World Health Organization modified its definition of palliative care from an approach for “patients with terminal illnesses” to “patients with life threatening illnesses”. While this definition may be considered too broad by some, it serves to make the point that “early is better than late”. Even cancer survivors and patients whose life threatening illnesses are under control (not progressing) may benefit from palliation early (including symptom control, improvement of quality of life, goals of care discussions and advance care planning).

This does not mean that all patients with progressive life limiting illnesses have to be referred to specialist-level palliative care teams and services. With some basic training, primary- or generalist-level palliative care can be delivered effectively by family physicians, oncologists, internists, cardiologists and other specialists treating patients with progressive life limiting illnesses. The Regional Palliative Care Consultation Team (RPCT) – a merger of the Bruyère Palliative Pain and Symptom Management Consultation Team and palliative care nurse practitioners at Champlain CCAC – is available across Champlain to assist family doctors in providing palliative care and EOL care in the home or hospice. The contact number is 613-562-6397 or 1-800-651-1139.

If, for whatever reason, you are not able to provide palliative or EOL care, there are groups of palliative care physicians providing palliative EOL care in Ottawa who could provide that care. For contact information on the groups, please visit www.alavidapalliativehelp.ca, then click on the Hospice Palliative Care in Champlain link and then the City of Ottawa link.

Dr. José Pereira
Head and Professor, Division of Palliative Care, Department of Medicine, University of Calgary.
Medical Chief, Department of Palliative Medicine, Bruyère Continuing Care.
Medical Chief, Division of Palliative Care, Department of Medicine, The Ottawa Hospital.
Medical Lead, Champlain Regional Hospice Palliative Care Program.

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¹ Cancer Care Ontario. CSQI Annual Report (2013)
² Temel J, et al. Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer NEJM 2010; 363:733-42
³ Connor SR, et al: Comparing hospice and non-hospice patient survival among patients who die within a three-year window. J Pain Symptom Manage 2007;33:238-246
4 Saito AM, et al: The effect on survival of continuing chemotherapy to near death. BMC Palliat Care 2011; 10:14