Reflections from Ontario

Ted and I have been travelling for the past week and have packed a lot into a short period of time!

We attended the PSNO PSW Conference 2014 in Markham, ON on October 21st. It was wonderful to meet 300+ personal support workers! One PSW, Derek, spoke about his work in hospice palliative care and highlighted some of the challenges. What stood out me was his emphasis on the value of team.

A big thank you to the PSW’s who stayed for the closing plenary. I know you were tired after attending for the entire day. I appreciate being able to tribute you and reflect on my learnings in HPC.

Next was the OCSA Annual Conference on October 22nd and 23rd.  Harry van Bommel, M.Ad.Ed., CTDP, spoke on Putting the ‘Care’ Back into Healthcare. Mr. van Bommel has developed resources to help people navigate and negotiate the system and these resources can be used and adapted to people’s local areas. He is as warm and as kind as when I met him in 1992 after the CHPCA conference in Winnipeg (my first HPC conference). I had the pleasure of meeting with Kathy Duncan from PalCare Network.  They have regular courses they offer in Newmarket, ON and an extensive library of palliative care books, manuals and journals available for loan. They also have a special conference coming up in March 2015 for PSW’s and community members that sounds fabulous, so if you’re in that area you may want to contact them to find out more information.

In the morning I met a beautiful woman named Jenny from Thunder Bay. She spoke about her work with such joy. Then she talked of the challenges and violence that has been happening in her community.  Within an hour she came to our table and told us about the shootings f the soldier in Ottawa.

As the day progressed and the story unfolded, my heart went out to those who mourn the death of Nathan. And along with other Canadians I share the collective sorrow that comes with witnessing violence born in mental illness.

Next up is Niagara Falls, Ottawa and then the OLTCA Fall Symposium in Markham which we’re really looking forward to.


Kath’s favorite read this month – ""Generalist plus Specialist Palliative Care – creating a more sustainable model of palliative care"

In the essay “Generalist plus Specialist Palliative Care — Creating a More Sustainable Model”  Dr Timothy Quill and Dr Amy Abernethy propose that even though specialist palliative care consultations improve quality of care, reduce costs, and may increase longevity that all practitioners should have a core set of “basic palliative skills”.

Examples of core skills include the ability to identify patient goals, align treatment with those goals, and provide basic symptom management.  Examples of specialist skills which require additional training and expertise include negotiating complex family meetings and managing refractory symptoms.

The authors identify a few negatives to referring all dying patients to a palliative care specialist: insufficient specialists to address increasing demand, interference with existing therapeutic relationships, and primary care clinicians being led to believe that basic symptom management and psychosocial support are not their responsibility.

I remember a time when I thought that best care for the dying in Canada included registering all the dying with a hospice palliative care program and providing them with specialty consultation as required. (Currently less than 25% of dying Canadians receive support from a specialty hospice service.)

Over the past decade I have come to understand more about the economic and practical challenges to funding, developing and operationalizing fully staffed specialist programs across Canada, including in remote, rural and urban areas. It would be impossible to provide specialist teams for every individual… but it is not impossible to ensure that all generalists have basic knowledge of skills in providing palliative care.

One example of the generalist nurse providing excellent palliative care is the work being done by Home Care Nurses across the country.  Another example is the work being done by Health Care Assistants in providing care for people dying in Long Term Care.  Their work has strengthened my appreciation for the role of primary care providers in delivering good hospice palliative care!

Thanks Drs Quill and Abernethy, (themselves specialists in palliative care), for valuing the role of the primary care providers and for identifying a more sustainable model of hospice palliative care.

American Cancer Society Awards Its Medal of Honor to a palliative care physician!

Yahooo!  Way to go!  Good choice!

Dr. Diane E. Meier, one of the leading figures in the field of palliative medicine, received the Medal of Honor for Cancer Control in recognition of her pioneering leadership of the effort to bring non-hospice palliative care into mainstream medicine. Her work as a researcher, physician, and policy advocate has greatly improved quality of life for patients, survivors, and their families, and has inspired an entire field of professionals. One of her enduring contributions is making palliative care accessible throughout the trajectory of cancer, so that patients now can receive care focusing on quality of life even at the early phases of illness.

Congratulations Dr Meier!  Good work!

This is a big moment!  It was not very many years ago that the Cancer world did not even have “death on the table”.  So, this is progress!