Description:
This ECHO session is built around case examples of patients who had chosen to be do-not-resuscitate (DNR), but who had a reversible medical issue arise that was overlooked for a variety of reasons. We will present the cases, discuss factors that facilitate misjudgments, and discuss a method that can reduce the likelihood of missing reversible causes. Click here to view the slides.
Presenter(s):     Dr. Romayne Gallagher, MD, CCFP(PC), FCFP
Clinical Professor, Division of Palliative Care, UBC
Board Member, CSPCP
Dr. Dave Williscroft, MD, CCFP (EM/PC) FCFP FRCP(C)
Clinical Associate Professor, UBC

Moderator:        Dr. Gordon McDonald, MD, CCFP(PC)
Clinical Assistant Professor – Family Medicine
Memorial University
Board Member, CSPCP

Description:
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 Results from prior studies, which were largely based on proxy measures, are now outdated.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.

Presenter(s):     Dr. Eric Finkestein

Description:
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.

Presenter(s):     Dr. Paolo Mazzota
Moderator:        Dr. Romayne Gallagher

Description:

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.

Presenter(s):     Dr. Amit Arya & Dr. Naheed Donsani

Description:
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.

Presenter(s):     Dr. Alexandra Saltman
Moderator:        Dr. Amit Arya