Clinical Programs in the Department of Supportive Care - Palliative Care
1. The Palliative Care Program at
University Health Network
ELLICSR Summer Student Program
BreELLICSR Summer Student Program
Ernie Mak MD CCFP
Palliative Care Physician
Princess Margaret Cancer Centre
10th June 2016
MB BAO
Palliative Care Physician
Princess Margaret Cancer Centre
12th June 2015
2. 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!
3. • What is your understanding of the term
Palliative Care?
4.
5. • “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
6.
7. 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
8. Palliative Care Outpatient Clinic
End of Life Care
Palliative
Care Unit
Hospital
Home
Hospital-based Care
Community-based Care
Palliative Care Clinic
9. 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
10. 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
11. Typical referrals made from the clinic
1
Community Care Access Centre
services include nursing, personal
support, physical therapy,
occupational therapy, and equipment
such as hospital bed, walker,
wheelchair.
2
Medical/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
12.
13.
14. • 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
15. Palliative Care Program at UHN
• Consultation service
– Outpatient consultations
– Inpatient consultations
• Inpatient Palliative Care Unit
16. 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
17. Palliative Care Program at UHN
• Consultation service
– Inpatient consultations
– Outpatient consultations
• Inpatient Palliative Care Unit
18.
19. 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
24. 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
Housed within a larger department of psychosocial oncology and palliative care, which has representation at the executive level. PMH organized into depts of med onc, rad onc, surg onc and dept of psychosocial onc and pall care.
One of the purposes of our palliative care clinic is to provide a link between hospital-based care and community-based care from early in the disease trajectory, once a diagnosis of advanced, incurable illness has been established. We manage symptoms such as pain, nausea, constipation, breathlessness, and also refer patients to appropriate community-based resources such as CCAC or home visiting palliative care physicians. We also discuss Advance care planning from early on, to establish what the patient and their family’s goals of care are, and to document these in a timely fashion
Note: Referrals to other services by Oncology Palliative Care Clinic staff are not included in this figure. Longitudinal follow-up is usually weeks to months, but may be days to years. Transfers of care to community PCUs, hospices or home palliative care are for transitional and end-of-life care; transfers to the Lederman centre may be for end-of-life care or symptom control.
Housed within a larger department of psychosocial oncology and palliative care, which has representation at the executive level. PMH organized into depts of med onc, rad onc, surg onc and dept of psychosocial onc and pall care.
Housed within a larger department of psychosocial oncology and palliative care, which has representation at the executive level. PMH organized into depts of med onc, rad onc, surg onc and dept of psychosocial onc and pall care.
