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Central West Palliative Care Network Conference

"Partners in Care"

Wednesday, November 14, 2018
Embassy Grand Convention Centre
8800 The Gore Road, Brampton, ON  L6P 0B1 (view map)
 
Click here to view printer friendly conference flyer
10:30 am- 11:45 am                              CONCURRENT WORKSHOPS - SERIES #1
 
Session 1A:
The Impact of Caring on Family Caregivers providing Palliative Care
 
Jodi Pereira, Director of Community Programs, Heart House Hospice
Raquel Betini, Senior Researcher, Canadian Institute for Health Information (CIHI)
 
Family Caregivers are ‘The Backbone of Our health care System. Chronic, seriously ill and palliative persons are heavily reliant on caregivers to support their day to day needs. Caregivers need to be heard, included, engaged and respected for the role they play in supporting their loved one as they approach end of life. We also need to be prepared to support the psychosocial, emotional needs of the caregiver throughout their journey. We will summary the finding of research conducted with over 280 caregivers providing care to palliative individuals including 40 re-assessments completed after the caregiver had been engaged with Heart House Hospice.
 
Learning Objectives:  
1) Highlight Importance of Caregivers for person and health system, 2) Summarize research conducted using Caregiver Distress Index, and 3) Discuss current and innovation ways to respect, acknowledge and include caregiver.
 
Target Audience: Physicians, Nurses (RN and RPN), Personal Support Workers, Social Workers, Occupational Therapist, Physiotherapist, Administrators/Managers, Psychosocial Spiritual Care Workers/Chaplains
Learning Level:    Introductory, Intermediate
 
 
Session 1B:
Let's talk about sex..uality: Sexuality and Palliative Care
 
Martha McKelvey, RN, MScN, CHPCN, Nurse Practitioner-Primary Health Care-Palliative Care, Multidisciplinary Regional Palliative Care Netwok Clinical Co-Lead, Central West Local Health Integration Network, Brampton, Ontario
 
Sexuality is an important aspect of who we are; unfortunately when diagnosed with a life limiting illness this aspect of assessment is often overlooked in the patient care experience receiving palliative care. Let's break down the barriers to understand how we can support our patients by having a better understanding of sexuality and palliative care.
 
Learning Objectives: 
1) To broaden the knowledge and understanding of sexuality and palliative care by providing an opportunity to explore definitions about sexuality, intimacy, sex and sexual health, 2) Identify factors affecting the assessment of sexuality and sexual health in patients with advanced illnesses, 3) discuss expectations and highlight assessment tools, current guidelines and interventions
 
Target Audience:  Physicians, Nurses, Personal Support Workers, Administration/ Management, Social Workers, Occupational Therapist (OT),   
Physiotherapist (PT), Psychosocial Spiritual Care Workers/Chaplains                            
Learning Level:    Introductory, Intermediate

 
Session 1C:
Full Code or DNR? An Approach to Goals of Care Discussions in a Larger Cultural Context
 
Dr Amit Arya, MD, CCFP, FCFP, Palliative Care Physician, Brampton Civic Hospital, William Osler Health System, Brampton, Ontario
Dr John Davey, MD, CCFP (PC), Palliative Care Physician, Brampton Civic Hospital, William Osler Health System, Brampton, Ontario
 
Palliative Care Providers face challenges engaging in goals of care conversations, which often include a conversation about cardio-pulmonary resuscitation (CPR). When patients or families make decisions that conflict with provider recommendations, this can present ethical and legal difficulties. Cultural factors affect all areas of medicine but can be especially relevant when discussing wishes around end of life care. Different cultures may vary in how they approach informed consent, shared decision making, and end of life care. This may clash with established practices in our healthcare system, causing stress and uncertainty for patients, families, and providers. We will explore several different variables and how they influence CPR outcomes. We will discuss the variety of external factors and sources of information that may inform patients’ decision making. The workshop will look at certain controversial changes made by regulatory bodies impacting CPR decision making. How do we define “futility” from an ethical perspective? What are some of the cultural and community based values which could impact decision making and be driving aggressive care? Could there even be a small subset of patients where “sham CPR” could show compassion and caring? Is there a point at which the needs of the patient become less important than the needs of the family and community at large? This workshop should allow providers to gain a better understanding of how different cultures view end of life decision making and provide them with tools to approach these potentially difficult situations.
 
Learning Objectives: 
1) Develop an improved understanding of how patients with terminal illness understand CPR, and how television influences public perception of CPR outcomes; 2) Understand advanced CPR statistics, including how outcomes vary based on type of illness and functional status; and 3) Understand cultural and community values, and how they may have a large impact on end-of-life decision making.
 
Target Audience:  Physicians, Nurses, Personal Support Workers, Social Workers, Occupational Therapist (OT), Physiotherapist (PT), Rehab Providers, Administration/ Management, Psychosocial Spiritual Care Workers/Chaplains      
Learning Level:     Intermediate, Advanced

 
Session 1D:
Resilience, Patient-to-Patient Education, Support and Learning Channels
 
Eileen Dahl, RP, BSc, MDiv, CT, Registered Psychotherapist, Educator and Consultant, Orangeville, Ontario
 
A diagnosis of a life threatening illness may be simultaneously disruptive and transformative for both patient and family, often requiring individuals to dig deeper for coping strategies as they make sense fo their experience, learn about the illness, treatment options, adapt to new daily routines, process loss and explore implications for the near and distant future. Learning to live with a life threatening illness is an ever evolving, multifaceted ongoing process. Accessibility of resources is a key aspect of resilience and coping, however individuals can only access those resources that they are aware of. Online patient-to-patient networks, support groups and collaborative learning and education channels can be powerful sources of coping and resilience. Accessible 24/7, online support groups allow individuals and their family members living with life threatening illness to access to a global body of lived experience, intimate knowledge of the stressors inherent in living palliative and a supportive community that minimizes isolation. This workshop will explore the world of online patient support groups and the impact they can have on the resilience and coping of both patient and family. We will explore ways to assist patients / family in navigating and negotiating online peer support, particularly when issues such as mobility, illness, caregiving responsibilities, distance, transportation, limited resources, etc. may make it difficult to access other sources support. We will explore the potential benefits and challenges of creating and facilitating online support groups.
 
Learning Objectives: 
1) Explore the world of online patient support groups and the impact they can have on the resilience and coping of both patient and family, 2) Explore ways to assist patients / family in navigating and negotiating online peer support; and 3) Explore the potential benefits and challenges of creating and facilitating online support groups.
 
Target Audience:  Physicians, Nurses, Personal Support Workers, Social Workers, Occupational Therapist (OT), Physiotherapist (PT), Rehab Providers, Psychosocial Spiritual Care Workers/Chaplains      
Learning Level:     Introductory, Intermediate, Advanced
 
1:15 pm - 2:30 pm                               CONCURRENT WORKSHOPS - SERIES #2
 
Session 2A:
Barbara Menhenitt's Story: Three Viewpoints on one End-of-Life Experience in the Central West LHIN
 
Jill Oliver, Community Ethicist, William Osler Health System, Brampton, Ontario
Rick Tredwell, Ontario
Mary Jane McNally, MN, Chief Patient Experience Officer, William Osler Health System/Central West LHIN, Brampton, Ontario
Paula Chidwick, Director, Research & Corporate Ethics, William Osler Health System, Brampton, Ontario
 
In this presentation, audience members will hear the story of Barbara Menhenitt, a person who died in the Central West LHIN in 2017. Barbara’s story will be told from the perspectives of (1) an ethicist she met just prior to her final discharge from hospital, (2) her family who supported her and were with her when she died, and (3) the Chief Patient Experience Officer at William Osler Health System who worked with Barbara’s family following her death. In the last few months of her life Barbara touched multiple points of the health-care system in the Central West LHIN. Despite having a number of providers and organizations involved with her care, Barbara’s final days highlighted numerous ways that we can do better for patients – especially those at the end of life. Barbara’s story highlights how better coordination and communication between providers and organizations can positively affect a patient’s final days, and the lasting impact this might have on family members. Barbara’s story also underlines the importance of patient and family access to the information they need to be informed and active participants in their end-of-life plans. Barbara’s story also stresses the importance of recognizing requests for information about Medical Assistance in Dying, especially from those whose death might not be imminent. Barbara’s, in the end, highlights that providers and organizations can work better together with patients and their families to improve end of life in the Central West LHIN.
 
Learning Objectives: 
1) Opportunity to hear a patient story of end of life that involves many organizations in the Central West LHIN, 2) Be able to identify where and how better communication and coordination within the LHIN might improve patient experience; and 3) Be able to identify how Medical Assistance in Dying might be part of some patients' end-of-life plans, and how access to information can impact access to the procedure.
 
Target Audience:  Physicians, Nurses,  Personal Support Workers, Social Workers, Occupational Therapist (OT), Physiotherapist (PT), Administration/ Management, Psychosocial Spiritual Care Workers/Chaplains 
Learning Level:     Introductory, Intermediate
 
Session 2B:                
Radiation Therapy in Palliative Care
 
Dr Anthony Brade, MD.CM., PhD,  Division Head, Carlo Fidani Regional Cancer Centre, Mississauga, Ontario
Krista McGrath, MRT(T), BSc.(hons), BMRSc, Clinical Specialist Radiation Therapist, Carlo Fidani Regional Cancer Centre, Mississauga, Ontario
James Loudon, MHS, MRT(T), PMP, Manager, Radiation Therapy, Southlake Regional Health Centre, Newmarket, Ontario

Radiation therapy plays an essential role in the palliative setting for cancer symptom control. Common indications for palliative radiotherapy include: pain management, spinal cord compression, tumour bleeding, airway obstruction, and superior vena cava obstruction. Radiation treatments are localized to minimize side effects and typically require a single treatment or 5 daily treatments. In the 2017 Annual Report by the Office of the Auditor General of Ontario, it was noted that the target utilization rate for radiotherapy is 48% based on international best practices. However, the 2015/16 rate across Ontario was only 39% [1]. A study by Mackillop and Kong (2016), found that approximately one-third of palliative patients would benefit from radiotherapy, but do not receive radiation treatment [2]. This session will review the utilization of radiation therapy in the palliative setting, and opportunities to reduce barriers to optimal care. References: 1. Office of the Auditor General of Ontario. (2017). Annual Report. Accessed July 18, 2018 from: http://www.auditor.on.ca/en/content/annualreports/arreports/en17/2017AR_v1_en_web.pdf 2. MacKillop, W. & Kong, W. (2016). Estimating the need for palliative radiation therapy: A benchmarking approach. Int J Rad Oncol Phys, 94(1), 51-59.
 
Learning Objectives: 
1) Understand radiotherapy utilization in Ontario, 2) Review radiotherapy in the palliative setting; and 3) Review opportunities to reduce barriers to utilizing radiotherapy for palliative care
 
Target Audience:  Physicians, Nurses      
Learning Level:     Introductory, Intermediate

 
Session 2C:
Improving Caregivers experience: A quality improvement initiative.
 
Jehanara Chagani, RN, BScN, MSc(N), CHPCN(C), Advanced Practice Nurse, Central West LHIN Palliative Care Network, Brampton, Ontario
Alex Smith, Operations and Facility Manager, Wellspring Cancer Support Network, Brampton, Ontario 
 
Caregivers are providing 90 percent of the unpaid personal care to their family, friends and neighbours, of any age, who have physical and/or mental health care needs. These caregivers are at risk of burnout if they remain unsupported. Reports have identified the importance of caregivers, the risk of caregiver burnout and the need to support them. At Central West we have many organizations that support caregivers, however, they still face challenges finding and accessing appropriate information and supports. Caregivers are providing 90 percent of the unpaid personal care to their family, friends and neighbours, of any age, who have physical and/or mental health care needs. These caregivers are at risk of burnout if they remain unsupported. Reports have identified the importance of caregivers, the risk of caregiver burnout and the need to support them. At Central West we have many organizations that support caregivers, however, they still face challenges finding and accessing appropriate information and supports. Central West Palliative Care Network (CWPCN) is committed to improving palliative care and supporting the programs and policies that reflect the needs of patients and caregivers. A working group has been initiated and includes variety of partners across the system including caregivers with lived experience. Based on the information and experiences shared by the group and using quality improvement tools, the working group have identified and prioritized the unsupported needs of the caregivers. The group has identified opportunities to influence caregivers experience by creating awareness and connecting them to appropriate resources using PDSA cycle (Plan do act study) model. The planning, process and results of these PDSA cycles will be shared with the participants who are supporting caregivers in the community (intermediate level).
 
Learning Objectives: 
1) To inform on the identified gaps and areas for improvement, specific to caregiver experience, 2) To discuss the process used to create the PDSA cycle, based on groups experience and identified needs; and 3) To share the quality improvement initiatives in the form of PDSA cycle and subsequent recommendations.
 
Target Audience:  Physicians, Nurses, Personal Support Workers, Social Workers, Occupational Therapist (OT), Physiotherapist (PT), Rehab Providers, Administrators/Managers, Psychosocial Spiritual Care Workers/Chaplains, Other
Learning Level:    Intermediate

 
Session 2D:
Development of A New Ambulatory Model of Care: Nurse Led Palliative Care Triage and Navigation.
 
Dr Laura Harild, MD, CCFP(PC), Division Head, Palliative Care, Trillium Health Partners, Mississauga, Ontario
Nancy Lee Brown, RN, MSc(A), Advanced Practice Nurse, Trillium Health Partners, Mississauga, Ontario
 
By 2014, the Oncology-Palliative Care Clinics at Credit Valley Hospital were experiencing unsustainable volumes of outpatient referrals from across the Mississauga Halton and Central West regions at various stages of a patient's illness trajectory. Recognizing no new net funding would be available to manage the growing volumes, we required a multi-step, multidisciplinary approach to implement an innovation. Over the last 4 years, we have developed and evolved a nurse led model of Triage and Navigation for the Oncology Palliative Care Program. The goals of the model were to encourage and support early identification of patients with palliative care needs; to match patients to the most appropriate palliative care providers in and outside of the centre based on their needs in a timely manner, and to ensure high quality, effective transitions in care. Through better integration and partnerships with community providers, we were able to implement a New Ambulatory Model of Care with outcomes including an immediate reduction in clinic wait times as well as patient and external provider satisfaction. In this workshop we will walk you through the steps from designing the change, implementation, evaluation and sustainability.
 
Learning Objectives: 
1) Learn strategies to implement a large practice change, 2) Identify and manage facilitators and barriers to achieve success; and 3) Identify feasible indicators and outcomes to measure success.
 
Target Audience:  Physicians, Nurses, Social Workers (SW), Occupational Therapist (OT), Physiotherapist (PT), Administrators/Managers, Psychosocial Spiritual Care Workers/Chaplains
Learning Level:   Intermediate
 
2:45 pm - 4:00 pm                               CONCURRENT WORKSHOPS - SERIES #3
 
Session 3A:
From Diagnosis to Bereavement: Engaging the Public Across the Continuum 
 
C. Elizabeth Dougherty, BSW, MSW, RSW, Palliative Care Psychosocial Clinician and Educator, Burlington, Ontario
 
Since its introduction to North America in the 1970’s, Hospice Palliative Care has championed brilliant advances in caring for those facing life-limiting illnesses. Yet despite advances in healthcare, working in this increasingly high-tech environment often feels at odds with providing care for families facing life-limiting illness, end-of-life and bereavement. Beyond management of pain and symptoms, Hospice Palliative Care recognizes the psychosocial implications of a complex illness, namely, that physical, psychological and spiritual suffering can begin at diagnosis and last into bereavement. As such, compassionate psychosocial support cultivating person and family-centred care is essential across the continuum of care. Health Care Professionals can provide invaluable opportunities for individuals and families to connect, and collectively process experiences from time of diagnosis through to end-of-life and into bereavement. Understandably, if the psychosocial needs of individuals and families remain unaddressed, this only serves to create avoidable suffering. As a Palliative Social Worker in private practice, I believe in the importance of offering inclusive public events to support individuals and families facing illness, grief and loss. This workshop will engage attendees in a conversation about the psychosocial impact of a life-limiting illness as we collectively explore compassionate community events as essential opportunities to support people facing complex illness, uncertainty and loss.
 
Learning Objectives: 
1) Consider systems challenges impacting care of people facing dying and loss, 2) Examine psychosocial implications for individuals, families and healthcare providers facing illness, grief and bereavement; and 3) Explore compassionate community events as essential opportunities to engage the public following a life-limiting diagnosis through to bereavement.
 
Target Audience:  Physicians, Nurses, Personal Support Workers, Social Workers (SW), Occupational Therapist (OT), Physiotherapist (PT), Administrators/Managers, Psychosocial Spiritual Care Workers/Chaplains, other
Learning Level:     Introductory, Intermediate, Advanced

 
Session 3B:
The Highs and Lows of Cannabinoid Therapies
 
Dr. Vincent Maida, MD, MSc, BSc, CCFP(PC), FCFP, ABHPM, Medical Director, Hospice Vaughan, Toronto, Ontario
 
Patients with advanced illness that require palliative care continue to suffer significantly despite adherence to existing guideline driven treatment protocols. Cannabinoid therapies in general, and Medical Cannabis, in particular, has the potential to improve the quality of life of patients in this clinical context and beyond. Extracts of the cannabis plant have been used for medical maladies for thousands of years. Although the emphasis has long been on the role of the cannabinoids agents, THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol), recent research is highlighting the vast potential of the non-cannabinoid agents within cannabis, namely the terpenoids and flavonoids. An evolving theory dubbed the “Entourage Effect”, touts the potential synergy that occurs between the cannabinoid and non-cannabinoid agents observed in patients employing Medical Cannabis. Cannabinoid therapies have demonstrated efficacy in both malignant and non-malignant diseases for the treatment of multiple symptoms including pain, nausea, spasticity, anorexia, and anxiety. Emerging research is demonstrating an evolution in the utility of cannabinoids from polysymptom management to potential disease modulating effects. Furthermore, Cannabinoid therapies not only have the potential to improve overall pain and symptom management but may also be part of an overall risk-reduction strategy to reduce the overuse and abuse of opioids. Medical Cannabis may be purchased in either dried botanical format or in extracts that are compounded with organic oils. Dried MC may be either smoked or vapourized while MC oils may be directly ingested, made into edible products, or applied topically to skin and wounds.
 
Learning Objectives: 
1) Discuss the scientific basis for cannabinoid therapies and their potential for disease modulation, 2) Integrate cannabinoids as effective agents for poly-symptom management in malignant and non-malignant diseases, and 3) Reflect on the range of cannabinoid products and their routes of administration.
 
Target Audience:  Physicians, Nurses, Social Workers, Occupational Therapist, Physiotherapist, Rehab providers, Administration/Management, Psychosocial Spiritual Care Workers/Chaplains, Other 
Learning Level:     Intermediate

 
Session 3C:
Better Together: the Importance and Impact of Partnerships
 
Julie Pehar, R.R.T., BA, MEd, Director, Children and Youth Grief Network
Jodi Pereira, Director of Community Programs, Heart House Hospice, Mississauga, Ontario
 
WHY PARTNERSHIP IS IMPORTANT 1 in 50 children are bereaved, 13 in every school and one in every other classroom. In 2011 there were 318, 605 children and youth in the Region. 4-5% of children will lose a parent before the age of 16. In 2011 there were 318, 605 children and youth in the Region. This means at least 12,744 children in the Region of Peel will lose a parent before they are 16This means at least 12,744 children in the Region of Peel will lose a parent before they are 16. This session will highlight the collective approach used by Children and Youth Grief Network (CYGN) to influence change. It is the CYGN vision that every child and youth has honest information and well informed support when somewhere they care about is dying or has died. The CYGN’s mission is to advocate for educational opportunities and support services that will benefit children and youth who are grieving the dying or death of someone the care about. We will provide examples of practical ideas for steps others that will help develop collaborative informed and compassionate communities. In 5-years since its inception, The Children and Youth Grief Network has grown to encompass 13 grief organizations and professionals working in Peel, Halton and Toronto regions. Its’ vision is that every young person has access to honest information and well-informed support when someone they care about is dying or has died. Today, the Network is a vehicle that helps connect families to supports and resources and is a primary source of current and relevant data for member organizations. Additionally, we strive to ensure programs and resources adequately attend to the equity, diversity and inclusion of the local demographics.
 
Learning Objectives: 
1) Identify benefits and impact of working in collaboration, 2) How impact and influence of data; and 3) Inspire, motivate and share learnings with others
 
Target Audience:  Physicians, Nurses, Personal Support Workers, Social Workers, Occupational therapist, Physiotherapist, Rehab Providers, Administrators/Managers, Psychosocial Spiritual Care Workers/Chaplains, Other
Learning Level:     Introductory, Intermediate

 
Session 3D:
Social Work Practice in Residential Hospice: Resident and Family Needs Prediction by PPS
 
Linda Hochstetler, MSW, RSW, Social Worker, Education & Quality Lead, Bethell Hospice, Caledon, Ontario
Nazira Jaffer,  MSc, MHA, MBA, CHE, Executive Director, Bethell Hospice, Caledon, Ontario
 
Social Workers in residential hospice conduct intentional conversations with residents and family members. Many of these conversations are intuitive and are led by the needs of the residents and family members. Which conversations are needed are influenced by the Performance Palliative Scale (PPS) score of the resident. Often there is only one social worker working on a team of other staff and volunteers, and the unique role and contribution of the social worker may not be well defined. This workshop will describe preliminary qualitative research results conducted at Bethell Hospice based on simplified versions based on Grounded Theory and Phenomenological Research. The results demonstrate that knowing the PPS of a resident may help anticipate the psychosocial conversation needs of that resident and their family throughout their stay in the residential hospice. Anticipating needs also allows for the identification of relevant hospice palliative care knowledge from a psychosocial perspective and a thorough list of social work competencies for any residential social worker. Participants will leave with a list of specific conversational topics relevant to residents and family members at end of life.
 
Learning Objectives: 
1) To learn about how to conduct your own quality improvement research inspired by grounded theory and phenomenological research methods, 2) To understand the unique contribution made by social workers in a residential hospice setting; and 3) To understand the specific conversations needed by dying persons and their family members
 
Target audience:  Nurses, Personal Support Workers (PSW), Social Workers (SW), Occupational Therapist (OT), Physiotherapist (PT),  Psychosocial Spiritual Care Workers/Chaplains
Learning level: Intermediate
 
 
 

 
 
 
Thank you to our sponsors:
 
 
   
 
RIGHT AT HOME
CALEA
UNIVERSITY OF GUELPH-HUMBER
 
SPECTRUM HEALTH CARE
 
 
 
 
 
TWEED  WARD FUNERAL HOMES WILLIAM OSLER PRORESP      
 
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