PALLIATIVE CARE UPDATE  MONTREAL – CANADA

 

bullet PALLIATIVE CARE UPDATE: The federal government chose the 15th International Congress on Care of the Terminally Ill to go public with its support for palliative care. Along with that initiative, the field will also be achieving a higher medical profile now that it is to be incorporated as a discipline in the curriculum of every medical school in Canada. Meanwhile, a new pilot program that applies the principles of nutritional rehabilitation to long-term cancer patients shows promise for potentially offering better quality of life. Staff writer Susannah Benady was at the conference and files reports here.

 

ARTICLES ON THIS PAGE: 

bulletICCTI: End-of-life care to reach curriculum by 2008
bulletICCTI: Chronic care research gets $16.5-million booster shot

 

 

October 12, 2004 Volume 40 Issue 38

bulletICCTI: End-of-life care to reach curriculum by 2008

 

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Medical Schools must develop programs or lose their accreditation

bulletBy Susannah Benady

KEY FEATURES OF PLAN

bulletPalliative medicine is being introduced in every medical school in Canada to ensure that every doctor in the country qualifies with some training in end-of-life care
bulletBy 2008, all medical students and residents will have received training in end-of-life care and will have been evaluated on it in their final exams
bulletAll physicians should feel competent to manage pain control and know how to talk to patients at the end of life

Palliative medicine is being introduced in every medical school in Canada to ensure that every doctor in the country qualifies with some training in end-of-life care.

By 2008, all medical students and residents will have received training in end-of-life care and will have been evaluated on it in their final exams, Dr. Larry Librach, director of the Temmy Latner Centre for Palliative Care in Toronto, told the conference here.

"All physicians should feel competent to manage pain control and know how to talk to patients at the end of life," said Dr. Librach, a palliative care physician for 27 years.

The change comes after all the deans of Canada's 17 medical schools (including the new Northern Medical School in Ontario) agreed at this year's annual meeting of the Association of Canadian Medical Colleges that palliative medicine and end-of-life care should be incorporated into the curriculum.

"We have the approval of every single undergraduate and postgraduate dean in Canada for this project," he said.

Important area

The move is further evidence that palliative care is emerging as an important area of medicine and is part of a national strategy to improve the care of patients at the end of life.

Each medical school is now setting up an interdisciplinary curriculum change-team of palliative and end-of-life care educators, local opinion leaders and undergraduate and postgraduate training advisers to oversee development of the discipline.

"We have identified teams in each college to develop the curriculum, concentrating on undergraduates. The teams will address both local issues and help develop a national strategy."

But the curriculum won't change overnight, he said.

"This is a five-year project and at the end of that time we will just begin to see some changes. Some schools will start immediately while others will lag behind," said Dr. Librach, who, with his colleague Dr. José Pereira, has worked for years to bring palliative care into the medical mainstream.

Dr. Pereira, of the Calgary Palliative Care Program at the University of Calgary, and Dr. Librach collaborated on the Educating Future Physicians in Palliative and End-of-Life Care (EFPPEC) [emphasis in bold added] project, an initiative of the association of medical colleges and the Canadian Hospice Palliative Care Association funded by Health Canada.

Education standards

The EFPPEC organizers want core competencies and education standards for undergraduate and postgraduate trainees in the key clinical specialty areas, such as internal medicine, pediatrics, surgery, medical and radiation oncology, family medicine, critical care and emergency care.

Until now, physicians have been graduating from medical school almost completely untutored in end-of-life care, said Dr. Librach.

"Every year the American Association of Medical Colleges surveys every exiting medical student in both the U.S. and Canada and finds students feel totally unprepared to manage people at the end of life.

"Only about 30% say they feel competent in palliative care. All the rest say they feel totally incompetent to manage that.

"You can't practise what you don't know, what you don't see and what you are not evaluated on."

It is the involvement and commitment of the association of medical schools that will ensure the curriculum change really comes about, said Dr. Librach in an interview.

"The association is the accrediting body, and the medical schools will have to develop an end-of-life curriculum or lose their accreditation as a medical school.

"That's a huge, powerful stick."

ICCTI: Chronic care research gets $16.5-million booster shot

KEY FEATURES OF PLAN

bullet$16.5 million in funding for palliative care research
bulletthe initiative puts Canada ahead of the rest of the world in preparing for age-related illness that is set to double in the next 20 years.
bulletThe comprehensive scope of the research being carried out makes The Palliative and End-of-Life Care Initiative a world first 
bulletDr. Heyland's research team, of the kind that the government aims to build on in encouraging a research infrastructure throughout the country, is currently trying to assess the population's palliative care needs

 

bulletICCTI: Chronic care research gets $16.5-million booster shot

By Susannah Benady

MONTREAL – Following pressure from the Institute of Cancer Research and a number of provincial cancer agencies, the federal government has announced $16.5 million in funding for palliative care research. It's described as the largest investment ever made into this specialty in Canada.

The Palliative and End-of-Life Care Initiative will be funded mainly through the Canadian Institutes of Health Research (CIHR), with $2 million coming from other agencies.

The money, spread over five years, will enable the setting up of research teams around the country in an effort to create a nationwide palliative care infrastructure. Tony Ianno, minister of state for families and caregivers, said the initiative puts Canada ahead of the rest of the world in preparing for age-related illness that is set to double in the next 20 years.

"The comprehensive scope of the research being carried out makes The Palliative and End-of-Life Care Initiative a world first," he said as he announced the funding here at the 15th International Congress on Care of the Terminally Ill, hosted by McGill University.

The initiative is attracting international attention, particularly from Britain and the U.S. (National Institutes of Health). Both countries have expressed an interest in partnership possibilities, according to CIHR president Dr. Alan Bernstein.

The Institute of Cancer Research was the driving force behind the initiative after identifying palliative and end-of-life care as its number one priority.

"In 2001, we conducted a survey of 700 people throughout Canada, including caregivers and health professionals closely involved in looking after people with cancer and, in every case, palliative care came out as a critical priority," said Dr. Phil Branton, director of the institute.

Palliative care has been neglected as an area of research. An aging population means the end-of-life care burden will become even greater, Dr. Branton said.

"We were all profoundly moved by the burden of suffering carried by individuals (in the survey).

"The baby boomer generation will face this in larger and larger numbers. We are going to be seeing a lot of aging and critically ill individuals and we have to attract and train new researchers to ensure Canadians are always offered the highest and best quality end-of-life care," he said.

"Just in terms of cancer alone, the number of cases will double in the next 20 years."

At present, while the government spent $3 billion annually on end-of-life care, there was no way of knowing whether resources were being distributed effectively.

"We know that at present there is no system and I think we don't yet fully understand how to deal with this issue," said Dr. Branton.

"We need to know better how to cope with the problem, to look at how institutions can help and how we can, for example, develop better painkillers that don't have the side-effects of morphine, so that people can communicate to the end and yet have their pain dealt with."

While the focus of the initiative is on providing cancer care, there are about 300,000 people a year in Canada needing palliative care who are dying from non-cancer causes, said Dr. Daren Heyland, director of research at the critical care program at Kingston General Hospital.

"The majority of people in Canada die of non-cancer causes —heart disease, end-stage renal disease and liver disease," said Dr. Heyland, also an associate professor of medicine at Queen's University in Kingston, Ont.

Dr. Heyland's research team, of the kind that the government aims to build on in encouraging a research infrastructure throughout the country, is currently trying to assess the population's palliative care needs.

"The information does not exist right now about how satisfied or dissatisfied Canadians are," Dr. Heyland said."We are looking at what is best practice, what are the important elements of palliative care that satisfy communication between patients, caregivers and medical professionals and what is important in end-of-life decision-making."

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