Health Care Professionals

Demystifying Grief and Honouring Loss: Exploring Healing While Caring for Others and Ourselves

I am incredibly honoured to deliver Virtual Palliative Care Grand Rounds, “Demystifying Grief and Honouring Loss: Exploring Healing While Caring for Others and Ourselves” at University Hospitals, Case Western Reserve University School of Medicine.

In healthcare we move through an array of experiences, navigating acute emergencies, illness, death and a myriad of non-death losses, for ourselves, for all we love, and all we serve.

What about experiences that cannot be cured or fixed? As Dr. Kenneth Doka states, “Grief is a reaction to loss. We often confuse it as a reaction to death. It’s really just a very natural reaction to loss. When we lose any significant form of attachment, it’s the process of adjusting”.

There is no closure or “getting over” loss, nor are there finite timelines in grief.

We continue to grieve someone (or something) after loss and the cumulative effects and secondary losses that follow. Grieving the loss means learning to move forward, integrate, and metabolize the loss(es), while honouring the connection in meaningful and supportive ways.

In the face of trauma, loss and uncertainty, it can feel overwhelming to consider moving forward. Tedeschi & Calhoun highlight the importance (and benefit) of Post-Traumatic Growth, specifically:

  • Traumatic events are not viewed as desirable

  • Stories of others moving through trauma are always important in post-traumatic growth

  • Strength is often correlated almost paradoxically, following an increased sense of being vulnerable

In Kitchen Table Wisdom, Dr. Rachel Naomi Remen writes, “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.”

There is healing power in connecting with the voices and stories of others. I am grateful to share a space to honour healing in healthcare, in the face of grief, loss, connection and community.

FREE National Community-Based Primary Palliative Care Community of Practice (CoP)

I am honoured to be co-presenting “Practical Tips: Lessons from the Front Line”, the final session in the National Community-Based Primary Palliative Care Community of Practice (CoP) series. This Continuing Professional Development is FREE for all health care professionals is part of The Palliative Care ECHO Project led by Pallium Canada.

This community of practice focuses on supporting primary care clinicians to integrate primary palliative care in their practices. It is geared towards interprofessional primary health care providers across Canada. Each session is accredited by the College of Family Physicians of Canada.

This is the final session in the second series, which includes 11 sessions taking place on a bi-weekly basis. All webinars are recorded and available for playback. Topics include:

Pain: Beyond the Basics: November 9, 2022

Communication: Part 1: November 23, 2022

Communication: Part 2: December 7, 2022

Palliative Care and Substance Use Disorders: January 18, 2023

GI Symptoms in Palliative Care: February 1, 2023

Delirium: February 15, 2023

Spiritual Care and Rituals Around Death and Dying: March 1, 2023

Palliative Sedation: March 15, 2023

Grief and Bereavement: Beyond the Basics: April 12, 2023

Practical Tips: Lessons from the Front Line: April 26, 2023 from 1–2:00 p.m. ET
 
Interested in becoming a part of this FREE COP? Visit The Palliative Care ECHO Project

Loss in the Time of COVID: Exploring the Impact of Grief

Honoured to deliver Loss in the Time of COVID: Exploring the Impact of Grief as the Keynote address at Trillium Health Partners in support of National Hospice Palliative Care Week in Canada.

My sincere gratitude to everyone who joined our discussion via Zoom, for sharing time, reflections and energy - and for acknowledging the impact of trauma, loss and grief for healthcare providers as we continue to serve so many facing trauma, loss and grief during the pandemic.

COVID-19 Response – Free, Online Palliative Care Modules from Pallium Canada

Enhance your knowledge, skills, and practice in providing high-quality palliative care with these free, self-directed modules.

Pallium, in collaboration with the Canadian Medical Association (CMA), is providing access to essential education on palliative care for all health care professionals in response to this unprecedented COVID-19 pandemic. In these difficult times, it is more important than ever that all health care providers are equipped with the essential skills to provide compassionate, palliative care to patients in need.

Available modules

These modules are self-directed and completed at your own pace:

  • Taking Ownership

  • Advance Care Planning

  • Decision-Making

  • Managing Dyspnea

  • Palliative Sedation

  • Last Days and Hours

Additional Information

Pallium and CMA are making these 6 Learning Essential Approaches to Palliative Care (LEAP) modules available online for free to all health care professionals for 3 months (March 30 – June 30, 2020). These modules will help provide health care teams with an introduction to the palliative care approach focused on the important knowledge and skills required during the COVID-19 pandemic response. The modules are currently only available in English.

The Pallium Palliative Pocketbook can be found here. This best-selling book is a practical, one-stop resource with easily accessible information to help non-specialist physicians, nurses, pharmacists, and social workers provide a palliative care approach when needed.

Additional learning opportunities to help you expand your knowledge in palliative care can be found on Our Courses page, including our newly available LEAP Online course.

Have any questions? Email anytime at: info@pallium.ca

Source: Pallium Canada

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Death Cafe for healthcare professionals, health science students or healthcare volunteers

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Excited to be facilitating another Death Cafe for the Division of Palliative Care, McMaster Faculty of Health Sciences at McMaster University.

If you are a  Healthcare Provider, Health Science Student, Hospice Palliative Care  Volunteer  or Funeral Service Employee, this Death Cafe is specifically for you!

A Death Cafe is a group directed discussion of death with no agenda, objectives or themes. It is a discussion group rather than a grief support or counselling session. The objective is 'to increase awareness of death with a view to helping people make the most of their (finite) lives'. Source: Death Cafe

Please join us at this FREE event at the David Braley Health Sciences Centre on Wednesday, July 24th from 6-8pm as part of our Public Health Palliative Care Elective.

Please help spread the word. While the event is free, registration is required via Eventbrite: https://www.eventbrite.ca/e/death-cafe-tickets-62361840945?fbclid=IwAR2aqlWTC8CcDPU4TKspXU3hZC65Om4ZxZZikvgh9ztqz3TEUe9GJcFLJ00

Function in the Midst of Dysfunction: Supporting Families Facing Serious Illness

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Exploring the Language of Loss: Caring, Supporting and Empowering

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Honoured to offer "Exploring the Language of Loss: Caring, Supporting and Empowering" as the Opening Keynote for the PalCare Network 2018 Fall Symposium.

This workshop will explore the language of loss while also examining tools and resources to support individuals, families, and ourselves. 

Objectives:
1. Examine the impact of loss in person and family-centred care
2. Encourage the caregiver to engage in the dialogue of loss
3. Explore self-care as an essential element of professional practice 

For more information about the PalCare 2018 Fall Symposium, or to register, please visit: http://www.palcarenetwork.org/

From Diagnosis to Bereavement: Engaging the Public Across the Continuum

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Excited to present "From Diagnosis to Bereavement: Engaging the Public Across the Continuum" at the 2018 Partners in Care: Central West Palliative Care Network Annual Conference. 

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; 
3. Explore compassionate community events as essential opportunities to engage the public following a life-limiting diagnosis through to bereavement. 

For more information, or to register, please visit: http://cwpcn.ca/en/annual-conference/

End Game Documentary and Discussion

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Excited to co-host and participate on the panel for the launch of the 2018-9 season of "The 100% Certainty Project. Death: Something to Talk About". Join us for a screening of the Netflix documentary, "END GAME" followed by a conversation with Palliative Care clinicians.

Our free public event at McMaster University features the brilliant documentary "End Game" from Shoshana Ungerleider, MD highlighting the essential tenets of Hospice Palliative Care. The film showcases the collaboration, compassion and communication as the heart of person and family-centred care at UCSF Medical Center with Steven Pantilat and the extraordinary interprofessional team. The film also highlights the brilliant work of Zen Hospice Project, showcasing Dr. BJ Miller and the extraordinary interprofessional team in Hospice.

Please join us for this engaging event! While the event is free, registration is required via Eventbrite via https://www.eventbrite.ca/e/end-game-documentary-and-discussion-tickets-50535681584

Almost all Canadians would benefit from palliative care. Only one in seven can actually access it at end-of-life

“The key to providing decent palliative care is a little bit of basic planning. Four conditions – cancer, cardiovascular disease, COPD (lung disease) and diabetes – account for 70 per cent of deaths.

Those chronic conditions all have fairly predictable courses of illness in the terminal phase. You don’t get diagnosed with lung cancer or heart failure one day and die the next. It’s a months-long process and providing pain relief (palliation) should be standard, and a priority.

Two in three people receive home care in their last year of life. But only one in seven receive palliative care in the home.

That’s the failure point – and that’s what we need to fix.

There needs to be a commitment – philosophical and financial – to bringing palliative care to patients when they need it and where they want it.

Not everyone can (or should) be cared for at home in their final days. It’s back-breaking, emotionally-draining work for loved ones. Yet many would do so willingly and lovingly.

But they run up against a gross number of barriers, ranging from difficultly getting home visits from physicians (who are poorly remunerated for that work in many provinces), lack of nursing support (because of caps on home care hours), and absurd rules that mean drugs taken at home are not covered by medicare.

All the problems raised by the CIHI report are easily resolved. For example, having paramedics provide palliative care can eliminate transfers to hospitals. Sending doctors and nurses to homes or nursing homes can free up hospital beds – and save money in the process. Not to mention that, at the very least, people deserve a modicum of dignity in their dying days.

The whole point of palliative care is to improve quality of life. We shouldn’t let bureaucratic and structural inadequacies undermine that necessary and noble work.“ by the brilliant André Picard via The Globe and Mail

Honoured to be on Faculty for the National Learning Institute hosted by the Canadian Hospice Palliative Care Association 

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Honoured to have been on Faculty for the National Learning Institute hosted by the Canadian Hospice Palliative Care Association (CHPCA) in Ottawa (June 14th-16th).

The CHPCA’s Learning Institute brings together healthcare professionals from across the country for an intense learning weekend. The program is directed towards intermediate and advance learning levels and is facilitated by specialist Hospice Palliative Care Clinicians, Educators and Researchers from across Canada, together with international leaders, making a sophisticated caliber of educators and mentors. This is the only event of its kind in Canada.

For information about the event, please visit: http://conference.chpca.net/about/

Many healthcare students and providers do not feel prepared to encounter dying and death

Am excited to co-facilitate this event with the Division of Palliative Care at McMaster University as we discuss, "What makes life worth living in the face of death?".

Many healthcare students and providers do not feel prepared to encounter dying and death. As part of our 100% Certainty Project. Death: Something to Talk About, this event will feature: the stunning memoir When Breath Becomes Air; will show the brilliant TED Talk from Dr. Lucy Kalanithi; and will conclude the evening with a Death Cafe where we will discuss how to make the most of our finite lives.

Dinner is provided. Registration is required and space is limited. All healthcare disciplines are welcome!

For information, or to register, visit:

https://www.eventbrite.ca/e/100-certainty-project-death-cafe-tickets-43946860242 

Patients feel psycho-social impact of chemo more acutely than physical side effects

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Highlighting the need for integrated Person and Family-Centred Care...

"The results show that there might be a gap between what doctors think is important or disturbing for patients, and what patients really think. Physical, psychological, social and spiritual support is needed at every stage of the disease" 

Source: Patients feel psycho-social impact of chemo more acutely than physical side effects. MedicalXpress

Practising compassion in an uncompassionate health system. Hearts in Healthcare

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"Yet, amidst the storm, some remarkable health professionals create a circle of calm. They go about their work in an unhurried way, finding time to greet their patients, put them at ease, listening deeply and offering kindness and compassion. They don’t neglect their clinical tasks, indeed they seem to get the work done with quiet efficiency. These inspiring workers go home with satisfaction and joy in their hearts. How is that possible?"

Source: Hearts in Healthcare Practising compassion in an uncompassionate health system 

Informed Patient? Don’t Bet On It

"We’ve seen too many patients regret decisions that they made without fully understanding their options, or the possible outcome. We encourage our patients, and our colleagues, to be partners in what are often life-changing decisions about health care."

Read the full article The New York Times

The diagnosis of a serious Illness. Important considerations to discuss with the Healthcare Team

Starting a Conversation with Your Healthcare Team

Whether you or a loved one have been newly diagnosed with a serious illness, or have been told your disease has progressed, you will have to make decisions about treatment. You may have many thoughts and emotions at this time. This can be a time of uncertainty and it is common to feel worried. It can be helpful to ask your healthcare team questions about what to expect, how to plan and what support and resources are available to you and your family. 

It can be helpful to ask your healthcare team questions about your illness so that you can best understand your treatment options. The following is a list of questions that may help you to make informed decisions about your plan of care. Please ask these questions if they are helpful in guiding you and your family, or ask whatever questions are important to you. It can be helpful to bring your list of questions to your medical appointment and record/write down the answers. If you have the support available, you can have someone accompany you to your appointments to listen and help record the details. 

Some questions you may ask your Healthcare Team: 

• Is the condition short or long-term? Reversible or irreversible? 

• Is the Illness curable or incurable?

• What types of treatment are available to treat the illness/condition? 

• Where is this treatment offered? Hospital? Clinic? Home? 

• What is the goal of treatment (cure, manage pain/symptoms, improve function, extend life)? 

• If the goal of treatment is to extend-life, how long does the average person live while receiving this treatment? What about those who do not receive this treatment? 

• How often is this treatment successful? 

• Does having this illness/condition impact the effectiveness of treatments/
interventions one might receive in an Intensive Care Unit? 

• What are the common risks and side effects of this treatment? Are there any possible dangers connected to this treatment? 

• Where and how often will I receive this treatment? How long do you expect this treatment to continue? 

• Is there a financial cost associated with this treatment? 

• When and how will you know if these treatments are working? 

• When or why might these treatments stop? If this treatment stops, what are other treatment options? 

• How will this treatment impact my life? What are the expected physical, emotional, psychological and practical issues? 

• What type of additional support is available to me? What about my family? 

• What are the physical, emotional, psychological and practical resources that
can help? How do I/my family access them?

It is important to take time to have conversations about your treatment with your healthcare team. Please ask questions that are important to you. Honest and open communication about your healthcare is so essential. 

The Conversation Placebo

"What’s often overlooked is that the simple conversation between doctor and patient can be as potent an analgesic as many treatments we prescribe."

Letting #Patients Tell Their #Stories. @DhruvKhullar

“As we acquire new and more technical skills, we begin to devalue what we had before we started: understanding, empathy, imagination. We see patients dressed in hospital gowns and non-skid socks — not jeans and baseball caps — and train our eyes to see asymmetries, rashes and blood vessels, while un-training them to see insecurities, joys and frustrations. As big data, consensus statements and treatment algorithms pervade medicine, small gestures of kindness and spontaneity — the caregiving equivalents of holding open doors and pulling out chairs — fall by the wayside.

But all care is ultimately delivered at the level of an individual. And while we might learn more about a particular patient’s preferences or tolerance for risk while explaining the pros and cons of a specific procedure or test, a more robust, more holistic understanding requires a deeper appreciation of ‘Who is this person I’m speaking with?’

In Britain, a small but growing body of research has found that allowing patients to tell their life stories has benefits for both patients and caregivers. Research — focused mostly on older patients and other residents of long-term care facilities — suggests that providing a biographical account of one’s past can help patients gain insight into their current needs and priorities, and allow doctors to develop closer relationships with patients by more clearly seeing ‘the person behind the patient’.”

Surrounded by #pain, #doctors turn to poetry, writing to #cope with #loss

"The genre has blossomed as doctors have become more comfortable acknowledging their humanity and vulnerability through prose, said Dr. Paul Gross, the founder and editor in chief of the online journal Pulse, which carries the tagline 'voices from the heart of medicine.'

Doctors deal with so many difficult situations each day, Gross said. “How do you process it? And how do you remain whole as a person?” Writing helps them work through those issues by forcing reflection..."