Palliative Care McGill Annual Report 2008/2009




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Palliative Care McGill Annual Report 2008/2009


Annual Report 2008/2009


Palliative Care McGill


July 20, 2009


Director: Anna Towers, MD

Research Director: Robin Cohen, PhD

Acting Research Director: Bruno Gagnon, MD, MSc


Prepared by: Gayle A. Shinder, PhD

DIRECTOR’S REPORT


Introduction

The past year has been a very productive one for the Palliative Care Division. We have again made our mark on provincial, national and international levels. Following successful reviews by the Programme Québecois de Lutte Contre le Cancer both the MUHC and JGH Programs have achieved level 4 supraregional designation. We have also shown leadership at the Quebec level in promoting interdisciplinary education via the Réseau Québecois des Soins Palliatifs. We have been active within the McGill RUIS, leading a successful pain and symptom protocol development effort in Gatineau. Nationally we have been advocating for subspecialty status for Palliative Medicine via the Canadian Society of Palliative Care Physicians. Internationally we are recognized for our research efforts and for the organization of the very successful 17th edition of the International Congress on Palliative Care, a four-day Congress that took place in September 2008. The effort continues with the next biennial conference being prepared for October 2010.


Palliative Care McGill researchers cover the spectrum from psychosocial research, clinical trials and rehabilitation issues, including anorexia/cachexia and lymphedema. Further information on the research interests of the group can be found below in the Acting Research Director’s report.


The Palliative Care Residency Program is preparing for an internal review in September 2009 and is confident of being able to meet that challenge.


Highlights

Significant achievements in our palliative care divisions in the past year were:

  1. Successful site visits by the Programme Québecois de Lutte Contre le Cancer, Québec Ministry of Health with both the MUHC and JGH Palliative Care Programs receiving full level 4 supraregional designation. Our Palliative Care Divisions have therefore been recognized as provincial leaders in interdisciplinary models of care.

  2. Major renovations of the MGH Palliative Care Unit were completed in July 2008 with very pleasing results and a more comfortable environment for patients and families. JGH palliative care unit renovations are underway and due to be completed by June 2009.

  3. A successful 17th International Congress on Palliative Care.

  4. Leadership in a nationwide process to investigate the status of palliative medicine as a specialty in Canada, via the Canadian Society of Palliative Care Physicians.

  5. On the provincial and national level we are involved in outreach to other Faculties and Schools (Nursing, Social Work, Pharmacy, Philosophy) to promote interdisciplinary teaching and learning, via our leadership efforts within the RUQSP (Quebec) and the EFFPEC project (Federal).

  6. New clinical research protocols under the leadership of Dr. Bruno Gagnon as MUHC coordinator of clinical trials.

  7. In May 2009 Palliative Care McGill hosted our most successful Palliative Care Week to date, co-ordinating the efforts of five different Montreal palliative care/hospice programs to host a well-attended community outreach program and a Hike for Hospice.


Past Year’s Activities

Teaching activities

Dr. Golda Tradounsky completed her first year as Educational Program Director and has lent innovation and stability to the undergraduate and graduate programs. The McGill Divisional Education Committee has met every 3 months to enhance the undergraduate and postgraduate programs. We are preparing for an internal review of our residency program in the fall of 2009.


Dr. Tom Hutchinson, one of our Faculty, is Director of the Centre for Whole Person Care which runs a popular film series, workshop series and which is very active in undergraduate teaching.


Several of our Faculty are Osler Fellows and are very involved in undergraduate teaching in The Physician Apprenticeship Course.


We have been active at the provincial level through the Réseau Universitaire de Soins Palliatifs (RUQSP) of which Dr. Towers was Founding Chair 2001-2008. Over the past year this group has been promoting interdisciplinary teaching and learning and held a special workshop in Drummondville on this theme in November 2008, regrouping Quebec palliative care teachers and researchers from various disciplines.


We collaborated with colleagues in the McGill RUIS region of Gatineau, organizing site visits, reviewing all their clinical protocols and planning conjoint teaching sessions.


We are active not only in medical teaching but also in nursing, psychology and music therapy. We are leaders in the palliative care volunteer training programs for the McGill hospitals and internationally via our biennial Congress.


The MUHC site continues to promote development of palliative care for non-cancer chronic conditions through a teaching program on communication around end-of-life care. Activities of the program in 2008 included the organization of three Medical Grand Rounds on the topic given by local and visiting professors.


International Development Activities: The 17th International Congress on Palliative Care. September 23-26, 2008

(See Palliative Care McGill Research News, Winter 2009 Special Issue for a more complete report)


The 2008 edition of the biennial International Congress on Palliative Care was a very successful event, attracting close to 1500 participants from 48 countries. For the first time the Congress was a trilingual one, with French and Spanish simultaneous interpretation. The four day program included five Plenaries, with an opening plenary by Charles Taylor, four concurrent Day Seminars, three Research Fora and two Special Seminars—one on volunteer issues and another on caregivers. There were 65 invited speakers from ten countries and 413 submitted abstracts from 31 countries. Some of the psychosocial highlights of the Congress are presented here.


The first day of the Congress included a day-long seminar on international issues entitled Palliative Care is a Basic Human Right – How Can We Right the Wrong? The International Association of Hospice and Palliative Care (IAHPC) and the Worldwide Palliative Care Alliance (WPCA) drafted a “Joint Declaration and Statement of Commitment on Palliative Care and Pain Treatment as Human Rights” (http://www.hospicecare.com/resources/pain_pallcare_hr/). As palliative care organizations are now mobilizing to encourage international human rights organizations to take up the cause, it seemed an opportune time to put this topic on the agenda at the 2008 International Congress on Palliative Care. Organized by Dr. Martin Chasen, this all-day seminar focused on palliative care delivery around the world.


From the Intensive Care Unit to the Home: An Examination of Hope and Meaning in Palliative Care for Children. Organized and chaired by Dr. Stephen Liben, this all day seminar took place on the first day of the Congress and focused on communication between palliative care physicians and the families of children in intensive care.


Healing and Whole Person Care: Palliative Care – Just Another Specialty?

This all day seminar was organized by Dr. Tom Hutchinson and brought to the forefront the notion that palliative care becomes more than just another specialty when the physician or other healthcare worker puts him or herself at least partly in the shoes of the person who is ill and possibly dying. This is a challenging step to take but changes the relationship of patient and caregiver in a profound way – one that fosters healing.


Clinical Master Class. The clinical Master Class, organized by Dr. Robin Love, covered a wide range of topics on pain and symptom management.


Research Fora. Organized and chaired by Dr. S. Robin Cohen, each of the three Research Fora featured three speakers and a discussant, followed by a question and answer period.


Family Caregivers. The Family Caregivers special seminar was organized and co-chaired by Drs. S. Robin Cohen, Serge Dumont and Johanne de Montigny.


A special volunteer training seminar was organized by The Council on Palliative Care together with the McGill Medical Simulation Centre. The videos are an excellent training tool for volunteers as they provide an opportunity for learning and reflection about key issues and challenges in providing support to palliative care patients and their families.


Clinical activities

The Montreal Neurological Institute has created a Neuropalliative Service that plans to include inpatient beds. This service will become an integral part of Palliative Care McGill once physician leadership is in place.


At the regional level the Palliative Care Division continues to advocate for more inpatient facilities for cancer patients with a prognosis of 3-12 months, who are too weak or symptomatic to be cared for at home. We made formal representations to the Agence on two occasions in the past four years. Our estimate is that we require 50 more hospice beds to ease pressure on the McGill hospital network. These patients are presently waiting at home with their distraught families, are on stretchers in our emergency rooms or are inappropriately taking up acute care beds on all our wards.


From January to June 2008 the MUHC palliative care unit on 10 East at the MGH underwent a $2 million dollar renovation to increase the number of private rooms, to increase the beds from 14 to 16 and to create better and more appropriate facilities for patients and families. The new unit, inaugurated in October 2008, was christened the Balfour Mount Palliative Care Unit.


Major renovations to the Palliative Care Unit of the JGH to improve infrastructure and facilities for patients, families and staff are due to be completed in June 2009.


We need to continue to advocate for increased beds in Montreal for palliative patients with a prognosis of 3-12 months. These patients are inappropriately occupying our acute care beds and our emergency room stretchers.


Academic Staff

There were no academic recruits in the past year.


As regards future recruitment, we require three more clinician teachers (one each for MUHC, JGH and St. Mary`s) and a clinician researcher who will help develop the clinical trials program.


Objectives and Priorities

  1. We are awaiting the appointment of a new holder of the Eric Flanders Chair in Palliative Medicine, the fruit of very active recruitment efforts over the past few years through the untiring efforts of Dr. Gerald Batist and the Search Committee.

  2. We will continue to host the International Congress on Palliative Care in Montreal and are now actively planning for the 18th edition that will occur in October 2010.

  3. We are organizing a full-day CME on pain and symptom management for physicians in November 2009, targeting family physicians and nurses in our RUIS area and beyond.

  4. We are supporting the movement towards interdisciplinary teaching and learning in Quebec universities through participation in initiatives of the RUQSP – a group that McGill has led since 2001.

  5. We are looking to recruit another clinician researcher who will help enhance our clinical trials program.

  6. At the regional level we will continue to advocate for more palliative care and hospice inpatient and chronic care facilities, especially for cancer patients with a longer prognosis of 3-12 months.

  7. We will support the development of the Neuropalliative program at the Montreal Neurological Institute site of the MUHC.



Anna Towers, MD

Director, Palliative Care McGill

RESEARCH DIRECTOR’S REPORT


Introduction

Dr. Bruno Gagnon was named Acting Research Director, Palliative Care McGill. He is also the new MUHC Palliative Care Clinical Trials Director and, under his leadership, a new Palliative Care Clinical Trials Unit was created. There are currently four ongoing industry-sponsored trials.


Dr. Robin Cohen continues to lead two important national research teams: the NCIC Sociobehavioural Cancer Research Network Palliative Care Team and the CIHR New Emerging Team in Family Caregiving in Palliative and End-of-Life Care (the latter as co-PI). Dr. Tom Hutchinson has had a very productive year in his Programs on Whole Person Care (see separate report). Dr. Antonio Vigano runs a CFI-funded McGill Nutrition and Performance Laboratory (www.MNUPAL.mcgill.ca). Dr. Anna Towers has been McGill lead in a Canadian-wide CIHR funded lymphedema research project since 2004. Drs. Neil Macdonald and Bruno Gagnon are co-leaders, with Dr. Jerry Pelletier from McGill’s Goodman Cancer Centre, of a Terry Fox Research Institute grant for the study of Cancer Anorexia –Cachexia Syndrome.


The Lymphedema Program received further pilot funding to develop a model tertiary care program and has established a multidisciplinary clinical, teaching and research presence at the MUHC and the JGH. The programs presented their activities at the International Lymphedema Framework conference in the UK in April 2009. Dr. Towers and the McGill program was nominated Canadian co-leader in the newly established and incorporated Canadian Lymphedema Framework (CLF)., with the support of the McGill Department of Oncology. This body is applying for charitable organization status and its aims are to promote Best Practice Guidelines and an international Lymphedema Minimal Data Set throughout Canada. The CLF is preparing a site visit to Uganda in June 2009 and will prepare a curriculum for lymphedema training and service development in that country.

The Cancer Anorexia-Cachexia Syndrome research project is a unique international collaborative research effort. It involves the development of animal models for investigating possible drugs for treatment of this syndrome, and the collection of clinical data from a cohort of cancer patients for human phenomenology of the syndrome.


New and Ongoing Research

The research conducted in the Palliative Care Division is broad and includes projects supported by the four CIHR pillars, the Kidney Foundation of Canada, the Terry Fox Research Initiative, the Social Science and Humanities Research Council and the National Cancer Institute of Canada. Broadly, the different topics of research are:

  1. Social behaviour including cultural influence, family and caregivers quality of life, home setting of and hospital setting evaluation of care.

  2. Development of outcome measures in the field of quality of life, cognition and pain.

  3. Pain and symptom management including pain, constipation, fatigue.

  4. Pathophysiology at the end of life, including cognitive failure, anorexia-cachexia.

  5. Whole person care.

  6. Alternative medicine, bereavement and communication, and decision-making in end of life care.

  7. Ethical issues at the end of life.


The research is being done in the field of cancer and advanced renal disease.


Funding

Funding was received for 19 new projects. For 13 of these projects, a member of our team is the principal investigator (total $3,596,365). Total funding for these new projects is $4,240,901. There are 30 studies or team grants continuing, representing a total of over $9.4 million (over $5.5 million as PIs).


Post-Graduate Research Training and Supervision

The research projects of a total of 9 master’s and 7 doctoral students, and 1 international student doing a Diploma in Experimental Medicine were supervised by our team.
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