POSTER PRESENTATIONS

P1:
Hospice Information Transfer: A Calgary Collaborative Approach
Hospice Information Transfer: A Calgary Collaborative Approach

Background: Safe transitions in care require effective information transfer among health-care providers and patients/families. When transferring patients to hospice in Calgary, this has been complicated due to the involvement of multiple service providers from locations within and external to Alberta Health Services (AHS), use of several information systems not accessible to all, and inconsistent processes for sharing paper and electronic information. A 2 year quality improvement project was implemented to revise processes and improve collaboration between care teams.

Methods: Using a qualitative improvement methodology, and with multiple stakeholder groups including deceased patients’ families, we redesigned information content, processes, and tools. Throughout the process, assumptions and differing perceptions of participants were clarified to enhance inter-professional respect and understanding.  Proposed changes went through extensive stakeholder feedback.  A pre-test survey was conducted prior to implementation of changes to quantify the existing concerns with information transfer.

Outcomes: Pre-test survey results from 141 respondents showed strong agreement that accurate (89%), relevant (89%), and timely (83%) information sharing was already occurring. Concerns reported included missing or duplicate information, extra time spent with phone calls, printing, and faxing documents, repetition of information provided, and information being outdated by the time of transfer. Participants described a shift in the culture of working together. 

Lessons Learned: Improvement requires collective understanding of problems before making changes. A collaborative and structured approach to identify needs and documenting rationale for decisions helps clarify what, how, and why certain information is needed at key points in a patient’s journey to hospice.

Authors:  Erin Forsyth RN BScN CHPCN(C)1, Kristen Ward MPT2,  Aynharan Sinnarajah MD MPH CCFP (PC)1,3, Heather Shantz, MN RN CHPCN(C)4
1
Palliative / End of Life Care, Alberta Health Services – Calgary Zone
2Clinical Quality Improvement, Alberta Health Services – Calgary Zone
3University of Calgary
4Palliative / End of Life Care, Alberta Health Services – Calgary Zone

Presenter: Shantz, Heather MN RN CHPCN(C), Palliative / End of Life Care, Alberta Health Services – Calgary Zone

P2:
Use of Standardized Assessment Tools to Improve the Effectiveness of Palliative Care Rounds: A Quality Improvement Initiative
Use of Standardized Assessment Tools to Improve the Effectiveness of Palliative Care Rounds: A Quality Improvement Initiative

Background: Optimal care for patients in the palliative care setting requires effective clinical teamwork. Communication may be challenging for health-care workers from different disciplines. Daily rounds are one way for clinical teams to share information and develop care plans for patients. 

Objective: The objective of this initiative was to improve the structure and process of daily palliative care rounds by incorporating the use of standardized tools and improved documentation into the meeting. We chose a quality improvement (QI) approach to address this initiative. Our aims were to increase the use of assessment tools when discussing patient care in rounds and to improve the documentation and accessibility of important information in the health record, including goals of care. 

Methods: This QI initiative used a pre-intervention and post-intervention comparison of the outcome measures of interest. The initiative was tested in a palliative care unit (PCU) over a 22-month period from April 2014 to January 2016. Participants were clinical staff in the PCU. 

Results: Data collected after the completion of several plan-do-study-act
cycles showed increased use and incorporation of the Edmonton Symptom Assessment System and Palliative Performance Scale into patient care discussions as well as improvement in inclusion of goals of care into the patient plan of care. 

Conclusion: Our findings demonstrate that the effectiveness of daily palliative care rounds can be improved by incorporating standard assessment tools and changes into the meeting structure to better focus and direct patient care discussions.

Authors:
Donna Spaner1,2
Valerie B. Caraiscos
Christina Muystra1
Margaret Lynn Furman
Jodi Zaltz-Dubin1
Marilyn Wharton1
Katherine Whitehead1,2

1. The Salvation Army Toronto Grace Health Centre, Toronto, ON
2. Department of Family and Community Medicine, University of Toronto, Toronto, ON
3. Freeman Centre for the Advancement of Palliative Care, North York General Hospital, Toronto, ON

Presenter: Spaner, Donna, The Salvation Army Toronto Grace Health Centre, Toronto, ON, Department of Family and Community Medicine, University of Toronto, Toronto, ON

P3:
How the Community Perspective is Transforming Hospice in Collingwood
How the Community Perspective is Transforming Hospice in Collingwood
ABSTRACT: “Hospice = End of life”. This is believed by two thirds of people Hospice Georgian Triangle (HGT) connected with during their successful 2017 Community Engagement Campaign. Using an innovative survey, It Won’t Kill You to Talk With Us™, a determined Speakers’ Bureau, and extensive media campaign, HGT asked, “What role does hospice play in your community?”. The answer? Hospice = End of Life. And yet, when asked “What type of support do you think you might need after being diagnosed with a significant health challenge?” these same respondents indicated the need for supports and services that typically comprise the suite of possible Hospice offerings. Further analysis indicated individuals had removed themselves from the opportunity to seek support due to barriers created by the words “hospice” and “palliative care”. We needed a new way of addressing the needs, preferences and expectations of individuals facing the difficulties of a life-limiting illness. How then to effect societal change, to change the equation, gain recognition for a whole-journey approach to care? HGT believes change in perceptions happen by changing language and engaging in a different type of conversation. Utilizing this approach, HGT has undertaken a complete re-branding of their community services, designed new programs and worked with health partners to develop an integrated Shared Care Team delivering a palliative approach to care to all who need it. These efforts are resulting in community engagement with hospice in a different type of relationship; one that acknowledges unique needs and facilitates the best outcomes for all.

AUTHORS:
Goodwin, Heather
Integrated Care Program, Hospice Georgian Triangle, Collingwood, ON
Presenter: Goodwin, Heather, Integrated Care Program, Hospice Georgian Triangle, Collingwood, ON

P4:
Pallium’s Compassionate Communities Start-up Kit
Pallium’s Compassionate Communities Start-up Kit

Background: Pallium Canada has been providing palliative care education for healthcare professionals across Canada since 2001, and is now invested in helping Canada mobilize Palliative Care in the community setting, primarily through Compassionate Communities (CC). A compassionate community understands that death, dying, loss and caregiving are a natural part of life and that it is everyone’s business to care for one another at times of crisis and loss.  

Objectives: To mobilize communities across Canada to participate in creating their own CC’s.   To share best practice tools with interested individuals to continue the movement.  

Results: It has been demonstrated that when best practice supports are shared with communities looking to develop their own CC, they can reduce the start-up time by roughly 50%.  The resources included in the start-up kit are: 1) PowerPoint presentation to show why and how to build a CC, 2) Compassionate City Charter framework summary sheet, and 3) Activity to evaluate the audience interest in starting a CC.

Conclusion: Pallium has received repeated requests for help in starting CCs from all across Canada. In hopes of mobilizing the spread of CCs across Canada, Pallium created the start-up kit to help champions feel comfortable enough in launching their own CC initiatives. This health care community approach will lead to a more wholistic palliative journey.  

Authors:
Tompkins, Bonnie1
1. Compassionate Communities National Lead, Pallium Canada, Ottawa, ON

Presenter: Tompkins, Bonnie, Compassionate Communities National Lead, Pallium Canada, Ottawa, ON

P5:
Integration of an Electronic Medication Record (EMR) Utilizing a Shared Care Model
Integration of an Electronic Medication Record (EMR) Utilizing a Shared Care Model

Presentation Description:
As the healthcare system faces increased numbers of patients with chronic and complex needs, clinical collaboration and coordination of care can be improved. 

Our experience in home based Palliative Care is that patients may experience care that is fragmented, communication is often poor and information is not shared.

A pilot project was developed between the Temmy Latner Center for Palliative Care (TLCPC) Physicians and Toronto Central Local Health Integration Network (LHIN) Palliative care team to document in a shared Electronic Medication Record. The goal was to improve seamless exchange of information in a timely and secure manner, integrate care delivery and enhance team collaboration.
The pilot project was launched in July 2016 in one sub-region, Central North and included 2 Nurse Practitioners, 8 Physicians, 4 Palliative Care Coordinators and 1 Palliative Team Assistant.  
The project included an extensive process mapping exercise, pre-implementation time studies of current practice, documentation review and addressing privacy issues between participating organizations. 

Post implementation participants agreed the shared EMR contributed to team integration (100%), team-based decisions (85%) and improvements in overall care (92%).
The outcomes of the project showed timely access to information, avoidance of duplication for both the clinicians and patients, improved patient and caregiver satisfaction and improved patient outcomes.  

Next steps in the project will be to implement the EMR across the entire TC LHIN palliative care program catchment area, including all Palliative Nurse Practitioners, Palliative Care Coordinators and Palliative Team Assistants and ensure all privacy concerns are addressed as the implementation spreads to other areas.  

Authors:
Muscat, Meredith;
Puntanen, Leea


Toronto Central Local Health Integration Network, Toronto, ON

Presenter: Muscat, Meredith, Toronto Central Local Health Integration Network, Toronto, ON

P6:
Mentoring in Hospice Palliative Care: An Innovative Partnership Between Hospice and Home Health Care Services
Mentoring in Hospice Palliative Care: An Innovative Partnership between Hospice and Home Health Care Services

Nurses often educate themselves regarding how to provide a palliative approach to care however having the opportunity to practice and develop competency in a supportive environment with expert mentors offers enrichment that elevates the bar for best practice learning, professional growth and interdisciplinary team development.

The Nursing leaders at Carpenter Hospice and CalaCare Home Health Care Services have established a collaborative partnership to provide a guided practice experience in a residential hospice for RNs and RPNs employed by CalaCare. The initiative has been highly successful because of the involvement of hospice nurses who are very passionate to mentor and community nurses who are very committed to advance their learning in palliative care.
Nurses from CalaCare have attended the hospice for 1 or 2 days, working alongside the hospice interdisciplinary team to provide high quality palliative care that includes pain and symptom management and the establishment of rich therapeutic relationships grounded in providing emotional, psychological, social and spiritual support.

Our poster presentation will provide helpful tools for implementation – including samples of the documentation that was created to remove any potential legal and liability concerns. In addition, a summary of the qualitative self-reported benefits/challenges to both hospice nurses and home care nurses will provide insight into the importance of eliminating barriers and being innovative to enhance quality hospice palliative care integration, collaboration and practice in your community!

Authors:
Varga, Lynn1; Kazmaier, Jennifer2; Sisson, Kariz3; Best, Heather4
1. Carpenter Hospice, Burlington, ON
2. CalaCare Home Health Services, Oakville, ON
3. Carpenter Hospice, Burlington, ON
4. Carpenter Hospice, Burlington, ON

Presenter: Varga, Lynn, Carpenter Hospice, Burlington, ON

P7:
Learning Together: Redefining Palliative Care Continuing Education with Community Nurses
Learning Together: Redefining Palliative Care Continuing Education with Community Nurses

Nurses engaged in providing a palliative approach to care in the community have rich experience and are engaged in diverse settings – home, hospice, retirement home or long term care. Nurses sharing, networking and learning together create opportunities for improved provider knowledge, confidence and role satisfaction which potentially translates to improved care and satisfaction outcomes for both patients and families.

In 2014 leaders at Carpenter Hospice, the Hamilton Niagara Haldimand Brant CCAC/LHIN, the Palliative Care Consultancy Program and a representative community nursing agency (Paramed) formed an informal partnership to provide Palliative Care education for community health care providers. The Burlington Community Nursing Education Committee (CNEC) was developed in response to requests for continuing education about a range of topics important in all practice environments. The committee goals were aligned with local Palliative Care planning aims, as well as regional network objectives for coordinated education programs across sectors, and provincial priorities for strengthening service capacity and human capital.

Using existing networks for communication and resources, free education sessions were provided by CNEC members and local PC experts. Each educational session was intentionally focused on enhancing knowledge about evidence informed best practices in palliative care and building collaborative partnerships amongst nurses working in varied practice settings. Recent inclusion of retirement and long term care staff has broadened participation in these lunch hour sessions. This poster will describe this innovative approach to community nursing continuing education, significance and impact, and applicability to other communities.

Authors:
Forbes, Ruth1; Varga, Lynn2; Jarosewicz, Mira3; Amell, Travis4

1. Haldimand Norfolk Hamilton Brant LHIN Home Care, Burlington, ON
2. Carpenter Hospice, Burlington, ON
3. Paramed Home Health Care, Oakville, ON
4. Acclaim Health, Oakville, ON

Presenter: Forbes, Ruth, Haldimand Norfolk Hamilton Brant LHIN Home Care, Burlington, ON

P8:
Measuring Palliative Care Across the Continuum: Applying Big Data Concepts to Administrative Data Sets to Capture Current State Service Utilization
Measuring Palliative Care Across the Continuum: Applying Big Data Concepts to Administrative Data Sets to Capture Current State Service Utilization

The end-of-life journey is complex and in Ontario, care provision is shared across various providers and institutions along the continuum of care. The Ontario Palliative Care Network (OPCN) is an organized partnership of community stakeholders, health service providers and health system planners responsible for the development of a coordinated, standardized approach to the delivery of palliative care services in Ontario, Canada. With a health system perspective, the OPCN has built a data repository that links multiple routinely collected health administrative data sets at the patient level to capture care provided to those in their last year of life (end-of-life). This repository allows the OPCN to assess variance and gaps in service utilization, and identify benchmarks that can ultimately inform and improve delivery of palliative care services. 

The repository was leveraged to generate informational tools to share with OPCN partners to describe current system capacity and inform local capacity planning decisions. The OPCN will use the data to identify provincial capacity planning priorities and generate additional planning questions. This work is foundational in the OPCN’s efforts to understand delivery and timeliness of care across regions, rurality, income quintiles and disease types.  Ongoing development will ensure that the data repository will adapt to meet the evolving needs of the OPCN. For example, the repository is being leveraged to understand the current state of physician funding models for palliative care and to measure performance of palliative care in the Province.  

Authors:
Sniekers, Daphne, PhD1; Schwartz, Jason, PhD1; Esensoy, Ali Vahit, PhD1; Della Mora, Lauren, MPH1; Vahid, Saba, PhD1; Wu, Deanna, MBA1; Favell, Lisa, MBA1; Handa, Kiren, MBA, MSc1; Jakda, Ahmed MD, MBA Candidate (2018), CFPC (PC) 2,3,4,5 Gollnow, Angelika, MBA1,2
1. Cancer Care Ontario, Toronto, ON
2. Ontario Palliative Care Network, Toronto, ON;
3. Palliative Care, Grand River Regional Cancer Centre, Kitchener, ON;
4. Faculty of Medicine, McMaster University, Hamilton, ON;
5. Faculty of Medicine, University of Western Ontario, London, ON

Presenter: Sniekers, Daphne, PhD, Cancer Care Ontario, Toronto, ON

P9:
Innovative Delivery of Palliative Care Education Unique to Northern Ontario
Innovative Delivery of Palliative Care Education Unique to Northern Ontario

Introduction: Northern Ontario is geographically vast, with forty percent of the population living in rural and remote communities. The participation of primary care providers is essential to achieve equitable, high-quality Palliative Care (PC), yet geography and a lack of human resources present unique challenges for participating in PC education.

Objective
: The Northern Ontario School of Medicine’s PC Planning Committee, comprised of highly dedicated, interprofessional providers, has developed an innovative model of PC education, offering active learning opportunities designed to enhance knowledge translation and skill development.

Methods:  
1.
Educational strategies:

  1. face-to-face conference with expert keynote addresses, concurrent workshops for skill development, and posters that highlight local initiatives;
  2. educational series addressing foundational competencies
  3. clinical rounds to highlight best practice and provide access to regional expertise;
  4. workshops to address emerging needs. 
  5. Use of WebEx/Webcast and OTN ensure access to interactive group learning
    3.  Local needs are identified during program planning to ensure that gaps are addressed

    Results
    : More than 25 OTN sites participate in the series, rounds, and workshops; up to an additional 20 individuals participate in any given session via Webcast.
    Program Evaluations and self-reported outcomes demonstrate improvement in:  
  6. provision of PC aligned with best practice;
  7. communication with patients/families;
  8. collaboration among providers and partners;
  9. human and financial resource management

Conclusions: A distributed, community-engaged model of PC education is successfully reaching communities across Northern Ontario and has fostered a ‘clinical community of practice’ that is increasing access to quality PC. 

Authors:
Depatie, Alisha1; Cook, Clare2; Westaway, Heather1, 3
1. Continuing Education and Professional Development, Northern Ontario School of Medicine, Sudbury, ON
2. Continuing Education and Professional Development, Northern Ontario School of Medicine, Thunder Bay, ON
3. Lecturer, Clinical Sciences Division, Northern Ontario School of Medicine, Sudbury, ON

Presenter: Depatie, Alisha,  Continuing Education and Professional Development, Northern Ontario School of Medicine, Sudbury, ON

P10:
It Takes an Island: Creating the Manitoulin Hospice Palliative Care Resource Team
It Takes an Island: Creating the Manitoulin Hospice Palliative Care Resource Team

The provision of palliative care on Manitoulin Island in Northern Ontario is challenging: demographics, dispersed population, cultural diversity, limited resources, multiple health and social service agencies and institutions. In 2015, a group of providers and community members from across professions, agencies and cultures came together for a ‘value stream mapping’ process. Respecting diverse forms of wisdom and using both male and female gender spirits for balance, a common understanding of both current and desired palliative care experiences was created. The ‘Manitoulin Hospice Palliative Care Resource Team’ came into being and key areas were identified, aligned with the NELHIN priorities, to create the future for palliative care on Manitoulin Island.

Authors:
Pitawanakwat, Karen1; Fields,Paula2;  Kilbertus,Frances2

1- Wikwemikong Health Centre, Wikwemiking, ON
2- Manitoulin Health Centre, Little Current, ON

Presenter: Pitawanakwat, Karen, Wikwemikong Health Centre, Wikwemiking, ON

P11:
More than a Pretty Space: Admission Criteria for a Hospice Suite in an Acute Care Rural Hospital
More than a Pretty Space: Admission Criteria for a Hospice Suite in an Acute Care Rural Hospital

Hospice beds, co-located in acute care facilities, were funded across northeastern Ontario in 2017. Palliative care is an orientation to care described as a cultural shift in healthcare away from acute disease-focused interventions towards a holistic and person centered approach. Embedding hospice in acute care environment poses challenges that include establishing admission criteria that effectively use a limited resource and respect local values and cultures. The Manitoulin Hospice Palliative Care Resource Team, representing providers and community members from across professions, agencies and cultures came together to create admission criteria that were fair and equitable, based on local values and cultures. 

Authors:
Fields, Paula1; Kilbertus, Frances1

1- Manitoulin Health Centre, Mindemoya, ON

Presenter: Fields, Paula, Manitoulin Health Centre, Mindemoya, ON

P12:
Early Integration of Palliative Care and Advance Care Planning Discussions in a Pulmonary Rehabilitation Program
Early Integration of Palliative Care and Advance Care Planning Discussions in a Pulmonary Rehabilitation Program

North York Integrated Care Collaborative (ICC) is an innovative project focusing on caring for patients with chronic obstructive pulmonary disease (COPD) as they transition from hospital to home.  Patients attend an 8-week pulmonary rehabilitation (PR) program with education on diagnosis, treatment, care, rehabilitation, health promotion, and advance care planning (ACP).  Patients experience a collaborative and coordinated team approach across health care partners to reduce Emergency Department visits and readmissions, improve patient experience, and achieve seamless care.   At North York General, the Supportive Care Team has been an integral part of the PR program by facilitating ACP discussions, as well as providing symptom management and early palliative care.  
Facilitated group discussions have been shown to be helpful in emotionally charged situations such as young women diagnosed with breast cancer or adults newly diagnosed with dementia.  The Supportive Care Team offers ACP education for the ICC program since June 2016.  The conversations exploring wishes, fears, values and trade-offs, which are necessary for ACP discussions have been shared in a facilitated group discussion environment.  Anonymous feedback has been collected after each session.  The purpose of this poster is to showcase the integration of palliative and supportive care in the ICC program for patients living with COPD and the participants’ feedback to determine whether group discussions are an effective method for discussing sensitive issues related to ACP.  The results can guide further enhancement of ACP discussions so that families are aware of the wishes of their loved ones when it comes to end-of-life care.

Authors:
Daphna Grossman 1,2; Karen Lock 1; Valerie Caraiscos 1,2; Susan Woollard 1

1. North York General Hospital, Toronto, ON
2. Department of Family and Community Medicine, University of Toronto, Toronto, ON;
Presenter: Caraiscos, Valerie, North York General Hospital, Toronto, ON, Department of Family and Community Medicine, University of Toronto, Toronto, ON

P13:
Palliative and End of Life Care in Ontario First Nations: Responding to a Call for Action
Palliative and End of Life Care in Ontario First Nations: Responding to a Call for Action

The First Nations and Inuit Home and Community Care program is funded for a service delivery model of 5 days a week, 8 hours a day (FNIHB Policy, National 2008). With Palliative Care being recognized as a supportive but not specifically funded element of the program, a significant care gap for First Nations clients has been identified. First Nation communities that have established integration across organizational and service boundaries are better poised to successfully support the wishes of their community members; to remain in their homes and communities to palliate. The intention of the project was to respond to the Call to Action from the Lakehead University’s Recommendations to Improve Quality and Access to End-of-Life Care in First Nations Communities: Policy Implications from the “Improving End-of-Life Care in First Nations Communities” Research Project (December 2014). A Request for Proposal process was initiated to invite First Nation recipients (86) of the First Nations and Inuit Home and Community Care Program to submit proposals. 34 proposals were received, and 17 were accepted (representing 26 Ontario First Nation communities). Integration across organizations and service boundaries were mapped. These included, project alignment with provincial palliative and end-of-life care initiatives, collaboration with provincial home and community care services and the uptake of current resources, e.g. Cancer Care Ontario and The Canadian Virtual Hospice. Practice Highlight: A Community of Practice Model was used to promote communication and collaboration among programs allowing group members to identify successes and overcome challenges forging these new linkages and relationships.  

Authors:
Edey Hobson, RN, BNSc, MPH, Nurse Advisor, Home and Community Care, First Nations and Inuit Health Branch, Health Canada

Vanessa Follon, RN, BScN, Regional Coordinator, Home and Community Care, First Nations and Inuit Health Branch, Health Canada

Presenter: Hobson, Edey RN BA BNSc MPH, Nurse advisor, Health Canada – First Nations and Inuit Health Branch – First Nations and Inuit Home and Community Care

P14:
Legacy Program in Residential Hospice
Legacy Program in Residential Hospice

Legacy work provides a unique opportunity to reflect on one’s life while providing something tangible to loved ones for the future. The program is beneficial to enhance communication and increase social interaction at the end-of-life. Allen et al (2008) and Steinhauser et al (2009) in their research set out to demonstrate decreased rates of depression and anxiety in patients at the end-of-life who were involved in legacy programs. Since little data is available regarding the impact of legacy programs on patients and caregivers in residential hospice settings Lisaard and Innisfree Hospices set out to develop, implement and evaluate an organizational legacy program for their residents and their families. Making moments matter is a deeply valued statement within our organization. The heart of this project is providing a keepsake of individualized memories that will last forever. This project has been implemented and successfully evaluated through qualitative data, using minimal financing, volunteer hours and residential staff support. The initial responses have proven several key outcomes; verbalize relief of stress surrounding making meaning of one’s life, the completion of memorable moments at the end of one’s life, and increased staff job satisfaction in the work that staff do.   

Authors:
MacCuaig, Heather BSW, RSW, Social Worker, Lisaard and Innisfree Hospice and Karn, Martha RN, BScN, CHPCN(C), CON(C), Resource Nurse, Innisfree and Lisaard Hospices

Presenters: MacCuaig, Heather BSW, RSW, Social Worker, Lisaard and Innisfree Hospice and Karn, Martha RN, BScN, CHPCN(C), CON(C), Resource Nurse, Innisfree and Lisaard Hospices

P15:
Creation of a Grandparent Bereavement Support Group: Addressing an Identified Need
Creation of a Grandparent Bereavement Support Group: Addressing an Identified Need

Over time, professionals working in pediatric palliative care at Roger Neilson House have noted the important role of grandparents in the lives of both parents and children.  Once a child dies, few supports are available to these grandparents who often continue to provide support to bereaved parents.   The research literature highlights the important grief needs of grandparents who have lost a grandchild.  Grandparent grief is recognized as comprising of three parts: the grief for their grandchild, the grief for their own child, and the grief they themselves experience.  After reviewing the resources available to grieving grandparents in the Ottawa community, and finding that few exist especially in the form of group support, Roger Neilson House created a Grandparent Bereavement Support Group to help meet the needs of grieving grandparents.  The goal of the group is to provide a safe therapeutic space for grandparents to explore their grief and meet other grieving grandparents in order to reduce some of the isolation they may feel while grieving their loss.  The group includes both structured topics and open discussion recognizing that grief is unique to all individuals and will be experienced differently.  Tools and resources are offered to aid in the grandparent’s own personal experience of grief and in their role as a support to their grieving children.  Our next steps include conducting a research study to evaluate if the group is meeting the needs of grandparents and to provide program improvements. 
 

Authors:
Arnone, Madelena1; Grandmaison-Dumond, Lynn1

  1. Palliative Care Program, Children’s Hospital of Eastern Ontario, Roger Neilson House, Ottawa, ON 
Presenter: Arnone, Madelena; Grandmaison-Dumond, Lynn, Palliative Care Program, Children’s Hospital of Eastern Ontario, Roger Neilson House, Ottawa, ON

P16:
Bereavement Care: Where do We Begin? A Palliative Care Quality Improvement Initiative
Bereavement Care: Where do We Begin? A Palliative Care Quality Improvement Initiative

Background: Identified a gap in approach to care for individuals at risk for complex grief or maladaptive bereavement.  Needed accessible and sustainable practices in an inpatient palliative care unit where bereavement care is limited to the time during admission. This led to the development of a validated risk screening process, interprofessional care pathway, and bereavement resources. AIM: To improve access to bereavement care during admission for 75% of at risk care givers on the SMH PCU.

Methods:  Quality improvement framework using PDSA cycles of continuous improvement.

Results: A two year pilot study including internal validation of risk screening tool with a total of 366 caregivers screened. 23% identified as at risk for complex grief or maladaptive bereavement which is in alignment with existing literature.  Family satisfaction scores demonstrated improvement (26% to 39% satisfied or very satisfied with bereavement support) however approximately 49% respond “N/A” or left blank. 45.4% of at risk care givers have documented intervention with targeted resource or referral for specialist follow up.

Conclusions and next steps: Internal validation demonstrated the risk screening tool to be appropriate for our target population.  Documentation of bereavement care is not consistent and is an area for improvement.  Communication to caregivers around what bereavement care is provided in the time leading up to death is not consistent.  Current PDSA cycle including internal validation of the Bereavement Care Pathway may contribute to more consistent communication and documentation practices which will demonstrate improved access and satisfaction.

Authors:
Deans-Buchan, Sheila1; LaDelfa, Ignazio2; Kacicanis, Anna3; Villeneuve, Jamie4; Ailon, Jonathan5; Lewis, Jordan6

1. Specialized Complex Care-Palliative Care Program, St. Michael’s Hospital, Toronto ON and Adjunct Faculty-Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON

2. Specialized Complex Care – Palliative Care Program; Inner City Health – Internal Medicine St. Michael’s Hospital, Toronto, ON; Facutly of Medicine, University of Toronto, Toronto, ON

3. Specialized Complex Care – Palliative Care Program,Specialty Clinics, Breast Center and Department of Environmental and Occupational Health, St. Michael’s Hospital, Toronto, ON

4. Department of Spiritual Care – St. Michael’s Hospital, Toronto, ON

5. Specialized Complex Care Program – Palliative Care and Inner City Health Program – Internal Medicine St. Michael’s Hospital, Toronto and Assisstant Professor Faculty of Medicine, University of Toronto, Toronto, ON

6. Specialized Complex Care Program – Palliative Care, Positive Care Clinic St. Michael’s Hospital, Toronto, ON 

Presenter: Deans-Buchan, Sheila, Specialized Complex Care-Palliative Care Program, St. Michael’s Hospital, Toronto, ON, Adjunct Faculty-Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON

P17:
Talking to Kids About Death - Dying, Death, and Loss through Applied Theatre
Talking to Kids About Death - Dying, Death, and Loss through Applied Theatre

My name is Keri-Lyn Durant and I am a second-year student in the Joint PhD Educational Studies programme at Lakehead University. In addition, I am a qualified teacher and theatre arts specialist. My work uses applied theatre (Boal, 2000) to support experiences with dying, death, and loss in a volunteer capacity in hospital/hospice settings as well as work as a drama facilitator at grief camps for children. If you attended HPCO 2017, my therapy sloth friend, Phoebe, and I had the pleasure and privilege of delivering a HIIT talk. The purpose of this poster is to highlight the work we currently do in hospital/hospice and palliative care, and set the scene for our upcoming study in elementary school classrooms in a northwestern Ontario town.

Phoebe and my work recently garnered the TBayTel For Good Community Award, worth $5,000, in order to take our project – Talking to Kids About Death – into a community that has expressed interest in embracing death education. As death education is a public health issue (Kellehear, 2015), we offer an interdisciplinary approach; children are voicing questions and concerns about dying, death, and loss and deserve to be heard (Kortes-Miller, 2014; Lee, 2004). We as educators actively prepare pupils for life, but we also need to prepare them for death (Ratner and Song, 2002). Affording communities a more prophylactic approach has the potential to bring both awareness and understanding of these difficult issues, equipping people, young and not-so-young, with coping strategies to face inevitable life events.

Authors:
Durant, Keri-Lyn1; the Therapy Sloth, Phoebe2
1. Faculty of Graduate Studies – Education, Lakehead University, Thunder Bay, ON
2. Thunder Bay Regional Health Sciences Centre/Hospice Northwest, Thunder Bay, ON

Presenters: Durant, Keri-Lyn, Faculty of Graduate Studies – Education, Lakehead University, Thunder Bay; the Therapy Sloth, Phoebe, Thunder Bay Regional Health Sciences Centre/Hospice Northwest, Thunder Bay, ON

P18:
Too Good to be True? Is There a Role for Charcoal in Diarrhea Management?
Too Good to be True? Is There a Role for Charcoal in Diarrhea Management?

Objective: Symptomatic therapy is an intervention centred on the symptom management and pain relief. The utilization of charcoal in diarrhea management is an example of this type of medical care. Diarrhea is an ailment defined as an escalation in the frequency of bowel movements, unformed stool, abdominal discomfort and pain. These symptoms can be extremely debilitating for patients, effectuate frustration, severely damper mood and overall well-being. This study aims to explore the use of charcoal in diarrhea management and its possible benefits in alleviating discomfort associated with these symptoms.

Methods: 
PubMed, MEDLINE and Google Scholar searches were used on recent literature available on the role of activated charcoal in diarrhea management and the finding were applied to case(s) study.

Results: 
It was found that the main precursors of diarrhea are drugs and bacterial infection. Activated charcoal has a firm history in its ability to attract and expel ingested toxins from the gastrointestinal tract. It acts to prevent system absorption of these adverse entities, adsorbing them on the surface of its particles, making it a suitable option in diarrhea management.

Conclusions: 
Diarrhea can present itself alongside a multitude of treatments and conditions, (eg.chemotherapy, primary malignancy, intestinal, colorectal and pancreatic cancer, bacterial infection, and irritable bowel syndrome), making activated charcoal a potential therapy in these conditions. In comparison, with other common anti-diarrheal treatments, activated charcoal has exceptionally few side effects. Overall, further research is necessary in order to wholly determine the effectiveness of charcoal in the management of diarrhea.

Authors:
Helen Senderovich (MD MCFP (COE) (PC))1,2,3,4 Megan J Vierhout5
1.Baycrest Health Sciences System, 2.University of Toronto, 3.Department of Family and Community Medicine, 4.Division of Palliative Care, Toronto, ON; 5.McMaster University, Hamilton, ON

Presenter: Senderovich, Helen MD MCFP (COE) (PC), Baycrest Health Sciences System, University of Toronto, Department of Family and Community Medicine, Division of Palliative Care, Toronto, ON

P19:
Physicians' Perceptions of Breaking Bad News to Cancer Patients and Family
Physicians' Perceptions of Breaking Bad News to Cancer Patients and Family

Breaking bad news to patients with a cancer diagnosis is not an easy task for physicians. The diagnosis must be explicitly stated and understood, and prognosis must be discussed in the most gentle and comfortable manner.

Objective:  to explore pre and post-training workshop the physicians’ perceptions and perspectives of breaking the bad news to cancer patients.

Methods: A quasi-experimental design which performed among physicians working in cancer center to compare their performance in breaking bad news before and after attending a communication skill workshop.

Results: Pre-intervention survey result showed 68% responded to the survey. 84% were comfortable with breaking bad news, and 70% had training in breaking bad news. 86% of responders stated that patients should be told about their cancer. 30% of them stated that they would still disclose the diagnosis to patients even if it would be against the preference of the relatives. Nearly 61% said that details be disclosed if asked. 67% of them disagreed that patients should be told about the diagnoses only if the relatives consent.  51% of physicians wanted to discuss the bad news with the family and patient together, whereas 24% said to discuss it with the patient alone

Conclusion: Physicians face a dilemma when families do not wish the patient to know the cancer diagnosis and taking into consideration the social circumstances in health care. When taking these into considerations, curriculum in the medical school must, therefore, be updated and must integrate the acquisition of skills in breaking bad news early in training.

Authors:
Sami Ayed Alshammary1, Abdullah Bany Hamdan1, Lobna M A. Saleem1, Savithiri Ratnapalan2, Balaji Duraisamy1
1. Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
2. Department of Pediatrics, Dalla Lana School of Public Health, Toronto, ON

Presenter: Alshammary, Sami Ayed, MD, MOH, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia

P20:
A Palliative Approach to Care for CKD: Goals of Care Discussions
A Palliative Approach to Care for CKD: Goals of Care Discussions

In its Ontario Renal Plan II, the Ontario Renal Network identified palliative care as a priority for people living with advanced chronic kidney disease (CKD).  A data analysis of 5,507 Ontario patients receiving dialysis showed high use of emergency department (59%) and intensive care (38%) in the last 30 days of life. Through a current state analysis of Regional Renal Programs, early Goals of Care discussions to inform shared decision-making were identified as a key gap across the province.

A province-wide intervention is being implemented to ensure that by 2019 all CKD patients have a Goals of Care discussion annually to inform their treatment decisions (including code status), with data collection required.

Education is being implemented to support the initiative, including a partnership with Pallium Canada and ORN-developed materials.

Over 400 healthcare providers have received training through the Pallium partnership and 26 Regional Renal Programs have begun data collection.

The poster will describe the multi-phased implementation strategy of the initiative and initial results from educational interventions.

Authors:
Peter Blake1,2, Jade Rust1, Jennifer Minelli1, Tea Palamarevic1,Tara Walton3, Sharon Gradin1, Marnie Mackinnon1

  1. Ontario Renal Network (ORN), Cancer Care Ontario (CCO)
  2. Department of Nephrology, London Health Sciences Centre 
  3. Ontario Palliative Care Network 
Presenter: Blake, Peter, Ontario Renal Network (ORN), Cancer Care Ontario (CCO), Department of Nephrology, London Health Sciences Centre 

P21:
Reframing our Conceptualization of ‘Alleviating Suffering’: Early Experiences of MAiD in a Hospice Setting
Reframing our Conceptualization of ‘Alleviating Suffering’: Early Experiences of MAiD in a Hospice Setting

Kensington Hospice is a 10-bed urban home-hospice that provides interdisciplinary palliative and end-of-life care to patients living with incurable illnesses and their caregivers. The hospice admits adults with an expected prognosis of less than 3 months and with goals of care focused on symptom management, with the aim of optimizing quality of life until death occurs naturally. 

Medical assistance in dying (MAiD) was legalized in Canada in June 2016 and allows a capable adult living with a grievous and irremediable medical condition to request medical assistance to hasten death. From June 2016 to September 2017, Kensington Hospice admitted 155 patients, 7 of whom requested, were approved for and received MAiD at the hospice. Admitted patients must meet the hospice admission criteria described above, and may not be admitted for the sole purpose of MAiD intervention. The assessment and provision of MAiD at the hospice is completed through a partnership with a local academic tertiary care centre with an established and recognized MAiD protocol, with independent physician and nursing staff.

Clinical characteristics of patients admitted to Kensington Hospice and those who have received MAiD at the hospice will be presented. Successes and challenges in providing simultaneous palliative care to patients considering or awaiting MAiD will be explored and the importance of interdisciplinary team support will be highlighted.

Authors:
Marchington, Katie1,2,3; Lewin, Warren1,2,3; Draper, Haley1,2,3.

  1. Kensington Hospice, Kensington Health, Toronto, Canada.
  2. Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Canada.
  3. Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Canada.
Presenters: Marchington, Katie; Lewin, Warren; Draper, Haley, Kensington Hospice, Kensington Health, Toronto, ON, Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON

P22:
Perceptions of Palliative Care in the South Asian Community
Perceptions of Palliative Care in the South Asian Community

This 2016 study used survey and qualitative interview methods to probe the perceptions of palliative care (PC) held by South Asian patients at William Osler Health System (WOHS).

The integration of PC into a treatment plan has the potential to improve quality of life for patients while reducing healthcare costs. Yet, several barriers exist to accessing these services, including misunderstandings of what PC is and culturally distinct beliefs and norms around later and end-of-life care.

 WOHS serves the Central West LINH, in which the per capita South Asian population is over 30%. Knowledge of perceptions of PC within this population is essential as the community increases and ages. Thus, this study sought to 1. Identify the perceptions that South Asian community members hold about PC, and 2. To explore the barriers that prevent individuals from utilizing conventional PC services.

The study surveyed and interviewed 20 participants. There was a significant lack of prior knowledge about PC among study participants. While there is a stigma associated with discussions of death and dying within this population, the majority of participants with some prior knowledge did not consider PC in conflict with spiritual beliefs or norms of family caregiving. These findings suggest further education among South Asian community members about PC could lead to a greater appreciation and uptake of PC services. They suggest it is critical for physicians to better communicate with patients about this approach earlier in the illness trajectory to ensure more equitable access to care. 

Authors:
Dosani, Naheed1; Chasen, Martin2, Ravi Bhargava, Ravi2; Dhillon, Sukhjeet2; Gill, Gurwinder2; Arya, Amit2; Keating, Bonnie M.2; Pang, Celeste3; Tut, Pavinder2
1. William Osler Health System, Brampton, Ontario; Department of Family Medicine, McMaster University, Hamilton, Ontario
2. William Osler Health System Brampton, Ontario
3. Department of Anthropology, University of Toronto, Toronto, Ontario

Presenter: Dosani, Naheed, William Osler Health System, Brampton, ON; Department of Family Medicine, McMaster University, Hamilton, ON

P23:
Identifying People with Palliative Care Needs in Ontario
Identifying People with Palliative Care Needs in Ontario

Evidence shows that early integration of palliative care can lead to a better quality of life for those with a progressive, life-limiting illness. Despite clear benefits, among Ontario decedents in fiscal year 2015-2016, only 60% of them were reported to have received palliative care services in their last year of life, and 25% were reported to have received palliative home care services. In partnership with the Ontario Palliative Care Network (OPCN), the Cancer Care Ontario Strategic Analytics Team is working to implement and evaluate data-driven approaches and algorithms to support earlier identification of patients who may benefit from palliative care. This abstract will discuss (i) a number of population-based methods for estimating the need for palliative care using mortality data, and (ii) predictive modeling approaches for early identification of individuals with palliative care needs, using administrative data. This important work aims to provide evidence to support health system measurement and planning of palliative care services in the province. 

Authors:
Liu, Zhihui (Amy)1,2; Schwartz, Jason1; Jakda, Ahmed3,4,5,6; Sniekers, Daphne1; Esensoy, Ali Vahit1; Woltman, Kelly3; Martin, Taylor G3, Gollnow, Angelika3
1. Strategic Analytics, Cancer Care Ontario, Toronto, ON;
2. Dalla Lana School of Public Health, University of Toronto, Toronto, ON; 
3. Ontario Palliative Care Network, Toronto, ON;
4. Grand River Regional Cancer Centre, Kitchener, ON;
5. McMaster University, Hamilton, ON;
6. University of Western Ontario, London, ON

Presenter: Liu, Zhihui (Amy), Strategic Analytics, Cancer Care Ontario, Toronto, ON, Dalla Lana School of Public Health, University of Toronto, Toronto, ON

P24:
Prevalence of Dementia in a Geriatric Palliative Care Unit
Prevalence of Dementia in a Geriatric Palliative Care Unit

Background: Considering the globally aging population, dementia is more prevalent as an illness managed by palliative care and the burden of dementia in various palliative care settings is anticipated to increase exponentially.

Objectives: To determine the prevalence of dementia on a PCU and to determine if there is a difference between length of stay (LOS) and palliative performance scale (PPS) score in individuals with or without dementia.

Methods: This is a single-center descriptive retrospective chart review of all individuals (N=780) admitted to Baycrest Health Sciences PCU from January 1, 2014 to September 1, 2016.

Results: 780 patients were admitted to the PCU during the study period. 32 (4.1%) individuals had advanced dementia, 121 (15.5%) had a non-cancer diagnosis and 627 (80.4%) had cancer as the primary reason for admission. In the cancer and non-cancer groups, 113 patients had a comorbid dementia diagnosis. The mean admission PPS score in patients with cancer was 36%, non-cancer was 32.6% and dementia was 23.8% (p<0.001). Mean LOS in patients with cancer was 32 days, non-cancer was 34.3 days and advanced dementia was 33.3 days (p=0.90).

Conclusion: Individuals with an admission diagnosis of advanced dementia had a lower mean PPS score than individuals admitted with other non-cancer and cancer diagnoses. There was no difference in the mean LOS between the three groups. Individuals with an admission diagnosis of advanced dementia should not be refused admission because of fear of outliving their prognosis. 

Authors:
Giulia-Anna Perri 1,2,  Anna Berall 1Jurgis Karuza 1Amnada Lo 1,3

1. Baycrest Health Sciences, University of Toronto, Toronto, ON
2. Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON
3. Providence Healthcare, University of Toronto, Toronto, ON
1. Baycrest Health Sciences, University of Toronto
2. Division of Palliative Care, Department of Family and Community Medicine, University of Toronto
Presenter: Perri, Giulia-Anna, Baycrest Health Sciences, University of Toronto, Toronto, ON, Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON

P25:
Improving the Early Identification of Individuals Experiencing Homelessness who can be Connected to Palliative Care
Improving the Early Identification of Individuals Experiencing Homelessness who can be Connected to Palliative Care

Individuals experiencing homelessness suffer from increased and early mortality from chronic disease due to a variety of factors such as the social determinants of health, co-morbidity with complex mental health disorders and substance use disorders.  Because of this, it is often difficult to identify individuals who would benefit from palliative care.   The issue is further impacted by poor predictability of currently available prognostication tools and a lack of expertise and support for health & social service providers to recognize clients who would benefit from palliative care.  For example, identification tools such as Cancer Care Ontario’s INTEGRATE tool employ screening criteria that do not account for the complexities of this population.  The overall goal of the project is to improve the identification of individuals experiencing homelessness who would benefit from formalized palliative care.  This will be achieved in part through the completion of a retrospective chart review of clients of the Palliative Education and Care for the Homeless (PEACH) to determine what factors are associated with prognosis after referral to the program.  The data derived from this study will then be utilized to help inform the development of a modified identification tool to help facilitate earlier referrals to palliative care services.   This, in turn, will contribute to a larger initiative supported by the Toronto Central Palliative Care Network and funded by the Ministry of Health and Long Term Care titled “Strengthening Palliative Care for Toronto’s Homeless Population”.

Authors:
Schneider, Evan1; Dosani, Naheed1,2;Buchman, Stephen1,2; Berger, Philip2
1.  Department of Family and Community Medicine, Division of Palliative Care, University of Toronto
2.  Department of Family and Community Medicine, St. Michael’s Hospital – Inner City Health Associates (ICHA)

Presenter: Schneider, Evan, Department of Family and Community Medicine, Division of Palliative Care, University of Toronto, Toronto,ON

P26:
Creative Caregivers
Creative Caregivers

It is the goal of the College, through the Office of Research and Innovation, to bring faculty and students together with business collaborates to conduct applied research, development and innovation activities (the project), which will help collaborators become provide practical educational opportunities to College faculty, staff and students.  Of interest to Hospice Niagara was the challenge expressed by caregivers of creating nutrient-rich meals and snacks that taste good (given medication side-effects), are easy to eat and prepare, with accessible and affordable ingredients. 

Through a well-developed project plan, prototyping, hands-on testing, nutritional analysis (using Genesis R&D SQL software) and evaluation, 12 recipes have been developed and included in a recipe book primarily for caregivers of people living with cancer. 

These recipes are nutritionally balanced and specific to cancer patients as they are high in fat, protein and fiber, yet are made available in small portions.  Product taste complements drug interactions and side effects such as dry mouth, constipation and easy swallowing.  They are easy to prepare and affordable. 

Participants in this session will learn about this collaborative project, are provided with a project management template for projects of this kind that include participant input and feedback. Finally, participants will experience a live demonstration of a recipe preparation, tasting and have access to the recipes for sharing in their own community. 

Author:
Mataya, Joanna, MBA, BHScOT, Director Community Programs, Hospice Niagara

Presenter: Mataya, Joanna, MBA, BHScOT, Director Community Programs, Hospice Niagara

P27:
Using the Health Links Approach to Care and Innovative Practices to Support Coordinated Care Management for Palliative and End-of-Life Patients
Using the Health Links Approach to Care and Innovative Practices to Support Coordinated Care Management for Palliative and End-of-Life Patients
The Health Links approach to care targets patients living with four or more complex or chronic conditions. Consultation has identified that up to 40% of Health Links patients are likely to need high quality palliative and end-of-life care. This approach includes the patient, family, healthcare and community providers in the coordination of care to manage a single plan ensuring patients and families receive the care they need. Between 2015-2017, Health Quality Ontario completed a review of the best available information about Health Links and analyzed innovations and practices related to Coordinated Care Management, Transitions of Care and Mental Health and Addictions. As a result, innovative practices and supporting implementation information were endorsed and disseminated to support Health Links in their work to optimize coordination of care. These practices provide standardizaton to the field, align wiith statements emanating from Quality Standards and include tools and resources to inform adoption and measure impact. Practices range from how to identify target populations, initiating care plans, engaging patients as partners, to transitioning from hospital to home with considerations related to health equity and social determinants of health and partnerships with social and community services. (Source: http://www.hqontario.ca/Quality-Improvement/Quality-Improvement-in-Action/health-links).

At present, Health Links are actively recruiting patients and working through inter-professional teams to provide integrated and coordinated care. As the innovative practices are implemented across the province, there is opportunity to work through Health Links approach and innovative practices for Coordinated Care Management for all patients with complex or chronic conditions, including patients receiving palliative and/or end of life care.

Authors:
Stacey Bar-Ziv1, Kim Kinder1, Lorri Eckler1, Shannon Brett1, Jennifer Wraight1, Joanna DeGraaf-Dunlop1, Karen Poon1, & Lee Fairclough1
1. Health Quality Ontario, Quality Improvement Branch, Toronto, ON
Presenter: Bar-Ziv, Stacey, Health Quality Ontario, Quality Improvement Branch, Toronto, ON

P28:
Lidocaine Use for Neuropathic Pain in Palliative Inpatient and Home Settings: Policy Development, Implementation and Case Series
Lidocaine Use for Neuropathic Pain in Palliative Inpatient and Home Settings: Policy Development, Implementation and Case Series

Intro: Lidocaine has been used effectively in the post-operative (Vigneault et al. 2011 , Marret et al. 2008) and chronic pain settings, but we are just starting to realize the medication’s potential in palliative care (Seah 2017).  The opioid crisis and more chronic nature of our palliative population necessitates innovative pain management strategies.

Objectives: In a large community suburban hospital:  
1.  Collaboratively develop and implement a lidocaine bolus/infusion policy with the anaesthesia department in palliative patients. 
2.  Use a case series to assess effectiveness of lidocaine in hospital and at home.  

Results: After successful interprofessional development of the lidocaine policy, we effectively implemented it in 8 patients over 3 months.  Patients with a strong neuropathic pain component were recruited.  Pain scores and total opioid doses decreased appreciably. Overall, pain scores improved by 5-9 points (numeric rating scale) after lidocaine introduction, and total opioid doses decreased by >50%.  1 patient was discharged home with lidocaine boluses.  1 patient had adverse effects (drowsiness) possibly related to the lidocaine. 

Conclusions: A successful collaboration with anaesthesia colleagues produced a safe and effective lidocaine protocol in palliative care patients.  These partnerships should become more commonplace, and we plan to introduce anaesthesiologists into our regional cancer centre’s palliative clinics. 

Intravenous lidocaine boluses and infusions are safe, effective for pain relief and have decreased total opioid doses.  In the future, we plan to initiate lidocaine at home, and develop a policy for outpatient ambulatory care use. 

Authors:
Sutton, Kimberly1; Punja, Alim2; Sirr, Valerie2; So, Cindy1; Yuen, Harold1; Baguio, Arnell1; Lebner, Adrianne1, Mulhern, Katie1
1.  Division of Palliative Care, Southlake Regional Health Centre, Newmarket, ON
2.  Department of Anaesthesia, Southlake Regional Health Centre, Newmarket, ON

Presenter: Sutton, Kimberly, Division of Palliative Care, Southlake Regional Health Centre, Newmarket, ON

P29:
Developing a Collaborative Compassionate Community; Crossing the Divide Between Acute and Community Care for Volunteers in an Acute Care Palliative Care Setting
Developing a Collaborative Compassionate Community; Crossing the Divide Between Acute and Community Care for Volunteers in an Acute Care Palliative Care Setting

Part of the current strategic planning for  SJHC Medicine and Senior’s Program Plan  is to expand supportive, palliative and end of life services. Over the next 5 years one key deliverable include  creating an ongoing educational and teaching resource for staff ,learners from  interprofessional groups  to volunteers associated with components of palliative and end of life services. There are numerous training programs throughout the province, nationally and internationally that are consistent with the overall philosophy and model of palliative care as set out by the Palliative Care Stewardship Committee at SJHC. 

Long standing provincially standardized curriculum for palliative volunteer training is available through our community hospice palliative care partners.SJHC partnered with Heart House Hospice community hospice . Heart House Hospice provides the training for a number of other hospice organizations .  Their training program is  integrated with ongoing quality improvement to meet changing needs of the community. There has been an opportunity to meet with a variety of stakeholders and develop a short and long term plan to support this training for SJHC volunteers. The training model and materials  have been adapted and customized to support SJHC philosophy of care for palliative care. Funding was secured through the centralized education fund at SJHC for volunteers to participate.SJHC and Heart House Hospice will work to continue the volunteer training and education moving forward. As part of the ongoing continuing education and quality improvement the two organizations will work to ensure that these specially trained volunteers are part of initiatives within the program around self-care and team building and evaluation.

Authors:
Rugg, Maria 1: Nicole Poos1; Ratchord, Katherine 2

1. Medicine and Seniors Program, St. Joseph’s Health Centre
2.Volunteer Department, St. Joseph’s Health Centre
3.Hart House Hospice, Inc
Presenter: Rugg, Maria, Medicine and Seniors Program, St. Jospeh’s Health Centre

P30:
Grief Happens
Grief Happens

Grief Happens is being submitted as a major thesis project for the Toronto Art Therapy Institute as a comic art therapy case study on myself and the topic of grief. This project focuses on my journey of grief and self-identification caused by the loss of my mother, by means of a graphic novel journal. Through this project, I have used my personal case study as a vehicle to explore the use of art therapy to heal and redefine oneself and demonstrate how comic art can be used to shape the therapeutic dynamic for art therapists and clients alike.

I want to use this project as an opportunity to share with the community my personal experience of losing a loved one. To make this information accessible through a transgressive format, such as a graphic novel journal, I have intentionally focused on the ‘comic’ art therapy sessions (art therapy sessions where comic art was created as part of my chosen visual medium) that formed my healing

process. My hope in exhibiting this project is that it could ignite a conversation about art therapy and the possibilities of comic art being employed as a tool for dealing, healing and grieving openly.


Authors: 
Taylor, Chantal BA, Fine Arts, Ontario College of Art and Design, Graduate Candidate, Toronto Art Therapy Institute

Presenter: Taylor, Chantal BA, Fine Arts, Ontario College of Art and Design, Graduate Candidate, Toronto Art Therapy Institute, Toronto, ON