Canadian Hospice Palliative Care Association

(1) Background: Pancreatic cancer causes significant morbidity and mortality, and guidelines recommend early integration of palliative care alongside active treatment. As access to palliative care is often mediated by oncology clinicians, this survey sought to understand these clinicians' perspectives on barriers and facilitators to clinician palliative care referral and patient palliative care access. (2) Methods: An online survey was distributed via community and academic institutions across Canada to oncology clinicians who were able to refer a pancreatic cancer patient to palliative care (e.g., oncology nurses, medical oncologists). (3) Results: Of 134 clinicians from ten provinces, almost all (97%) believe that palliative care is 'very important' in pancreatic cancer care. The greatest perceived barriers to patient palliative care access included patient-family reluctance to accept palliative care (73%), lack of knowledge about services (50%), and lack of support from other healthcare professionals (40%). Perceived barriers to referring included patient-family reluctance to accept palliative care (57%) and lack of available specialist services (58%). Most providers suggested patient education as a strategy to overcome barriers (85%). (4) Conclusions: Perceptions about public acceptance may preclude oncology clinicians from referring to palliative care, despite nearly universal belief in its importance. The findings highlight service and education gaps for future intervention.

BackgroundDisparities exist in ACP engagement rates among culturally diverse communities. To address this, we developed an online learning course to help healthcare providers apply a culturally considerate and safe approach and appropriate communication skills when conducting ACP conversations with culturally diverse patients, particularly patients with a Chinese or South Asian background.MethodsThe course was developed using information from literature reviews, and focus groups with members of the Chinese or South Asian communities. The target audience is any healthcare provider that may have ACP conversations with their patients. Basic ACP information and cultural safety knowledge are considered prerequisites. Three modules were developed:Evolution of ACP: a refresher module about ACP.Culturally Safe Care: how culture can impact care, with an overview of cultural safety. This module applies to all cultures.Culturally safe ACP with Chinese and South Asian communities: bringing together the lessons of the previous two modules in the context of ACP with members of Chinese and South Asian communities.The course is evaluated through a survey following course completion.ResultsHealthcare providers that completed the evaluation survey were predominantly Nurses (42%) and Social Workers (36%) and did not identify with either the South Asian or Chinese Community (73%). Over 90% of respondents agreed the course was clear and well written, the content was easy to understand, it met their learning needs, and increased their knowledge on how to conduct culturally safe ACP. 97% of respondents thought the information could be applied in practice, and 85% said they are likely to recommend the course to a friend/colleague. Respondents requested expansion to cover additional cultures.ConclusionUsing the learnings from the course in ACP conversations, healthcare providers can help their culturally diverse patients to get care aligned with their values, beliefs and wishes.

Background: The palliative approach to care is playing a larger rolein the healthcare of older adults in Canada. Within (hospice) palliative care,informal caregivers play a crucial role as part of the interdisciplinary careteam. Ensuring high quality palliative care includes providing effective griefand bereavement supports for them. Objective: This study aimed toidentify current interventions addressing the grief and bereavement experiencesof informal caregivers of geriatric patients in the Canadian (hospice)palliative/end-of-life care realm. Methods: A scoping review wasundertaken using Arksey and O’Malley's framework. Seven electronic health andsocial science databases were searched. In addition, several stakeholderorganizations’ websites were reviewed to identify grey literature sources.Interventions that took place in Canada, were in English, and explored grief andbereavement supports for informal caregivers in an adult/geriatric (hospice)palliative care setting were included. After full text review, data wereextracted and charted. Major themes were established following thematic contentanalysis. Results: Within a total of 18 sources, three themes wereidentified: (1) Classification of intervention, (2) Format of intervention, and(3) Intervention target. Method of delivery and type of intervention for griefand bereavement supports were aligned with the international literature. Thereis a need for large-scale evaluations of interventions and informal caregiversshould be engaged in this process. Practitioners should be encouraged to directbereavement interventions toward grieving caregivers, and to collaborate withthem to improve access to these interventions. Policy makers should provideadditional funding for grief interventions for informal caregivers.Conclusions: It is important to better understand the needs ofinformal caregivers experiencing grief and bereavement. Interdisciplinarycollaborations will be necessary to develop, evaluate, and scale futureinterventions.

Long-term care homes (LTCHs) were at the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada and were the sites where most deaths occurred.[1][1] With increased morbidity and mortality of residents in the LTCH setting, clinician burnout risk is high, and team debriefs, especially

BackgroundPeople who engage in advance care planning (ACP) are more likely to receive healthcare that is concordant with their goals and wishes at the end of life. Primary care providers are ideally positioned to facilitate ACP. This study sought to describe the confidence, willingness and participation of primary care clinicians to have advance care planning discussions.MethodsWe conducted a survey of family physicians and allied health professionals (AHP)in primary care in three Canadian provinces. We asked about willingness and confidence to have ACP discussions and current participation on Likert-type scales (0=not at all, 6=an extreme amount). A modified Dillman approach was used for online survey administration.ResultsThe response rate was 72% (n=117) among physicians and 69% (n=62) among allied health professionals. Most physicians (77%) were practicing in an interprofessional practice. The mean willingness to initiate ACP was 5.0 for physicians and 4.8 for AHP. Mean confidence ratings for initiating ACP was 4.8 for physicians and 3.5 for AHP. Current participation in ACP among patients aged 50 years and older was lower; 2.6 for physicians and 1.4 for AHP.ConclusionsThe willingness of family physicians and AHP in primary care to initiate ACP discussions with patients is high. However, confidence is only moderate in AHP and actual activity is low for all clinicians. Efforts to remove barriers in primary care and provide support for AHP to improve their confidence to engage in ACP discussions should be priorities.

Patients with intracranial hemorrhage (including intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic hemorrhage) are commonly admitted to the intensive care unit (ICU). Although indications for oral antiplatelet agents are increasing, the impact of preadmission use on outcomes in patients with intracranial hemorrhage admitted to the ICU is unknown. We sought to evaluate the association between preadmission oral antiplatelet use, in-hospital mortality, resource utilization, and costs among ICU patients with intracranial hemorrhage. We retrospectively analyzed a prospectively collected registry (2011-2016) and included consecutive adult patients from 2 hospitals admitted to ICU with intracranial hemorrhage. Patients were categorized on the basis of preadmission oral antiplatelet use. We excluded patients with preadmission anticoagulant use. The primary outcome was in-hospital mortality and was analyzed using a multivariable logistic regression model. Contributors to total hospital cost were analyzed using a generalized linear model with log link and gamma distribution. Of 720 included patients with intracranial hemorrhage, 107 (14.9%) had been using an oral antiplatelet agent at the time of ICU admission. Oral antiplatelet use was not associated with in-hospital mortality (adjusted odds ratio: 1.31 [95% confidence interval [CI]: 0.93-2.22]). Evaluation of total costs also revealed no association with oral antiplatelet use (adjusted ratio of means [aROM]: 0.92 [95% CI: 0.82-1.02, P = .10]). Total cost among patients with intracranial hemorrhage was driven by illness severity (aROM: 1.96 [95% CI: 1.94-1.98], P < .001), increasing ICU length of stay (aROM: 1.05 [95% CI: 1.05-1.06], P < .001), and use of invasive mechanical ventilation (aROM: 1.76 [95% CI: 1.68-1.86], P < .001). Among ICU patients admitted with intracranial hemorrhage, preadmission oral antiplatelet use was not associated with increased in-hospital mortality or hospital costs. These findings have important prognostic implications for clinicians who care for patients with intracranial hemorrhage.

With the legalization of medical assistance in dying (MAiD) in Canada, physicians and nurse practitioners now have another option within their scope of practice to consider alongside hospice palliative care (HPC) to support the patient and family regardless of their choice toward natural or medically assisted death. To elucidate insights and experiences with MAiD since its inception and to help adjust to this new end-of-life care environment, the membership of the Canadian Hospice Palliative Care Association (CHPCA) was surveyed. The CHPCA developed and distributed a 16-item survey to its membership in June 2017, one year following the legalization of MAiD. Data were arranged in Microsoft® Excel and open-ended responses were analyzed thematically using NVivo 12 software. From across Canada, 452 responses were received (response rate: 15%). The majority of individuals worked as nurses (n = 161, 33%), administrators (n = 79, 16%), volunteers (n = 76, 16%) and physicians (n = 56, 11%). Almost 75% (n = 320) of all respondents indicated that they had experienced a patient in their program who had requested MAiD. Participants expressed dissatisfaction with the current psychological and professional support being provided by their health care organization and Ministry of Health - during and after the MAiD procedure. The new complexities of MAiD present unique challenges to those working in the health-care field. There needs to be an increased focus on educating/training providers as without proper support, health-care workers will be unable to perform to their full potential/scope of practice while also providing patients with holistic and accessible care.

Reviews developments, strengths and challenges in evidence-based spiritual care practice (EBSCP) using a hermeneutical method which compares and interprets a variety of written texts. EBSCP originated from evidence-based medicine (EBM) developed at McMaster University and was adopted as evidence-based practice (EBP) by multiple professional disciplines. EBSCP was first addressed in Canada and American spiritual care researchers in the US have since advanced EBSCP. Questions are raised about processes of integrating EBSCP in a Canadian context as well as areas for future research.