In 1981,Dr. Kathleen M. Foley was appointed chief of the newly formed Pain Service within the Department of Neurology at Memorial Sloan-Kettering Cancer Center. It was the first designated pain service in a cancer center in the United States. Dr. Foley was elected to the Institute of Medicine of the National Academy of Science for her efforts in the treatment of patients with cancer pain. She is currently Medical Director of the International Palliative Care Initiative of the Public Health Program of the Open Society Institute which advocates for the integration of palliative care into health systems globally.

All current members of the Canadian Hospice Palliative Care Association (CHPCA) are invited to attend the CHPCA Annual General Meeting.

Maureen McTeer is a fluently bilingual Canadian lawyer and the author of Tough Choices: Living and Dying in the 21st Century, which explores the legal and ethical challenges that science and medicine raise for society on matters as diverse as reproductive technologies and genetics through to the end of life concerns of palliative care, assisted suicide and euthanasia. She is the Canadian representative for the White Ribbon Alliance for Safe Motherhood and the public member of the Society of Obstetricians & Gynaecologists of Canada.

Description: This challenge panel will lay out the state of Hospice Palliative Care in First Nations Communities including jurisdictional issues; how health care is delivered in the First Nations and a glimpse of the future of Palliative Care in First Nations Communities. Rosella Kinoshameg will discuss how to best support the workers in the community in order to avoid burnout; what role educations plays; the changing times and the belief systems and where First Nation people would like to die - at home not in the hospital. Holly Prince will then will conclude with a discussion on the process and lived experience in developing programs through a community capacity development approach; assessing community needs; and grass-roots program development. This session will be provocative and informative.

Description : Advance care planning is increasingly more visible in Canada. In addition, there are ongoing restraints on resources within the health care system and other systems. This Challenge Panel will explore advance care planning in the context of these restraints. They will bring forward two scenarios related to engaging in advance care planning – one related to patients and families and one related to the system.

Description: This challenge panel will elaborate on the Canadian Society for Palliative Care Physicians National Consensus Guideline on Palliative Sedation Therapy. The National Consensus Guideline will be summarized by the first presenter. The second presenter will lay out ethical dilemmas around challenges and contentions issues as well as recommendations in the national consensus guideline. Lastly, there will be a “so what” presentation and discussion. How does one implement the national consensus guideline, what if professionals don’t abide by its guidance and what are some of the ethical dilemma’s.

Advance Care Planning (ACP) is the process by which a person considers options about future health care decisions and identifies what his or her wishes or preferences are. An advance care plan is a verbal or written instruction describing what level of care he or she would want (or not want) if he or she is no longer able to speak for him or herself. As health care technologies improve and advance and people with complex diseases live longer, ACP is becoming increasingly important. There is considerable evidence showing that ACP is poorly done; happening only at the very end of life when a crises occurs which complicates the decision-making process. Advance Care Planning in Canada: A National Framework and Implementation is a five-year project of the Canadian Hospice Palliative Care Association that aims to implement a number of changes to the current practices in ACP. The Framework has been developed through a national consultative process. One of the core components of the Framework addresses the development of tools that professionals need to facilitate and engage in ACP with their clients. The national Framework consultation process has identified the core elements of ACP tools and the need for tools across the country. The workshop will familiarize participants with tools that are currently available; to have the opportunity to provide input into the development of new tools; and to explore the use of and need for ACP tools in their own communities.

1. Background: Cancer patients do not voluntarily reveal all symptoms they experience. By asking them about symptoms using a structured systematic method, clinicians can find out about other symptoms, some severe and distressing; however, does systematic symptom assessment result in patients having improved symptom control? Goal: To systematically review the best research evidence regarding the effects of repeated, structured, systematic assessment of adult cancer patients’ symptoms on their wellbeing. Methods: Electronic bibliographic databases were searched to July 2009. Search sources included MEDLINE, EMBASE, HealthSTAR, CINAHL, Cochrane Database of Systematic Reviews, Health and Psychosocial Instruments and Proquest Dissertations and Theses. Search strategies were developed with the assistance of an experienced librarian. Criteria for inclusion were: published full papers in English reporting controlled clinical trials or systematic reviews examining the effects of systematic symptom assessment on cancer patients’ wellbeing. Partial Results: After screening by one person to eliminate obviously ineligible papers, 54 articles required full paper review by 2 reviewers, from which another 12 papers were reviewed arising from the reference lists. Five studies met the eligibility criteria. Two independent reviewers assessed the methodological quality of eligible studies using the Jadad Instrument to Measure the Likelihood of Bias and extracted information from the published reports. The 2 reviewers compared their data to reach consensus on the final data extraction. Conclusions: Data from eligible studies will be summarized and information synthesized to draw conclusions regarding clinical care and future research needed.

2. Every year, approximately 9000 children are diagnosed with cancer in the USA, and 1,289 in Canada, leading to 210 deaths. With the improvement of cancer treatment and pain management, increased attention has been given to other symptoms, as fatigue, that children experience and that may have a significant impact on their quality of life. Cancer Related Fatigue (CRF) is a condition characterised by diminished energy and functional deficiency. CRF may be acute, episodic, or chronic and is correlated with health status, emotion, pain, cognitive functioning, and role functioning. Although CRF has received much attention in the adult cancer population, comparatively little is known about the quality of life impact of fatigue among children with cancer and moreover its epidemiology and assessment. A comprehensive literature review was carried out in order to evaluate fatigue in children with cancer and in palliative care, to identify instrument developed for measuring fatigue in children with cancer and to describe the development and psychometric properties of the tools. This search was conducted on several databases (MEDLINE, CINHAL, ALL EBM, DISSERTATION PROQUEST, HAPI, PSYCHINFO) of scientific studies published from 1996-2008 on CRF in children. Over 40 references met the criteria for the review about CRF, among them 20 articles mentioned the assessment of CRF. Few validated assessment tools on CRF were found. Based on these results, the CHU Ste Justine Research Center has started a research project for the development of a new instrument to assess fatigue in children in palliative care and oncology.

3. With the advance of new treatments against cancer and great improvements in survival, particular attention is made in the literature to the different symptoms felt by children. Among ten most recognized symptoms, fatigue was reported by parents, children and healthcare professionals as one of the most prevalent symptoms. Few researchers have tried to explain cancer related fatigue (CRF) in children. The elaboration of a qualitative research design with a phenomenological interpretative approach will allow us to increase our understanding of the experience lived by children suffering from CRF. The first objective of this research is to describe the experience of children suffering from observable signs and symptoms of CRF. The second objective is to identify the signs that can lead to a description of CRF in children. Participant recruitment will be done at CHU Sainte Justine Hospital. The convenience sample will include at least 20 children suffering from cancer. Data will be collected through standard socio-demographic questionnaires, semi-structured interviews, as well as focus groups, and parent focus groups and participant observation. Finally, written documents shall be used to complete our analysis. For purposes of interpretative analysis, all interviews transcribed in verbatim as well as observation notes, dairy books and samples of human actions will be treated as similar texts. Data analysis will be made following the tradition of Hermeneutic Phenomenology. The knowledge built through the voice of children will allow elaboration of indicators of fatigue, leading us to the development of a fatigue assessment tool for children with CRF

4. Introduction: Continuity of Care (COC) is acknowledged to be a key indicator of quality of care. Yet, the impact of COC on patient outcomes in cancer has not been adequately studied. We examined patient-level measures of COC in relation to the patient outcome of supportive care needs. We also examined the contribution of different disciplines of health care providers to COC. Methods: This cross-sectional study recruited advanced-stage lung cancer patients. Three surveys of patient experienced COC were chosen to be tested in this study. 0f these, the ‘continuity and coordination’ domain of the Picker Ambulatory Cancer Care Scale (COC-PACC) captures COC at the cancer program-level. Additionally, patients completed the Supportive Care Needs Survey (SCNS) as a patient outcome. Results: 116 patients, 105 from ambulatory and 11 from the home setting, were enrolled. The COC-PACC distinguished between patients dichotomized to high and low supportive care needs on the informational (-23.86, 95% C.I. - 36.60, -11.13; P=0.001) and psychological domains (-20.67, 95% C.I. -31.17, -10.17; P<0.0001). This association remained significant in multivariate analysis. Patients identified providers from different disciplines as the most important to their COC: family physician (33%), oncologist (31%), nurse (12%), radiation oncologist (11%), palliative care physician (8%), other (5%). For those who identified a family physician in this role, there was a trend towards lower odds of having unmet needs. Conclusions: Better COC was associated with patients’ supportive care needs being met. This finding suggests that interventions that improve COC will likely improve patients’ supportive care needs being met.

1. Cancer rehabilitation is a process that assists the individual with a cancer diagnosis to obtain optimal physical, social, psychological and vocational functioning within the limits created by the disease and its treatment. An imperative in accomplishing these goals is a coordinated multidisciplinary team approach that addresses the potential rehabilitation needs of the individual from time of the cancer diagnosis onward. Palliative care and rehabilitation share common goals and therapeutic approaches. Both provide an interprofessional model of care which aims to improve patient’s level of functioning, taking into consideration the medical, physical, social, and psychological status of the patient. The program is based on the successful McGill Cancer Nutritional program. It will develop and administer nutritional and rehabilitation programs, provide an interprofessional approach to symptom management, conduct research related to symptom relief and improved quality of life from this type of program, develop and educate patients, family caregivers and other health professionals in new ways to manage the symptoms.

2. People are living longer, and due to increased efforts to implement home care services the aging population are entering long term care (LTC) homes much older and much frailer. This is causing LTC homes to become a major place of death for Canadians. However, palliative care (PC) has not been clearly defined as a program in most Canadian LTC homes. PC involves responding to the physical, social, psychological, spiritual and emotional needs of the dying person and their families and begins at the point of diagnosis with a life limiting, chronic or terminal disease. The Social Sciences and Humanities Research Council (SSHRC) has funded a five year Community University Research Alliance (CURA) to develop a holistic PC program that follows the Canadian Hospice Palliative Care Associations (CHPCA) norms of practice. Participatory action research (PAR) methodologies are being used to create a partnership between four Ontario LTC homes, thirty national and international researchers and thirty national health and social service agencies. This partnership has formed what is called the Quality Palliative Care in Long Term Care (QPC-LTC) Alliance. A five year logic model has been created using the principles of PAR. The participants themselves are involved and guide the process throughout the phases of research. Personal Support Workers have been identified in the methodology as major agents of change as a way of empowering this group in the hierarchical culture of LTC. The result of the project will be an evidence based toolkit for LTC PC programs to be shared nationally.

3. The presentation will focus primarily on the discussion of the Toronto Central hospice palliative care network’s regional index of performance indicators that will monitor a region’s performance in hospice palliative care. This will include an overview of the development of a regional index: the scope of the development exercise, the guiding principles identified to develop the index, the benchmarks, references and comparators used to identify a preliminary list of indicators and the criteria used to finalize a relevant list of regional indicators. The Toronto Central LHIN’s preliminary list of regional hospice palliative care system indicators will be reviewed: definition, formula, context and caveats on their application. The dimension of each performance indicator (client outcomes, efficiency, research & innovation and resources) will be explored. Lastly, a discussion of the process in developing a performance management system that enables ongoing data collection, data refinement, public reporting, systems performance improvement and linkage to a regional network's planning and decision-making processes.

4. The presentation outlines the background and enhancements to the Hospice Palliative and End-of-life Care standards to address the volunteer component. In addition, the presentation will highlight volunteer issues and outline the education and training provided for volunteers, organizations and surveyors.

Clinical subtyping of delirium according to motor-activity profile has considerable potential to account for the heterogeneity of this complex and multifactorial syndrome. Studies to date have identified clinically important differences between motor subtypes in relation to detection, causation, treatment experience and prognosis, but studies have been hampered by inconsistent methodology, especially in relation to definition of subtypes. This presentation considers research to date, including a number of recent studies that have attempted to address these issues and identify a means of achieving greater consistency in approaches to subtyping including the application of electronic motion analysis to the validation of motor subtypes as well as longitudinal study of motor activity over the course of delirium. Possibilities for future work will be considered.

While Palliative Sedation Therapy (PST) is recognized as both ethically and legally acceptable in Canada, it remains an emotionally charged issue for many interdisciplinary palliative care teams. Challenges often exist around the definition, indications, decision-making process, implementation, and team communication. Some struggle to clearly see how palliative sedation therapy is different from “consequential sedation” which does occur in the palliative care setting but is not palliative sedation. In addition, some are not completely clear on how it is distinct from euthanasia and physician assisted suicide. In response to our own teams struggles around a particular episode of Palliative Sedation Therapy, Victoria Hospice formed a task group which created a PST Communiction Worksheet based on an extensive literature review and clinical experience. This worksheet is meant to be a tool for communication and key conversations, ultimately leading to increased competency and compassion in care given at the bedside. During the development of the tool, “tension points” were identified that may be linked to ethical issues that cause moral distress for patients, families and /or the care team. Workshop participants will be presented with the worksheet and the identified “tension points” and asked to consider how these might be incorporated into interdisciplinary team practice.

Workshops were custom built for each cancer care team in order to address identified aspects of interprofessional functioning that they wanted to develop. Interactice workshops sought to ensure; - the acquisition of knowledge and competencies of non-psychosocial professionals likely to encounter psychosocial needs, - the support of administrators in providing opportunities for interprofessional exchanges, - a regional orientation towards improved psychosocial care for patients with cancer, - that clinicians are supported to work with a psychosocial intervention plan that is developed in an interprofessional way, - that competencies using a systemic perspective serve as a base to orient teamwork, assessments, care plans and pt/family centered care.

Hospice palliative care is growing in scope and involvement in the health care system. Now that we are in the mainstream, we need to get involved in the quality improvement process in a comprehensive fashion. We cannot assume that our processes of care actually improve patient outcomes. We also cannot be sure that the care we deliver is quality care or even safe care. This interactive workshop will examine the definition of quality improvement, issues of quality improvement in hospice palliative care, the challenges of being part of the quality improvement movement in health care and some of the possibilities for action.

Parents with life-threatening illness, facing end-of-life issues often struggle to find the means to discuss their condition with young children. For fear of scaring the child, and/or being unable to answer difficult questions, parents often struggle in these conversations. Families tend to underestimate a child's interest in the family's will and end-of-life decisions. In actuality, if a will is discussed with a child using language appropriate for the child's developmental needs, this may alleviate much anxiety children experience while managing anticipatory grief. The purpose of this workshop is to identify a family’s will as a useful tool in facilitating a non-threatening context within which a family may discuss their end of life decisions. Caregivers often overlook the importance of discussing wills with children as ‘legal jargon’ that children are unable to understand; likewise, children often have the misconception that a will is simply a list of your belongings and the people you would like to give these belongings to when you die. This workshop is designed to lift these impressions and explain how important decisions are manifested in a family’s last will and testament, give care providers a model for using a family’s will as a tool for facilitating conversation within the family, and encourage the use of this tool in allaying anxiety in children managing anticipatory grief.

Nous voulons démontrer comment le rêve peut devenir un outil d’accompagnement dans un milieu de soins palliatifs. Deux infirmières d’expérience dans une maison de soins palliatifs dans une communauté en banlieue de Montréal se sont intéressées au sujet. Elles ont débuté une collecte de données en se questionnant à savoir si les personnes en fin de vie rêvaient, si oui, à quoi pouvait ressembler le scénario? Quel pouvait être le contenu de ces rêves? ‘’Est-ce que vous rêvez?’’ devenait alors la question initiale à demander. Obtenir de l’information, permet par la suite de vérifier précisément où le patient se situe dans son cheminement. C’est en partageant différents scénarios de rêves avec l’assistance qu’elles pourront mieux témoigner, comment le rêve peut être récupérer afin de favoriser un meilleur suivi tant auprès du patient que ses proches. Elles aborderont les pièges à éviter comme intervenant en se rappelant que le but ici est d’avantage de développer un outil d’intervention, qu’une interprétation profonde. Quelques symboles universels seront également souligner, vu qu’ils sont observables dans l’ensemble de la collecte. Des rêves de progression chez la même personne peuvent être présents, favorisant aussi l’accompagnement tant chez le patient que ses proches. Les présentatrices souhaitent que les participants de cet atelier se familiarisent avec l’utilisation du rêve comme outil d’intervention dans le milieu des soins palliatifs. L’assistance pourrait être sollicitée pour un court exercice.

“Hospital boards, peer reviews, and ministry inspections, investigations, and supervisor appointments have identified and/or recommended many best practices for …. governance. However, no formal process has been established to share these practices among ……. boards.” 2008 Annual Report of the Office of the Auditor General of Ontario Good governance is critical for a hospice to operate with one vision and one voice. While many recognize the need for effective governance (including the Auditor General of Ontario), achieving it is not always easy. Individual agendas, lack of understanding of the role of governance, mismatched skill sets, etc. can all detract from effective governance.

The Honourable Sharon Carstairs, P.C. has been a tireless champion for hospice palliative care in Canada since 1994, as a Senator and as federal Cabinet Minister. A teacher before joining public life, in 1986 Senator Carstairs was elected to the Legislative Assembly in Manitoba. In 1988, she became the first woman to lead the Official Opposition in a Canadian Legislative Assembly. She remained a provincial Member of the Legislative Assembly until 1994 when she was appointed to the Senate of Canada to represent the province of Manitoba.

Description : Although this is listed as a pediatric session, it will be of interest to practitioners working with all age groups.  Is it appropriate to withhold nutrition and hydration?  Are we enabling euthanasia if we do?  What conditions exist that might suggest withholding nutrition and/or hydration is the best course of action?  These questions and more will be explored during this provocative session.

Description: This panel will tackle questions including: What are the values at the center of our system? How do you serve those who don't fit into our model and how do we challenge our own bias? How do we manage the current Palliative Care models limitations, with an eye to the needs of the homeless? What is the lived experience is our system failing to meet needs. What is missing from our system? This will be a provocative challenge panel that should trigger a lively discussion.

Description: This panel will take an in-depth look at the research, clinical and policy landscape around systems approach to care. How does this affect you?

1. The cross-education of interprofessional caregivers has been an issue in the provision of collaborative comprehensive and holistic care for palliative care. Building on the success in the private sector, academic institutions and hospitals are successfully implementing e-learning solutions to provide much needed education programming to health care professionals. A review of the literature emphasized that an e-learning solution to providing clinical education is an equally viable and effective option when compared to traditional methods. Additionally, e-learning as an educational strategy provides opportunities to learn across different sectors and different regions, therefore assisting in increasing knowledge in more remote areas. Consequently ‘Managing Pain Together’, an online program designed to teach teams how to manage pain in the palliative care setting, is being developed. This presentation will focus on the development, implementation, and evaluation of one section of this program: the pathophysiology of pain. A team comprising palliative care experts, an anaesthesiologist, a medical illustrator, education specialists, an instructional designer, a videographer, a graphic designer, a programmer, and information systems experts worked collaboratively to develop this innovative and interactive resource. Interactive images, animations, text, and video are used to present the pathophysiology of pain and explain many pain phenomena. This module is also being used in the University of Ottawa undergraduate medical education curriculum. Preliminary evaluation results will be shared.

2. Roger’s House is an 8 bed pediatric hospice located on the grounds of the Children’s Hospital of Eastern Ontario in Ottawa. We opened our doors on May 15, 2006 and offer a range of services to children and youth with life limiting illness including respite care, transition from hospital to home, pain and symptom management and end of life care. Due to the complex needs of the children and youth we service, a system of staffing based solely on numbers proved to be inadequate. Using the prototype evaluation tool developed by Canuck Place in Vancouver as a model, we grouped guests according to some observable characteristics and quantified these categories as a measure of nursing effort. We confirmed inter-rater reliability by having the nursing team assign a workload score to each guest we had serviced and demonstrated strong consistency among our nurses in assigning these scores. Workload scores are currently assigned to each guest at intake to the program and are updated from admission to admission and shift to shift as condition changes. Analysis of these scores over time has permitted us to identify peak periods and adjust staffing levels accordingly. This has led to creative staffing using varying levels of staff and is an adjunct to reports to the Board of Directors and Ministries of Child & Youth Services and Health regarding fiscal responsibility and program planning.

3. Les infirmìeres consultantes en Montérégie ont vu le jour en Janvier 2008 en Montérégie. Leur rôle est d'offrir de la formation en soins palliatifs, de servir comme consultantes pour le personnel auprès de la clientele en soins palliatifs, de contribuer au développement des outils et des protocoles spécifiques en soins palliatifs basés sur les données probantes et d'assurer une pratique en soins infirmiers qui est basées sur les normes en soins palliatifs infirmiers. Nous présenterons le déploiment du rôle, les enjeux, les barrières à la mise en oeuvre du rôle, ainsi que les directions vers lesquelles nous nous dirigerons dans l'avenir.

4. Les décisions éthiques à haute charge émotive que sont les décisions et discussions de soins de fin de vie et de non réanimation sont propices au déclenchement de conflits. L’objectif principal de cette étude est de déterminer si, selon les différents soignants impliqués ou témoins de pareilles discussions, le conflit, le désaccord, la tension, le malaise, la divergence d’opinion sont ressentis ou perçus. Les objectifs secondaires de l’étude visent à déterminer les moyens, mécanismes et démarches entrepris pour aborder et résoudre ces conflits. Devis de type exploratoire. Un questionnaire, élaboré à l’aide des données de la littérature et distribué à tous les soignants du CHU Sainte-Justine, soit à plus de 2 300 personnes. 946 répondants (taux de réponse de 41%) dont 46% du corps infirmiers, 22% de médecins et 32% d’autres membres du personnel soignant. 70% des répondants ont pris soin d’un enfant qui est éventuellement décédé et un même pourcentage a été témoin ou impliqués dans des décisions de fin de vie. Or 72% de ces répondants disent avoir perçu un conflit lors de ces discussions décisions de non réanimation. Pour 57% des répondants, le conflit se situait entre différents soignants alors que pour 32% des répondants, le conflit se situait entre un soignant et un parent. Plus de 76% des répondants se disent insuffisamment ou aucunement formés pour faire face à une pareille situation, et 55% des répondants considèrent ce défi éthique comme un de plan majeur, sinon le plus important à adresser.

EPEC™-O Canada is an education program developed specifically for the inter-professional oncology team caring for people with cancer. The program was adapted from the successful EPEC™-O program in the United States by a team of Canadian professionals and reviewed by 25 Canadian peer reviewers. The program is designed to provide the practicing clinician with information and strategies necessary to provide palliative interventions to his/her patients, and educational tools and materials for use in teaching the core competencies of palliative care to others involved in the care of cancer patients. In early 2010, two pilot training sessions were held in Canada – one in the east and one in the west. The Canadian Partnership Against Cancer (CPAC) funded the adaptation of the curriculum and the pilot training sessions. These sessions were evaluated to determine how the program will better serve oncology professionals in the future. This workshop will give participants hands on experience with the curriculum. The overall elements of the curriculum will be presented along with the teaching/learning approaches utilized. The evaluation of the Canadian pilots will be presented – focusing on the participants experience; the achievement of the objectives of the program and the participants’ learning as demonstrated in pre- and post-tests. Participants will have the opportunity to work through one curriculum module in detail – to experience the approach utilized in EPEC™-O Canada training.

En 2006, nous avons initié une recherche qualitative visant l’identification des besoins spirituels et religieux des personnes en soins palliatifs suivies à domicile. Vingt-quatre patients, âgés de 52 à 88 ans, ont été interrogés à l’aide d’un questionnaire semi-structuré. Les entrevues ont été réalisées sur une période de quatorze mois, soit de mai 2007 à juillet 2008. La recherche visait essentiellement deux objectifs :1) une meilleure connaissance des besoins spirituels et religieux des personnes en soins palliatifs à domicile; 2) l’élaboration d’une grille d’analyse de ces besoins. Au cours de cet atelier, nous présenterons, dans un premier temps, les résultats globaux de cette recherche; la méthodologie privilégiée, la cueillette des données et une première grille des besoins spirituels et religieux qui émergent. Dans un deuxième temps, nous travaillerons avec deux (2) ou trois (3) de nos vingt-quatre (24) verbatims et présenterons une analyse de nos résultats en regard du paradigme anthropologique ternaire. En effet, ce paradigme considère l’être humain dans ses dimensions somatique, psychologique et spirituelle. Dans l’évaluation de la souffrance globale, les soins palliatifs proposent des échelles d’évaluation. Cet atelier vise une contribution à l’évaluation de la souffrance liée à la dimension spirituelle.

Over the past 10 years, the 30 national organizations that are members of the Quality End-of-Life Care Coalition of Canada (QELCCC) have worked together to improve end-of-life care for all Canadians. Their goals were to improve access to care, promote research that would improve care, support the family members who care for people who are dying, and educate Canadians about their choices at end of life. This skills building workshop will explore the realm of Advocacy. Participants will learn what it is, how to develop a strategy, and rules for effective advocacy. Participants will review the Blueprint for Action progress report and will discuss how it can be used effectively as an advocacy tool.

Palliative Care is often a secondary consideration in an acute care setting. As a tertiary academic health science centre committed to promoting excellence in nursing practice, it can be challenging to ensure nurses have the knowledge and skills required to provide holistic care for palliative patients. Fellowships are used amongst physicians to promote skill development, but they are not commonly used in the realm of nursing. Our Model of Nursing Clinical Practice promotes and supports nurses working to their full scope. A key component of this model, the clinical nurse expert, is assigned on each shift to be a clinical resource for peers, especially novice nurses, as well as other inter-professional team members. This Clinical Nurse Expert role would facilitate the transfer of Palliative Care knowledge and expertise cultivated during a fellowship with the Palliative Care Consultation team. Our nursing fellows were seconded to the Palliative Care Consultation Team to complete a three month long fellowship. This 60 minute workshop will focus on the development, implementation and evaluation of this fellowship. Since funding is an obvious barrier, given the current health care economic environment, we will also explore innovative approaches to securing initial and ongoing fellowship funding. In addition, we will provide practical suggestions, strategies and tools used during all phases of this unique clinical fellowship. One of our fellows and her mentors will discuss their fellowship experiences, challenges and successes. We will also highlight individual, Palliative Care team and home unit benefits and outcomes resulting from the fellowship.

Introduction: While the benefits of hospice palliative care are well recognized, numerous barriers exist that may limit the access of terminally ill Canadians to palliative home care services. To ensure more equitable access for all Canadians, it is important to understand who utilizes palliative home care services and to identify individuals who are underrepresented. Objective: This descriptive epidemiological study characterizes terminally ill individuals who use palliative home care services in Ontario. Methods: Data were collected as part of normal clinical practice for 5963 terminally ill individuals receiving palliative home care services in Ontario. Assessments were conducted between January 2006 and December 2009 using the interRAI Palliative Care (interRAI-PC) instrument. The interRAI-PC is a standardized tool that assesses the strengths, preferences, and needs of palliative care clients residing in the community, as well as facility based settings. This instrument includes health, demographic and service utilization items. Results: A description of socio-demographic variables including age, gender, location, and prognosis will be provided. Cross-sectional analyses of clinical characteristics are discussed including the prevalence of cancer and non cancer disease diagnoses, symptoms, functional ability, cognitive impairment and mood. Comparisons between the prevalence of terminally ill individuals who received palliative home care and were assessed using the interRAI-PC and those who died without utilizing palliative home care services assessed using the interRAI-Home Care assessment instrument will be provided.

Delirium is a syndrome that affects 50-80% of terminally ill patients.It is a complex syndrome that occurs in many terminally ill patients consequently contributing to symptom distress. Signs and symptoms of delirium will be presented. A literature review from a nursing perspective will examine evidence-based practices. It is important for nurses to be keenly aware of all the medical treatments in order to achieve optimal results for their patients. During this workshop, we will explore the challenges of this syndrome for patients, their families and health care professionals. The presenters will provide an opportunity for a discussion with the participants regarding the difficulties faced by the the patient's family and by the interdisciplinary palliative care team.

This workshop will provide a model for health care providers to develop a national or international environment where they can discuss the spiritual issues they face on a daily basis. The group consists of 3 palliative care physicians from Canada, 1 palliative care (APN) nurse from the US and 3 chaplains, one of each from Canada, the US and Ireland. Every 2 months one member of the group coordinates a teleconference and provides a case for discussion. The discussion allows for self-reflection and collegial feedback which in turn nourishes the motivation and ability to carry on with the intense and rewarding work of addressing the spiritual needs of palliative patients. From its inception in November 2006, the group has consistently reflected on the intrinsic value of an international and interprofessional supportive work community that allows open and honest discussions about the suffering to which we bear witness daily. The reflection necessary to participate and the support provided by the group are a means of promoting self-awareness, self-care and avoiding burnout. Having a regular opportunity to reflect upon and discuss spiritual issues with an international, interprofessional group is a means of discussing how the spiritual domain of care impacts on us personally and professionally. Through these powerful conversations, the suffering to which we bear witness is imbued with new meaning and helps all participants to carry on with their rewarding and intense work. This presentation represents the first occasion all group members have met in person.

Description: This challenge panel will take examples of personal stories from practice that will challenge conventional thinking on interprofessional practice and education. It will be an interactive challenge panel with opportunity for all to participate.

Description of session: This panel will discuss the issue of defining hospice palliative and end of life care…. Are we chasing our tails? Is this a “so what” moment? Can we describe what we do? Is end of life a trigger word? The Norms of Practice says hospice palliative care should be offered from diagnosis, most funding systems look at six month of services but we get continue to get referrals late in the process. Is this acceptable? Is it only an approach to care? Come to this presentation that promises an active discussion opportunity.

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After David Kuhl's plenary, we invite you to join us for reflections on the 2010 Conference by CHPCA representatives, as well as the annoucement of the location of the 2011 Canadian Hospice Palliative Care Conference.

We invite you to join us as we reflect on the 2010 Conference by CHPCA representatives, as well as the annoucement of the location of the 2011 Canadian Hospice Palliative Care Conference.