EPEC Oncology Canada. EPEC O Canada Gaps in Cancer Care: Transitions from Acute to Palliative Care

Transcription

1 EPEC Oncology Canada Education in Palliative and End-of-life Care Oncology Canada Gaps in Cancer Care: Transitions from Acute to Palliative Care

2 Overall Message Gaps between current and desired practice need to be filled so that palliative care becomes an essential and inextricable part of comprehensive cancer care

3 Objectives Describe current cancer incidence, prevalence and mortality Describe suffering associated with cancer Define palliative care Introduce

4 Cancer incidence In Canada in 2010 ~173,800 diagnosed with cancer ~ 76,200 die of cancer Males: prostate, lung, colorectal Females: breast, colorectal, lung ~40% of women, ~ 45% of men will develop cancer during their lifetimes

5 Cancer prevalence In Canada on Jan 1/05: 695,049 people living who had been diagnosed with one or more primary invasive cancers in previous 10 years = 2.2% of Canadian population

6 Cancer mortality In Canada in 2010, ~76,200 Canadians die of cancer ~29% of Canadians die of cancer Lung, colorectal leading causes of cancer death Mortality rates down significantly from 1996 to 2005

7 Symptoms, suffering Pts have multiple physical symptoms Inpatients with cancer averaged 13.5 symptoms, outpatients 9.7 Related to Cancer Adverse effects of medications, therapy Intercurrent illness Portenoy RK, et al. Qual Life Res. 1994

8 Symptoms, suffering Representative sample of patients at home (n=998) Dyspnea 71% Pain 50% Incontinence 36% Emanuel EJ, et al, N Engl J Med. 1999

9 Symptoms, suffering Psychological distress anxiety, depression, worry, fear, sadness, hopelessness, etc. 40% worry about being a burden Covinsky KE, et al, JAMA. 1994

10 Social isolation Canadians live alone, in couples Working, frail or ill Other family Live far away Have lives of their own Friends have other obligations, priorities

11 Caregiving Canadians estimate they need 54 hrs / wk to take care of a dying loved one at home 64% indicated they could not devote that number of hours / wk given their current schedule Ipsos-Reid Survey. Hospice Palliative Care Study: Final Report, The GlaxoSmithKline Foundation and the Canadian Hospice Palliative Care Association, January 2004

12 Place of care Most Canadians prefer to die at home in the presence of loved ones 75% of deaths today take place in hospitals, long-term care facilities Canadian Institute for Health Information, Health Care Use at the End of Life in Western Canada Ottawa: CIHI, Standing Senate Committee on Social Affairs, Science and Technology. Subcommittee to update "Of Life and Death". Quality End-Of-Life Care: The Right of Every Canadian. Final Report. Ottawa

13 Financial pressures In 2007, 23% of Canadians had cared for a family member or close friend with serious health issue (12 mo.) 41% of these used personal savings to survive, 22% missed one or more mo. work. 10th Annual Health Care in Canada Survey: A national survey of health care providers, managers, and the public, 2007

14 Coping strategies Vary from person to person May become destructive Substance abuse Suicidal ideation Premature death by PAS or euthanasia

15 Quality EOL Care: Patient s Perspectives Adequate pain and symptom management Avoid inappropriate prolongation of dying Achieving a sense of control Relief of being a burden Strengthening relationships with loved ones Singer P.A., Martin D.K., Kelner M., Quality End-of-Life Care: Patient s Perspectives, JAMA (2)

16 Hospice palliative care Canadian definition: Relieve suffering; improve quality of living, dying Address physical, psychological, social, spiritual, practical issues Address associated expectations, needs, hopes and fears Prepare for and manage life closure, dying process

17 Hospice palliative care Appropriate for Any patient and/or family living with, or at risk of developing, a life-threatening illness due to any diagnosis Any prognosis, regardless of age At any time of unmet expectations, needs Anyone prepared to accept care

18 Comprehensive Care

19 1998 ASCO survey 6,645 oncologists surveyed 118 questions n=3,227 (48% response rate) No significant differences in answers based on oncology specialty Emmanuel EJ. ProcASCO 1998:17

20 ASCO survey Source of information re: palliative care 90% trial and error 73% colleagues and role models 38% traumatic experience Message: No one is teaching this to oncologists Emmanuel EJ. ProcASCO 1998:17

21 ASCO survey Barriers to palliative care 76% feel a sense of personal failure if patient dies of cancer 90% feel some anxiety discussing poor prognosis 75% feel some anxiety discussing symptom control with pts and families Emmanuel EJ. ProcASCO 1998:17

22 ASCO survey Barriers to palliative care Unrealistic expectations make oncology practice difficult 29% said unrealistic patient expectations created a problem 50% family 27% conflict Emmanuel EJ. ProcASCO 1998:17

23 ASCO survey Professional satisfaction in providing palliative care 98% feel emotional satisfaction 92% feel intellectual satisfaction Better core competencies and sense of role in psychosocial care, better outcome for oncology professional, patient, family Emmanuel EJ. ProcASCO 1998:17

24 Professional education Still a need for curricula development in palliative and EoL care The Educating Future Physicians in Palliative and Endof-Life Care (EFPPEC) Project integrated competencies into undergraduate medical curricula Competencies in palliative and EoL care integrated into curricula in Royal College programs Competencies have been developed for physicians, nurses, social workers and spiritual care professionals Canadian Partnership Against Cancer. Competency-based Education Approaches in Palliative and End-of-Life Care in Cancer: Environmental Scan. Toronto: CPAC, 2008

25 The EPEC TM -O Canada Project Education in Palliative and End-of-life Care Oncology Canada The EPEC -O Canada Curriculum is produced by the EPEC -O Canada Project, which has been made possible through a financial contribution from Health Canada through the Canadian Partnership Against Cancer. This curriculum is adapted with permission from The EPEC -O Curriculum, Emanuel LL, Ferris FD, von Gunten CF and Von Roenn J, Education in Palliative and End of Life Care - Oncology, The EPEC Project, Chicago, ISBN #

26 Goals of EPEC -O Canada curriculum Practicing oncology professionals Integration of core clinical skills Improve competence, confidence patient physician relationships patient/family satisfaction physician satisfaction Not intended to make every oncology professional a palliative care expert

27 Curriculum Comprehensive assessment Pain management Symptoms Psychosocial care Survivorship

28 Curriculum Communicating effectively Clarifying diagnosis and prognosis Negotiating goals of care Clinical trials Withdrawing nutrition, hydration

29 Curriculum... Conflict resolution Advance care planning Last hours of living Physician-assisted suicide Work life balance

30 Curriculum How to teach Models of palliative care Next steps to improve palliative care in cancer Interdisciplinary teamwork

31 Curriculum Apply each skill in your practice Enhance professional satisfaction Foster creative approaches to create change in cancer care Change will not be effective without oncology professionals

32 Summary Gaps need to be filled so that palliative care becomes an essential and inextricable part of comprehensive cancer care

33 No, I m not the Grim Reaper anymore. I prefer to be known as an End-of-Life Provider.

34

35

36