A DFCM Collaboration for Social Accountability: Harnessing the Power of Relationships Jeff Myers - DPC Grand Rounds - Dec 4, 2014

This is NOT a request: To sit on a committee or working group To take on additional work For time My ask is that you reflect on: Your story…how palliative care makes sense Still committed…what is it? Primary care colleagues’ stories...relationships The ask

“Jeff, it’s Sharon and I’m driving to see a patient at home. She has advanced CHF and I want to address end-of-life issues with her. Do you have a minute to talk this through?” - Dr. Sharon Domb, FPTU “I’m on call this weekend and have a patient who is dying at home. I just need some help with the logistics of ordering medications and advice on a dose for one med in particular.” - Dr. Alison Culbert, FPTU The outcome…in real time

Our reality….evidence & relevance 3.Avoid chemotherapy and instead focus on symptom relief and palliative care in patients with advanced cancer unlikely to benefit from chemotherapy (e.g. performance status) 5.Don’t delay or avoid palliative care for a patient with metastatic cancer because they are pursuing disease-directed treatment

Our reality…expands 1.Avoid CT scans of the head in ED patients with minor head injury who are at low risk based on validated decision rules 2.Avoid placing indwelling catheters in the ED for either urine output monitoring in stable patients who can void

: Inpatient New Referrals Projected (2X) Our current reality

Deaths in Ontario: We are here… Our future reality

Palliative approach to care? GTA = inequity in accessibility & timeliness GTA = 50% of the province’s population DFCM Strategic Planning Retreat: Plea for help We want to provide the care to patients, just need a hand How do I have the conversation? We want to teach this well Our reality…GTA

Auditor General of Ontario: palliative care audit & report will be tabled next week Family Health Teams Temporary Parking Lot: existing challenges & barriers Here’s the thing… Colleagues asking “help, so we can teach & provide care” Consider impact of “Would you be surprised…?” Who will care for all the “No”s? Caveat: 24/7 Why now

Your story…how palliative care makes sense Still committed…what is it? Primary care colleagues’ stories….relationships Does the DPC have a role, even a social responsibility in helping to teach a workforce that better integrates a palliative approach to care? Social responsibility?

…an element of all of our stories, every learner interaction & every phone call for advice…it’s our fabric and it unifies Social responsibility

1,400 DFCM faculty members, many of whom practice in 1 of 14 academic teaching units and in community practices provide care to one million people ONE MILLION PEOPLE have their values & wishes documented from advance care planning conversations FAMILY MEMBER DECISION MAKERS are involved in these conversations, aware of these values & wishes… ….and worry much less HEALTH CARE TEAM MEMBERS as life evolves, can access & revise documentation of the conversations, 24/7 The DFCM: Caring for one million people, the rest of their lives

“DFCM leading the transformational change to improving care for people in the last year of life and their family members” What message does this send?

It’s a place to start (continue) Why?

Build on regional successes 2014 Minister’s Medal - Toronto Central Integrated Palliative Care Program

Integrate: DFCM-DPC faculty, members & learners Possible integration strategies: Clinical & teaching skills: Develop/Maintain-Facilitate Care provision: Provide-Support/Mentor Possible standard elements/tools: Advance care planning conversation template LEAP: Interprofessional & Faculty Development course How

This is NOT a request: To sit on a committee or working group To take on additional work For time My ask is that you reflect on: Your story…how palliative care makes sense Still committed…what is it? Primary care colleagues’ stories...relationships The stage is set…build relationships My ask