This 1 credit-per-hour Group Learning program has been certified by the College of Family Physicians of Canada and the Alberta Chapter for up to 14 Mainpro+ ® Credits.
This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada and approved by the University of Calgary Office of Continuing Medical Education and Professional Development. You may claim a maximum of 14 hours (credits are automatically calculated).
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Wednesday, May 3
Two Pre-conference Workshops – click here for details
Thursday, May 4
| 09:30-12:30 | National Academic Half Day and Lunch for Residents Only |
| 13:00-13:05 | OPENING REMARKS AND WELCOME |
| 13:05-13:45 13:45-14:00 Interaction with audience (Q&A, discussion) |
OPENING KEYNOTE Walking Alongside Indigenous Peoples who are Seriously Ill: Addressing the Need for Culturally Safe-r Palliative Care Indigenous peoples have long-standing cultural knowledge in caring for community members preparing to journey to the spirit world. However, over 150 years of colonization denigrated these practices and imposed Westernized Eurocentric health care systems. The ongoing effects of colonization persist into the present day and impact the health and access to quality care for Indigenous peoples. This session explores the historical and current state of Indigenous peoples’ access to equitable health care. It challenges healthcare providers to examine their positionality and outlines how health systems can support the delivery of culturally safe-r care for Indigenous peoples. Holly Prince |
| 14:00-14:45 14:35-14:45 Interaction with audience (Q&A, discussion) |
CSPCP SPECIAL SESSION PART I Developing Billing Codes to Facilitate Meeting Population Need for Generalist and Specialist Palliative Care This session will explore the work happening in British Columbia within a rapidly changing remuneration environment. Pippa Hawley |
| 14:45-15:00 | Break |
| 15:00-16:00 15:45-16:00 Interaction with audience (Q&A, discussion) |
CSPCP SPECIAL SESSION PART II Palliative Care Training Pathways: Navigating the Changes and Implications for the Future of the Specialty The Training Profile for the Enhanced Skills training in palliative care were recently updated and the Royal College subspecialty program in palliative medicine has newly updated training objectives and practice description. This session will focus on the differences between the two accredited training pathways in Canada and potential implications for graduates, programs and the specialty. Ebru Kaya, Anne Boyle, Dave Henderson, Leonie Herx |
| 16:00-17:00 16:45-17:00 Interaction with audience (Q&A, discussion) |
CSPCP SPECIAL SESSION PART III Clearing the Path to Certification: A Step-by-Step Guide to Navigating Practice Eligible Routes for RCPSC and CFPC Physicians Moderator: Ebru Kaya
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| 17:00-17:30 | Awards Presentations (Unaccredited activity) |
| 17:30-19:30 | Welcome Reception (Unaccredited activity) |
Friday, May 5
| 07:30-08:00 | Continental Breakfast |
| 08:00-09:00
Each presenter will have 15 minutes plus 5 minutes for Q&A |
MEMBERS’ SHOWCASE Creating an Inclusive Palliative Care Curriculum The process of creating a more inclusive Palliative Care curriculum should begin with self-awareness and self-reflection. Evaluating the AHD curriculum created an opportunity to reflect on the need to improve representation and diversity in current presentation slides, assigned readings and case vignettes. We will review the specific strategies and suggestions in the session. Dilshaan Panjwani |
| Providing Palliative Care to Refugees: Exploring Barriers and Facilitators in the Greater Hamilton Area of Ontario This oral presentation will provide a case study on barriers to and facilitators in providing palliative care to refugee populations in the Greater Hamilton Area of Ontario from the perspectives of primary care providers (PCPs) and refugees (and/or their family members), allowing audience members to gain a better understanding of the regulatory, financial, and administrative environments. Priya Gupta |
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| Emotional Expression During Care Planning Discussions with Chinese Patients and Caregivers Emotional expression during high-stakes care planning conversations with Chinese patients and caregivers may be infrequent and grounded in social, topical, and temporal context. Future work is necessary to understand how clinicians could best respond to distressing emotions during naturally occurring palliative care conversations with Chinese patients and their caregivers. Wenna Deng |
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| 09:00-09:35 09:35-10:00 Interaction with audience (Q&A, discussion) |
KEYNOTE Reflections on Dignity in Palliative Care: The Human Side of Medicine This talk will provide an overview of some of the key findings and insights that have come out of a program of research, extending over three decades, focused on palliative care. This will include understanding the experiential landscape of approaching end-of-life; examining factors that move patients towards a wish to die; along with understanding how considerations of dignity can influence the delivery of person-centered care. Harvey Chochinov |
| 10:00-10:30 | Health/Networking Break and Exhibits |
| 10:30-11:45 | WORKSHOP SESSION I – Choice of 5 Workshops (repeated in PM) 11:25-11:45 – Interaction with audience (Q&A, discussion) |
| Workshop 1 | Redefining Suffering: A New Perspective for Current Times Palliative care’s goal is to improve the quality of life by relieving suffering; at least, that is what every definition says. Being a core concept in palliative medicine, one would expect that we would have a common understanding of what suffering is, yet, there isn’t a unified definition, leaving its meaning to different interpretations on when patients experience it, how we assess it and how we should approach it. Despite the uncertainty, the word suffering is so embedded in our lexicon that we use it liberally to counsel patients and families in life or death decisions, justify treatments like palliative sedation, avoid interventions like CPR, or describe why we experience moral distress. In this workshop, we will challenge the current definition of suffering while hashing out its relationship with pain, quality of life and decision-making. We will use different frameworks of how suffering has been described in the literature and deconstruct them to approach suffering from a new perspective. Gregorio Zúñiga Villanueva |
| Workshop 2 | Characterizing, Evaluating, and Treating Psychomotor Slowing in Patients With Advanced Cancer Psychomotor slowing (PS) is observable in hypoactive delirium and in patients who do not meet the diagnostic threshold for delirium. It is difficult to recognize and diagnose. Several current tools used in the context of delirium assessment include cognitive and/or motor items. However, motor behaviour characterization is only reported unidimensionally and based on healthcare professionals’ (HCPs) observations. Starting from the results of a study with focus groups with oncology and palliative care health professional, this syndrome will be described, and cases will serve as starting point to stimulate discussion about diagnosis and treatment. Lack of scientific knowledge in the literature will be compensated by the presenter’s experience. Bruno Gagnon |
| Workshop 3 | Non-Violent (Compassionate) Communication Non-violent (Compassionate) Communication is a technique and approach that allows its practitioners to connect with themselves and with others from the heart. It’s a way of communicating that acknowledges our shared humanity, recognizing our commonalities (universal needs). It also allows for the illumination of our differences with compassion and honesty. The practice creates opportunities for self-awareness, self-compassion, and community building, and has the potential for cultural transformation. Please join Charlie in the discovery or ongoing practice of this communication strategy to make life more wonderful for all of us. Charlie Chen |
| Workshop 4 | How to Implement Early Palliative Care Are you curious about how to increase timely referrals to specialist palliative care? Wondering what kind of results to anticipate from your local efforts to integrate the palliative approach to care with disease management? Have you hit an implementation hump? This workshop explores “co-design” with patients and providers and facilitated implementation of care pathways, as effective solutions to earlier palliative care access. We will share methods, results and lessons learned from two “PaCES projects” (Palliative Care Early and Systematic) and invite you to share your current projects or new ideas. We’ll energize, problem-solve and celebrate palliative care successes together. Jessica Simon, Janet Vandale |
| Workshop 5 | ALS Symptom Management: A Practical Approach to Care This workshop will cover common symptom issues affecting ALS patients and management strategies. Marisa Dharmawardene and Marcus Povitz |
| 11:45-13:00 | Networking Lunch and Exhibits |
| 13:00-14:15 | WORKSHOP SESSION II – Choice of 5 Workshops Repeat of Session I 13:55-14:15 – Interaction with audience (Q&A, discussion) |
| 14:15-14:45 | Health/Networking Break |
| 14:45-16:00 | WORKSHOP SESSION III – Choice of 3 Workshops (non-repeating) 15:30-16:00 – Interaction with audience (Q&A, discussion) |
| Workshop 1 | Learners in Palliative Medicine – Evaluation, Identification of Challenges and Interventions Palliative Medicine skills have become an increasingly important component of medical education. Many undergraduate and postgraduate medical programs seek to expose learners to palliative medicine as part of their core curriculum, with clinical exposure being highly valued. As palliative medicine practitioners, we balance our duty to education with our duty to provide excellent patient care. Some learners come to clinical rotations with minimal knowledge of palliative care. This workshop will outline the main components of a plan for learner assessment which allows identification of strengths and challenges early in a training experience. A series of cases will be discussed in small groups to share strategies for effective feedback and ways to provide suggestions for improvement. The workshop will conclude with an outline of the learning attributes which the learner is striving to achieve. Christina Vadeboncoeur |
| Workshop 2 | Meeting Each Other and Our Patients Where We’re At: The Benefits of Harm Reduction Approaches in Palliative Care Structurally vulnerable (SV) populations suffer disproportionately from the inequities created by social systems. When facing life-limiting illness, barriers and injustices are compounded, further widening the disparities. Physicians striving to provide high quality palliative care (PC) to SV people may also face challenges when we inevitably work within the same inequity-producing systems. Literature exploring end-of-life experiences of SV people emphasizes the integration of harm reduction (HR) approaches as key to improving care for this group. However, there is little to no direction for applying HR within PC. HR is grounded in justice and human rights – a person-centered approach prioritizing self-determination. Often associated with care for people who use drugs, it is also part of a trauma-informed approach, which can benefit all people, especially those experiencing SV. PC and HR share several similarities, including “meeting people where they’re at,” a fundamental HR principle which parallels the PC process of eliciting and centering patient goals and values in care planning. In this workshop, we will illustrate latent affinities and key differences between HR and PC. Affinities will serve as a strength-based jumping-off point for integrating the two approaches. Differences will highlight what PC providers might learn from HR. Through self-reflection activities and case studies, and by modeling the HR approaches that we advocate, we will offer a new conceptual grounding for understanding and acting on the systemic barriers faced by both SV patients and their physicians in either accessing or delivering high quality PC. Alissa Tedesco and Cam Matamoros |
| Workshop 3 | Recognizing Culture and Communication Styles to Build Trust Within Clinical Interactions Miscommunication between patients and clinicians can leading to devastating consequences, particularly for the seriously ill patient. Minority populations are disproportionately affected by lapses in communication. How clinicians communicate with patients often reflects their respective cultural background. Much of existing communication training in palliative care is steeped in direct, low-context communication, with the emphasis on the speaker delivering a message clearly to the listener. However, many cultural groups rely on indirect, high-context communication, in which the listener carries the responsibility to understand the meaning behind the words and actions of the speaker. Cultures that preferentially use high-context communication may find standard communication practices in medicine too direct and inappropriate. For example, the commonly used phrase “tell me more” to explore a patient’s values and understanding may not resonate with patients whose cultural values prioritize collectivism rather than individualism. Furthermore, revealing one’s inner life directly may be considered inappropriate or even threatening. This workshop extends from prior communication workshops by examining the role of context and directness in intercultural palliative care conversations. In this session, we discuss the cultural framework of high- and low-context communication, first conceived by anthropologist Dr. Edward Hall. We then take a closer look at how communication mismatches can occur in the medical setting between patients, families, and palliative care clinicians. Lastly, we examine how we might be able to level up our communication skills by understanding our reliance on the direct dialogue and learning how to use different communication strategies that aims toward improving our intercultural interactions. Zhimeng Jia and Irene Yeh |
| 16:00-17:00 | CSPCP AGM (Unaccredited activity) |
Saturday, May 6
| 07:30-08:15 | Continental Breakfast |
| 08:15-09:15
Each presenter will have 15 minutes plus 5 minutes for Q&A |
MEMBERS’ SHOWCASE A Standardized Letter to Improve Care Coordination for Patients With Cancer The delivery of patient care in Canada is fragmented. Patients with cancer have trouble coordinating between multiple providers. Family physicians can play a crucial role as the Patient’s Medical Home. Coordination is essential to ensure patient needs are seamlessly addressed and that family physicians can clarify their care roles with palliative care physicians. Currently, at our institution’s Palliative Oncology clinic, new referrals from oncologists are directly scheduled for consult and routine follow-up by palliative care physicians, without prior communication with the family physicians. We, a team of palliative care physicians and family physicians, have co-designed and implemented a standardized “collaborative care” letter to improve care coordination. The letter includes an introduction to our team; various options for collaborative care based on family physician capacity, that the family physician can complete and return to us; and contact information for access to 24/7 palliative care physician support. Our quality improvement study evaluates the 6-month pilot implementation of this letter. We aim to assess the feasibility and perceived usefulness of this intervention. Stephanie Cheon |
| METHADOPT: Treatment of ‘Adenocarcinopathic Pain’ using Methadone/Morphine: Vanguard Double-Blinded RCT Patients suffering from cancer report different types of pain including nociceptive, visceral, and neuropathic pain. An emerging mechanism for neoplastic induced pain may be related to the excretion of glutamate, a by-product of glutamine which is needed for tumor cell growth and energy production. Adenocarcinomas have been found to produce high levels of glutamate in vitro. Unused intracellular glutamate and extracellular cysteine, an amino-acid necessary for cell growth, are transported in opposite directions through the Na+-independent cystine/glutamate exchanger. Slosky et al demonstrated that glutamate released by the tumor could explain cancer pain in animal models. This experiment suggested that glutamate, a pain mediating neurotransmitter, may be an important pathophysiological pain mechanism that could be called ‘adenocarcinoma generated pain’ or adenocarcinopathic pain. Adenocarcinopathic pain may be especially present when the tumor is in the vicinity of nerves or nerve plexuses.Methadone being a NMDA antagonist above its action on as a µ-receptor agonist, serotonin and noradrenaline reuptake inhibitor could be considered the best opioid for the management of adenocarcinopathic pain. We have developed a research project to test this hypothesis. Bruno Gagnon |
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| Specialist Palliative Care Service Interventions in Long-term Care: A Proposed Multi-staged Program of Study As the population ages rapidly and with healthcare under increasing strain, residents in long-term care (LTC) are increasingly more medically complex with a high disease burden and mortality risk. We aim in this multi-staged program of study to report on preliminary findings of a specialist palliative care intervention in LTC. Helen Tam-Tham |
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| 09:30-10:45 | WORKSHOP SESSION IV – Choice of 5 Workshops 10:25-10:45 – Interaction with audience (Q&A, discussion) |
| Workshop 1 | Beginning the Journey Into the Spirit World: First Nations, Inuit and Métis Approaches to Palliative and End-of-life Care in Canada In July 2021, the Canadian Partnership Against Cancer organized a virtual roundtable discussion with First Nations, Inuit and Métis Elders, Knowledge Carriers, community health professionals and researchers—all of whom have experience and knowledge of Indigenous approaches to palliative and end-of-life care. Beginning the journey into the spirit world: First Nations, Inuit and Métis approaches to palliative and end-of-life care in Canada is a foundational background document that was created in response to the meeting recommendations. Cara Bablitz and Natasha Caverley |
| Workshop 2 | Building Capacity for a Palliative Approach in Our Primary Care Colleagues Palliative care is everyone’s business. As leaders in the filed, it is our responsibility to have effective mechanisms to mentor, coach, teach and enable our primary care colleagues and communities to participate and succeed in this work. Applying a capacity-building lens to our work allows us to identify barriers to the development of our primary care colleagues and systems, as well as participate in creative solutions. This workshop will allow participants to: describe the complexities of various palliative care education and delivery models; identify barriers to primary care capacity building in their own environments; and start the process of creating a quality improvement initiative to address such barriers. Erin Gallagher |
| Workshop 3 | Integrating Palliative Care into Advanced Heart Failure Management Cardiology professional practice guidelines recommend integrating a palliative approach to care for patients with advanced heart failure. The purpose of this workshop is (1) to review basic heart failure pathophysiology, treatment and device use; (2) learn about the trajectory of heart failure and why integrating palliative care presents unique challenges in this population and (3) learn about specific management techniques in this population including the use of a home-based diuretic protocol to facilitate symptom management and (4) Discuss some communication techniques to assist the clinician when talking to people about advanced heart failure. Additional information will be provided about devices such as deactivating ICDs and Left ventricular assistive devices (LVADs). Leah Steinberg |
| Workshop 4 | Building Resilience & Mindful Self-Compassion for Palliative Care Clinicians (max 30 participants) We work in an increasingly stressful and dysfunctional healthcare system that often values “doing something” even if it causes more harm than good; that steers patients and families towards sometimes futile, painful, and costly attempts at curing over efforts to effect healing; and that sees dying and death as failures to be avoided at all costs. Working in palliative care means that we offer patients what they and their families may not want to recognize and accept, and the palliative care clinician is often faced with “going against the stream” of what mainstream medicine has on offer. How can we, as palliative care clinicians, learn to care for ourselves as we care for others? Clinical resilience and mindful self-compassion are two skill sets that can be learned and practiced that offer evidence-based ways to support us in our work. In this participatory workshop, based on the McGill Whole Person Care “Mindful Medical Practice” course (https://www.springer.com/gp/book/9783030224295) we will engage in contemplative practices, as well as small-group narrative and structured dyad work, as an introduction to resilience and mindful self-compassion. Stephen Liben and Krista Lawlor |
| Workshop 5
Workshop only offered once Part 2 at 11:15 |
The Non-Malignant Palliative Care Clinic Part 1: A Way Towards Increasing Access to PC for Patients Without Cancer? Research demonstrates that patients with non-malignant illness(es), frailty, and multimorbidity continue to face significant challenges accessing Palliative Care (PC). Barriers to care include uncertain illness trajectories, hesitancy to refer, and lack of clarity regarding the most appropriate role of PC physicians in the care of these patients, both in terms of scope and boundaries. While the concept of early PC for patients without cancer continues to gain theoretical support, important questions arise around the feasibility and practicalities of providing care for this patient population. What should PC involvement look like for patients without cancer? Where should care be provided and how? Who should provide this care and who should receive it? What outcomes should we be targeting?In this interactive workshop, we’ll focus our attention on one specific early PC intervention for patients without cancer: the Non-Malignant Palliative Care Clinic. Collaboratively we will explore the above questions regarding the practicalities, intention, and outcomes of non-malignant PC in the ambulatory setting. Lessons learned from the creation of our own tertiary non-malignant PC clinic will be shared, as well as opportunities for participants to discuss their own local initiatives. Our workshop will welcome discussion of how we as individuals, and as communities of practice, can leverage the ambulatory space as a stop gap between inpatient and home-based palliative care for our unique patient populations. Kyra Harris-Schulz and Kathleen Milne |
| 10:45-11:15 | Networking/Health Break and Exhibits |
| 11:15-12:30 | WORKSHOP SESSION V – Choice of 5 Workshops Repeat of Session IV 12:10-12:30 – Interaction with audience (Q&A, discussion) |
| Workshop 5 | The Non-Malignant Palliative Care Clinic Part 2: Breaking Down Barriers and Building Up a Community of Practice Access to specialist palliative care among patients with non-malignant illnesses is poor, particularly in the outpatient setting. Increasingly, specialist palliative care teams across the country have attempted to address this inequity by establishing stand-alone clinics or by embedding themselves in existing specialty clinics. The establishment of these services is highly institution-specific and dependant on available resources, degree of engagement by specialist teams, and the patient populations serviced by the institution. In addition, the creation of non-malignant palliative care clinics faces fundamental challenges, both clinically and logistically. Clinically, it is difficult to identify which patients would most benefit from services and to engage in advance care planning in the context of unpredictable disease trajectories and evolving treatments. Logistically, it is difficult to determine the optimal model of care in collaboration with the specialist, and to accrue institutional and financial support for the clinic. Considering the heterogeneity in clinic implementation and the challenges thereof, there is promise in the creation of a national community of practice among specialist palliative care providers caring for patients with non-malignant illnesses in the outpatient setting. Michael Bonares and Daphna Grossman |
| 12:30-13:00 | Lunch will be served and delegates will be invited to take it into the plenary room |
| 13:00-14:00 14:00-14:15 Interaction with audience (Q&A, discussion) |
KEYNOTE Top Articles of 2022 The workshop will share and discuss papers published in peer review journals that the Journal Watch team have identified as being “game changers” and particularly noteworthy with respect to advancing palliative care. These papers will cover various domains, from clinical care to health services, research and education. The workshop will be interactive in that there will be opportunities for participants to share key papers that they have also found recently. Leonie Herx and Jose Pereira |
| 14:15-14:30 | CLOSING REMARKS |