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Palliative Care – Present and Future

Palliative Care – Present and Future. By Dr. Howard Burke Regional Leader, Palliative Care, Central East LHIN. Dr. Howard Burke . Family physician in Bowmanville since 1990 Developed the Bowmanville Palliative At-Home-and-Hospital Care Team (PACT) - 1991 Coroner since 1992

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Palliative Care – Present and Future

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  1. Palliative Care – Present and Future By Dr. Howard Burke Regional Leader, Palliative Care, Central East LHIN

  2. Dr. Howard Burke • Family physician in Bowmanville since 1990 • Developed the Bowmanville Palliative At-Home-and-Hospital Care Team (PACT) - 1991 • Coroner since 1992 • Member of Executive of Section of Palliative Medicine for the Ontario Medical Association 2000-present • Facilitates Education with Ian Anderson program or Learning Essentials of Applied Palliative care (LEAP) – 2003- present • Regional Leader for Palliative Care for Cancer Care Ontario for the Central East LHIN – 2007 to present

  3. Disclosure of Potential for Conflict of Interest • Dr. Howard Burke • Relationships with commercial interests: • Grants/Research Support: none • Speakers Bureau/Honoraria: Paladin, • Purdue, JOI • Consulting Fees: none • Other: none

  4. Objectives • Cancer Care Ontario : Symptom Management Toolkit • Exceptional Access Program and medications in palliative care • Where are we going? • Questions?

  5. Provincial Symptom BurdenHigh prevalence of numerous symptoms in ambulatory cancer population Of 224,606 ESAS records for 45,118 patients: • 75%report fatigue • 57%report anxiety • 53%report pain • 49%report shortness of breath • 44%report depression • 25%report nausea Results based on 224,606 ESAS records for 45,118 patients (2007-2009) from the CCO Symptom Management Database (Barbera et al, Cancer2010)

  6. Ontario Cancer Symptom Management Collaborative (OCSMC) • Why • What • How Patients’ self-assessed symptoms are managed according to evidence and best practice • Gold Standard Approach • To improve the quality and consistency of the patient’s physical and emotional symptom management and care planning across the cancer journey • Standardized Tools • Routine Screening • Decreased overall symptom burden to cancer patients and the system as a whole Improved care planning and fewer instances of inappropriately aggressive treatments for cancer patients Every Ontario cancer patient has the ability to electronically assess their symptoms Every Ontario cancer patient has their performance status assessed Performance status is routinely used in planning treatment and care planning Innovation

  7. Symptom Management Toolkit: Assessment Tools • ESAS > ESAS-R (Edmonton Symptom Assessment Scale – revised) • Palliative Performance Status (PPS) • Patient Reported Functional Status (PRFS)

  8. Palliative Performance Scale (PPS) 8

  9. ESAS- R

  10. Patients who complete ESAS value this approach to symptom assessment CCO: Survey of 3,320 patients from 14 Regional Cancer Centres in 2012

  11. Patient Reported Functional Status (PRFS) • Like ECOG and PPS, PRFS assesses a patient’s functional status • ECOG and PPS are determined by the clinician, PRFS is patient-reported • PRFS is based on the Patient Generated Subjective Global Assessment (PG-SGA) - a version of ECOG expressed in lay language and designed to be completed by patients • Study demonstrated that majority of patients referred to Edmonton’s Regional Palliative Care Program were able to rate their own performance status, which is as predictive of survival as PPS * *Baracoset al. (2010). Prognostic Factors in Patients With Advanced Cancer: Use of the Patient-Generated Subjective Global Assessment in Survival Prediction. Journal of Clinical Oncology.

  12. Patient Performance Status to Guide Care Planning

  13. Symptom Management Toolbox • ‘google’ Cancer Care Ontario

  14. Evidenced Based Tools to Guide Care http://www.cancercare.on.ca/toolbox/symptools/

  15. Symptom Management Guides to Practice Pain Dyspnea Delirium Anxiety Nausea and vomiting Mouth Care – dysgeusia, infections, mucositis, xerostomia Loss of Appetite Bowel Care – constipation, diarrhea Fatigue

  16. App available for point of care decision support Named one of nine ‘Best Medical apps’ by The Medical Post (June 2011)

  17. Ontario Drug Benefit Formulary • Exceptional Access Program: Palliative Care Facilitated Access Program (PCFA)

  18. PCFA and list of physicians

  19. Palliative Care Teams • Clarington: Bowmanvilleand area • Oshawa/Whitby/Brooklin • Ajax/Pickering • Scarborough

  20. QUESTIONS?

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