a dfcm collaboration for social accountability: harnessing the power of relationships jeff myers -...
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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
2009 2010 2011 2012 2013 2014
2009 -14: Inpatient New Referrals
Projected (2X)
Our current reality
1996
-97
1998
-99
2000
-01
2002
-03
2004
-05
2006
-07
2009
/201
0
2011
/201
2
2013
/201
4
2015
/201
6
2017
/201
8
2019
/202
0
2021
/202
2
2023
/202
4
2025
/202
6
2027
/202
8
2029
/203
0
2031
/203
2
2033
/203
4
2035
/203
60
20
40
60
80
100
120
140
160
80 80 80 81 81 81 83 84 85 84 8689
92 94 96 98 100102104106108110112114116118120122124127129131134137140143145148
152
Nu
mb
er
of
De
ath
s (
10
00
's)
Total # of Deaths projected to in-crease: By 20% in 10 yrs from 2010 to 2020 By 65% in 25 yrs from 2010 to 2036
Deaths in Ontario: 1996-2036
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