The International Journal of Whole Person Care
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Whole person integrative cancer care in action - an overview of its implementation and patient related outcomes
Get PDFLearning Objectives: Explore and understand the implementation and evaluation of an integrative cancer care model based on evidence based care and programming. Goals of care are to improve quality of life for those with cancer and work towards cancer prevention through a combination of approaches including Complementary medicine including nutrition, exercise and lifestyle management.Background and Project Objectives:The Ottawa Integrative Cancer Centre (OICC) provides evidence-informed integrative and preventative cancer care, research, and education across the spectrum of prevention to survivorship. The purpose of this presentation is to describe the population receiving care at the OICC in terms of demographic and disease-related characteristics, in addition to their experience receiving care in terms of therapies received and preliminary outcomes.Methods: All people receiving care at the OICC are invited to complete a registration package that documents demographic and disease-related characteristics in addition to baseline quality of life (EORTC-QLQ C30), cancer-related symptom (ESAS) and patient-identified concerns or problems (MYCaW). Every 3 months, a follow up assessment is completed for continuing patients.Results:The majority of people seek care at the OICC to manage cancer and treatment related side effects. Other people seek supportive care with their prescribed standard care, to control or cure their cancer, or to prevent a recurrence. Approximately one half of people self-identify as under distress for at least one common cancerrelated symptom. Most patients consult a naturopathic doctor, often in combination with a general practitioner, nutritionist, acupuncturist, physiotherapist, or counselor.Results will be presented regarding quality of life, cancer related symptoms and patient-identified concerns, stratified as possible by age, sex, cancer type, stage and types of treatment received.
A novel source of patients' and families' written words to identify what they value in the doctor-patient encounter
Get PDFContext: The value and desirability of a positive doctor-patient relationship has traditionally been described using case histories and narratives, and less often with formal literature, art, movies, and theatre. To the detriment of this relationship some family physicians are facing pressure to engage in volume medicine, at the possible expense of personalized care. What patients appreciate in their care is at risk of being ignored. Objective: To understand what adult patients value in the clinical encounters with their family physicians. Design: In this research, still in progress, we have adopted an interpretive hermeneutics approach to examine a collection of over 140 cards and letters received by an academic family doctor in practice for 39 years. Participants: The patients or their family members who sent the aforementioned notes. Findings: Preliminary analysis suggests that correspondence is not spontaneous, but initiated at holidays (Christmas, New Years, Chanukah); life cycle events (birth, recovery from illness, death); and transitions (leaving the practice because of geographical re-location). Notes are commonly personalized through hand-written text written on behalf of oneself and/or ones family. Showing a wide variety of word selection they expresses appreciation for family physician care of oneself or a family member that was perceived as knowledgeable bio-medically, and experienced as available, authentic, supportive, professional, compassionate, offering hope, and sensitive to suffering. Conclusions: The writing of notes to ones doctors may serve many functions: catharsis, closure, and bearing witness to patients’ appreciation of care in which Hippocratic and Asclepian traditions overlap and complement each other
Building resilience: an innovative reflective writing method for clinical palliative care – the 55 word story
Get PDFFinding innovative reflective self-care techniques reduces the potential for burnout and the stress associated with attending to the needs of the very ill and the dying. Time is often a barrier to self care; and narrative methodologies often seem to require too much time or writing ability. We offer a novel, time efficient, practical approach for debut at AAHPM/HPNA that is useful to almost everyone.The 55 word medical narrative about clinical encounters from the perspective of the clinician is the self care therapeutic tool offered during this session. Participants will experience and leave empowered to approach the medical narrative in a brief but meaningful way. In this workshop session, participants will be introduced to pertinent research and content on narrative medicine, and will participate in writing a 55 word story about a personal or professional encounter in hospice and palliative care, or about a topic that they want to explore in palliative care such as hope, compassion, doubt, or guilt.Participants will share their 55 word story in dyads, give feedback on this method and its impact on resilience and reflection.Objectives:1. Describe a novel, effective yet brief framework for the use of medical narrative as a reflective exercise for increasing resilience within the larger literature of narrative medicine methods.2. Demonstrate and experience the 55 word medical narrative as a brief but effective reflective exercise.3. Integrate the 55 word story narrative method into various clinical care and teaching settings in palliative care
Whole person care rounds: helping a hospital heal
Get PDFMoving the culture of healthcare to embrace healing in addition to curing is a daunting task. Multiple approaches are required. One such approach has been the introduction of quarterly Whole Person Care (WPC) Rounds at our medical center. The Rounds are creatively developed by an interdisciplinary committee and are open to the entire hospital community, including non-clinicians, volunteers and hospice/home health staff. The Rounds have taken on a variety of formats, from panels of providers, panels of patients/family members, mixed panels and interactive workshops. Examples of titles are Mindfulness in the Workplace, Moral Dilemmas in Medicine, Flourishing in the Workplace, Whose Pain Is It, Anyway?, Death Over Dinner (at Lunch), Joy to the (Our) World. The format is a lunch meeting lasting one hour. The emphasis is always on some aspect of healing for patients, families, clinicians, non-clinical staff or volunteers. Mindfulness work is part of every Rounds. The Congress workshop format would allow an introduction of the concept, examples of previous Rounds, video clips of Rounds, feedback from attendees and interactive sample exercises performed with Congress learners accompanied by robust discussion
Do Canadian and Japanese palliative care physicians perceive the concept of resilience differently?
Get PDFTeaching about resilience is one of the biggest challenges in medical education. One of the problems of currently accepted definitions is that they attribute individualistic notions mainly originating in North American society, such as “endure ongoing hardship,” “thrive on challenges,” “be healthy,” and “be stronger.” In response to this situation, Tsuchiya et al (2017) proposed a description of a broader model of a resilient physician in healthcare that incorporates concepts of self-definition as described in both North American and the East Asian societies; that is, “a person’s capacity to be aware of the aspects of the self differently identified in each context, and to consciously value oneself and others in the context”. However, the concept is still theoretical, and more empirical understanding is needed.This presentation will examine the findings from our exploratory study on physician resilience using semi-structured interviews with 20 palliative care physicians (10 each in Canada and Japan) to answer the following questions:(1) Are there any differences in the way Canadian and Japanese palliative care physician perceive resilience? (2) What factors might affect the similarities or differences of their perceptions of resilience? (3) Are these findings consistent with Tsuchiya’s description? Following qualitative analysis using a grounded theory approach, a schematic representation of resilience in physicians will be offered, to inform a coherent educational program for resilient healthcare professionals.
It was Lauren - and she just wanted to help. Putting the human side back into the critical illness experience
Get PDFThere’s something diabolical about Critical Illness: the illness itself is so severe, that it strips its victim of all control. Regardless of the road to it - whether by slow illness with loss of function followed by sharp decline, or by sudden brutal Trauma, the inability to move, speak, think straight, and have dignity from clothing, has to be the most terrifying and dehumanizing of experiences.But the diabolical nature of critical illness is not found there. It is found in the fact that it mandates a rapidity and Intensity of Care that by its very definition compounds the dehumanization. Even when done “nicely”, insertion of a chest tube, central line or urinary catheter, endotracheal suctioning, or any of the litany of other things we need to do are painful at the least, and injurious to the soul at the worst. It is found in that fact that Critical Illness forces very caring people to do things that injure and leave scars- when that is the farthest thing from what they wish for their charges. Finally, it is found in the very nature of the Critical Care Environment which isolates patients’ families from them, at a time when exactly the opposite may be needed. So how do we put the human connection back into Critical Care? Impossible? A huge task? Actually, it’s a very small one; it’s the Little Things that Matter
Envisioning a McGill University lifelong learning and living (L4) community
Get PDFLifelong learning and cognitive resilience are integral to a changing 21st century education paradigm for learners of all ages, as they are for health and well being of the individual student and wider community. Neuroscience in particular is continually making inroads on the impact that learning has on the brain and the interrelationships between body and mind that help to maintain physical and intellectual capacity over a lifetime. There is a long-standing community dedicated to sustainable lifelong learning on campus, the McGill Community for Lifelong Learning (MCLL). There are also worldwide efforts underway to promote lifelong learning in the context of age friendly cities under the auspices of UNESCO and the World Health Organization. Moreover, the international network of Age Friendly Universities, Lifelong Learning Institutes and over 200 University Based Retirement Communities (UBRCs) in the USA offer resources, guidelines, operating principles and research for building unique and innovative local responses to the changing demographics, increased cultural diversity and technological changes in education futures for learners in a given community. The poster will highlight national and international research initiatives and networks to enhance well-being and mental health through lifelong learning.Different L4 community options will be explored, building on MCLL’s peer learning experience over the past 27 years. It will reflect opportunities for interdisciplinary collaboration with university and wider Montreal community stakeholders, including health care professionals, caregivers, and educators.The poster will demonstrate that a lifelong learning approach to whole person care has the potential to be transformative.
Having fun with role plays
Get PDFRole plays are almost universally loved by educators as a great teaching tool in the medical context, and almost universally hated by students and doctors on training programs, who cite embarrassment and humiliation as key barriers to embracing this teaching technique. “I would rather walk barefoot over hot coals than participate in a role play in front of my colleagues” is not an uncommon response to the suggestion of using role plays in teaching for doctors and medical students. But the good news is that it does not have to be this way! During this fun workshop, Dr. Hilton Koppe will present a number of role play techniques borrowed from psychodrama and adapted for use within the medical context. His use of role plays in teaching has achieved virtual legendary status as a result of the high evaluations they receive from medical students and doctors in training. Workshop attendees will be invited to participate in a number of scenarios which will be used to demonstrate a range of techniques which make the use of role plays both fun, and a highly effective teaching tool. The rationale underpinning these techniques will be outlined