living your best to the end

Advance Care Planning: Women’s College Hospital and Kathy Kastner

National Advance Care Planning Day sees Women’s College Hospital as leaders: bringing the first consumer-created End-of-Life website to Family Doctors. TORONTO APRIL 16…Women’s College Hospital  (WCH) is the first to embark on a project with Family Doctors and patients to evaluate the only consumer-created website for end of life education, BestEndings.com, developed by Kathy Kastner. With the trend to involve patients in all aspects of health care – from research to policy – selected WCH Family Doctors will ask their patients to help evaluate BestEndings, via paper or electronic survey. Feedback and input will be used to improve the overall user experience. Dr Chen championed BestEndings.com in ‘Dragon’s Den’ type pitch session. Dr Chen, Assistant Professor, Department of Family and Community Medicine, University of Toronto, is winner of the 6th annual Excellence in Education awards recognize WCH staff who demonstrate a commitment to education, create an environment that enhances understanding and teamwork and who have a broader impact on WCH’s and women’s education and interprofessional activities. “Women’s College Hospital is leading the way by hosting a project like this. Working together is the first step to creating a mutual understanding of improving patient-doctor end of life conversations and being able to care for and treat patients in the best way possible. “ Says Dr Chen. “Kathy has a history of creating award-winning patient-centered education: she brings a ‘layperson’s perspective to end of life issues, along with curating evidence-based resources and an electronic Advance Directives form.” About Kathy Kastner: With a background in journalism and entrepreneurship, Kathy pioneered North America’s first hospital-based patient-education television networks, implemented for 20 years in top teaching hospitals...

High Risk Surgery: Best Case, Worst Case

Decision tool to help understand chances of dying after high risk surgery “People worry about ‘dying poorly’, so one of the reasons for agreeing to surgery is the mistaken belief they’ll likely die – peacefully – in the Operating Room. This rarely happens.” Dr Gretchen Schwarze To understand what can happen even if the surgery or operation is successful, Palliative doctor, Toby Campbell and Surgeon, Gretchen Schwarze feel stories are necessary to paint a picture for ‘consent’. To illustrate, Dr Schwarze tells this story: “She’s in her late 70’s, with chronic kidney failure and COPD. She’s making it a home with lots of support – but just barely. Now she has an aneurysm, that’s likely going to lead to a medical crisis. Should she have surgery for the aneurysm to prevent the medical crisis?” Using statistics to describe success or failure, her family’s told: 50% chance of not surviving surgery 60% going to need dialysis for renal failure 80% chance going to need ventilator (breathing machine) What the family hears is: 50% chance of survival 40% chance of NOT needing dialysis 20% chance of NOT needing “So, they went for the surgery, took about 8 hours, overall doing well, as best as could be hoped for. When her family came to see her in the ICU, you can imagine what they saw. She was puffy with a breathing tube, with lines and wires and machines. They said, ‘this is not what she would have wanted’ and asked the team to withdraw all supports.” We’ve been so good with innovating in so many areas, communication is not one of them....

Connectivity and Cyber Seniors

Cyber Seniors: the growing internet demographic For the legion of cyber seniors, age 60-90 who rely on internet access to stay connected,  it will come as no surprise that I put forward, in a recent tv panel, ‘internet for free’  for the elderly and low income as a number one priority: Lest that seem a frivolous request, one in three cyber seniors uses social networking sites like Facebook and LinkedIn. This figure is from most recent report from Pew Research Center: Older adults and internet use – dated 2012 and  likely already outdated. Also from this report: Social networking site use among seniors has grown significantly over the past few years: From April 2009 to May 2011, for instance, social networking site use among internet users ages 65 and older grew 150%, from 13% in 2009 to 33% in 2011. As of February 2012, one third (34%) of internet users ages 65 and older use social networking sites such as Facebook, and 18% do so on a typical day. So increasingly important is access to the internet for this ‘demographic’ that cyber seniors services to help master connectivity and take advantage of the riches offered by the digital world are much in demand. Take TechBoomers: free educational website that teaches older adults with limited computer skills how to use the most popular and trusted websites: cyber safety at its best. Some of their most popular courses include: How to use PayPal, How to use eBay, and Introduction to Internet Safety. To quote LifeHackers’ Alan Henry  The team behind the service started it because, well, they’re the folks their parents always...
Palliative Home Visits are the Future

Palliative Home Visits are the Future

“What I fear the most – what really terrifies me – is being short of breath and not being able to swallow.” So said the husband of his dying wife. This is terrifying to me, too, so I listened closely to the response given by Palliative Care  physician, Dr Sandy Buchman: “I can help with shortness of breath: there are medications that change the perception of that feeling of breathlessness. It doesn’t change the underlying cause, but I see patients whose breathing is still labored yet they say they’re now feeling fine. About swallowing: eventually, your wife will not be able to eat. That’s normal, and I can help both of you cope with that. “ I am in the privileged position of being invited to ‘ride’ with Dr Sandy Buchman on palliative house calls. Working at a teaching hospital, he often brings residents as part of their learning experience, but I am the only layperson to get this access. And what an experience it was: learning more about the palliative approach – to symptom management and to that all-important aspect of any meaningful interaction: communication. We decided my best introduction would be ‘educator’ and, although a bit apprehensive about intruding at a fraught time, I was universally welcomed. In a couple of the visits, I was able to employ ‘active listening’ with family members feeling comfortable enough with me to share insights that proved helpful. A range of palliative patient and family situations A B, 100 years old, on oxygen, was a renown pathologist; L.M., 88, bed-bound, the right side of his face paralyzed, was key economist to...

Death and doctors who don’t want to talk about it

What happens when patients want to talk about death, but their doctors don’t? My 94 year-old father-in-law was relieved and delighted when I brought forth the subject of medical directions, in the event he couldn’t speak for himself. My brother in law – a paramedic – brought a standard Do Not Resuscitate (DNR) form. Although written in largely incomprehensible language for a mere non health care professional, I took it upon myself to discuss more than just the decision to resuscitate – shocking his heart back to life. He was right on board with ‘no heroic measures’ – and even more adamant when he understood what ‘heroic’ and ‘measures’ meant in the context of his quality of life.This form required signature from a doctor, so he brought it to his next regular visit to his long-time family doctor. His doctor was aghast. “Who put you up to this? I’m not going to sign this. I don’t think this is what you’d want.” What?! Not an isolated incident, as I’ve discovered. I’ve been conducting informal interviews with healthcare professionals of all stripes about their reaction to not initiating or discontinuing life-prolonging interventions. This includes supplemental feeding (Feeding Tubes) breathing (ventilators and tracheostomies) and dialysis. It’s as if you’ve asked them to condone murder. It’s as if you’ve asked them what they’d want for themselves.. Often these are the same healthcare professionals who purport to want to follow patients wishes, but who try to talk their patients out of their wishes. “If I do that, you know what it will lead to.” Well, yes. It’ll lead to the death, but possibly...