Palliative Care – St. Joseph’s Hospice of London

Contact Person:  Dr. Natalie Hertzman, Medical Director

 Practice Profile

St. Joseph’s Hospice of London is a 10 bed residential hospice.  Patients are admitted directly from the Southwest LIHN / London-Middlesex community as well as via transfer from local acute care hospitals.  These patients are admitted for the purpose of pain control, symptom management and ultimately for end-of-life care.  These patients are in the end stages of both cancer and non-cancer advanced disease and are estimated to have a life expectancy of 3 months or less.

Along with the Medical Director, there are 2 additional focused palliative care physicians who attend Hospice patients at any one time.  The Resident will be assigned to the Medical Director as primary preceptor, but will work regularly with the other Hospice Team physicians throughout the rotation.  Often these physicians carry a roster of palliative patients within the community and the Resident will be encouraged to accompany these physicians during house calls.

The Resident will work as a member of the interdisciplinary team (RN, RPN, PSW, Director of Residential Services, Spiritual Care Coordinator, volunteers) who provide daily care to both patients and their families, becoming familiar with each of their respective roles.  The Resident is expected to attend and participate in the weekly Interdisciplinary Team Rounds.  As well, the Resident will become familiar with the various complimentary therapy options provided at Hospice, including Reflexology, Reiki, Meditation, and Healing Touch.  During the rotation, the Resident will be expected to research and present a pertinent topic in palliative care surrounding a current or recent case.  Acting in the role of educator, this will be presented to staff and coworkers.

The Resident will have ample opportunity to be responsible for the full admission of new patients.  This will include becoming familiar with and using standard tools for symptom assessment eg. pain, dyspnea, cognitive function, bowel function, nausea and vomiting and depression.  The Resident will learn to first establish a patient’s goals of care and then develop a comprehensive management plan based on these goals.  After admission, the Resident will continue to follow the patient during the rotation.  The Resident will also be expected to initially meet, review and then follow all patients residing at the Hospice by rounding daily and charting accordingly.

The Hospice Team physicians are part of a larger on-call group that covers St. Joseph’s Hospice, the Parkwood Institute Palliative Care Unit and the London-Middlesex community palliative patients.  The Resident may assume first on-call (first person called with the Hospice Team physician as backup) according to the group’s ongoing call schedule.

The Resident will also work alongside the Medical Director and Director of Residential Services in order to become familiar with the community’s process of applying for Hospice admission, through the local CCAC, and the subsequent process of triaging these applications as they are received.

 

Objectives:

The Resident is expected to:

MEDICAL EXPERT/FAMILY MEDICINE EXPERT

 

  1. Perform a complete and comprehensive palliative care admission, including the medical history, physical examination, symptoms review, assessment of physical/psychological/social/spiritual functional status, goals of care, and establishment of a treatment and management plan.
  2. Demonstrate knowledge of common diseases encountered in hospice palliative care, including colon, lung, breast, hematologic and pancreatic cancers.  Also, end stage non-malignant diseases eg. ALS, CHF, renal failure, COPD.
  3. Demonstrate understanding of the pathophysiology and management of frequently encountered symptoms eg. pain, nausea and vomiting, dyspnea, delirium, constipation.
  4. Demonstrate knowledge and pharmacological understanding of the various medications ordered to treat these symptoms, including indications, dose selection and route conversion, titration, side effects and management of side effects.

 

COMMUNICATOR

 

  1. Report all findings clearly, accurately and effectively, both verbally and written.
  2. Demonstrate skill in physician-patient interaction, both verbal and non-verbal, including development of rapport, active listening and use of an overall compassionate and caring “bedside manner”.
  3. Actively participate in Team discussions and family meetings when establishing goals of care and management plans, including dealing with their fears, anxiety and grief.
  4. Effectively prepare and present educational topics in palliative care / case reviews.

 

COLLABORATOR

 

  1. Work effectively as a member of the Interdisciplinary Team and attend weekly Team rounds.
  2. Become familiar with each member of the Team and describe how their individual roles / disciplines allow for important contribution to the Team.

 

MANAGER

 

  1. Become familiar with the application for admission process for St. Joseph’s Hospice of  London as it applies to CCAC, the Medical Director and the Director of Residential Services.
  2. Take part in the daily review and triaging of urgent, active and pre-registration applications for admission.

 

HEALTH ADVOCATE

 

  1. Describe the societal, environmental and resource allocation factors in the healthcare system affecting the care of the dying, not only locally but provincially and federally.
  2. Describe the current barriers to effective palliative care in various settings across the city, region and province.

 

SCHOLAR

 

  1. Perform an effective literature search on a pertinent topic in hospice palliative care, related to a specific patient case, and present this to staff and physicians during the rotation in the role of educator.
  2. Act as an effective educator to patients and their families when discussing their disease process end-of-life issues.

 

PROFESSIONAL

 

  1. Consistently deliver the highest quality of care while demonstrating compassion, integrity, confidentiality, sensitivity and respect for all patients at Hospice and their families.
  2. Demonstrate consistent professional and respectful behavior when interacting with coworkers, staff and volunteers.
  3. Recognize and describe any personal attitudes or concerns surrounding the care of dying patients and discuss methods for managing these and other potential stressors.