Home Based Palliative Care

(Available to residents in their second or later years of their program)

Contact person: Dr. Kirk Hamilton 

Dr. Hamilton is the lead physician for the London Home Palliative Care (LHPC) Team and maintains a roster of 80-100 patients within their home environments. These patients have a wide variety of cancer and non-cancer (ALS, COPD, CRF, CHF, dementia, MS etc.) end stage illnesses, which allow the residents an exciting and unique opportunity to learn how to manage a wide range of clinical scenarios.

Caring for patients and their families with life limiting illnesses is a fundamental skill which is essential when working in many different fields of medicine. The provision of high quality care to this group of patients which focuses on compassionate, patient-centred, symptom based care directed at easing the suffering related to the patient’s end stage disease processes is mandatory when working with these patients and their loved ones. This is a very challenging and satisfying domain of medicine and acquiring effective skills managing these patients will improve the resident’s care when dealing with managing patients with end stage illnesses.

This rotation will help the resident enhance their communication techniques, clinical skills and their management plans in treating palliative care patients and their families who are dealing with their life limiting illnesses. After completing this rotation, residents will have the foundation to eventually become confident and skilled in managing patients with end stage illnesses in a variety of clinical settings, including; community Hospice homes, patients in their home environments, palliative care hospital units, nursing homes or acute hospital in-patient units.

  • At the end of this rotation for Palliative care/ End of Life Care, the resident will also be able to:
    Manage end stage palliative care patients and their families who are suffering from both cancer and non cancer illnesses (COPD, CHF, MS, ALS, CRF (on dialysis), MS, end stage dementia etc.) within their home environments.
  • Perform and document a comprehensive palliative care assessment. A detailed plan of management for these patients experiencing their life threatening illnesses addressing their physical, psychosocial and spiritual problems as they relate to their disease process.
  • Understand Clinical Pharmacology and Utilization of Medications for Symptom Management: Pain, nausea, vomiting, dyspnea, constipation, anxiety and depression.
  • Develop improved Communication skills: Assessing patient and family preferences and goals of care, attending to emotion, managing uncertainty, delivering bad news and understanding the components and benefits of an interdisciplinary team approach.
  • Develop Strategies for Self-Care: Assess coping strategies and practice behaviors for self-care.
  • Develop a Plan of care for patients with Life-Threatening Illnesses: Construct a prognostic estimate along with predicted collection of symptoms related to the patient’s specific illness along with a plan of care for these specific anticipated scenarios.
  • Understand Pain Management: Construct a differential diagnosis of pain mechanisms along with therapeutic management including use of adjuvant medications and the use of non-pharmacological measures.
  • Be able to Evaluate and Manage Delirium: Carry out an evaluation of patients with altered mental status and construct a differential diagnosis. Describe clinical pharmacology and construct a therapeutic management plan for delirium.
  • Understand Screening, Evaluation, and treatment for Psychological Disorders (Patient/Family): Describe an initial evaluation of psychological disorders leading to the design of a plan. Understand the clinical pharmacology and construct therapeutic management plans incorporating the use of psychoactive agents for anxiety, depression, and insomnia.
  • Gain an appreciation for Spiritual and Cultural Aspects of Palliative Care: Perform an initial evaluation identifying the patient’s spiritual and cultural aspects which are important to them. Understanding the significance of your patient’s personal sense of culture and spirituality and how this will impact their palliative care.
  • Fine tune the residents Advanced Communication skills: Shared decision-making, conflicts regarding goals of care, difficult/challenging patients/families and foregoing life-sustaining interventions. The use of principles of communication while carrying out meetings with patients/families leading to shared decision-making, resolution of conflicts, effective communication in difficult situations, and eliciting patient/family preferences for goals of care.
  • Achieve the training, skills and confidence required for the resident to be the eventual MRP for palliative care patients in a Hospice, palliative care unit, hospital or nursing home environment.
Details related to this rotation:
  • Call is home call and the suggested on call schedule would be 1 in 4 and one weekend of call per month. The residents will have the option of being on call 2 weekends per month and in return, they will be offered 2 long weekends (2 additional weekdays off along with the weekend) off in lieu of this additional weekend work. Call for palliative care home patients is not onerous and surprisingly there are very few pages after 6:00 pm and most of these pages can be managed by phone. There is no expectation to ever travel to a patient’s home after daytime hours.
  • The resident will provide palliative care follow up home visits and perform the initial palliative care consultation (urgent and semi-urgent) during this elective time. The usual start time for home visits is 8:30 am and the last home visit is usually completed by 3:00 pm.
  • Dr. Hamilton is also a palliative care consultant at a tertiary hospital and occasionally covers the inpatient palliative care ward (14 bed unit) and consultation service and the resident may have the opportunity to be on call with Dr. Hamilton during the weekends he covers this service.
  • The ability for the resident to have their own transportation for the house calls is a mandatory requirement for this rotation.
  • This rotation qualifies the resident for the home call stipend and most programs offer an out of town living allowances and a $100.00 per month gas allowance stipend (from the LHPC team).
  • Dr. Hamilton is available for guidance and mentoring for all home visits.
  • Dr. Hamilton will accompany the resident for several house calls during the rotation for an enhanced didactic learning experience. The majority of the resident’s house calls will be performed independently, however, all visits will be reviewed by Dr. Hamilton and is always available for guidance and support during all patient encounters.
  • All home visits will be done during day time hours (no mandatory night time visits).
  • The resident is never required to provide care to patients if they feel their safety is in jeopardy. Dr. Hamilton will have already assessed the patient within their home environment and would never ask the resident to assess a patient in a home if there are any questions related to the resident’s safety. If during or after any patient or family encounter, the resident is not comfortable continuing to follow a particular patient or family within their home for any reason, future house calls to that home by the resident will cease!
  • Dr. Hamilton will be the main supervisor for this rotation, however, a few members of his palliative care team will occasionally participate in the supervision and teaching during the resident’s elective time at Western.
  • Participate in didactic “case of the week” exercises which will challenge the resident’s management plans related to various clinical scenarios and the specific leaning objectives related to this rotation.

Residents will be expected to submit their personal specific learning objectives for palliative care prior to beginning their rotation in order for Dr. Hamilton to plan your elective experience.

If you have any further questions about this rotation, please contact Dr. Kirk Hamilton at drkirkhamilton@gmail.com

PLEASE NOTE: ELECTIVES MUST BE FOUR WEEKS (1 MONTH) IN DURATION (PART OF A MONTH IS NOT ACCEPTABLE). ALL ELECTIVES ARE ARRANGED BY JOHN BERGER AND DENNIS SUE, DEPT. OF FAMILY MEDICINE, WESTERN.