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Choosing Wisely Talks | Choosing Wisely Talks | Communicating About What Matters Most: Encouraging Serious Illness Conversations - Shared screen with speaker view
Jaana Ranchithan
30:46
https://choosingwiselycanada.org/events/past/
Karen Born
35:23
Link to Time to Talk: Encouraging Serious Illness Conversations https://choosingwiselycanada.org/serious-illness-conversations/
Jaana Ranchithan
40:34
Please feel free to enter any questions or comments in the Chat box.
Aileen Comerton
41:12
I thought that the term living will was no longer used ??
Jacinta Slobodan
41:28
@Aileen - it's not something used in Canada.
Jacinta Slobodan
42:34
We use different terminology provincially. In BC it would be an Advance Care Plan or Written Expression of Wishes.
Kathy Kastner
43:43
My experience (as a patient partner in various end of life, palliative care and end of life communication initiatives) is the the general public does not (yet) know the change in terminology - eg that Living Will is now called Advance Directives
Richard Edwards
44:38
How to get the horse to drink? "Better communication" a fundamental, SIC useful, but how to help busy clinicians take it up when other exhortations to communicate haven't succeeded?
Kathy Kastner
45:18
Yes! Dr Sanders - thank you for acknowledging lack of resources oft prevent dying at home.
Esha Ray Chaudhuri
46:12
I have to leave early for another meeting so wonder about the response to my question/ comment. But here it is, the assumptions about why some expect LST are typically culture specific and do not consider the contexts of variations in global bioethics where sanctity of life impacts most values and wishes for (even) aggressive treatment.
Aileen Comerton
46:18
Unless someone has a very quick death/ short end of life period , lots of insurance , a big family or support system and or lots of money dying at home just not realistic in many cases
Gloria Wilkinson
46:45
In Alberta we have hospitalists. They interrupt the flow and trust with your family physician. How do we get rid of them?
Karen Born
47:07
Hi @Esha - what is LST?
Kathy Kastner
47:10
@Richard Edwards: such a key point. The PCORI initiative I’m involved with is developing scaling up/sustainable strategies for incorporating SICP
Amy Ma
47:44
@Kathy what I find discouraging is in QC due to acute staff shortages, people at EOL requiring either MAiD or palliative care must now go to the hospital instead of receiving this care at home.
Esha Ray Chaudhuri
48:50
It is also time now to share with patients and families about the unusual cruel clinical practice of Unilateral DNR ORDER in cases where clinicians do NOT agree with even conscious well informed adult patients' wishes despite recods of SIPP or ACP
ardis smith-sewell
49:48
is there a link to the tool kit thank u
Karen Born
50:20
https://choosingwiselycanada.org/serious-illness-conversations/
Karen Born
50:25
This is the link to the toolkit
ardis smith-sewell
50:50
thank u!
Esha Ray Chaudhuri
50:56
There are also important protocols of the Due Process which do protect patienyts and families in dispute settings and it is critical that all SIPP conversations inform patients and families about these.
bhooma bhayana
52:05
can you put the qr code up again? thank you for a great presentation
Alexandra Kushliak
52:24
In Alberta proxy /agent legal paper work includes a advance care plan which is legally enforced by the Personal directive act
Karen Born
52:34
Here is the link to the Choosing Wisely tools for serious illness conversations, this was what Dr. Sanders QR code linked to @Bhooma Bhayana https://choosingwiselycanada.org/serious-illness-conversations/
Connie Joylani
52:56
Thank you for the great lecture!
Angela Jenkins
55:58
Yes!!! What to expect when you are expecting - what to expect when you are diagnosed with a chronic illness!!!
Cody Kelly
55:59
Absolutely!
Aileen Comerton
56:40
Maybe we need to change the term Advanced Health Care Planning. I teach this , work in long term care , do palliative care , the medical team get the term but the lay public don't get it. This came home to me recently doing a volunteer talk in the community to seniors on ACP and they had no clue as to what it was ? financial , life , health etc
Richard Edwards
56:46
Except we rather look forward to a birth more than the other end of things...
Nicole Porquet-Seitz
57:13
I often say - people deserve as much attention, love and education at end of life that they get a beginning of life
Connie Joylani
57:37
@Nicole absolutely!
Gloria Wilkinson
57:38
Patient-centred care along with co-design creates informed patients who are much better prepared for all sorts of events - and have the courage to speak up.
Emily Farrell
57:41
We all need death plans! Everyone plans their life; school, weddings, babies, careers, etc. but we never plan for our death. Detah is something that we will all have the opportunity to experience.
Emily Farrell
57:58
Death*
Michele King
58:35
Definitely! We need to change the culture to accept death. Change the death phobia.
Cody Kelly
58:37
it's a realtionship
Esha Ray Chaudhuri
59:20
Both ACP and SIPP need to be inclusive to resonate with diversities and dynamism of patients and families in addition to their contexts of soecific illness
Kathy Kastner
59:31
@Richard: couldn’t agree more about birth being a joyous anticipation, vs end of life - not so much. I always push back against that comparison (with all due respect @Leah Steinberg)
Esha Ray Chaudhuri
59:43
and exceptional situations such as the pandemic
Cindy Dumba
59:51
Agree! The relationship is key to the experience/ journey
Sandra Andreychuk
01:00:23
The role of the SDM is to interpret the previous expressed wishes of the patient, whether written or verbal, and apply it to the decision to be made. Therefore any information ACP, Advance Directives, informal conversations and SIC is all important to support future decisions needing to be made on behalf of an incapable person.
Cody Kelly
01:00:33
Public need to know what their options are
Esha Ray Chaudhuri
01:00:56
Absolutely !
Judith Coutts
01:02:14
Early education might be a place to start. My children changed my role in recycling with education...What has the panel seen in regards to early education advocacy?
Kathy Kastner
01:02:18
How’s about determining what language we (patients/fam) use rather than trying to get us to understand your jargon
Alexandra Kushliak
01:02:43
Its usually the clinician making an excuse for their lack of skill blaming the patient that the patient just doesn't understand
Esha Ray Chaudhuri
01:02:50
Values and contexts of life and death are typically culture specific and it is critical to integrtae these cultural variations in both public awareness raisng and healthcare providers'education
Jennifer Baird
01:02:52
The relational component: one outcome of this that I have never heard discussed is clinician reward (avoidance of burnout). I am an intensivist so spend much of my work day with patients with whom I cannot communicate. The time that I spend sitting with a patient on the ward, prior to ICU admission, discussing their options, is one of the most emotionally rewarding parts of my job, and I think protects me from burnout because of the connection that we develop. Just to make the point that the value of these conversations is not just one-way to the patients.
Kathy Kastner
01:04:13
I also push back on ‘values’ (I know, politically incorrect ) but..- too obtuse, and oft requires too much explanation to get to the questions that I think more easily accessable: hopes and worries.
Jeff Myers
01:05:41
My worry with COVID is reinforcement that a person could know what they would and would not want as far as specific medical interventions in the absence of context
Daren Heyland
01:06:07
There is a bit of disconnect for me. Choosing wisely is about not offering tests and treatments that are not wanted or valued. This means treatment decisions need to be made congruent with patient values. If SIC is about ‘preparing’ the patient and relationship building, there seems to be a gap in improving medical decision-making. seems like there needs to be more work done on improving shared decision-making in the context of serious illness if we are going to realize the CW goal.
Esha Ray Chaudhuri
01:06:22
Have to leave now but thank you for organizing this very important conversation ! Look forward to many more !
Kathy Kastner
01:07:45
@Daren: Yes! Shared Decision-Making in end of life. Hard, IMHO because oft we don’t know as much as you (doctors etc) about what (may be) ahead and consequences of decision.
Cindy Dumba
01:11:01
Thanks for a fantastic presentation!
Gloria Wilkinson
01:11:17
Perhaps change the pcp payment to an annual panel payment. Stop the fee for service
Aileen Comerton
01:11:33
with the serious illness charts maybe including all the possible billing codes attached to help folks with the billing
Richard Edwards
01:11:43
Indications too that effective conversations are time-saving longer term.
Jacinta Slobodan
01:12:11
Agree, Leah! Sometimes it might be one question from the guide that is relevant to the situation that helps us to ascertain goals, values, wishes. I have gleaned great information by using parts of the guide (especially in time-pressed situations) in the moment.
ardis smith-sewell
01:12:34
wondering about the intent of "green sleeves" in family praxtice..I worked in alberta which i have seen more prevalence of this conversation, now in nova scotia...I find not as prevalent
Aileen Comerton
01:13:21
process of discussions all along the course of the serious illness
Aileen Comerton
01:14:14
normalize these conversations not just at the time of crisis ?
Kathy Kastner
01:14:53
@Janet Reynolds: Yesss! Built into annual, with a Q ‘prompt’. Also SO critical to prepare us for convo: give us time to think bout what we do or don’t know
Gloria Wilkinson
01:17:05
pcps must have these conversations. prevention is way cheaper and more effective with outcomes than treatment later
Aileen Comerton
01:17:58
Different conversations at different stages in the disease and whether it's learning values or at a time when a treatment decision needed
Connie Joylani
01:21:19
@ Ailee: Totally agree. These conversations should be normalized. Regularly "touching base" with patients regarding these discussions are so helpful.
Olga Nikolajev
01:21:40
Thanks for your great work everyone
Gloria Wilkinson
01:22:21
How many of us on this call are patients? I hope lots are here .
Gillian Fyles
01:23:27
Thanks Justin, Leah et al for this great sessions. A group of us nationally are working with Pallium to create nationally accessible SIC workshops for clinicians and to train facilitators.
Erryca Robicheaux
01:23:56
Fantastic conversation! Thanks, Justin and Leah!!
Aileen Comerton
01:24:18
Normalize from the get go
Richard Edwards
01:24:22
Surely "communication skills" are integrated into medical training?
Olga Nikolajev
01:24:49
Thanks Justin and Leah
Alexandra Kushliak
01:25:10
Thank you great discussion .
Kathy Kastner
01:25:58
Oh please, can I be (a patient partner) on continued convos?
Richard Edwards
01:26:13
There are "official" patient groups who might be happy to receive guidance on how to start such conversations with their clinicians.
Paula Kirk
01:26:24
Wendy, Choosing Wisely could lobby medical schools to begin an understanding of these issues with medical students before they begin their careers.
Gloria Wilkinson
01:26:24
I believe the patient must be part of this whole conversation. I am a PaCER trained volunteer and a patient.
Danusia Kanachowski
01:26:35
Thank you for the session, good conversation
Connie Joylani
01:26:54
Excellent conversations, thank you.
Kathy Kastner
01:26:58
Most def patient partners needed in convo to make it most effective for all stakeholders
Zhimeng Jia
01:27:07
Thank you Leah and Justin for this stimulating conversation!
Jaana Ranchithan
01:27:07
Survey Link (English): https://www.surveymonkey.com/r/72MT89ZSurvey Link (French): https://fr.surveymonkey.com/r/72XSPM2
Amy Ma
01:27:07
Excellent presentation!
JoAnne Connors
01:27:38
Thank you for a great presentation and discussion - from Nova Scotia
Vicki Bassett
01:27:39
Thanks so much!
Jaana Ranchithan
01:27:44
Please email your questions to: info@choosingwiselycanada.org
Jaana Ranchithan
01:28:02
https://choosingwiselycanada.org/event/cwtalks-jan13/
Jacinta Slobodan
01:28:03
Thank you, Justin. So happy to have you and your wisdom on this side of the border! :)
Jaana Ranchithan
01:28:44
Abstract Submissions: https://choosingwiselycanada.org/perspective/abstracts-2022/