Hospital Care

The Research:

The Hospital Project Team will adapt and pilot test different advance care planning tools, with a goal to increase the uptake, impact and access to advance care planning (ACP) for hospitalized, older Canadians living with frailty. The team will and their acceptability and usability from the perspectives of patients, families, clinicians and partner organizations, and explore the barriers to and facilitators for, the implementing a multi-faceted suite of ACP tools among elderly hospitalized patients living with frailty.

 

Work to date:

Earlier research has revealed a number of barriers to end-of-life discussions between doctors and hospitalized, elderly Canadians living with frailty. As well, even though most of these patient prefer comfort measures, life-sustaining technological measures are increasingly being used at the end of life. The result is that many patients are receiving care that they don’t necessarily want or need.

Results from the ACCEPT study found that correct patients’ preference for end-of-life care showed up in their medical records only 30% of the time. For example, even though 28% of the studied patients stated a preference for ‘comfort care’, this was documented in only 4% of their charts.

A review and synthesis of Communication About Serious Illness Care Goals concluded that “although care of patients with serious illness has improved over the past 15 years …  many opportunities for improving serious illness care still exist … Evidence is accumulating of the value of early discussions with patients about serious illness care goals as a key process for improving end-of-life outcomes.”

 

Principal Investigators:

Dev Jayaraman, MD, MPH

The Research Institute of the McGill University Health Centre

Dev Jayaraman is an Associate Professor in the Departments of Medicine and Critical Care at McGill University. He is also the Director of Quality Improvement in both departments and Director of one of the clinical teaching units in the Division of General Internal Medicine. His major research interest is in improving the quality of care provided to in-patients on the medical wards and critical care units, particularly end of life care.

 

Dan Kobewka, MSc, MD, FRCPC

University of Ottawa

Daniel Kobewka is an Assistant Professor in the Department of Medicine, and the School of Epidemiology and Public Health at the University of Ottawa. He is a general internist at the Ottawa Hospital. His research interests are in medical decision making during serious illness and in health systems as they relate to the care of the frail elderly.

 

Jessica Simon, MBChB, FRCPC

University of Calgary

Jessica Simon is Physician Consultant for Advance Care Planning and Goals of Care (Calgary Zone) with Alberta Health Services, and Clinical Assistant Professor and Interim Division Head with the Division of Palliative Medicine, University of Calgary. A specialist in Internal Medicine, her clinical work is as a palliative consultant at the Foothills Medical Centre in Calgary. Before training in palliative medicine she completed clinical research fellowships in dementia and stroke medicine. She is a member of the Canadian Researchers at End-of-Life Network (CARENET), and her research interests are in advance care planning and the care of people living with advanced chronic disease.

 

John YouJohn You, MD, MSc, FRCPC

McMaster University

John You is a hospital-based general internist who is a staff physician with Hamilton Health Sciences and an Associate Professor in the Departments of Medicine, and Health Research Methods, Evidence and Impact at McMaster University. He received his BSc from McMaster University, and his MD and an MSc in Clinical Epidemiology from the University of Toronto. He is a member of the CLARITY (Clinical Advances Through Research and Information Translation) research group at McMaster, and an executive member of CARENET (Canadian Researchers at the End-of-Life Network), an interdisciplinary network of health care professionals from across Canada who collaborate to improve palliative and end-of-life care.  His primary clinical and scholarly interests are in improving the quality of end of life communication, decision-making, and care for seriously ill elderly patients and their families.