Palliative Care

Researchers at U of T Mississauga tap immersive technologies to improve palliative care

Christopher.Sorensen — Fri, 07 Aug 2020 13:34:20 +0000

Researchers at U of T Mississauga tap immersive technologies to improve palliative care

Christopher.Sorensen Fri, 08/07/2020 - 09:34

Cutline

With VR, palliative care patients can embark on virtual trips, share virtual travel experiences with family members, reminisce about the past and share stories (photo by Levente Bodo via Getty Images)

Patricia Lonergan

Topic

Breaking Research

Graduate Students

Palliative Care

Research & Innovation

U of T Mississauga

Virtual Reality

Researchers at the �ؿ�ζSM are looking to the virtual world to improve the quality of life for those in palliative care.

Cosmin Munteanu, assistant professor at U of T Mississauga’s Institute for Communication, Culture, Information and Technology, and PhD student Sho Conte are exploring how virtual reality (VR) devices can be used to enhance people’s experiences.

The impetus for the study, funded by the Canadian Institutes of Health Research, came from Conte’s experiences as a volunteer at a Toronto hospice. During some of his pre-pandemic visits, Conte took along some VR equipment (one of his hobbies) to entertain clients. He found himself using Google Earth to explore places they wanted to visit – or revisit.

“The reception was incredible – super emotional and super effective,” Munteanu says, noting those in palliative care often have limited mobility and few opportunities to enjoy new experiences.

The lack of social participation has been exacerbated by the recent pandemic. Conte notes he hasn’t been able to see his client since March due to COVID-19.

“It’s a bit upsetting to me, just thinking about that, if I was in that situation,” he says.

VR may be a way to break through the social isolation – whether caused by the pandemic or the nature of palliative care itself – and open new opportunities to facilitate social participation.

“I see VR as a window into these virtual experiences that are immersive and very lived. It’s not as good as the real thing, but in light of their mobility challenges, it works really well,” Conte says.

It may also be a tool that helps provide a more holistic approach to end-of-life care.

“We have a very good palliative care system in Canada,” says Munteanu, although he notes there tends to be a medical focus.

“It’s the soft side that’s often neglected.”

With VR, patients can embark on virtual trips, share virtual travel experiences with family members, reminisce about the past and share stories while looking at Google Street View. VR could also give them a means to have an immersive experience, augment personal connections or even escape the confines of the hospice and meet others in a virtual setting.

The pandemic has put a temporary hold on exploring ways to put VR in the hands of palliative care patients because it’s not currently safe to work with such a vulnerable group. So, Conte has pivoted his research to focus on helping clinicians have difficult planning discussions with patients.

Studies show that 90 per cent of people want to have conversations about planning their care if things go badly, but only about 10 per cent have those conversations, Conte says. “Having conversations and planning before it’s too late is one of the biggest predictors of quality at end of life.”

He’s now turning to VR to help practitioners prepare for these emotionally charged discussions that happen too infrequently. Using a 3D chatbot that provides rich, simulated responses based on a serious illness conversation guide, medical students record themselves having a conversation about advanced care planning. They then review the conversation through VR, where they can see it from the other person’s perspective, giving them a tool for critical self-reflection, learning and training. The goal is to help caregivers gain the confidence to talk about sensitive issues.

Munteanu explains that the immersive technology could be used to develop more empathetic and more attentive listening skills that, in turn, help improve the social and personal aspects of palliative care.

“It’s not that people aren’t doing all they can,” he says. “[But]here are so many more opportunities to make it even better.”

Meanwhile, Munteanu’s Technologies for Aging Gracefully (TAG) lab is part of a three-year international research and development project that has received 1.5 million euros from the European Union’s Assisted Augmented Living to use of emerging technologies improve the quality of life of palliative care recipients, their family caregivers and professional care providers.

The studies are putting the U of T Mississauga’s TAG lab at the forefront of innovation.

“There’s a lot of good research on the medical side,” Munteanu says, but it’s time for everything else to catch up.

In Memoriam: Barrie D. Rose (1930-2018)

noreen.rasbach — Wed, 18 Jul 2018 19:31:11 +0000

In Memoriam: Barrie D. Rose (1930-2018)

noreen.rasbach Wed, 07/18/2018 - 15:31

Cutline

"Barrie Rose was a generous friend to the �ؿ�ζSM who played an important role in advancing palliative care and educating future leaders in this area,” says U of T President Meric Gertler

Topic

Our Community

Faculty of Arts & Science

Faculty of Medicine

Meric Gertler

Palliative Care

Subheadline

Barrie Rose transformed personal loss into dedicated support for palliative care, research and education

Barrie Rose, one of the �ؿ�ζSM's most dedicated donors and a champion for palliative care, has passed away at the age of 88.

“Barrie Rose was a generous friend to the �ؿ�ζSM who played an important role in advancing palliative care and educating future leaders in this area,” says U of T President Meric Gertler. “The comfort and kindness that his philanthropy has made possible for patients and families confronting life-threatening illness continue to be incalculable.”

An accomplished businessperson, Rose supported many areas at U of T over the past 30 years. Following the passing of his first wife, Amelia, Rose made palliative care his primary focus to address the need for a better approach to caring for patients with serious illnesses.

In 1998, he helped create the Rose Family Chair in Palliative Medicine and Supportive Care. The chair, which is held by Dr. Camilla Zimmermann, focuses on developing and testing potential models for the provision of palliative care.

After the loss of his second wife, Carol, to cancer, Rose redoubled his efforts to improve palliative care by establishing the Rose Family Chair in Palliative Medicine and Complex Care at University Health Network (UHN) in 2009. The chair, held by Dr. Michael Baker, focuses on the clinical training of physicians in palliative care.

“We are grateful to Barrie Rose for his support of this important branch of medicine,” says Dr. Trevor Young, the dean of the Faculty of Medicine. “Through the work of Drs. Baker and Zimmermann, he has made a powerful contribution to palliative care and established a program of research and education that will have a formidable impact on care for patients with advanced illness, in Canada and internationally.”

Most recently, Rose gave an additional $5 million to U of T and UHN to support a new residency and fellowship program in palliative medicine. Approved by the Royal College of Physicians and Surgeons of Canada in 2016, the residency program marks the first time palliative medicine has been recognized as an individual sub-specialty of internal medicine in Canada. Rose’s gift will support palliative medicine residents, local and international fellows, collaborative research projects and education and quality-improvement initiatives.

“Barrie Rose was not only passionate about palliative care but also about research, teaching and education,” says Dr. Zimmermann. “He has established a legacy that will only continue to grow as the fellows we train in turn train others in palliative medicine.”

In addition to his contributions to palliative care, Rose generously funded scholarships and research at the Jackman Humanities Institute and the Anne Tanenbaum Centre for Jewish Studies within the �ؿ�ζSM’s Faculty of Arts & Science.

Beyond U of T, Rose supported many other charities, including the Toronto General and Western Hospital, the Toronto Symphony Orchestra, Technion Canada, Sunnybrook Health Sciences Centre, Mount Sinai Hospital, and the Princess Margaret Cancer Centre.

In 2018, the university welcomed Rose into the Chancellor’s Circle of Benefactors, which recognizes the most generous donors in U of T history. “Barrie Rose was an exceptionally compassionate individual,” says David Palmer, U of T’s vice-president of advancement. “He touched many lives and important causes across our community through his giving to U of T and leading organizations in education, health care, arts and culture, and other areas.”

Barrie Rose leaves his partner Karen Solomon and his sons and daughters-in-law John and Susan, Robert, and Paul and Jenn Law.

Almost two years later, medically assisted dying remains complicated, U of T experts say

noreen.rasbach — Wed, 16 May 2018 04:00:00 +0000

Almost two years later, medically assisted dying remains complicated, U of T experts say

noreen.rasbach Wed, 05/16/2018 - 00:00

Cutline

From left, Maureen Taylor, Camilla Zimmermann, Jeff Myers and Sandy Buchman all took part in the Faculty of Medicine's event on end-of-life care

Topic

As a journalist, Maureen Taylor remembers covering the case of Sue Rodriguez, who was denied assisted suicide through a Supreme Court decision in 1993. At the time, Taylor couldn’t have imagined that 10 years later she’d be surreptitiously investigating a way to help her own husband, Dr. Donald Low, take his life.

After a terminal cancer diagnosis in 2013, the �ؿ�ζSM professor and infectious disease specialist longed for control over how and when he would die. Frustrated at not having that choice, Low made a compelling case for the right to assisted dying in a widely viewed video, released after his death.

Taylor – who had already transitioned from award-winning health journalist to physician assistant – took on yet another vocation: assisted dying advocate. She co-chaired an expert panel making recommendations to government and has spoken out publicly for changes in legislation.

She recently joined U of T physicians, educators and researchers at a Faculty of Medicine event called UofTMedTalks, where they delved into how end-of-life care is changing in the era of medical assistance in dying.

“It’s been almost two years since Canadians have had the right to discuss assisted dying with a health-care provider, but how is the system working?” Taylor asks. “How easy is it to navigate, for patients and for health-care providers?”

It’s complicated, was the resounding consensus.

As medical assistance in dying has shifted from controversial debate to constitutional right, there’s a clear need for more research and education to address gaps in knowledge and access, especially for the broader field of palliative care, the speakers said.

One of the big surprises was the unease among many palliative care specialists to be involved in medical assistance in dying. Having worked hard to counter the misconception that palliative care hastens death, many of these specialists found this new function at odds with their practice.

“Medical assistance in dying is 100 per cent palliative care,” says Jeff Myers, an associate professor in U of T's Faculty of Medicine, “and at the exact same moment it’s 180 degrees opposite of palliative care.”

Myers – the W. Gifford-Jones Professor in Pain Control and Palliative Care, head of the division of palliative care in the department of family and community medicine and site lead at Sinai Health System’s Bridgepoint Palliative Care Unit – is focused on reconciling this contrast.

“Now in Canada, the end-of-life part of palliative care is inextricably linked with medical assistance in dying,” he says. He shared his own recent experiences providing the procedure, and reflected on the hope and relief it offered patients.

For Sandy Buchman, an associate professor in the department of family and community medicine, it was that relief from suffering that convinced him to provide medical assistance in dying. As a family and palliative care physician with the Sinai Health System’s Temmy Latner Centre for Palliative Care, Buchman cares for patients at end of life, in their homes.

Buchman didn’t set out to provide medical assistance in dying – or even palliative care before that. As a family physician, it was patients with HIV/AIDS who introduced him to the field of palliative care. And more recently, as he was grappling with the decision of whether he would provide medical assistance in dying when it became legal, a patient and U of T professor and cardiologist who suffered from advanced Parkinson’s asked if Buchman would help.

“Just the hope that MAiD [medical assistance in dying] offered him was incredible to me,” he says. “I went into medicine to relieve suffering.”

Buchman came to consider medical assistance in dying as consistent with these values.

It’s not the only way to relieve suffering, however, stresses Buchman. When patients are given other options to manage pain and reduce suffering – core goals of palliative care medicine – many will no longer request medical assistance in dying.

This is one of the frustrations in the palliative care community: With so much attention on medical assistance in dying, some feel that unmet needs in palliative medicine continue to be overlooked.

“MAiD is only a choice if there’s another option,” says Myers, who worries that not enough Canadians have access to palliative care. He hopes the spotlight shining on medical assistance in dying will help illuminate the broader field of end-of-life care.

Already, researchers and palliative care specialists like Professor Camilla Zimmermann have been transforming our understanding of the field. A professor in the departments of medicine and psychiatry and palliative care physician and senior scientist at the University Health Network’s Princess Margaret Cancer Centre, Zimmermann holds the Rose Family Chair in Palliative Medicine and Supportive Care. She has shown how early access to palliative care – starting at the time of diagnosis – leads to greater quality of life.

While she recognizes there wouldn’t be enough palliative care specialists for every patient in need, she believes education is key. She says we should be training all medical students and many specialists in providing some level of palliative care.

“If you’re a specialist in lung cancer,” she gives as an example, “you should really know how to treat shortness of breath.”

While much remains to be done, there’s been major progress, in both palliative medicine education and in medical assistance in dying. Just last year, Zimmermann and Myers have helped launch a new Royal College subspecialty training program in palliative medicine at U of T. And researchers and educators have been developing guidelines and best practices about medical assistance in dying.

“It is in complex areas like this that knowledge, expertise and passion, become so essential,” says Faculty of Medicine’s Executive Director of Advancement Darina Landa, who hosted the event.

Maureen Taylor still has questions, both in her role as a health-care provider, and advocate: “If a patient doesn’t bring MAiD up as an option, can I? Is that appropriate?"

U of T researchers and educators are committed to examining this question and the the field’s many other grey areas,

Doctors' Notes: Palliative care benefits both patients and families

lanthierj — Mon, 11 Sep 2017 20:51:02 +0000

Doctors' Notes: Palliative care benefits both patients and families

lanthierj Mon, 09/11/2017 - 16:51

Dr. Helen Senderovich

Author legacy

Dr. Helen Senderovich

Topic

It’s common to see palliative care as a last resort, says Dr. Helen Senderovich – but research shows it offers the most benefit when started soon after the diagnosis of a life-threatening illness and alongside medical treatment.

“I chose this specialty because the ability to help patients feel comfortable in their last days and provide support to their loved ones is one of the most fulfilling contributions I can make to enrich their lives,” says Senderovich, an assistant professor in the department of family and community medicine, division of palliative care.

But more needs to be done to ensure all Canadians have access to this type of care, Senderovich says.

Writing in this week’s edition of Doctors’ Notes, The Toronto Star’s weekly column created by medical experts from the �ؿ�ζSM, Senderovich, a physician focused on geriatrics, palliative care and pain medicine at Baycrest Health Sciences, says it’s “an honour and a privilege” to work in this field.

“The demand for palliative care continues to grow as baby boomers age,” Senderovich writes. “It has been shown to not only benefit patients but caregivers as well, by lessening their stress and helping with grief and mourning.

“Even when patients are suffering from chronic illnesses they can still maintain their quality of life at any age and at any stage of a serious illness.”

Read the complete column in Doctors' Notes

Does Palliative Care Need a Rebrand?

lavende4 — Tue, 19 Apr 2016 15:14:50 +0000

Does Palliative Care Need a Rebrand? lavende4 Tue, 04/19/2016 - 11:14

Topic

Patients are missing out on earlier access to supportive care, all because the stigma attached to the label “palliative care,” according to new research by U of T Professor Camilla Zimmermann, published recently in the Canadian Medical Association Journal.

The problem, Zimmermann uncovered, is that patients viewed palliative care as equating end-of-life care, when it’s actually a much broader range of services.

“Patients told us if palliative care were called something else, they wouldn’t feel so stigmatized,” says Zimmermann, a department of medicine professor and Rose Family Chair in Supportive Care. “We have a branding issue and that’s the central message of this research.”

The researchers performed and analysed qualitative interviews with 48 patients with advanced cancers and 23 caregivers who had participated in an earlier randomized controlled study of 461 patients. Participants had advanced lung, breast, gastrointestinal, genitourinary and gynecological cancers, and an estimated survival of between 6-24 months. Half had received early palliative care intervention in the outpatient clinic setting, in addition to standard cancer care. The other half received standard care only.

Those who had received early palliative care intervention were found to have an improved quality of life — and the researchers noted a shift in perception towards palliative care itself.

Read the CBC story

“Initially, both groups perceived palliative care as synonymous with death,” says Zimmermann. For the intervention group, however, this outlook changed over time. “They began to see palliative care as relevant early in the course of their illness and as being beneficial to them by supporting them and improving their quality of life. “

The findings signal the need to rebrand palliative care. Zimmermann believes this is essential in order to ensure the full spectrum of supportive care is offered — from the moment of diagnosis through the course of illness.

In 2002, the World Health Organization broadened its definition of palliative care, to underscore that it is applicable even at the beginning stages of an illness, and in conjunction with therapies intended to prolong life. Yet many still equate the term with end-of-life care, and medical professionals and media outlets reinforce that message.

“Palliative care is supportive care that improves quality of life throughout the course of illness,” says Zimmermann, who is also Medical Director of the Al Hertz Centre for Supportive and Palliative Care at the Princess Margaret Hospital and Head of the University Health Network’s Palliative Care Program. “It is not something to be afraid of or that is stigmatizing, but is helpful even while patients are receiving life-prolonging therapies.”