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One Month to Go Until Sask Palliative Care Conference

Seasons

Inside this issue:

Profile of Dr. Ken Stakiw 1,

5

President’s Message 2

Hike for Palliative Care & National Palliative Care Week

2

Advance Care Planning Day 3

Breath of Care 4-5

Budget, 2011 Federal Election 6-7

Various Headlines 8

Membership Renewal

Have you renewed your

SHPCA membership?

www.saskpalliativecare.org

Or call Pres. Carla Carlson

(306) 773-6523

Celebrate all seasons of life

Spring 2011

A Quarterly Newsletter

Spring 2011

Conference attendees still have a

few days to save with early-bird

pricing! Until April 30th, the regis-

tration price for professionals is just

$300. When April’s over, the price

goes up to $330! Still reasonable, for

sure, but about 10 per cent more.

Why not save—book now! Registra-

tion is always a little less for volun-

teers and students. Full promotional

poster, itinerary, and conference

fees are available on pages 4 & 5 of

this newsletter. You have until May

2nd to book your rooms at the door

busting price of $124/night. Please

call the Saskatoon Inn at 1-800-667-

8789 and quote “Palliative Care Con-

ference” for the special rate.

Keynote speakers include Stephen

Jenkinson, “Dying Centred End-of-

Life,” and Dr. Graeme Rocker,

“Managing Dyspnea in a Palliative

Care context.”

He will be part of the conference closing panel discus-

sion on Dyspnea, but to many people in Saskatchewan,

Dr. Ken Stakiw has been a mainstay on the provincial

medical scene for close to 40 years. The good doctor,

who began his career in Saskatoon in family practice in

1975, will discuss Dyspnea with Dr. Graeme Rocker.

“I’m certainly not the kingpin in this discussion,” said

Stakiw, ceding top billing to Dr. Rocker. However, Stakiw,

Medical Director, Palliative Care Services, SHR, did add a

little of what he’ll be talking about.

“Shortness of breath management is a big part of Pallia-

tive Care, so it’s not just drugs–there are a lot of other

areas. It’s one of the symptoms a lot of the patients

fear—they fear pain but they also fear being short of

breath, dying short of breath.”

Now with 13 years of Palliative Care experience under

his stethoscope, four years part-time and full-time since

2004, Dr. Stakiw has settled into the role nicely and loves

the team he works with.

“No. 1, this is an area where we work with really great

people. Most people here choose to do this, so the en-

tire team is really committed to doing a good

job.” (Continued on page 5)

Saskatoon Health Region Palliative Care

Medical Director Dr. Ken Stakiw

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April 28-29, 2011

Dynamic Approaches to Palliative Care,

Miramichi, New Brunswick

May 1, 2011

Hike for Hospice Palliative Care

(Canada)

May 1-8, 2011

National Hospice Palliative Care Week

May 2, 2011

2011 Canadian General Election

June 2-3, 2011

A Breath of Care—2011 Saskatchewan

Palliative Care Conference, Saskatoon

Inn, Saskatoon, Saskatchewan

October 27-29, 2011

2011 Canadian Grief and Bereavement

Conference: “Circle of Hope and Heal-

ing.” Toronto, Ontario, Toronto Airport

Marriott Hotel (see page 10).

President’s Message

Upcoming Events

Page 2 Seasons

With the newness of spring upon us, I am

excited to share with our membership

some of the new and upcoming initiatives

of your Board of Directors.

First and foremost, thanks to our network-

ing team our website has been revitalized

(www.saskpalliativecare.org).

On behalf of the Board of Directors, I’d like

to express appreciation to our new web-

master, David Howick.

David is a Spiritual Care Coordinator for

the Five Hills Health Region and he gra-

ciously volunteered to not only revamp

our existing website, but also maintain it

on an ongoing basis.

We are delighted with the results (check it

out!) and grateful for David’s ongoing sup-

port and advice. Our organization is based

purely on volunteer efforts and David is a

welcomed addition. Thank you!

Next, our research team is working to-

wards a Provincial Palliative Care Re-

search Day. This event would serve as an

opportunity to bring researchers together

from across the Province to discuss cur-

rent research activities as well as pro-

posals for the future.

We are meeting with the Palliative Care

Coordinators to discuss needs and oppor-

tunities for research within the regions.

Hike for Hospice Palliative Care National

Hospice Palliative Care Week May 1-8, 2011 Is your community hiking for hospice palliative care?

The Hike for Hospice Palliative Care 2011 will kick off

National Hospice Palliative Care Week (NHPCW) Sun-

day, May 1st, 2011! The Hike is a national fundraising

event that joins organizations who work together in

hospice palliative care to raise funds and awareness in

their community. All of the funds raised remain in your

community.

NHPCW is a one-week campaign that focuses on raising awareness about hos-

pice palliative care. It is a time to celebrate, recognize, and share the achieve-

ments of hospice palliative care throughout the nation. Think about a hike and

about what else you can do to help!

The theme for the 2011 campaign is “Communities

Share the Care.” The theme is built upon the World

Hospice Palliative Care Day’s campaign, “Sharing

the Care”. The responsibility of caring for someone

with a life-limiting illness is one that needs to be

shared collectively within your community.

The Hike is coordinated by the Canadian Hospice

Palliative Care Association. For more information,

please visit: http://www.chpca.net/hfhpc

Our education team has been busy at

work and we are looking forward to pre-

senting a Mini- LEAP conference via tele-

health. Please watch for further details on

our website and in upcoming editions of

our newsletter.

Finally, we are gearing up with much ex-

citement for our upcoming conference in

Saskatoon: “A Breath of Care”. We hope

that you will set aside June 2 & 3 for an

opportunity to network, educate and reju-

venate yourself! Hope to see you there…

Carla Carlson, President

SHPCA

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PC-FACS (Courtesy of Dr. Ken Stakiw)

PC-FACS (Fantastic Abridgements Created Selfishly for Clinicians in Palliative Care too busy to scan journals) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 50 medical and scientific journals and less traditional sources such as popular media.

Knucklehead: Does Knuckle Cracking Lead to Arthritis?

Background: Substantial anecdotal evidence and popular

perception support a causal relationship between knuckle

cracking and arthritis. Does a long-term practice of knuckle

cracking lead to arthritis of the fingers?

Design and Participants: This was a two-armed,

nonrandomized, prospective, n-of-1 clinical trial of knuckle

cracking vs usual finger management. The longitudinal study

was conducted over a 50-year period. The study arms were:

the participant's left hand (intervention) and the participant's

right hand (control). Knuckles on the intervention hand were

cracked at least twice per day throughout the entire study

period; control knuckles were not cracked. At the end of the

study period, intervention and control hands were compared

for the presence of arthritis of the fingers, measured by

participant self-report.

Results: Intervention-hand knuckles were cracked at least

36,500 times; control knuckles were cracked rarely and

spontaneously (when they did crack). No correlation was found

between knuckle cracking and development of arthritis of the

fingers. These results confirmed those of a previous paper,

identified through a search of the literature on this topic.1

Commentary: Palliative care providers have been wringing

their hands over this one for decades. Let the finger pointing

begin! Just don't crack up over the conclusions. Whichever

knucklehead designed this study should be cracked over the

head for failing to include in the study design the lower

extremity and for not blinding the subject or at least providing

a Three Stooges-esque poke in the eye.

Bottom Line: Rheumatology researchers have too much time

on their hands. You can crack away at your knuckles.

Reviewer: Paul "Hey Moe" Tatum, MD CMD FAAHPM,

University of Missouri, Columbia, MO .

Page 3 Spring 2011

Saskatchewan Government declares April 12

“Advance Care Planning Day” in Saskatchewan!

In a written proclamation dated April 4, 2011, Saskatchewan

Minister of Health Don McMorris declared April 12, 2011, as

“Advance Care Planning Day” in Saskatchewan.

The Advance Care Planning National Task Force, a group repre-

senting professional organizations and non-governmental

groups from across Canada, has developed the “Speak Up: start

the conversation about end of life care” campaign to remind

Canadians to think about and talk about their wishes for end of

life care. It warns that “A lack of knowledge about preferences

for care can result in confusion and conflict between family

members and health professionals at a critical time.”

http://www.advancecareplanning.ca/home.aspx

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A Breath of Care Conference, Profile of Dr. Ken Stakiw, Cont’d “No. 2, Palliative Care can really help patients and fami-

lies and it’s not just a single person job,” referring to the

‘team approach’ that includes a doctor, a nurse, admin

people, a social worker, and preferably, a pharmacist.

“It really is gratifying to help families and patients in so

many ways, such as symptom management, pain, the

psych and social aspect of it. Even mundane things, like

the dollars and cents and other things that need to be

done in readiness for death. Those aren’t necessarily

areas that are brought up anywhere else.”

Dr. Stakiw has spent a great deal of his time in Palliative

Care with a focus on spreading care into the rural areas

through the Smaller Centre Outreach program, and earli-

er with the Pallium Project weekend seminar sessions.

“I’ve been to virtually every place in Saskatchewan talk-

ing about Palliative Care and continue to do that,” he

said. “We’re trying to take the teaching into to rural are-

as and trying to get the doc there to champion the cause

and to, perhaps, be the advisory physician for Palliative

Care in the locale that they’re in.”

The nurses, are always the “keen learners”, Dr. Stakiw

said, because they’re willing to spend a whole weekend

in training, whereas the doctors are a little harder to

catch, normally over a meal for just an hour a time.

“It’s a little harder getting the message out to docs but

we’re continuing to try,” he said. Unfortunately, Pallia-

tive Care everywhere is facing setbacks, though Stakiw

said not all news is grim. In terms of trying to practice

Palliative Care as a multi-disciplinary team, Stakiw said

Saskatoon is having trouble maintaining the team ap-

proach. The pharmacist has been pulled off the team in

Saskatoon due to a “funding crunch” so they’re down to

the nurse, doctor, and sometimes social worker.

On the good side of the ledger, Palliative Care has done

well, it has just had some struggles in maintaining its

presence and strong commitment to patients, he said.

“Unfortunately, it’s not a very sexy topic—we’re associ-

ated with death and dying, so people want to hide from

even bringing the topic up. But with the aging popula-

tion, it’s bound to rebound, so Palliative Care will always

be an important part of health care,” he concluded.

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(March 23, 2011 - Ottawa, ON) The Ca-nadian Hospice Palliative Care Associa-tion (CHPCA) welcomes several initia-tives announced yesterday in the federal budget, and encourages the government to build on them so that the needs of dying Canadians and their families can be better served.

Contained in the budget was a commit-ment for one-time funding of $3 million to help support the development of new community-integrated palliative care models. Each year, more than 259,000 Canadians die. But only 2 or 3 out of 10 receive hospice palliative, or end-of-life care. Even fewer receive support to help them and their families cope with grief and bereavement.

Building hospice palliative care into com-munity health care services is an im-portant step toward ensuring that all Canadians have the same access to qual-ity end-of-life care, no matter where they live.

"Quality palliative care is the right of every Canadian, yet not every Canadian can access these services at a time when they and their families need it most," said Sharon Baxter, Executive Director of the CHPCA. "This funding will help to ensure that hospice palliative care is available at the community level for those Canadians who are dying, as well as their families. It will also ensure that it is easily accessible as part of the con-tinuum of care."

Canada's population is aging and, com-bined with increasing numbers of chron-ic diseases, the demands for hospice palliative care will continue to grow. Seniors make up the fastest-growing age group.

In 2003, an estimated 4.6 million Cana-dians were 65 years of age or older, a number that is expected to double in the next 25 years. By 2041, about one in four Canadians is expected to be 65 or over.

The CHPCA estimates that for every dy-ing Canadian, five other people are affected. Many of these people become caregivers. The CHPCA therefore was pleased with the announcement of a Family Caregiver Tax Credit, as well as the removal of the $10,000 limit on the amount of eligible medical expenses that caregivers can claim for a credit.

"More and more Canadians are taking on the role of caregiver for a loved one afflicted with a life-limiting illness," said Wendy Wainwright, President of the CHPCA. "It is crucial that these people receive adequate support, including fi-nancial, for the work that they do. Caring for an infirm or dying loved one is al-ready stressful, yet thousands of Canadi-ans every year are expected to cope with these burdens."

We encourage the Government of Cana-da to increasingly find ways to support caregivers in the future as their contribu-tion grows.

Hospice Palliative Care Had Place in Pre-Writ Federal Budget

Party Platforms:

Home & End-of-Life Care The Canadian Medical Assoca-

tion Journal’s 2011 Election

survey—Home/Palliative care:

The Canadian Home Care Association

estimates that public outlays on home

care in Canada are about $5.8 billion per

year. There is no known estimate of

private outlays for home care, although

the Health Council of Canada has esti-

mated that in the neighbourhood of

500 000 Canadians are tending ailing

relatives. The level of private spending,

though, has never been quantified.

Some families spend on the order of

thousands of dollars annually for medi-

cal supplies and equipment, while oth-

ers shell out between $30 000–

$60 000 per year to hire private services.

One thing is certain, though — there is

no sign that spending by Canadians on

home care will abate any time in the

near future. A slew of campaign trail

promises related to home care, mean-

while, might suggest that major support

for families providing home care or ma-

jor changes in Canadian policies, pro-

grams and strategies are in the offing.

The promises have included a Conserva-

tive party proposal to increase nonre-

fundable tax credits for family caregivers,

a Liberal Party vow to provide financial

relief for family caregivers through em-

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ployment insurance and tax benefits, and a

New Democrat promise to enshrine home

care as a medically necessary service under

the Canada Health Act. But experts warn

that what has actually been promised is

either altogether meager or somewhat

lacking in detail (www.cmaj.ca/cgi/

doi/10.1503/cmaj.109-3856).

Party responses to a home care question in

CMAJ’s 2011 election survey marked no

departure, as they confined their responses

to very general commitments, or ones fo-

cused primarily on providing a modest

measure of tax assistance to families to

care for their loved ones (see below).

Survey question:

What measures/programs would your

party introduce in response to Canada’s

home care/palliative care crisis?

Conservative response:

Please see 2011-12 federal budget story on

page 6 for details, such as the budget com-

mitment for one-time funding of $3 million

to help support the development of new

community-integrated palliative care mod-

els.

Liberal response:

“Responding to the pressures faced by

Canadian families grappling with the fi-

nancial and emotional strains of home

care and palliative care is at the core of

the Liberal platform.

A Liberal government will act immediate-

ly to deliver direct support to Canadians

who care for elderly or seriously ill loved

ones at home. The Liberal Plan for Family

Care includes a Family Care Employment

Insurance Benefit, allowing Canadians to

take six months off work to care for loved

ones without having to quit their jobs,

and a Family Care Tax Benefit of up to

$1,350 a year to help low- and middle-

income family caregivers manage the

costs.

With the federal-provincial-territorial

Health Accord expiring in 2014, a Liberal

government will be at the table for Cana-

dians. Two specific areas will also be pri-

orities for a Liberal government: home

care services and drug coverage. With

more and more patient care taking place

at home rather than in the hospital, we’ll

work with provinces and territories to

ensure that Canadians in different parts

of the country don’t face significant vari-

ations in drug coverage, and home care

services, including priority areas like

mental health and palliative care.”

New Democrat response:

“Jack Layton and the New Democrats

will establish a new designated federal

home care transfer to guarantee a basic

level of home care services to all Cana-

dians wherever they live. The NDP will

also, initiate a new designated federal

long-term care transfer to begin ad-

dressing the shortage of quality care

spaces across the country. We will take

further action to double the funding for

forgivable loans under the Home Adap-

tion for Seniors’ Independence program

(HASI) to help seniors remain in their

own homes.

Finally a New Democrat government

will introduce an Inter-generational

Home Forgivable Loan Program, mod-

eled on a Manitoba Government initia-

tive, to help up to 200,000 families a

year retrofit their homes to create self-

contained secondary residences for

senior family members. Families will be

eligible for a forgivable loan to cover

50 per cent of the costs of a renovation

up to a maximum of $35,000.”

BFF: Video Review—Best Friends Forever (PC-FACS)

The fourth episode of the 9th season of South Park, "Best Friends Forever," first aired on March 30, 2005, during the Terri Schiavo controver-

sy. In this episode Kenny is one of the first lucky customers to get the newly released PlayStation Portable (PSP) and has just reached level 60

of the video game, Heaven vs. Hell. An ice cream van hits and kills him, leaving the PSP without an owner. Heaven had apparently created

the PSP to identify the hero who, as "our Keanu Reeves," could defeat Hell in a final battle; Kenny's calling awaited him on the "other side."

However, thanks to medical technology, Kenny is brought back from Heaven and left in a persistent vegetative state. An intense debate fol-

lows between Cartman (and those supporting Kenny's right to die), and Kyle and Stan (and those favoring life support). Cartman's desire to

acquire Kenny's PSP complicates his side of the argument, although eventually Kenny is allowed to die and returns to Heaven just in time to

defeat Hell with the help of a golden PSP. Based on the Terri Schiavo case, this episode won a 2005 Emmy Award for Outstanding Animated

Program. While clever, humorous, and immensely entertaining, it highlights arguments and emotions on both sides of the "plug-pulling"

debate which, to a lesser degree, arise in many end-of-life care situations involving the family and friends of a person with limited or no cog-

nitive capacity. In these instances, clarification of a mission defined by Heaven for the individual potentially at the end of life will facilitate

clinical decision-making.

Bottom Line: Although patients in persistent vegetative state (and, some say, Keanu Reaves) may have no discernible upper brain activity,

clinicians must be careful to avoid the premature conclusion that watching stuff like this won't put us in the same state.

Reviewer: Brad Stuart, MD, Senior Drama Critic, Sutter VNA & Hospice, Emeryville, CA

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Headlines University of Western Ontario Journalism project reflects on death and dying—Western’s Graduate Journalism Program

and London Palliative Care providers are celebrating their innovative partnership in a groundbreaking journalism project

addressing death and dying. This unique project entitled “Miles to Go” results from a first-ever journalism course on dying,

and involves students visiting palliative care units in the London area to interact with an array of terminally-ill patients, as

well as their families and health care providers. Together, the students have created 16 personal, multi-media stories culmi-

nating in a moving, at times unsettling, and very revealing examination of dying in Canada in 2011. -UWO Communications

Palliative care: Do we know enough about end-of-life care? —The Canadian Hospice Palliative Care Association (CHPCA),

the national voice for hospice palliative care in Canada, estimates the demand for hospice palliative care will increase over

the next 40 years. Canadians are living longer than ever with the average life expectancy of over 80 years. However, Statis-

tics Canada has projected that the mortality rate will also increase by the year 2020 by about 33 per cent from 2004. About

90 per cent of the people that die can benefit from palliative care. -By Subha Chilukuri, ALS Society of Canada. Read more!

Senator Sharon Carstairs announces retirement from politics—But just because Carstairs is retiring from the Senate (she

said it will be this fall, but no date has been set) it doesn't mean she'll be putting her feet up. “My greatest satisfaction has

been the movement we have made in caring for the dying.” In 1995, only five per cent of Canadians had access to palliative

care, however, today coverage is up to 30 per cent, Carstairs explained. “Clearly we still have work to do and I will continue

to work in this area after I have retired as I am on the Champions Council of the Canadian Hospice and Palliative Care Asso-

ciation.” The Senator also said she also plans to write a book on her coast-to-coast-to-coast travels on behalf of palliative

care. –By Kevin Rollason, Winnipeg Free Press. To read more here, just click!

Framework urges physicians to proceed with caution on palliative sedation—Easily the most controversial tool in the palli-

ative care arsenal, the practice of sedating patients near death to relieve intolerable and refractory suffering may also be

the most widely misunderstood. Debate over the therapy’s potential for misuse, confounded by a lack of clear or consistent

guidance on its ethical and medically appropriate use, has misled the public and even some health professionals to view it

as a covert form of euthanasia, says Dr. Larry Librach, director of the Temmy Latner Centre for Palliative Care at Mount Si-

nai Hospital in Toronto, Ontario. “In these days of budget cutbacks, people are suspicious we just want to speed up death to

free up resources.” -By Lauren Vogel, CMAJ Please click here to finish the article.

Bringing palliative care to the homeless—Canadian palliative care programs are generally created with the needs of main-

stream society in mind. Though these systems attempt to accommodate everyone, the unique challenges of serving mar-

ginalized populations make this difficult. And there is perhaps no population more challenging to assist in dying than the

homeless. Yet this population needs support more than most others, says Wendy Muckle, executive director of Ottawa In-

ner City Health, a program in Ottawa, Ontario, that aims to help homeless people receive the same quality of health care as

other Canadians. "With the homeless, I would argue that their need and right to have support through the end of life is

even greater than the mainstream populations..." -By Roger Collier, CMAJ Read more here.

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