Palliative Care in the Inner City Elective

Palliative Care in the Inner City:

Integrating Social Accountability and Clinical Care for Marginalized Populations

Background:

This elective was developed with the goal of integrating clinical palliative care of structurally vulnerable populations with social accountability. Structurally vulnerable populations, often associated with the “inner-city,” are characterized by “living in poverty and experiencing various levels of homelessness, as well as multiple forms of social isolation, racism, ongoing trauma and violence, stigma associated with mental health issues or cognitive impairments, behavioural issues, previous or ongoing substance use, experience with the criminal justice system, and(dis)ability and/or mobility challenges.”1 As part of this elective, you will experience the rewards and challenges of providing care in the inner-city, specifically learning about the barriers faced by these populations, and what is, and can, be done to overcome them, with an aim of achieving equity in palliative care provision. A crucial part of caring for these populations is honing your skills as an advocate and gaining an appreciation for what it means to be “socially accountable,” which you will explore over the course of your rotation through readings and the completion of a “Social Accountability Workbook.”

Learning Objectives

Medical Student:

1. To enhance understanding of a palliative approach to care and the principles of advanced care planning.

2. To become familiar with basic approaches to symptom management in the palliative care setting.

3. To explore shared models of care and the importance of collaboration and building capacity with inner city providers when caring for a marginalized population.

4. To be able to describe the barriers that exist to providing effective palliative and end-of-life care for structurally vulnerable populations.

5. To enhance understanding of social accountability and of the skills required to advocate for marginalized patients on micro, meso and macro levels.

6. To practice trauma-informed, culturally safe care with a focus on harm reduction in the palliative care setting.

Resident:

1. To enhance skills in facilitating goals of care conversations and describing a palliative approach to care.

2. To enhance skills in providing effective pain and symptom management.

3. To explore shared models of care and the importance of collaboration and building capacity with inner city providers when caring for a marginalized population.

4. To be able to describe the barriers that exist to providing effective palliative and end-of-life care for structurally vulnerable populations.

5. To enhance understanding of social accountability and of the skills required to advocate for marginalized patients on micro, meso and macro levels.

6. To practice trauma-informed, culturally safe care with a focus on harm reduction in the palliative care setting.

Palliative Care Resident/Fellow:

1. To be able to describe the barriers that exist to providing effective palliative and end-of-life care for structurally vulnerable populations.

2. To become skilled in providing palliative care in the inner city community while collaborating with, and enhancing the capacity of, inner city workers.

3. To gain an appreciation for the value, rewards and challenges of providing hospice care for marginalized populations.

4. To enhance understanding of social accountability and of the skills require to advocate for patients on micro, meso and macro levels.

5. To practice trauma-informed, culturally safe care with a focus on harm reduction in the palliative care setting.

Elective Structure

You will work at Journey Home Hospice and with the mobile PEACH (Palliative Education & Care for the Homeless) team.

• The Journey Home Hospice (https://journeyhomehospice.ca) is a joint project to improve equitable access to hospice palliative care for Toronto’s homeless community in a socially innovative way. It is a partnership between Hospice Toronto, Saint Elizabeth Foundation and Inner City Health Associates (ICHA). It currently stands as a 4 bed pilot.

• PEACH (http://www.icha-toronto.ca/programs/peach) is a supportive palliative service fostered by Inner City Health Associates (ICHA). Aimed to meet the needs of homeless and vulnerably-housed patients with life-limiting illnesses, PEACH's focus lies with the pain, symptoms and psychosocial goals related to each and every patient's life's end.

PEACH operates as a "trailblazing" mobile unit, providing attentive care on the streets, in shelters, and with community-based service in collaboration with Toronto Central LHIN Home & Community Care team.

Rotations must be for a minimum of 3 weeks in duration. This elective is available to medical students, residents and fellows.

*PLEASE NOTE: This elective is fully booked for the year 2019. We will only be fielding scheduling inquiries for 2020. Please contact HirschS@smh.ca for scheduling availability.