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Seeking better approaches for end of life care

Daren Heyland studies the inevitable and, for many Canadians, the unspeakable. But he and his network of researchers are working to change that.

A professor of Medicine at Queen’s University, an intensive care doctor at Kingston General Hospital, and a clinician scientist with the KGH Research Institute, Dr. Heyland has spent much of the past 20 years examining the quality of care given to the critically ill, its effects on the quality of end of life, and the need for families and medical practitioners to talk about end of life care.  

“I have always been interested in the intersection between critical illness, the use of technology, and death,” he says. His experiences in caring for patients in intensive care have given him a unique perspective on patient care in the context of the inevitable.  His research examines the topic from all corners of the bedside, from the patient, to their families, to the medical practitioners, and from all stages along the care continuum, from the routine visit to the family physician to the crucial decisions at end of life.

Daren Heyland researches end of life care.

His most recent study, published last month in the U.K. journal Palliative Medicine, looked at the families’ perspectives on the quality of care of elderly patients admitted to intensive care units across Canada.  That research showed a significant disconnect between families’ wishes for “comfort only” measures, and the use of life-sustaining treatments such as ventilators or CPR, on those patients.

“Patient care should provide quality of end of life care, rather than prolonging the dying experience,” Dr. Heyland says. “End of life should not be traumatizing.”

While he has done extensive investigations into specific critical care issues -- such as nutritional therapy for the critically ill, and the use of antibiotics and ventilator-associated pneumonia in the ICU -- he and collaborating researchers are producing a growing body of work targeting the broader, multi-generational topics that affect everyone:  care for elderly patients, end of life care, and advance care planning for end of life.

Dr. Heyland’s work is reflected across a variety of centres and initiatives, both local and national. He leads CARENET, a national network of health care professionals who collaborate on understanding and improving palliative and end-of-life care through research, tools and communication and decision-making between patients, their families and health professionals. 

In 2012 he led the establishment of the national Technology Evaluation in the Elderly Network (TVN), a $23.9 million Networks of Centres of Excellence, based at Kingston General Hospital, focused on developing and implementing technologies for improving quality of life and end of life for the elderly and their families.

He was also instrumental in building awareness of the need for Canadians to think about end of life care through the Speak Up Campaign for National Advance Care Planning Day. ACP Day this year is April 16, and more information can be found at advancecareplanning.ca.

“Speak Up is about the importance of communication and decision-making at the community level,” Dr. Heyland says. “For good care at the end of life, communication is essential.”

This story is the seventh in a series on the KGH Research Institute, a collaboration between Queen’s and Kingston General Hospital, and the clinician-scientists recruited to work in the centre.