Camille Munro

Although physicians with disabilities are underrepresented in medicine, their lived experiences of disability can increase empathy for patients, enrich the learning environment, and improve working conditions. However, they face barriers related to procedures, policies, clinical accommodations, disability and wellness support services, and physical environments as well as cultural barriers that affect their meaningful inclusion and ability to work at their full capacity. Despite national Canadian physician organizations recommending accommodations and inclusive policies and practices, an environmental scan of the top 10 ranked Canadian hospital institutions in April–May 2020 did not identify any existing accommodations policies. The Medical Advisory Committee and senior management team at The Ottawa Hospital (TOH) formally endorsed the first position statement in Canada supporting physicians with disabilities in 2021, which led to the establishment of a process to develop and implement an accessibility and accommodations policy for the Department of Medicine (DOM) at TOH. After careful review and an iterative development process, the DOM approved a formal Accessibility and Accommodations Policy in June 2022. The policy ensures physicians are accommodated during the recruitment, interview, and appointment phases. It outlines a process for the development of an accommodation plan, addresses funding for accommodations, protects physicians returning to work following absences due to a disability, and requires exploration of opportunities for physicians to make a meaningful contribution if they cannot practice clinically due to their disability. In this article, the authors discuss the process of developing and implementing the DOM Accessibility and Accommodations Policy, outline the key elements of the policy, and discuss broader implementation of the policy and how they are monitoring its impact. They also discuss the importance and benefits of collecting data on physicians who self-identify as having a disability and, through confidential surveys, focus groups, and interviews, monitoring the impact of accessibility and accommodations policies.

Malignant pleural mesothelioma is a rare, aggressive, and incurable cancer with a poor prognosis and high symptom burden. For these patients, little is known about the impact of palliative care consultation on outcomes such as mortality, hospital admissions, or emergency department visits. The aim of this study is to determine if referral to supportive and palliative care in patients with malignant pleural mesothelioma is associated with survival and decreased hospital admissions and emergency department visits. This is a retrospective chart review. Study participants include all malignant pleural mesothelioma patients seen at The Ottawa Hospital—an acute care tertiary center—between January 2002 and March 2019. In total, 223 patients were included in the study. The mean age at diagnosis was 72.4 years and 82.5% were male. Of the patients diagnosed between 2002 and 2010, only 11 (9.6%) were referred to palliative care. By comparison, of those diagnosed between 2011 and 2019, 49 (45.4%) were referred to palliative care. Median time from diagnosis to referral was 4.1 months. There was no significant difference in the median survival of patients referred for palliative care compared to those who did not receive palliative care (p = 0.46). We found no association between receiving palliative care and the mean number of hospital admissions (1.04 vs. 0.91) from diagnosis to death, and an increase in mean number of emergency department visits in the palliative care group (2.30 vs. 1.18). Although there was increased utilization of palliative care services, more than half of the MPM patients did not receive palliative care despite their limited survival. There was an increase in emergency department visits in the palliative care group; this may represent an increase in the symptom burden (i.e., indication bias) in those referred to palliative care.

Objective To determine the level of palliative care involvement before and after medical assistance in dying (MAID) requests, and to compare the differences between those who completed MAID and those who requested but did not complete MAID. Design Retrospective chart review. Setting The Ottawa Hospital (TOH) in Ontario. Participants Ninety-seven patients who requested MAID at TOH between February 6, 2016, and June 30, 2017. Main outcome measures Completion of MAID. Results Eighty-four patients were included in the study. Fifty patients (59.5%) completed MAID. The most common reasons for not completing MAID were death before completion of the required assessments (47.0%), ineligibility (26.5%), and loss of capacity (14.7%). The most common diagnoses were cancer (72.6%) and neurologic disease (11.9%). The most frequent reasons for requesting MAID were physical suffering (77.4%), loss of autonomy (36.9%), and poor quality of life (27.4%). Patients who completed MAID in this study were more likely to report physical suffering as the reason for their request than those who did not complete MAID (84.0% vs 67.6%; P = .08), yet only 23.8% of all patients requesting MAID had an Edmonton Symptom Assessment Scale completed. Before MAID request, 27.4% of patients had a community palliative care physician and 59.5% had palliative care involvement in any setting. The TOH palliative care team was involved in 46.4% of patients who requested MAID. Conclusion There is still inadequate provision of palliative care for those requesting MAID. Guidelines, legislation, and guidance are needed to help physicians ensure patients are aware of and understand the benefits of palliative care in end-of-life decisions. However, the involvement of palliative care with patients who completed MAID was similar to those who did not complete MAID. Multicentre studies are needed to further explore the MAID process and clarify the role of palliative care in that process.