Talking about end-of-life care isn’t easy—Dr. Jeff Myers wants to help

As the newly appointed Bresver Family Chair in End-of-Life Care and Medical Assistance in Dying at the University of Toronto’s Department of Family and Community Medicine, part of the Temerty Faculty of Medicine. Dr. Myers is at the forefront of efforts to drive meaningful change for patients and their families.

The Chair is the first of its kind in Canada. In this question and answer, Dr. Myers shares his plans for this new role and more about his work.

Q. Why did you choose to specialize in palliative care and end-of-life care?

Palliative care is something that made sense the moment I was exposed to it. I completed my family medicine training in Toronto 25 years ago, a time when very few people understood palliative care. This has meant continuous efforts to advocate for access to palliative and end-of-life care. I also feel strongly about scholarship that aims to improve the experiences of people with advanced, serious illness. This is where the Bresver Family Chair comes in.

Q. Why is the creation of the Bresver Family Chair in End-of-Life Care and Medical Assistance in Dying (MAiD) important?

The commitment and generosity of the Bresver family provides an opportunity for meaningful and sustainable change. The focus is on implementing education interventions that will support family physicians to have advance care planning conversations as well as discussions that address end-of-life, which may include MAiD. Physicians want to have these conversations, but it is challenging to improve confidence and skills in these areas. Being successful in this role will mean better experiences for patients and families.

Q. Tell us about the relationships between palliative care, advance care planning, end-of-life care and MAiD.

As a palliative care clinician my role is to help people live well throughout the course of serious illness and relate to them in a way that makes them feel safe to explore and discuss their needs. Because serious illness is incurable and progressive, end-of-life care is one component of palliative care.

Some people with serious illness will consider MAiD, but there’s a clear distinction between palliative care and MAiD. I am a palliative care clinician. For a number of patients I have also been their MAiD provider. The majority of MAiD providers in Canada are not palliative care clinicians as the two are quite distinct.

In this new role, one of my aims is to help people understand advance care planning. A common misconception is that it involves making decisions about end-of-life in advance of being ill. Advance care planning is about preparing a person and their substitute decision maker for decision-making in the future and that both understand what it means to have a serious illness.

Q. What kind of research will you pursue in your new role?

The part of this role that is particularly exciting for me is the focus on educational interventions. The aim is to address the effectiveness of different educational strategies in changing clinician behaviour and improving patient and family experiences.

The work is positioned at the intersection between education, research, quality improvement and implementation science, which creates tremendous opportunities for partnerships and innovation.

Q. How will this new academic position intersect with your clinical practice at Hennick Bridgepoint as a palliative care physician?

Advance care planning and quality end-of-life experiences are relevant to 100 per cent of Canadians. In part due to widespread misunderstandings of terminology and what patients and families need, improvement efforts so far have had limited impact. Over the next five years, skills related to advance care planning and discussions addressing end-of-life and MAiD will be the focus for my clinical and academic practice at Hennick Bridgepoint.