Canadians prefer to avoid aggressive life-sustaining treatments at the end-of-life, but they often receive this care because their healthcare team failed to engage in ACP before they became seriously ill. It can be challenging to identify patients who are dying; even when accurate prognostic tools are available, clinicians often forget or are unwilling to use them and act on the result. If we had an accurate, automated, computer-based tool to identify patients with a limited prognosis, we could use this tool to trigger ACP and EOL interventions more appropriately and reliably
In this project, an automated mortality prediction tool based on the HOMR score was developed. The feasibility of calculating the modified HOMR prospectively at the time of admission and the impact of using the tool to identify patients at risk of death, from the perspective of all stakeholders, was then studied.
James Downar, MDCM, MHSc, FRCPC is the Head of the Division of Palliative Care in the Department of Medicine at the University of Ottawa and splits his clinical time between the Intensive Care Unit at the Ottawa General Hospital and the Palliative Care Unit at Bruyere Continuing Care. James Downar graduated from McGill Medical School and completed residency training in Internal Medicine, Critical Care and Palliative Care at the University of Toronto. He received a Master’s degree in Bioethics from the Joint Centre for Bioethics at the University of Toronto in 2010. He has worked as an attending physician in the Intensive Care Unit and Palliative Care consultation services at the University Health Network and Sinai Health System in Toronto since 2009. He has served as Program Director for the conjoint program in palliative medicine and the subspecialty program in palliative medicine at the University of Toronto. He is the co-chair of the Pan-Canadian Palliative Care Research Collaborative, the chair of the Ethical Affairs committee of the Canadian Critical Care Society, and the co-chair of the Ontario Palliative Care Network’s Provincial Education Steering Committee. He has authored more than 60 peer-reviewed publications, has been principal investigator on nine peer-reviewed grants, and is an Associated Medical Services Phoenix Fellow for 2016-8. His research interests include communication and decision-making for seriously ill patients and their families, palliative care for the critically ill and palliative care for noncancer illnesses.