Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers goals of care conversations.

Our guest for this episode is Dr. Tavis Apramian, a clinician-investigator in the Department of Family & Community Medicine (DFCM) at the University of Toronto and scientist in the Office of Education Scholarship. He works as a palliative care physician at St. Michael’s Hospital and at Kensington Hospice. His largely qualitative program of research is focused on advance care planning; workplace-based learning and assessment; palliative care in family medicine; medical assistance in dying; and inequity in end-of-life care. His primary focus is on telling rich stories of learner and patient experiences to spark conversation about socioculturally complex educational and clinical problems in serious illness.

The learning objectives for this episode are as follows:

1. Describe a palliative approach to care and its relevance across different contexts

2. Demonstrate a structured and compassionate approach to goals of care conversations

3. Apply effective communication strategies to build therapeutic alliance, navigate difficult conversations, and involve multiple actors in the palliative context

4. Recognize and manage challenges in goals of care conversations

Guest: Dr. Tavis Apramian

Hosts: Dr. Daamoon Ghahari (PGY2) and Dr. Angad Singh (PGY2)

Audio editing: Dr. Angad Singh (PGY2)

Timestamps:

(1:07) - Journey to palliative care

(5:07) - What is palliative care

(14:47) - Understanding patient values

(33:47) - Structuring goals of care conversations

(44:16) - Communication strategies

(57:05) - Navigating family meetings

(77:25) - Reflections on MAiD for sole mental illness

Resources:

Roth, H. (2024). Hearing the unspoken. Canadian Family Physician, 70(10), 642-642. https://pmc.ncbi.nlm.nih.gov/articles/PMC11477260/pdf/0700642.pdf

References:

Bernacki, R. E., & Block, S. D. (2014). Communication about serious illness care goals: a review and synthesis of best practices. JAMA internal medicine, 174(12), 1994-2003.

Gross, J., & Koffman, J. (2024). Examining how goals of care communication are conducted between doctors and patients with severe acute illness in hospital settings: A realist systematic review. PLoS One, 19(3), e0299933.

Scheunemann, L. P., Ernecoff, N. C., Buddadhumaruk, P., Carson, S. S., Hough, C. L., Curtis, J. R., ... & White, D. B. (2019). Clinician-family communication about patients’ values and preferences in intensive care units. JAMA internal medicine, 179(5), 676-684.

You, J. J., Downar, J., Fowler, R. A., Lamontagne, F., Ma, I. W., Jayaraman, D., ... & Canadian Researchers at the End of Life Network (CARENET). (2015). Barriers to goals of care discussions with seriously ill hospitalized patients and their families: a multicenter survey of clinicians. JAMA Internal Medicine, 175(4), 549-556.

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