不良研究所

Palliative medicine, an interdisciplinary approach to relieving pain and other symptoms of a serious illness, has a long history at 不良研究所. It was Dr. Balfour Mount, CM, OQ, who coined the term 鈥減alliative care,鈥� having successfully advocated for Canada鈥檚 first comprehensive palliative care service, which opened at Montreal鈥檚 old Royal Victoria Hospital in 1975. Mount was the inaugural Kappy and Eric M. Flanders Chair in Palliative Care Medicine (1994 to 2009), the first such endowed chair in the world. Dr. Justin Sanders is the third chairholder, following on from Dr. Bernard J. Lapointe (2009 to 2021).聽

FMHS Focus: Thanks to Balfour Mount, the late , CM (LLD), and many others, 不良研究所 has been a pioneer in palliative care. How do you see your work building on that legacy?聽

Justin Sanders (JS): What Cicely Saunders [the founder of the modern hospice movement at St Christopher鈥檚 Hospice in London] famously said was: 鈥淵ou matter, and you matter until the end.鈥� We do not always have health systems that act on that belief. We sometimes leave people and their families in the dark about their illnesses. What I want to focus on is the importance of relationships to healing. This was articulated so beautifully by Dr. Mount and his colleagues. A focus on relationships is a way that we can develop a unique scholarly and academic identity that builds on some of the essential insights that have been articulated here.聽聽

不良研究所 has been a global centre of learning and excellence to which people come from around the world to understand what is happening in palliative care. I feel indebted to the legacy of this place.聽

FMHS Focus: Your research uses virtual technologies to study the emotional and cognitive impact of communication (between physicians, patients, and their families). What does that mean for palliative care?聽

JS: It is urgent that we lean into the skills, attitudes, and knowledge that allow us to build relationships with patients in ways that ripple out in their lives and make healing possible. What you experience as a palliative care physician is people for whom further treatment may not prolong or cure their illness. Yet it is not uncommon for people who are dying to say: 鈥淭he last year of my life was the best year of my life.鈥� We have to understand how that is possible.聽

We know that there is a relationship between emotional distress, cognitive load, and decision-making. We are trying to generate a body of evidence that makes it obvious that some of the ways in which clinicians communicate with patients about prognosis, for example, are better than others. We are trying to develop a basic science model that allows us to look at the inputs of communication, whether it is something that is said or something in the room, and to look at their precise effects. We are looking to establish a body of evidence for communication that helps people experience meaning and well-being in a difficult time.聽

Dr. Justin Sanders has a BA in art history from Haverford College, an MD from the University of Vermont, and an MSc in medical anthropology, which he completed at University College London as a US-UK Fulbright Postgraduate Scholar.

FMHS Focus: What is the role of palliative care within the Department of Family Medicine?聽

JS: The Division of Palliative Care at 不良研究所 joined the Department of Family Medicine in 2019. Previously, the division had been in the Gerald Bronfman Department of Oncology. I think there are good reasons for palliative care to sit in this department. One being that, in Quebec, most palliative care physicians train in family medicine first. The other reason is that there is a lot of overlap between palliative care and family medicine in our philosophies of care. We explicitly value the whole person and their family as a unit of care.聽

After a residency and chief residency in family and social medicine at the Montefiore Medical Center in the Bronx, Justin Sanders completed a fellowship in the Harvard Interdisciplinary Palliative Care Fellowship at the Massachusetts General Hospital and Dana-Farber Cancer Institute.

FMHS Focus: Can you tell us a bit about the emphasis you place on relationships in your approach to medicine?聽

JS: In medical school, we train people to recognize patterns. We teach them about human anatomy so they can recognize patterns in patients when they see them. Over a lifetime, a physician will gain experience in seeing these patterns. Artificial intelligence is going to replace many of the activities that we teach physicians, whether it is diagnosis, figuring out prognosis, or figuring out treatments. But the one thing that a computer will never replace is the human and the ability to relate鈥攖o make sense of what is happening, to understand the disease and to make choices. No computer can replace that activity.

Justin Sanders was also a research fellow in cancer communications outcomes research and associate director of innovation in the Serious Illness Care Program at Ariadne Labs, a joint health systems innovation centre at the Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health.

Justin Sanders is an associate professor in the Department of Family Medicine. He is the director of Palliative Care 不良研究所, an interdisciplinary network of clinicians, educators, researchers, allied-health professionals, volunteers and support staff dedicated to providing care and advancing the subspecialty. He chairs the , the longest continuously running congress in the field. He is also director of the Division of Supportive and Palliative Care at the 不良研究所 Health Centre, and works directly as a clinician with patients.聽