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S. Lawrence Librach, MD, CCFP, FFCP

dr. larry librach

Areas of interest/expertise

 Academic appointments

Publications

Presentations

Honours and awards

Dr. Librach's involvement in palliative care began in 1978. Dr. Librach was the co-founder of the Temmy Latner Centre for Palliative Care at Mount Sinai Hospital, and served as the Director for over 20 years.

Dr Librach was the W. Gifford-Jones Professor in Pain Control and Palliative Care at the University of Toronto from 1999-2011, and held the position of full professor in the Department of Family and Community Medicine. He was the first Head of the Division of Palliative Care in the Department of Family and Community Medicine at the University of Toronto from 2007-2011. Dr. Librach was the Sun Life Financial Chair in Bioethics and the Director of the Joint Centre for Bioethics at the University of Toronto. He was a member of the University of Toronto's Centre for the Study of Pain. He was an academic educator with the Centre for Professional Development at the Faculty of Medicine at the University of Toronto. He was the physician leader of the national Educating Future Physicians for Palliative and End of Life Care Project (EFPPEC) which introduced curriculum in palliative and end-of-life care to Canada’s 17 medical schools. He was an education consultant to the Education in Palliative & End-of-Life Care (EPEC) project in the USA. He was the Past President of the Canadian Hospice Palliative Care Association. He was a board member of the Room 217 Foundation, a music therapy foundation.

Dr. Librach was the recipient of a number of awards from a number of organizations including the Canadian Hospice Palliative Care Association, the Ontario Palliative Care Association, the Ontario Medical Association, the College of Physicians and Surgeons of Ontario, and the University of Toronto.

Dr. Librach’s academic interests were wide-ranging but the development and implementation of education programs, quality of care and patient safety were areas of special interest. He delivered over 500 lectures and workshops.

Dr. Librach published extensively and was the author of the Pain Manual (over 150,000 copies distributed) and co-edited a textbook, Palliative Care: Core Skills and Clinical Competencies which is into its second edition.

Areas of interest/expertise

Pain control

Constipation

Education

Bioethics in end-of-life care

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Academic appointments

Full Professor, Department of Family and Community Medicine, University of Toronto

W. Gifford-Jones Professor in Pain Control and Palliative Care, University of Toronto

Sun Life Chair and Director, Joint Centre for Bioethics, University of Toronto

Director, Division of Palliative Care, Department of Family and Community Medicine, University of Toronto

Associate, Centre for Studies in Pain, University of Toronto and Buehler Centre for Aging, Northwestern University, Chicago

Academic Educator, Centre for Faculty Development, University of TorontoAssociate, Buehler Centre for Aging, Northwestern University, Chicago

Education Consultant, Education in Palliative and End of Life Care (EPEC) Project, Northwestern University, Chicago

Publications

Peer reviewed

Bergsagel DE Ogawa M Librach SL: Mouse Myeloma: A Model for Studies of Cell Kinetics. Arch Int Med 1975: 135: pp 109 13. 

Librach SL: Are We Listening? Journal of Palliative Care 1985: 1:  pp 5 8.

Librach SL Rapson L: TENS: Its Role in Palliative Care. Palliative Medicine 1988:2: pp y. 

Librach SL: The Challenge of Caring for AIDS Patients. Journal of Palliative Care 1988: 4. 

Librach SL: Defining Palliative Care as a Specialty Could Do More Harm Than Good. Journal of Palliative Care 1988: 4(1&2): pp 23 4. 

Librach SL Talbot Y: Understanding Dying Patients and Their Families: The Family FIRO Model. Canadian Family Physician 1991. 

Librach SL: Managing Chronic Pain in Family Practice. Canadian Family Physician 1993 39(2): 539-44. 

Kleinman I, Brown P, Librach SL. Placebo Pain Medication: Ethical and Practical Considerations. Arch Fam Med 1994; 3: 453-457.

Librach SL. Special Issues in Pain Control in Terminal Illness. Can Fam Phys 1995: 41: 415-419

Librach SL. The Principles of Palliative Radiotherapy: A Palliative Care Physicians Perspective, Supplement of The Canadian Journal of Oncology; 6(1); February 1996   

 Judy Watt-Watson,, Judi Hunter, Peter Pennefather, Larry Librach, Lalitha Raman-Wilms, Martin Schreiber, Leila Lax, Jennifer Stinson, Tuan Dao, Allan Gordon, David Mock, Michael Salter: “An integrated undergraduate pain curriculum, based on IASP curricula, for six Health Science Faculties. Pain 110 (2004) 140 – 148.

C. Danjoux, E. Franssen, E. Chow, R. Wong, R. Connolly, L. Andersson, L. Holden, K. Stefaniuk, T. Schueller, L. Librach, J. Pope, E. Szumacher and C. Hayter. “Sublingual fentanyl citrate for control of breakthrough pain in patients referred for palliative radiotherapy”. Current Oncology. Volume 11, Number 1. 2004.

Abdullah Alkhenizan, Larry Librach and Joseph Beyene. NSAIDs: are they effective in treating cancer pain? European Journal of Palliative Care, 2004; 11(1).

Larry Librach. “Medical Competencies in Palliative & End of Life Care. Peer reviewed abstract. Journal of Cancer Education, Supplement to V21, Number 2, Summer 2006.

Lax, L., Singh, A., Scardamalia, M., & Librach, L. (2006) Peer reviewed. Self-Assessment for Knowledge Building in Health Care. QWERTY: Journal of Technology and Culture. Vol 1(2)

Kathy K. Li, Emily Sinclair, Joan Pope, Macey Farhadian, Dristin Harris, Julie Napolskikh, Albert Yee, Lawrence Librach, Lesia Wynnychuk, Cyril Danjoux, Edward Chow. “A multidisciplinary bone metastases clinic at Toronto Sunnybrook Regional Cancer Centre – A review of the experience from 1999 to 2005”. Journal of Pain Research 2008:1 43

The EPEC Project: wrote new modules on Psychosocial Issues and revised pain and constipation modules

Editor and major writer, Facilitating Advance care Planning: An Interprofessional Education Program. EFPPEC Project. CHPCA 2008

Judith Hunter, Judy Watt-Watson, Michael McGillion, Lalitha Raman-Wilms, Lynn Cockburn, Leila Lax, Jennifer Stinson, Andrea Cameron, Thuan Dao, Peter Pennefather, Martin Schreiber, Larry Librach, Tricia Kavanagh, Allan Gordon, Nora Cullen, David Mock, Michael Salter. “An Interfaculty Pain Curriculum: Lessons learned from six years experience”. Pain 140 (2008) 74-86

Barbera L. Susman, J, Viola R, Husain A, Howell D, Librach L, Walker H, Sutradhar R, Chartier C, Paszat L,  Factors Associated with End-of-Life Health Service Use in Patients Dying of Cancer, Healthcare Policy/Politiques de Santé, e125 –e143; 5(3) 2010.

Cheng SM, Librach SL, Berry R, Buchman S. Healthcare Integration: The study of the Toronto Central Regional Hospice Palliative Care “System” and Its Integration Challenges. Healthcare Quarterly. Vol. 13, No 4, 78-83. 2010

Librach SL, Bouvette M, DeAngelis C et al. Consensus Recommendations for the Management of Constipation in Patients with Advanced, Progressive Illness. J Pain & Symp Manag Vol 40., No 5., Nov 2010, pgs 761 – 773.

Tobler D, Greutmann M, Colman J, Greutmann-Antiri M, Librach SL, Kovacs AH. End of Life Care in Adults with Congenital Heart Disease. Palliative Medicine 2010.

End-of-life in adults with congenital heart disease: A call for early communication. Daniel Tobler, Matthias Greutmann, Jack M. Colman, Mehtap Greutmann-Yantiri, Lawrence S. Librach, Adrienne H. Kovacs. Int J Cardiol (2010), doi 10.1016/j.ijcard.2010.10.050

Non-peer reviewed

SL Librach: The Role of the Family Physician in Managing Cancer Pain. Oncore 1991: 3: pp n. 

SL Librach FD Ferris: Living Wills: Toward Informed Consent on Behalf of the Incompetent Patient. Ontario Medical Review September 1992.

SL Librach: Section on Palliative Care in each issue of Oncore Ontario 1993-1994, 6 issues.

SL Librach: Cases in Palliative Care Parkhurst Publishing. Quarterly Newsletter

SL Librach: Aerosolized Morphine in Treating Dyspnea, Patient Care Canada, Vol. 7, No.5 /May 1996.

SL Librach: Patient Care, Volume 8, Number 4, April, 1997, “Sedation for restless patients with renal failure”.

Working Group on Palliative Care Services, Health Canada 1981 and 1989 Palliative Care Services: Guidelines.

SL Librach: Managing Chronic Pain in The Terminally Ill, Dec, 1998, Newsletter provided as an educational service by Rhone-Poulenc Rorer Canada Inc

SL Librach: Bowel Obstruction, Supplement to Hot Spot, Newsletter of the Rapid Response Radiotherapy Program of Toronto-Sunnybrook Regional Cancer Centre, November 1999                                                                             

SL Librach: “Palliative Care. Hydromorphone versus morphine”. Patient Care Canada. Volume 11, No. 5, May 2000

SL Librach: “Neuropathic pain”. Health News. October/November 2000. Vol. 18 No. 5

SL Librach: (Corridor Consultations) Pain Management. Narcotic Bowel syndrome. Patient Care. December 2000. Volume 11, Number 12.

S. Watanabe, R. Goldman, J. Pereira, L. Librach: This house believes that opioid rotation is useful in palliative settings. Current Oncology. Volume 10, Number 1.

S. Lawrence Librach. “Methadone for cancer pain: An analgesic with a difference”, Supplement to Hot Spot, Vol 7, Issue 1, February 2005.

2005 Clinical Survey, “Palliative care not accorded significance it deserves. Caregivers need to do more to try and understand experience of terminal patients”, Fall 2005. The Chronicle of Cancer Therapy.

The Educating Future Physicians for Palliative and End-of-Life Care project (EFPPEC): Developing competencies in medical undergraduates and postgraduates. Temmy Latner Centre Update on Palliative Care, Larry Librach in Hot Spot, Volume 8, Issue 2, May 2006.

S. Lawrence Librach. “Breakthrough cancer pain: Assessment and management challenges”. Hot Spot. . Vol 12, Issue 3, August 2010

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Books / chapters in books / proceedings

Librach SL: Pain in a Terminally Ill Patient. In: Family Centered Medical Care: A Clinical Casebook (Doherty WJ Baird MA, ed). The Guilford Press, New York 1988: pp 87 - 90. 

Librach SL: Supportive Care for the Patient with Terminal Genitourinary Cancer. In: Current Genitourinary Cancer Surgery (Crawford ED Das S, ed). Lea and Febiger, Philadelphia 1990: 66. 2nd edition published in 1996.

Librach SL. The Pain Manual: Principles & Issues in Cancer Pain Management. 1st Edition Pegasus Healthcare, Toronto 1991.

Ferris FD, Flannery J (ed). Module 4: Palliative Care - - A Comprehensive Guide for the Care of Persons with HIV Disease - Member of National Working Group and wrote the Introduction

Librach, SL:   “Caring for Loved Ones at Home”, Canadian Medical Association Journal, Dec. 15, 1996.

Librach SL: Current Genitourinary Cancer Surgery, Second Edition, Williams & Wilkins, 1996, “Supportive Care for the Patient With Terminal Genitourinary Cancer”

Librach, SL: Patient Care, Volume 8, Number 4, April, 1997, “Sedation for restless patient with renal failure”

Librach SL: The Pain Manual, 2nd Edition, Pegasus Healthcare International, Toronto 1997

Edited by Dr. Derek Doyle, Professor Geoffrey Hanks, Dr. Nathan Cherny and Professor Sir Kenneth Calman, “Oxford Textbook of Palliative Medicine”, 3rd Edition. Chapter, “Palliative care in the home: North America”, S. Lawrence Librach. 2004.

Macdonald N, Oneschuk D. (Ed) Palliative Care: A Case based Manual, Oxford Press 2005. Two chapters on Grief and Malignant Bowel Obstruction.

Librach SL. The Specialty of Palliative Medicine in Walsh D, Caraceni AT, Fainsinger R et al (eds). (ed.)Palliative Medicine 2009 Saunders Elsevier Philadelphia

Librach SL Palliative care in the Home: North America, Hanks G, Cherny NI, Christakis N et al (eds) Oxford Textbook of Palliative Medicine 4th ed 2010. Oxford University Press, Oxford UK

Macdonald N, Oneschuk D. (Ed) Palliative Care: A Case based Manual, Oxford Press (in Press) Chapter on. Malignant Bowel Obstruction.

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Presentations

Has presented over 500 workshops, lectures and seminars.

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Honours and awards

2011

Rabbi Bielfeld Lecture, Temple Emanule, Toronto

2010

Earl Dunn Lectureship, DFCM Walter Rosser Day Retreat

2007

Dorothy Ley Award of Excellence, Ontario Palliative Care Association Third Annual Regina Palliative Care Lectureship, Regina

2006

Golda Fine Memorial Award. Mount Sinai Hospital

Certificate of Appreciation. Presented by Ontario Palliative Care Association, for outstanding service

2005

Award of Excellence, Presented by Canadian Hospice Palliative Care Association for being a national advocate for change to ensure quality end-of-life care for all Canadians

Recipient of John W. Whittick Memorial Lectureship, Division of Continuing Professional Learning, College of Medicine, University of Saskatchewan

2004

Recipient of MMLJ from The Military and Hospitaler Order of Saint Lazarus of Jerusalem, Grand Priory in Canada

2002

Neil Macdonald Lecturer, University of Alberta

Recipient of Queen’s Jubilee Medal, presented by Senator Sharon Carstairs. This commemorates the Golden Jubilee of Her Majesty’s accession to the throne as the Queen of Canada. It is presented to persons in recognition of a significant achievement or distinguished service to their fellow citizens, their community, or to Canada.

College of Physicians and Surgeons of Ontario. Council Award.

Ontario Medical Association Section on Palliative Care. Award of Excellence

2001

Recipient of Glenn Sawyer Award on behalf of Ontario Medical Association for service to the community and medical profession

2000

Recipient of The Colin R. Woolf Award for Long Term Contribution to Continuing Education, University of Toronto, Faculty of Medicine

1998

Recipient of the Carmelita Lawlor Lectureship, University of Toronto, Faculty of Medicine

1997

Practice of Excellence Awards, Honourable Mention, Family Practice Magazine, Maclean Hunter Publishing

1986

College of Family Physicians of Canada Traveling Scholarship

Canadian Palliative Care Foundation Study Award

Canadian Cancer Society Award to support sabbatical

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