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A Palliative Approach to Care is Everyone’s Business

An open letter to the public and care providers
By Dr. Ingrid Harle, MD
The South East Regional Palliative Care Network is building palliative care partnerships focused on enhancing competency in palliative care within the South Local Health Integration Network. Our plan is to engage in meaningful dialogue as we explore exciting partnership opportunities. This will ultimately facilitate increased access to high quality palliative care services for the individuals and families whom we serve.
Unfortunately, there is a common misunderstanding (public and health care providers) that palliative care equals end of life care but this is not the case. Palliative care can be provided from the time of diagnosis through to the end of life, and more importantly can be provided simultaneously with disease targeted treatments.
Palliative care is an approach to care that focuses on “the whole person”, not just the disease, for any person diagnosed and living with a life limiting illness (cancer and non-cancer diagnoses) along the illness continuum. Thus, a palliative care approach is supporting individuals and their families when a person is diagnosed with a life limiting illness; this includes assessing and managing the physical, psychological, social and spiritual domains of an individual’s illness experience…and ensuring continuity of care (wherever the person says they wish to receive care).  A palliative care approach also includes:
  1. Engaging in advance care planning1 at different stages of a person’s illness (this is a dynamic process and is not a one-time event), and
  2. Assisting individuals in determining their goals of care as the illness changes and/or progresses. This involves helping them to reflect on and share their values, beliefs and wishes, assisting them in understanding their prognosis and the possible outcomes of various treatments offered, so that they can make informed choices.
A palliative approach to care is everyone’s business and is best delivered in a collaborative manner and by an interdisciplinary team. The philosophy of family medicine….to provide care “from cradle to grave”, and to ensure continuity of care…. is optimally designed to provide a palliative approach to care. Just imagine…. how rewarding it is to honour your patient’s wishes, to understand their values, what is important to them and to get to know who they really are… but even more so… to have the privilege to journey with and care for them during the most vulnerable times in their lives.
Not every person with a life-limiting illness requires a specialist in palliative care……these physicians are available to manage complex cases and challenging management problems or intractable symptoms. There are not enough specialists in palliative care to go around, and this becomes even more so as the palliative care needs of individuals increases exponentially as they live longer with multiple medical comorbidities.
As we discuss enhancing competency in palliative care it is important to remember that receiving education in palliative care is not the same as developing competency in palliative care….one must be able to translate the knowledge learned into providing care, skill and knowledge at the bedside of one’s patients. It means doing the work. There are acknowledged gaps in standardized palliative care education and training2. These gaps have resulted in a shortage of health care professionals and volunteers with sufficient education in palliative care, and a lack of palliative care expertise and specialized resources. To address these needs, the Ontario Palliative Care Network established a Provincial Education Steering Committee to develop recommendations on the required competencies for health care providers delivering palliative care and establish consistent and standardized education and competency requirements for all levels of care provision across care settings.
Sadly, many individuals do not receive palliative care services or a palliative approach to care until the very end of life…this is essentially too late for individuals and their families to reap the benefits of a palliative approach to care. How can we, together, facilitate this occurring sooner? Whether you work in primary care, addictions and mental health services, social and community services, hospitals, long term care, hospice, or other care settings, you can be a part of raising awareness of the benefits to embracing a palliative approach to care.
One can begin by asking the “surprise question” 3: Would you be surprised if this patient died within one year? If one answers NO to this question, then at least this “twigs” one to think about general or disease specific features that could suggest a poor prognosis and/or declining functional status. This opens the door for providers and individuals/families/caregivers to have conversations about “what matters to them”, such as their understanding of the illness, the impact on their lives, their fears, symptoms, and other important discussions and decisions they face.
Ingrid Harle MD
Dr. Ingrid Harle is a palliative care specialist with Queen’s Palliative Medicine. She is the Executive Sponsor for the South East RPCN priority team for competency building and maintains a life-long interest in enhancing the provision of a palliative approach to care.
  1. Advance Care Planning – Speak Up Ontario. http://www.speakupontario.ca/
  2. Advancing High Quality, High Value Palliative Care in Ontario: A Declaration of Partnership and Commitment to Action (2011)
  3. Gold Standards Framework, NHS.