On­tario needs to im­prove pal­lia­tive care

Tremen­dous op­por­tu­nity for care sooner — and for peo­ple to un­der­stand ben­e­fits

The Hamilton Spectator - - COMMENT - JOSHUA TEP­PER

While our par­lia­ments and me­dia fo­cus in­tently on med­i­cal as­sis­tance in dy­ing, an­other im­por­tant end-of-life ques­tion needs to be brought to the fore­front: How do we build a high-qual­ity pal­lia­tive care sys­tem?

Pal­lia­tive care is the part of our health care sys­tem that deals not only with death, but with qual­ity of life when peo­ple are near­ing the end of life.

This ex­tends be­yond re­lief from pain and dis­com­fort to in­clude psy­choso­cial and spir­i­tual care: It’s about im­prov­ing the qual­ity of life for those fac­ing life-threat­en­ing ill­ness, and pro­vid­ing sup­port for their fam­i­lies.

Our health-care sys­tem has a re­spon­si­bil­ity for “cra­dle to grave” care; but far more at­ten­tion has been placed on the be­gin­ning of life, and the events dur­ing life, than at the end.

With­out sac­ri­fic­ing the gains we have made and the progress still to be made at the start of life and dur­ing life, we also need to cre­ate a strong fo­cus about what high qual­ity care looks like as peo­ple are di­ag­nosed with se­ri­ous ill­ness and get closer to death.

A fo­cus on death and dy­ing may have seemed con­tra­dic­tory to the tra­di­tional essence or fo­cus of what a health care sys­tem is de­signed to do — pro­vide health and heal­ing.

How­ever, modern medicine has ex­tended our lives in ways that once would have been unimag­in­able.

With the chang­ing na­ture of dis­ease, and chronic ill­ness at the root of most deaths, we now have the abil­ity to much bet­ter pre­dict end-of-life.

This means that there is a tremen­dous op­por­tu­nity for pal­lia­tive care to be­gin much sooner in the course of dis­ease, and for peo­ple to un­der­stand its ben­e­fits — care that not only helps pa­tients with their pain and symp­toms, but also helps them and their fam­i­lies through a dif­fi­cult time of loss and grief.

Health Qual­ity On­tario’s lat­est re­port looks at pal­lia­tive care in the prov­ince. We look at the care and ser­vices peo­ple re­ceived dur­ing their last month of life, and ask: How are we serv­ing those who are near­ing the end of their lives?

What we’ve found is much room for im­prove­ment. Of the 95,000 peo­ple who died in On­tario in 2014-15, only about half re­ceived some form of pal­lia­tive care. And of those, half did not be­gin re­ceiv­ing this care un­til their fi­nal month of life. This statis­tic alone is re­veal­ing. We also re­port that for the Hamil­ton Ni­a­gara Haldimand Brant LHIN, more than half of those who’d re­ceived pal­lia­tive care had un­planned emer­gency depart­ment vis­its in the last month of life. While it is un­likely the num­ber should be zero, the cur­rent rate is al­most cer­tainly higher than a well-per­form­ing pal­lia­tive care sys­tem would aim for. An­other area for im­prove­ment is our find­ing that nearly two-thirds died in hos­pi­tal, although we know most peo­ple’s pref­er­ence is to die at home.

Get­ting care when it’s needed, where it’s needed, and by well-trained care givers are hall­marks of qual­ity health care.

Joshua Tep­per is a fam­ily physi­cian and pres­i­dent and CEO of Health Qual­ity On­tario

We also need to cre­ate a strong fo­cus about what high qual­ity care looks like as peo­ple are di­ag­nosed with se­ri­ous ill­ness and get closer to death.

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