According to WHO (2002), palliative care is
- Aimed at improving quality of life for the patient and family through symptom management, assistance with decision-making and communication, increasing function and independence of patients.
- Is appropriate at any age or stage of a serious illness and can be provided alongside curative treatment.
- Prevention and relief of suffering by identifying symptoms early, through thorough assessment and treatment of pain and other problems, physical psychosocial and spiritual.
Palliative care began with the hospice movement – places for the dying often established and maintained by religious orders. Over the past 50 years, the concept of the modern hospice or palliative care has grown dramatically.
Palliative care was traditionally turned to as a framework of care once curative, or life-prolonging care was stopped. Increasingly, palliative care is integrated during the treatment course, with earlier intervention palliative care becoming the norm at many centres. This care does not have to be provided by palliative care specialists. In most cases, symptom management is managed by primary care physicians, or the main specialist team involved with the patient, such as the oncologist for cancer and the respirologist for Chronic Obstructive Pulmonary Disease (COPD).
At Princess Margaret patients are all oncology patients, but palliative care is not specific to those with cancer and can be applied to all with serious illness. Toronto General Hospital and Toronto Western get many referrals for patients with non-cancer life-limiting illnesses.
Regardless of which area of medicine you practice in the future, you will be managing patients with symptoms and severe illness. Patients expect a sound approach and knowledge base around the assessment and treatment of physical and emotional symptoms such as pain, nausea, dyspnea, anxiety and depression.
The common Quality of Care indicators include the ability to communicate openly and honestly with patients and their families, even around difficult topics, and the provision end-of-life care. These skills are increasingly valued by health professionals, administrators and the public at large.
The ethical and communication skill sets fostered in palliative care are also applicable across health care environments. The core competencies for all physicians include the abilities to discuss goals of care, to rationalize investigations and treatments that may be burdensome to patients and to understand the psychosocial and cultural aspects of disease.
We hope that your palliative care rotation is an enriching experience for you. However, palliative care can be overwhelming at times. We are involved in many intense discussions with sick and or dying patients. Sometimes, it is also difficult to shift our perspective from cure to the philosophy of comfort care.
As a health care professional, you give so much to our patients and their families. It is imperative that you take care of yourself too. We cannot help our patients and their families if we are not healthy ourselves. During this rotation, please remember to take care of yourself. Be sure to
- Eat your lunch every day
- Share your concerns by debriefing with your preceptor and team members.
Other helpful professionals include our various spiritual care providers and social workers.
