Healing the dying in Canada

David Walker, dean of Health Sciences, applauds new steps to train doctors for palliative care.
David Walker, dean of Health Sciences, applauds new steps to train doctors for palliative care.
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Easing into her chair in her office on Parliament Hill, the Honourable Sharon Carstairs expresses her vision for palliative care in Canada. “I hope that, one day, every single Canadian who requires palliative support will have it,” she said.

The seasoned senator from Manitoba, and former Leader of the Government in the Senate, dedicated herself to fighting for palliative care issues across the country.

“The main challenge we’re facing today is lack of access,” she said.

While things have improved significantly over the past decade, only 25 to 30 per cent of Canadians have reliable access to palliative care. In northern, Aboriginal, and rural communities, the statistics are worse. This is unacceptable, Carstairs said.

Palliative care, according to the World Health Organization, is “the active total care of persons for whom curative therapies are no longer possible.” It was pioneered by the British nurse—and later doctor—Dame Cecily Saunders, who devised an integrated approach to ease the suffering of dying patients. She said her intention was to help her patients not only “to die with dignity, but to live until [they] died.” She developed her ideas at St Christopher’s, the London hospice she founded in 1967. Among her many residents was Dr. Balfour Mount, a Queen’s medical alumnus who returned to Montreal in 1975 to establish the first palliative care program in Canada.

Thirty years later, Saunders’ and Mount’s work has taken root in Canada. Dr. Natalie Whiting, another Queen’s medical alumna and a palliative physician in Peterborough, describes the goal of palliative care as not merely to prolong life, but to also relieve suffering, so that patients and their families can enjoy the best possible quality of life.

“Palliative care is holistic and recognizes that suffering encompasses physical, psychological and spiritual domains,” she said. As part of a holistic approach to palliative care, Whiting works in an interdisciplinary team with nurses, social workers, rehabilitation therapists, chaplains and volunteers. She feels like she’s making a difference.

“By alleviating some of the obstacles such as pain and fear, it is possible to help create an environment for dying persons and their families in which growth and healing can occur,” she said.

“It is really a privilege to share this time of life with people and to try and help facilitate this process.”

Canadian palliative care provision varies widely between provinces. Alberta’s wealthy provincial government spends more than any other on palliative care, with several excellent centres in Calgary and Edmonton. Conversely, Nova Scotia has no governmental palliative care structure in place, but is currently creating one. The other provinces are somewhere in between.

Canada is an international leader in the field, however. This year alone, $12 million in federal grants are earmarked for palliative care research and development.

Despite this innovation, the field still faces several challenges in Canada. Dr. Deborah Dudgeon, professor of medicine and oncology and director of the palliative care program at Queen’s, believes palliative care is commonly misunderstood.

“Many people suffer from non-curative diseases, but may be years away from dying,” she says.

According to Dudgeon, there is a widespread misconception that palliative care is only for patients in the final, or terminal, stages of an illness. Consequently, some patients who are eligible for palliative care and need it do not seek help.

Another challenge has been the fragmentation of the palliative care delivery system and the varying quality of care across different hospices and local organizations. To address this issue, Dr. Dudgeon and her colleagues initiated the Kingston, Frontenac, Lennox and Addington (KFL&A) Palliative Care Integration Project. The publicly-funded project is the first of its kind in Canada. By harmonizing the practices of its 16 participating agencies, the project will facilitate access to palliative care, improve patient and family satisfaction with care delivery, and decrease the number of emergency department visits and hospital admissions.

Ultimately, the project aims to make it possible for more patients like them to die at home, rather than in the hospital, if they wish to and provided adequate support is available.

The lack of qualified physicians specializing in the field is another serious obstacle. Dudgeon believes educational initiatives, such as one-year certificates in palliative care for qualified physicians, might entice more doctors to consider the field as a supplement to their careers. Newly-qualified doctors will also graduate with more exposure to the field: starting in September, palliative care education will become compulsory in all Canadian undergraduate medical curricula. Dr. David Walker, dean of the Queen’s Faculty of Health Sciences, supports the initiatives.

“There shouldn’t be a physician, nurse, or rehabilitation worker who isn’t educated in palliative care,” he said.

Walker predicts that the demand for palliative care will increase substantially over the next decade, as the baby-boomer generation grows older. With greater life expectancies today than ever before, the prevalence of non-curative diseases, like cancer, is likely to increase, along with the number of people who need palliative care.

“[The government puts] tremendous pressure on us to put all our resources into family medicine,” Walker said. “However, there is also great interest in palliative care around the country, and the interest is likely to keep growing.”

Recent federal government initiatives seem to support Walker’s views. Just this year, Ottawa spent $4.3 million to develop two websites, pallium.ca and the Canadian Virtual Hospice, which will include chat rooms for bereavement and adult support. The websites will also offer 24-hour contact with professional palliative care doctors. Furthermore, Canadian workers can now expect to receive up to six weeks of partially paid leave while caring for a terminally ill parent, child or spouse. The program is expected to attract 270,000 applicants this year alone—another victory for Senator Carstairs.

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