A vote for keeping palliative care

Dr. Darren CargillOn April 12, Dr. Balfour Mount will be inducted into the Canadian Medical Hall of Fame in London, Ont. While Dame Cicely Saunders is credited with kickstarting the modern hospice movement, Dr. Mount can be viewed as the father of palliative medicine in Canada.Not only did he found the first Canadian palliative care unit at the Royal Victoria Hospital in Montreal, he is also credited with coining the term "palliative.” From the Latin palliare, it means to cloak or make hidden, referring to the symptoms of a life-threatening illness.Dr. Mount is a national treasure and deserving of our praise and appreciation.Unfortunately there is a growing desire to change the term “palliative” to “supportive.” Proponents of this change argue that there is a stigma attached to the term “palliative.” These individuals argue that palliative care is equated with death and dying. They argue this stigma limits access and discourages referrals.Palliative care, by definition, provides care to individuals and their families when facing a life-threatening illness. It can be provided concurrently with life-sustaining treatment and even, in some case, with treatments aimed at curative intent. It also provides care for patients at the end of life while supporting family and caregivers throughout this process. These types of care can be mutually exclusive or inclusive as part of a holistic continuum of care.Using the term “supportive” simply avoids addressing difficult topics such as death, dying, loss and bereavement. In the journal Oncology, a 2016 article showed that referrals to palliative care teams increased when they were referred to as “supportive care teams.” This is an overly simplistic interpretation. At its core, it demonstrates that some healthcare providers, rather than engaging patients in crucial conversations, were more willing to refer patients to another service who would then engage in these same conversations. It simply “kicked the can down the road” when a healthcare provider did not need to explain what palliative care meant and the reason for the referral.As palliative physicians, we begin most of our consultations with one simple question: “Do you know what palliative care means?” We know you can guess what the most common response is.This only puts the above concern in frank relief.No one refers to the ER as the "Everything is alRight" department or the ICU as the "Intensive Cuddles Unit." Words matter and convey meaning to patients and families.Palliative care is part of our national identity. We are proud of the role Canada has played in the promotion of palliative care and the compassion it provides to the gravely ill. We are fortunate to be a part of one of the oldest palliative care programs in both Ontario and Canada. The Hospice of Windsor was founded more than 35 years ago on the principle that we could provide better care for patients facing a life-threatening illness. A community-founded program started by a simple idea: better patient-centred and family-oriented care.We can now claim to provide a truly multidisciplinary service that include MDs, RNs, social workers, allied health workers, dedicated administration and a veritable army of volunteers. We now boast Canada’s first satellite hospice in Leamington, Ont., we are accredited by CARF and recognized as a centre of excellence. We boast a palliative care unit at Hotel-Dieu Healthcare that is the envy of many communities and recently added an inpatient service at the Windsor Regional Hospital, Metropolitan Campus, to compliment services at the Ouellette campus. We stand on very broad shoulders indeed, and owe thanks to those who have come before us for what we have today in Windsor-Essex.It is a disservice to Dr. Mount when we use the term “supportive.” We should resist this unnecessary and potentially detrimental change. Instead of endorsing stigma, we should educate around and confront it. Rather than run from misunderstanding and uncomfortable conversations, we should endeavor to change hearts and minds, not only of patients but healthcare providers and administrators alike. Better education for healthcare providers, whether doctors, nurses or allied health, will improve comfort and competence with these discussions.“Supportive care” is not the answer to increasing access to palliative care. More palliative care is.Respectfully submitted by Windsor-Essex palliative physicians,Darren CargillSheri BergeronStephen RukavinaLawrence AounNicole FreemanAshley KellamWendy KennetteThomas BurgessPatricia Hizo-AbesAndrea SteenJeff CohenDr. Darren Cargill is medical director of the Hospice of Windsor and Essex County Inc., and an adjunct professor at Western University in London, Ont. He is past-chair of the OMA section of palliative medicine and a staff physician at Windsor Regional Hospital and Hotel-Dieu Grace Health Care.Opinions expressed in this article are those of the writer, and do not necessarily reflect those of CanadianHealthcareNetwork.ca or its parent company.

A vote for keeping palliative care

Register for free access or login.

Related Topics