In the last 10 years of her life however, she struggled with several chronic illnesses and dementia, resulting in several trips to the emergency room. As they could not see a clear “death trajectory” though, she ended up moving between settings of care, and eventually passing away in an acute care facility instead of a residential hospice or at home, which she had originally wanted.”
I have heard many stories like this from the Canadians for whom we advocate. And like so many others I have heard, if a palliative approach to care had been available earlier in the trajectory of managing chronic disease, there would have been no emergency visits and no family panic, resulting in a better quality of life for the patient and family; not to mention less strain on our health care system. Most Canadians die in old age, and when this happens, most are suffering from two or more chronic diseases. Because end-of-life needs vary, the “right” setting for people to die also varies, but with the right supports and care, many are able to die at home. Some, however, need the kind of care that can only be provided in a hospital or hospice. Others will receive care in the settings where they live, whether that is a long-term care home, shelter or prison.
The questions we must answer now, and quickly, are: Will we be able to provide high quality end-of-life care for all Canadians when and where they need it?; Can we provide the physical, psychological, social, spiritual and practical care that individuals and families should have at end-of-life?; Is the health care system ready? And can we handle the rapid rate at which our population is aging? The truth of the matter is, if our system not only focuses on treatment and cure, but does integrate a palliative approach, we will be more ready to treat the influx of seniors and ensure “a good death” for everyone.
But what is the palliative approach to care?
Currently, only those who are perceived as “close to death” are referred to palliative care. With a palliative approach model, people have discussions about goals of care earlier in the trajectory, such as when they are diagnosed with a chronic, life-limiting illness like diabetes. As people live longer with life-limiting illnesses, time of death is often sudden and difficult to predict. This means that many are never offered the benefits of the palliative approach to care, which includes social support, advance care planning, and effective pain and symptom management throughout the trajectory of the illness[i].
Medical advances mean that many people will live years with one or more chronic, life-limiting illnesses; however, most will eventually die of these diseases and should have the right support to make informed decisions about care. If we implement a palliative approach to care, more Canadians will be able to make informed decisions about their end-of-life care, and hopefully more of us can die in the setting of our choice.
To learn more about the palliative approach to care and the Quality End-of-Life Care Coalition’s initiative The Way Forward: An Integrated Palliative Approach to Care, please visit www.hpcintegration.ca.