Health care workers at the St. Joseph’s Continuing Care Centre of Sudbury are taking cues from a program started in Halifax to help their patients make better decisions at the end of life.
Halifax-based geriatricians Dr. Laurie Mallery and Dr. Paige Moorhouse were in Sudbury to train the St. Joseph’s team and three emergency department nurses from Health Sciences North in the Palliative and Therapeutic Harmonization (PATH) program.
“The intention of the training is to improve the efficiency and effectiveness of team-based care,” said Mallery.
The PATH clinic in Halifax started in 2009, and has helped frail seniors and their families better understand their health status so they can make better informed decisions on care options.
Dr. Maurice St. Martin, chief of staff of St Joseph’s Continuing Care Centre, said the approach doctors use for cancers can also apply to chronic conditions and diseases such as dementia.
“Stage 1 cancer should be curable, so you throw everything at it,” he said. “At stage 4 cancer, we’re pulling the plug. We’re doing comfort and palliative measures. The same thing can apply to the frail elderly.”
St. Martin said 37 per cent of Ontario’s health-care budget is spent on the top one per cent of health care users, who are typically near the end of their lives.
The top five per cent of patients, use more than 50 per cent of the health-care budget.
“That’s a lot of money that is spent at the very end of life,” St. Martin said. “I know we have finite resources. If we can better spend that money somewhere else, that’s a dialogue we’re going to have to have as a province, and it’s going to be a difficult dialogue.”
With the PATH training, health-care providers can better help families and patients determine the best approach for their care.
If their condition is terminal, for example, a shift to more palliative care might be more appropriate than medical interventions that might only extend their lifespan by days or weeks.
After going through the PATH program in Halifax, frail elderly patients and their families cancelled 77 per cent of therapeutic procedures, and opted for a stronger palliative approach instead.
“This is really a matter of them having an enhanced or new understanding of their prognosis and what this intervention would mean for their future health and quality of life,” said Moorhouse.
Through the PATH program, health-care providers also help patients and their families understand what palliative care means.
“Palliative care is not akin to doing nothing,” Moorhouse said. “There are a lot of really good strategies and interventions that we have for patients and their families.”
Kari Gervais, vice-president of clinical services at St. Joseph’s Continuing Care Centre, said after they start the program at the centre, they plan to expand to their affiliated long-term care homes – St. Joseph’s Villa and St. Gabriel’s Villa.
“I’m very optimistic that with this training our team will have the same understand of frailty and that will propel us forward in terms of the quality of care we’re providing,” she said.