People believe that it is only administered at the very end of life when one is on their deathbed. This is a big falsehood as it is applicable early on in the course of an illness in conjunction with other treatments. It is also false to speak of “the withdrawal of care” when referring to the fact that disease‐modifying or life-‐sustaining treatments are no longer of benefit. On the contrary, nearing the end, very good care is still provided, although with a bigger emphasis on that of palliative care, the goal of which is ultimate comfort at the last stages of life.
Unfortunately, society, including health care professionals, may still see palliative care as a separate process only delivered very late (much too late) at the end of life when a patient is on their deathbed. Others may still see it as “giving up” or “losing the battle” to the disease. When put that way, it makes sense that people are afraid of it.
It is clear, however, that patients benefit immensely from an integrated approach in which palliative care is integrated into the continuum of care (as shown in the diagram below) alongside disease modifying treatments. This way, the patient is cared for as a whole throughout their entire disease process. In actuality, the intervention of palliative care should be implemented from the very beginning or very early on and continued through all the stages of the disease.
More and more prevalently as new models of care emerge, palliative care is being integrated this way. When restorative or curative care is no longer useful or becomes harmful, then palliative care takes over as the main form of care and consequently, becomes the most important and the most amplified during the very last stages of life. What is palliative care exactly? Palliative care addresses many physical symptoms common in advanced or terminal illnesses including, but not limited to, pain, nausea and vomiting, loss of appetite and weight loss, constipation; as well as functional limitations, social and family issues, spirituality, depression and bereavement. It requires a multidisciplinary team and has as a goal to treat the patient and their family as a whole in a holistic manner. Everyone deserves to benefit from palliative care in order to feel comfort and reduce suffering, whether or not they are in the last stages of their life.
There are physicians, nurses, psychologists and other health care professionals who are dedicated to this area of medicine and they offer great services to patients living or dying with chronic and terminal illnesses. These professionals are experts in pain and symptom management related to disease processes as well as the psychosocial difficulties that come along with them. Their hearts are open and rearing to reach out to those in need.
All that said, I hope it is becoming clear that palliative care is much more than just the death part; it is, rather, about the life before death part, about making moments memorable and suffer-free, promoting wellness and peace until the end of life. It therefore makes a lot of sense to follow an integrated model.
Interestingly, palliative care may actually help one live longer. “Findings published in The New England Journal of Medicine shed a new light on the effects of end-‐of-‐life care. Doctors have found that patients with terminal lung cancer who began receiving palliative care immediately upon diagnosis not only were happier, more mobile and in less pain as the end neared – but they also lived nearly three months longer.”
Palliative care teams exist and specialists are referring their patients to them more quickly so that they may benefit from these services. The Georges L. Dumont University Hospital Centre has a palliative care team at the Dr. Leon Richard Oncology Centre and is available to serve all of its cancer patients.
The preceding article is an excerpt from the document “Understanding Palliative Care – hashing up the myths and identifying the obstacles” by Saneea Abboud M.D., member of CHPCA.