Perspectives on palliative care: Our present and possible future

Categories: Featured, Highlight, Must Read, and Opinion.

As a physiotherapist at Sunnybrook Hospital, I started my career working in geriatric care. Working with elderly patients was like trying to fit a jigsaw puzzle together to help them with their needs – not only physical, but social and emotional needs too. There was no textbook that told you what to do, but patient by patient, I gained so many insights and strategies.

Over time and through various work settings, I became interested in chronic disease self-management which for me, was an extension of rehabilitation and aligned with my experiences with cancer (myself, my mother and my father). My mother died 22 years ago, and she received some palliative care, but it was more “end of life” care because it was arranged when she only had three months left to live. In fact, this is how we as a family were informed she was end of life – she was offered services!

I was drawn to work in palliative care, which I believe is a continuation of serving the chronic disease population and geriatric population. As the Executive Lead of Hospice Palliative Care Teams, I currently work with my Nursing Manager to lead a team of ten expert palliative care nurses in the Central LHIN who consult and educate patients and professionals in the community.

What I’ve experienced over the years is that too many patients end up in the hospital for conditions for which there is no cure and it’s really not the right place to receive the services they need. Then when patients are sent home from the hospital, they feel like they have been sent into a black hole, left alone to struggle through.

We have too many people going to the hospital in crisis or being sent home from hospital for crisis-type care where we are rushing to get all the needed services in place, and no one is sure of the patient’s true wishes or goals of care, so the cycle keeps repeating.

I think we often ask patients for consent – either to apply or withhold treatments – but do we really inform them properly of the risks and/or benefits of each? We tell patients what we can do from a medical perspective, but we don’t really go through all the options and explain the different possible results. We don’t really like patients to refuse care, but it’s their right to refuse and we can support their decisions.

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