Palliative care

 A friend of mine has been fighting a number of issues for the past year and finally, his family decided to follow the doctor's advice and put him into palliative care. The decision was made after my friend had a bad fall, which aggravated his health. A few weeks after the fall, I was told that he had pneumonia and was rushed to the hospital. He is having trouble eating, drinking and swallowing. It is unlikely that he will get to go home. His wish was to have palliative care at home. Due to his current condition that is unlikely to happen.

My friend like most patients requiring palliative care support is known to have complex health services needs and to be a high health system user in the last months of life. Research has shown that referral to specialized palliative services, and the application of a palliative approach by primary care services even when still receiving curative treatments, can lead to a reduction in aggressive intervention at the end of life, reduced emergency room visits and hospitalizations, thereby increasing the quality of life.

Patients often express their wish to have end-of-life care at home. They want to die peacefully in their own home surrounded by their loved ones. However, if they experience acute symptoms such as shortness of breath, inability to eat or drink, or delirium, their caregivers may call 911. In my friend's situation, it led to patients being transferred to the emergency room. In some jurisdictions in Canada, paramedics and palliative care programs allow paramedics to treat those acute symptom needs, avoid transfer to the hospital and ensure continuity of care with the community team. This allows the patient to get the right care, in the right place at the right time. Ultimately, it honours the patient’s wishes for a peaceful death at home.

Palliative care for many is not understood and so people are reluctant to use this service. The earlier a person can take advantage of palliative care the better. The goals of palliative care are to provide comfort and symptom relief when faced with a life-threatening or life-limiting illness. Primary care clinicians are well placed to identify and work with those who may need palliative care, and many regions have palliative home care community programs to support palliative patients and their caregivers. However, both primary and palliative care community programs are often unable to provide urgent care 24/7 and do not have immediate access to resources such as medications. Expansion of the primary health care team to include service providers outside clinical settings and structured hours of care, with the goal of improving access to palliative care services, is needed.