Teleman Suite in B flat major TWV 55:B10
At rounds this week, members of our team were lamenting the confused response they sometimes encounter from patients when they announce they are from the Palliative Care team.
"I must be dying"
"You mean there is no more hope"
"Have they given up on me?"
Similarly, we receive consults asking for "End of Life orders" when our presence earlier in the course of the patient's illness would have been helpful.
The World Health Organization calls palliative care "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness." The illness might be cancer, but increasingly the term palliative care is used in regard to conditions such as renal disease, chronic heart failure, HIV/AIDS, progressive lung disorders and neurological conditions. It is active holistic care. For this reason, the care team includes palliative medicine consultants and palliative care nurse specialists together with a range of expertise provided by social workers, physiotherapists, occupational therapists, dieticians, pharmacists and those able to give spiritual and psychological support. It is a sharing partnership between the person with the illness, their family and friends, the surrounding community and members of the health care team to re-frame hope, provide meticulous pain and symptom management and offer supportive care for the purpose of helping those involved cope with the condition and it's treatment, from diagnosis to cure or, through continuing illness to death and into bereavement.
The goal of palliative care is not dying, it is living each remaining day of life as fully as possible.
all very true, altho no mention of primary care providers - specialist pc teams will presumably never be resourced to replace palliation at the primary care level - idealistic definitions of palliative care leave something to be desired as they don't address how care will be delivered - raising expectations without being able to deliver? - what would be an approach to population-based service delivery? (see Lynn, Milbank Quarterly 2007 "Using Population Segmentation to Provide Better Health Care for All: The 'Bridges to Health' Model - shared care between primary care/specialist pc teams/other specialists? - see Marshall, et al. Can Fam Phys 2008 "Enhancing fam physician capacity to deliver quality palliative home care" & UK GSF http://www.goldstandardsframework.nhs.uk/
ReplyDeleteI enjoy your blog!
Paul McIntyre, Halifax
Hello Paul
ReplyDeleteI agree with your sentiments and lament the "lost" opportunities for emphasizing, supporting and holding sacred the relationships between family physicians and their patients. We are straying from this ideal and the patient's we are here to care for are suffering through inconsistency and isolation as they try to negotiate their way through today's care delivery models. Thank you for taking the time to post a comment.
JL
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