Dr. Wildish is a palliative care physician in Saint John, and we spoke with her about a recommendation to establish palliative care teams in New Brunswick.
Dr. Wildish: Palliative care is, by nature, a multidisciplinary endeavour. Its goal is to relieve physical and psychological suffering, and help dying individuals and their families achieve the best quality of life possible in the time they have left.
This can mean treating symptoms like pain, shortness of breath, and nausea, but it can also mean providing equipment such as walkers and hospital beds to make life easier at home, helping families access financial support for formal caregivers, providing emotional support through the grieving process, giving advice on nutrition and wound care, and a wide range of other services. No single health-care professional can do all that! A team approach, where all bases are covered, and where there is good communication between the team members, allows for more timely and comprehensive attention to all the needs of individual patients and their families, without anything falling through the cracks.
Dr. Wildish: I think we have some fragments of a team-based approach already. For example, the New Brunswick Extra-Mural Program provides excellent team-based service to individuals who need medical care and support at home. However, this care is not necessarily focussed on palliative care, and some important members of the team are missing. In hospitals, palliative care services are provided by a wide variety of health-care professionals, but in most cases the necessary coordination, support and even knowledge is not what it should be. The big shift in New Brunswick will be in identifying a team of health-care professionals whose specific focus will be on palliative care resources, and determining how that team will interact with patients, families, and the rest of the health-care system, in order to best support everyone in ensuring the best quality of life possible.
Dr. Wildish: Yes, for a couple of reasons. Firstly, a team-based approach makes providing care more efficient because the people with the right knowledge and tools are available to get the job done, so more work gets done by fewer people. Secondly, an effective palliative care team can provide support and education for non-specialist health-care providers to confidently recognize and manage issues that come up for their palliative patients, without always requiring the direct intervention of a palliative care specialist.
The vision for palliative care in New Brunswick is that the majority of care that palliative patients need should be able to be provided by health-care providers without specialized training. One of the major roles of the palliative care team is to inform and support high quality, evidence-based care by all of those health-care providers
Dr. Wildish: Many larger centres in the developed world have adopted a team-based approach of some kind, although this can look very different depending on local needs and medical cultures.
Close to home, Nova Scotia has adopted a general model based on teams of palliative physicians and consult nurses along with other health-care professionals dedicated to palliative care, including social workers, pharmacists and others according to availability and need.
Prince Edward Island has a provincial integrated palliative care team that consists of a physician, resource nurse, drug pilot manager/social worker and spiritual care advisor, all dedicated to palliative care, who work with primary care providers to design and put into effect appropriate care plans for palliative patients. These models work very well, and I have no doubt that similar models with adaptations based on New Brunswick’s unique characteristics will improve how we provide palliative care in the province.
Dr. Wildish: I think it is important to note that this is a patient-focused model. The most important members of the team are the patient and their family members, and care should be planned and provided in a way that is consistent with what they feel is important. The role of the health-care provider is to explore the possibilities and options available to the patient and help them decide on the right choice for them, not what suits the health-care system best.
Another important point is that there is a focus on care in the community. Staying home can be very challenging for dying individuals and their caregivers, but it’s naturally what most people want. Historically health care has been focused on hospitals and clinics, not on the individual and their preferred environment. Staying home to die is not going to be possible for everyone, but making it more feasible for more people is the right thing to do, both for our patients and for our budget.