Physician notes importance on changing perspective on palliative care
By Deborah Gyapong
Photo Caption: Dr. Jose Pereira, a palliative care expert, said palliative care should be introduced much earlier in a patient's care, even while treatments for cure or control of disease are underway.
Palliative care is about living and celebrating life and should begin much earlier than a patient’s last days and weeks of life, says palliative care physician Dr. Jose Pereira.
“We need to change a culture … that palliative care has to do with death and dying,” Dr. Perera told an information session in Ottawa Feb. 18.
Palliative care is about living, compassion, dignity and person-centred care, he said. Fear and depression associated with sickness and dying can be greatly reduced if palliative care principles are introduced earlier along with other treatments.
If the “p-word” is only introduced when physicians have given up on attempts to cure or control the disease, the anxiety will only increase, he said. “It’s not a matter of taking away hope; it’s a matter of reframing hope.”
Introducing palliative care earlier in the disease process does not shorten life because its principles – geared toward quality of life, patient-centred care, symptom management, and spiritual and personal life goals – can be applied while treatments are under way, he said. “Palliative care and treatments to cure and control are not mutually exclusive. They go hand in hand.”
When palliative care is not introduced, patients can experience inappropriate treatments and inadequate attention to symptom control, while not having their psychological distress addressed, Dr. Pereira said. “We need to erase the old model.”
In studies where palliative care techniques are patient-centred and more attentive to personal needs, patients have lived almost three months longer with less depression, less anxiety, better symptom control and a much better quality of life, he said. “Palliative care early is better than palliative care late.”
Dr. Pereira said palliative care is too often restricted to specialized units with specialized physicians and nurses, which limits access. “Our mission is to try to change that idea.”
Instead, every cardiologist, oncologist, kidney specialist and family doctor needs to start incorporating palliative care techniques into their treatment, he said.
If a doctor asks, “Do you want active care or palliative care,” he or she must be challenged, he said. “Palliative care is active care.”
Canada is recognized internationally for its expertise in palliative care, but because it is often reserved to specialized teams, coverage is a patchwork accessible to an estimated 30 per cent of Canadians.
Change needs to begin at medical schools, with the federal government setting national standards, he said.
“What if every family doctor had this training?” he said. “Then access would grow to almost 100 per cent.”