Breathing life into palliative care

A common myth surrounding palliative care is that it is only for patients who are at the end of their life. In reality, palliative care can begin at the time of diagnosis of a life-limiting illness and can coexist in parallel with active treatment.

Palliative care is best described as “supportive care,” says Dr. Daryl Roitman, Physician Lead for the Freeman Centre for the Advancement of Palliative Care at North York General Hospital (NYGH). It offers an added layer of support and assists patients and families in managing their physical, spiritual and psychosocial needs. The verb palliate means to relieve symptoms of pain and suffering.

Dr. Daryl Roitman meets with Catherine Watt-Roberts, a patient with breast cancer, to discuss how palliative care goes hand-in-hand with active treatment.

Dr. Daryl Roitman, Physician Lead for the Freeman Centre for the Advancement of Palliative Care, meets with Catherine Watt-Roberts, a patient with breast cancer, to discuss how palliative care goes hand-in-hand with active treatment.

Maintaining quality of life at every stage of illness

“Patients should and do receive palliative care at the same time as active treatment because it is crucial to maintain quality of life at every stage of illness,” he says. “Health care providers who specialize in palliative care are trained to provide patients with relief from pain and other distressing physical symptoms, as well as help to cope with fear, anxiety and changes in their functional status. They are also in tune with the spiritual needs of patients and families and ensure those needs are addressed.” 

How does Dr. Roitman deal with caring for patients with an advanced incurable illness? “It's true, much of what we see is sad, but to be allowed into someone's personal life and space and help them achieve physical and spiritual peace with their own mortality is quite rewarding,” says Dr. Roitman. “To be able to impact patient lives in such a way is a privilege, and the reality is there is sadness in every aspect of medicine, so it's not something I've tried to avoid.” 

Dr. Roitman was drawn to palliative medicine in medical school. Feeling ill-equipped to help care for a patient with a new diagnosis of incurable cancer, he was determined to make sure that medical students like himself would be equipped with the tools and skills to provide high quality palliative care. 

Today, Dr. Roitman leads a team of interprofessional health care providers at the Freeman Centre who provide patients with comprehensive palliative care at every stage of their illness, be it cancer or non-cancer. Together, physicians, advanced practice nurses, a nurse practitioner, social workers, and spiritual care providers deliver compassionate care to help patients live each day with quality, dignity and hope. 

Overcoming misconceptions about palliative care

Delivering palliative care seamlessly to NYGH patients is priority for Anna Tupis, Program Director, Ambulatory and Cancer Care Program. “We have a strong vision of providing high quality palliative care for our patients across different disease groups and to achieve this our interprofessional team works collaboratively, is committed to educating the next generation of practitioners, as well as engaging in research and innovation,” says Anna. “Together with our patients and families we are showing that it is possible to overcome the misconceptions about palliative care and provide the many benefits of comprehensive ‘supportive care.' ”

Freeman Centre recognized as a Leading Practice

In 2016, the Freeman Centre for the Advancement of Palliative Care was recognized as a Leading Practice by Accreditation Canada. It is one of the biggest sources of pride for the team, who have worked tirelessly to create a model of care that ensures patients and families always come first. 

The Freeman Centre for the Advancement of Palliative Care is comprised of four programs:

  • Inpatient consultation program
  • Pain and Symptom Management Clinic for patients with cancer
  • Supportive Care Clinic for patients with heart failure and pulmonary disease
  • Home-based outreach program for adults living with advanced cancer, whose wish is to die at home

The Freeman Centre was born out of the vision of a small group of family physicians who identified the need for palliative care support in our community. Approached by Dr. Val Rachlis, former Chief of Family and Community Medicine, Zoltan and Yetta Freeman placed their trust in this vision and generously created the Freeman Centre in 1999. For over 18 years, the Freeman Centre for the Advancement of Palliative Care has been driving the evolution and improvement of palliative services in Toronto, and has become a leader in the palliative care field. 

Starting difficult conversations

NYGH has been fortunate to partner with patient and family members to ensure that they are always at the centre of care provided. Pat Mackey was a Patient and Family Advisor who shared her experience with terminal cancer and how palliative care helped her find energy and joy in her day instead of focusing exclusively on her illness. It was her hope that by sharing her experience, she could help others facing similar challenges.

Watch the video Palliative Care and Me: Pat's Story

“Pat left us with an invaluable gift — sparking important conversations,” says Dr. Roitman. “As a society, we're not always comfortable talking about death or thinking about how we want to be cared for if we get sick, but we are getting there. As we do, it's gratifying to know that palliative care practitioners are helping to move this important conversation and work forward.”

Learn more about the Freeman Centre for the Advancement of Palliative Care.

This article first appeared in the December 2017-January 2018 issue of The Pulse.

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