It is a topic that most haven't really thought about or some try to avoid until the very last moment. Understanding end of life options isn't necessarily a discussion for around the dinner table but the value of having this conversation is part of life's journey.
On Sept. 13, clinical nurse specialist for the Rural Palliative Consult Service, Jill Uniacke, alongside Ozzie Sawicki, volunteer chair of the local hospice society, held a discussion at the Frank Wills Memorial Hall. The husband and wife duo have lived in Cochrane for 15 years and led an informative program focused on palliative care, end-of-life care, advanced care planning, home and hospice care, and family support.
As death is part of life, so is making the choices to be prepared for it just like choices are made and prepared for the beginning of life. The key is to educate people in the community so they can understand and be aware of the resources that are available, the pair told the crowd.
When a situation arises in life that is unexpected the instinct may be to shut down completely. This could be a terminal illness, cancer or even a progressive disease. As difficult as it may be to discuss the different options available, it will lead to a care plan that will better suit each individuals situation. Care plans are important as they help navigate the patient and their family from the early stages of diagnosis, through to the end and beyond to support families in the grieving process.
There are two palliative care nurses in Cochrane's homecare team. The focus of palliative care is to aid with relief from symptoms of pain, physical and mental stress. It is focused on improving the quality of life for patients and their family. End-of-life care focuses on the health care for those with a terminal, advanced or incurable illness in the final hours or days of their life. At times, palliative care can advance into end of life care so it is important to understand which goals of care path would better suit yourself and your needs.
The three general approaches are:
- Medical Care: Medical tests and interventions are used to cure or manage an illness. Symptom management, palliative and quality of life. Medical care can be provided at many locations depending on the person's wishes. Radiation control or management as well as chemotherapy. This is a life prolonging management method.
- Resuscitative Care: This focuses on lengthening or preserving life using any medical or surgical means including resuscitation and admission to intensive care to Benefit and recover to base line function.
- Comfort Care: Cure and control are no longer possible. Intervention and intense, thorough management to allow comfort. Specialized symptom management for complex diseases to ensure quality of life.
It is always a good time to start the conversation about advanced care planning before a crisis or illness arises. This will allow your loved ones and health care team to understand your wishes going forward. There are five steps that will assist you in the process.
- Think about your values and wishes
- Learn about your own health
- Choose someone to make decisions and speak on your behalf
- Communicate your wishes and values about health care
- Document in a personal directive
All of your information including, goals of care, personal directives and any other care planning documents should be kept in a plastic green sleeve. It is a universal understanding among emergency medical workers and health care providers that the green sleeve will be kept on or near the fridge. If you do not have one, talk to your doctor about obtaining one as it is an important part of communicating your advanced care plans.
In June 2016, the Parliament of Canada approved federal legislation to allow Canadian adults to request medical assistance in dying. Each province and territory has created a care coordination system to help patients learn more about the service.
The two options that are available in medical assistance dying are: A physician or nurse practioner will directly administer a substance that causes death or a physician or nurse practioner will provide or prescribe a drug that the patient will take themselves in order to bring about their death. This is for those suffering from grief, have a life-limiting illness and or the end of life is foreseeable. It allows yet another option for a patient to decide their fate and have it be part of their care plan.
Conversations matter, do not hesitate to talk with your family about the goals you wish to have should an unanticipated issue occur.
