Local - End-of-life care lacking: report

End-of-life care lacking: report May 22, 2010 Carmela Fragomeni The Hamilton Spectator (May 22, 2010) Despite years of complaints, end-of-life care remains an inadequate patchwork. A Canadian Cancer Society report this week focused on poor palliative care throughout the country. Help for dying at home is insufficient, and where other services do exist, as in Hamilton, patients are referred to palliative care too late. Care for the terminally ill is just as fragmented in Hamilton, according to researcher Dr. Kevin Brazil at St. Joseph's Healthcare. This, despite five area hospices attending to the dying and their families, the existence of hospital palliative care teams and of home support from local agencies.

"There's some real gaps and inconsistencies on how end-of-life care is delivered," says Brazil.

The number of hospice beds and quantity of home care are insufficient, and in hospitals, end-of-life discussions are missing among staff and families.

An average of four or five people a week die waiting for quality end-of-life care at Hamilton's Dr. Bob Kemp Hospice, said executive-director Beth Ellis. The hospice and one each in Burlington, Grimsby, Niagara and Brantford are five of Ontario's 19 hospices but together have only enough beds to serve a population of 1.2 million.

In nursing homes, a research paper by Brazil and colleagues found serious barriers to palliative care, and at Hamilton Health Sciences, which runs five city hospitals, few patients die under the care of its palliative team.

About 2,000 people a year die in HHS hospitals -- over 80 per cent from chronic and degenerative diseases like cancer and congestive heart failure, according to HHS ethicist Andrea Frolic.

They could benefit from end-of-life care but often don't get it, which is why HHS initiated a plan six months ago to help hospital staff discuss end-of-life wishes with patients and family.

"One of the barriers is it's emotionally difficult for health care professionals to deliver the bad news that a patient is not expected to survive," Frolic said. "There are huge cultural barriers in our society about talking about death. This normalizes it and gives people tools to deal with it."

The cancer society says most patients want to die at home, but more than 55 per cent of all deaths in Canada occur in hospitals, a sign of problems with supports.

This could get worse as cancer cases increase as the population grows and ages.

"One of the challenges we have is that the system is fragmented and this creates barriers to accessing good quality end-of-life care so people can die with dignity," says the cancer society's Sarah Bouma. Cancer is the leading cause of death in Canada.

A special Senate committee reported uneven access to palliative care in 1995 and a 2005 followup found little progress.

cfragomeni@thespec.com

905-526-3392

via thespec.com

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