The shared experiences of illness between patients and family physicians over the years set them up for ideal primary palliative care when life’s end is approaching.
Providing care at life’s end
A leader in end-of-life care in Nova Scotia, Dr. Fred Burge’s interest in family medicine stems from his appreciation of the physician-patient relationship. Dr. Burge believes that the relationship between a patient and their family doctor is the foundation of care, especially in end-of-life care.
“It’s these relationships that help me provide the best care to my patients as they enter the final stage of their life,” said Dr. Burge. “The shared experiences of illness between patients and family physicians over the years set them up for ideal primary palliative care when life’s end is approaching.”
Palliative care is often viewed or described as that aspect of care provided by a “specialized health care team for those very near death”. For family physicians, primary palliative care is about bringing a palliative approach to care earlier in the trajectory of life limiting illness. It is a unique yet important focus for Dr. Burge. Participating in the lives of his patients from birth through to the final phase is an extraordinary partnership that he values.
The palliative approach to care focuses on relieving and preventing the suffering of patients throughout the treatment phases of chronic diseases, as well as for patients who are approaching the end of their life.
Physicians and patients alike understand each other’s strengths and approach to care. This understanding and experience equips both the patient and family physician for the final phase. “Family physicians are uniquely positioned to identify those at risk of dying, to begin advance care planning and to coordinate that care,” said Dr. Burge.
According to Dr. Burge the best end-of-life care is delivered by an interdisciplinary team of community-based primary care providers, integrated with secondary care that focuses on the needs of individuals and not on the disease. Most of those facing death over the coming decades will bear multiple co-morbid chronic diseases requiring a cross-disease approach to setting goals of care.
Palliative care patients experience illnesses that get progressively worse. Sometimes it’s a gradual decline and other times it’s sudden. It can be difficult for patients to answer complex and detailed questions about their care. Primary care providers have the patient’s medical experience to call upon and an already established structure of trust.
“These teams need to be deeply integrated into the components of the health system and support patients at home, in hospital and in long-term care facilities,” said Dr. Burge. Dr. Burge not only provides palliative care to his patients but his principal work life is in leading research programs that explore the practice of end-of-life care and the various models that are used to deliver it.
His latest study, Experiences of Care at the End of Life: A Nova Scotia Mortality Follow Back Study, reviews more than 1,300 interview responses from the perspective of family members and friends of those who died from chronic disease in the province between 2009 and 2011.
Now in the early stages of analysis, Dr. Burge is hopeful that the study will provide information for the health care system, patients and their families, both in terms of developing better health policies and in the improvement of end-of-life care in Nova Scotia.