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NOR-MAN Regional Health Authority in partnership with The Pallium Project will bring palliative care education to Flin Flon with the delivery of Learning Essential Approaches to Palliative and End-of-Life Care (LEAP) on June 10, 11 and 12. This course is specifically designed for rural physicians, registered nurses, and pharmacists who need to work together on the delivery of palliative care in rural community and hospital settings. In the NOR-MAN Health Authority, Flin Flon was selected as a recipient community for the LEAP course, which has been offered as part of a recent investment by Health Canada. It is part of a $4.3 million investment being made in western and northern Canada through the Primary Health Care Transition Fund (PHCTF). The course is designed for a small-group learning environment of approximately 25 participants. Darby Johanson, NOR-MAN RHA's Regional Palliative Care Coordinator, is the local planner for the weekend. "I am excited to be involved in the planning of this course. I received immediate interest in the workshop and have 27 health care professionals registered to participate this weekend, all at no cost to the participants. The family physicians, pharmacists, and registered nurses taking advantage of this incredible educational opportunity will all play a key role in caring for palliative individuals throughout our region. The education provides during the LEAP course will truly ripple throughout the communities in our region, to ensure quality end-of-life care for individuals and their families." The LEAP course is part of the Pallium Project's outreach education efforts and makes palliative care learning accessible to busy rural physicians and community-based pharmacists, many who can not get away for extended periods from their place of practice due to difficulties in finding replacements. The course also makes learning more accessible to rural registered nurses, many whom have limited staff development options in light of tight education and training budgets. The course's multi-professional format mirrors the way that health care professionals are increasingly expected to work together, complementing each other's unique clinical skill sets. Although helping those with life-limiting illness to leave this life with dignity and compassion has been prominently placed on the public agenda for years, only 5 to 15 percent of Canadians caring for a dying loved one have adequate access to hospice palliative care. For those Canadians who do know about palliative care, most think the programs are in large cities. This can leave citizens in rural areas feeling as if they have little support from health care professionals, many who have had little or no formal preparation in providing palliative care at the rural community level. See 'Each' P.# Con't from P.# In Canada, national norms of practice for hospice palliative care were introduced in 2002 by the Canadian Hospice Palliative Care Association. Professional schools are only now starting to consider how they might incorporate palliative care into the curriculum. Medical students, historically, have had as little as one hour of professional training on pain control in a four-year degree program. The dominant culture in medical schools has been to cure illness and, when doctors can no longer cure, many resign themselves to the belief that there is nothing more they can do to help their patients. Our health system currently devotes almost all its resources to acute care, to diagnostics and treatment, but those same medical advances mean Canadians are living longer with chronic and life-limiting illnesses. The baby-boom generation is aging and nearly three million Canadians are caring for a loved one with a long-term or life-threatening illness. The Pallium Project was founded as a Health Canada supported education and professional development project focused on making palliative care, including end-of-life and bereavement support, widely available to community-based health professionals, especially those in western and northern Canada. The word Pallium is Latin, meaning a shelter or cloak. Because quality palliative care seeks to shelter an individual and family from the distress of illness, relieve symptoms and maintain functions and comfort. The Latin word "pallium" was chosen to reflect the spirit, direction, vision and hope the founders had for the project. The Pallium Project is a group member of the Canadian Hospice Palliative Care Association. Living Lessons We have learned that dying is an integral and fundamentally human stage of living, and that when physical and emotional needs are sensitively met, the journey toward death - though always difficult - can be a rich and profound experience that gives meaning and completeness to life. We have learned that it is essential to manage pain and other symptoms effectively so that those facing death, and their loved ones, can devote their energies not to fighting physical discomfort, but to embracing the life of mind, heart, and spirit. We have learned that living with life-threatening illness is tough, demanding and intense for loved ones as well as the patient. But with practical, emotional, and spiritual support through all the stages of illness and bereavement, loved ones can also experience privileged moments of special communication, growth, and even joy. Such moments can be a shared gift. We have learned that everyone faces death in his or her own way. Retaining the power of individual choice Ð about medical treatments, about the care setting, about practical, emotional, and spiritual services Ð is essential. Exercising choice preserves dignity and prevents isolation from the daily business of living. We have learned that patients and their loved ones must be well-informed, active decision-makers and partners in the care team, prepared to be advocates for the quality of care they deserve at the end of life. Caregiver Bill of Rights As a caregiver for a loved one with life threatening illness, I have the following rights. To take care of myself. This is not an act of selfishness. It will give me the capability of taking better care of my loved one. Seek help from others, even though my loved one may object. I recognize the limits of my own endurance and strength. Maintain facets of my own life that do not include the person I care for, just as if he or she were healthy. I know that I do everything that I reasonably can for my loved one; I have the right to do some things just for me without feeling guilty. Get angry, be depressed or happy, experience frustration, laugh and cry and express the normal range of human emotions. Reject any conscious or unconscious attempts by my loved one to manipulate me through guilt, anger or depression. Receive consideration, affection, forgiveness and acceptance from my loved one for what I do for them on a daily basis. Take pride in what I am accomplishing and to applaud my own courage in taking on the responsibility for caring for my loved one. Protect my individuality and maintain a life for myself that will sustain me once my loved one has passed on. Expect and demand that, as government makes strides in finding resources to support afflicted persons, similar strides are made toward aiding and supporting caregivers. Quick Facts One in ten Canadians is caring for someone with a long-term illness. Each year more than 220,000 Canadians die of a terminal illness. Each death affects, on average, five other people, or more than one million Canadians each year. This number will increase over the next decade. See 'The' P.# Con't from P.# It is estimated that only 5 to 15 percent of Canadians have access to hospice palliative care, yet 90 percent of Canadians want this kind of holistic care during the last stages of life. Only 6 per cent of Canadians feel they could adequately care for a dying loved one without outside support. Currently, 80 percent of Canadians would choose to die at home, yet 70 percent die in the hospital because hospice palliative care services and caregiver support are not available. More than 70 percent of Canadians feel that providing all non-medical care and support for a terminally ill loved one is too much for most families to handle without outside support. Statistics Canada estimates that one out of every two Canadians of working age will be caring for a loved one at home in the next generation. With the average age of a family caregiver being 42 years old, many Canadians are caring for a dying family member at the same time that they are raising children and working. Not surprisingly, job protection and paid leave for family members needing time away from work to care for a dying loved one Ð an end-of-life complement to maternity leave Ð is increasing in importance on the public policy agenda. There is currently no income security for family caregivers. As governments shift limited health care resources to community-based and in-home care, the need for additional support resources for families is becoming greater. When hospice palliative care services are available to patients and caregivers, stress is reduced and quality of life is enhanced. Caregivers are provided with reassurance that they have made the right choice, coping mechanisms and relief from the daily demands of caring for a loved one. Health care professionals are overworked and understaffed. Every Canadian has a personal responsibility to become better informed about the other choices and services available in our communities. Hospice palliative care offers choices about effective pain and symptom management and how end-of-life care can be experienced within a home, hospital or hospice. End-of-life care and support is the right of every Canadian and the loved one caring for them. Care giving can be a rewarding and meaningful experience when the proper supports are in place. It is often the final gift you can give your loved one. What is The Pallium Project? The Pallium Project is a collective of leaders from a variety of health and social science disciplines who collaborate in developing tools, learning resources, continuing professional development (CPD) and strategic initiatives for hospice palliative care. The focus of the Pallium Project's efforts is to improve access and quality of appropriate care for those living with life-threatening and life-limiting illnesses and to improve the capacity of health systems in Canada to deliver quality hospice palliative care. The Project helps empower health care providers to become more self-aware and skillful in order to help improve the quality of living when faced with dying. It promotes adoption of safe, ethical and effective practices when working with those experiencing complicated life-limiting illness, such as those facing difficult end-stage cancer symptoms or other difficult chronic progressive illnesses such as congestive heart failure and chronic obstructive pulmonary disease (COPD). The Project also encourages thoughtful health system change in care for the dying and improved collaboration among paid health care providers, family/friends and volunteers. It makes the results of its collaborative work available on a licensed basis across Canada to educators, health authorities and voluntary sector organizations. The Project's collaborators come from universities located in Vancouver, Edmonton, Calgary, Saskatoon, Regina, and Winnipeg, most regional health authorities in western Canada and various government and voluntary sector organizations, such as provincial hospice palliative care associations. In late 2003, the Project was awarded $4.3 million in Contribution Agreement funding under the aegis of the National Envelope of Health Canada's, Primary Health Care Transition Fund (PHCTF). These funds are being used with significant emphasis being placed on improving supports to regional health authorities (RHAs) and community-based, voluntary-sector partners to improve the local and regional capacity care for the dying. The PHCTF investment also is being used to improve collaboration among health regions, universities, provinces and territories in addressing common issues associated with care of the dying as part of Canada's primary health-care system renewal efforts.
