Providing equitable palliative care to diverse communities

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Conversations about end-of-life care for a loved one are never easy to have, regardless of how long they are expected to live. For William Osler Health System’s (Osler) palliative care team, these conversations hold the key to ensuring that the needs and wishes of each patient are understood. This is especially important because Osler serves one of the most diverse regions in Ontario, with close to 50 per cent of the population comprised of visible minorities and new immigrants.

Providing equitable care to such a diverse population means health care practitioners have to be knowledgeable of cross-cultural models and approaches, as well as the beliefs, values, and practices of the diverse populations being served. The needs of Osler’s rich religious, cultural, ethnic and socio-economically diverse population can vary dramatically from patient to patient and how the palliative care team addresses them can make all the difference to a patient and their family during their final days.

“By understanding and respecting diversity, we have allowed for individualized interpretations of the quality of life, death and dying, and we are able to integrate this into our patients’ care plans,” says Gurwinder Gill, Director of Diversity and Volunteer Services. “When a patient’s values and beliefs are not aligned with the care they receive, families can feel alienated, upset or misunderstood. This can negatively impact the patient’s palliative care experience as well as their family’s grieving process.”

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Gill works with various units and departments across Osler, including the palliative care team, to ensure health care services are provided in an environment that respects, values and embraces diversity. For palliative care staff and physicians, this also means understanding that cultural competency skills are vital for ensuring our patients and their families have a sense of dignity during their loved-one’s end-of-life journey.

Each palliative care patient undergoes a psychosocial and cross cultural assessment, which provides the palliative care team with an understanding of the patient’s beliefs, practices and values. Then a unique care plan is developed, with careful consideration being given to areas of potential conflict or challenges.

Sometimes the challenges the team faces are more complex and require additional sensitivity. “In some cultures,  families do not want their loved ones to know how long they are expected to live, however denying them this information goes against a physician’s obligations to disclose it,” says Gill. “In cases like this, we have to find a middle ground to ensure both the family’s wishes and the physician’s obligations are met.  For example, this can be done by applying cross-cultural techniques and asking the patient what they would like disclosed and/or how they make decisions in their family unit.”

Osler’s palliative care program applies an inter-disciplinary approach to its practice, providing patients with access to support from physicians, social workers, advanced practice nurses, and dieticians, to name a few, and a range of hospital and community resources.

Osler works closely with various community health partners who assist in providing the additional support some patients may need. For some, this may mean accessing Community Health Centres which are pillars of support for low-income patients who require help navigating social assistance while in care; or connecting with community organizations that provide religious and culturally-appropriate support services.

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“It is great to be able to chat with patients and their families to identify what their unique palliative care journey looks like and incorporate those wishes into the patient’s care plan,” says Dr. Naheed Dosani, Palliative Care Site Lead and Physician at Osler’s Brampton Civic Hospital. “For example, in some cultures, it is customary for patients to remain at home under the care of their loves ones for as long as possible, and we are happy to help families develop the skills needed to provide certain types of care themselves to their loved ones so that we can honour their request.”

It is not uncommon for some patients to struggle with understanding palliative care because of their cultural or religious background. Often times it is difficult for them, to comprehend that their disease is incurable and palliative care is needed. In cases like this, the team works to help educate patients and their families about end of life care and focuses on enhancing their quality of life.

“Palliative care isn’t just about dying, it’s about living well,” says Dr. Dosani. “Each patient has their own unique outlook based on their background and lifestyle and being able to identify this and work with the patient and their family can have a positive impact on their quality of life.”

Osler is a key member of the Central West Palliative Care Network (the Network), itself a partnership of Health Service Providers committed to providing leadership for a high quality, comprehensive, integrated and well-coordinated hospice palliative and end-of-life care system in the Central West Local Health Integration Network (LHIN). Osler’s palliative care program is evolving to meet the high demand for specialized services required of a rapidly growing and aging population. In collaboration with the Network, the Central West Community Care Access Centre, Central West LHIN, Headwaters Health Care Centre and Osler have served as founding participants for a joint palliative and end-of-life care “Pledge” which, when complete, will strive to improve the patient experience for those living with life-limiting illness in the Central West Region. A great need for coordinated, individualized and respectful palliative and end-of-life care has been identified and, through enhanced service delivery, work has already begun to close the gap