World-renowned palliative care program in Edmonton focuses on the whole person

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Capital Health’s Regional Palliative Care Program in Edmonton is recognized worldwide as a leader in research, education, and clinical care. This program is run by Capital Health and Caritas Health Group, and hosts healthcare professionals from all over the globe who spend time in Edmonton to learn from their standards of practice.

Palliative care strives to provide relief from pain and other forms of distress. Social, mental and spiritual aspects of care are harmonized in a support system to help family and friends cope during a patient’s illness.

Medical leaders in Palliative Care agree that the key to managing pain is thorough assessment, and to recognize that people express pain in different ways. Palliative Care has emerged as a new discipline emphasizing an interdisciplinary approach with the goal of reducing pain and suffering. Pain management will be required in about 70 per cent of cancer patients.

Dr. Robin Fainsinger, Clinical Director of Capital Health’s Regional Palliative Care Program, says assessing pain is an ongoing process. “We need to learn as much as we can about the person’s pain at any given time.”

The first step in putting together a plan to manage a patient’s pain is to perform a multidimensional assessment. Dr. Fainsinger says it is important to look at the impact the pain is having on the patient’s overall quality of life. “This portion of the assessment can identify factors that indicate potential difficulties in controlling pain related to family and social support systems, financial concerns or cultural issues influencing the illness experience.” Pain that has a large psychosocial or spiritual component is often referred to as “total pain” or “total suffering.”

The mainstay of pain assessment is the regular recording of the patient’s pain intensity. Most commonly used are numerical, verbal or visual scales to rank pain intensity as well as other symptoms. The usefulness of these scales becomes even more evident when they are used on an ongoing basis for the same patient. Terminally ill patients need to be assessed regularly since symptoms can change rapidly.

Carleen Brenneis, Program Director, says the practice of pain management will continue to grow and be the focus of future research, as the need for Palliative Care grows, especially due to increasing mortality from cancer. Approximately one in three Canadians will be diagnosed with cancer and of those, approximately 50 per cent will die from it. “During the next decade, we expect a 42 per cent increase in cancer mortality, together with increases in deaths from other chronic incurable illnesses,” says Brenneis.

The Capital Health program provides comprehensive acute and community-based care to about 1,200 patients per year, ranging in age from the teens to over 100. The program reaches about 80 per cent of all advanced cancer patients in the region; fewer than half die in acute-care hospitals in the region today, compared to 87 per cent prior to 1995. About 40 per cent are cared for in three dedicated palliative hospice units in continuing care facilities, and a hospital-based acute palliative unit; the remaining 20 per cent receive specialized home care services.

The success of Edmonton’s approach is attributed to the regional structure with combined acute and community care services delivered in a patient-focused, family-centered environment.

Members of the Edmonton Palliative Care team are committed to education and research in pain management and all aspects of end-of-life care. For their colleagues both in and out of region, Edmonton puts on an annual conference. The theme of this year’s Education & Research Days is “Celebrating Life” and will be held October 21 & 22, 2002. Conference information is available from Lynda Bykewich at (780) 450-7727 or at lbykewic@cha.ab.ca

More information on pain management and other areas of Palliative Care is available to health care professionals and the public from the Regional Palliative Care website at www.palliative.org