Supporting palliative care patients with a team approach

St. Joseph’s Health Centre, Toronto is not designated as a palliative care facility, but we provide quality treatment and compassionate support for palliative patients in medicine units throughout our hospital. In some cases, the Health Centre is the last place of care for our patients diagnosed with life-threatening illnesses.

Our Palliative Care Team consists of doctors, a nurse practitioner, coordinator, chaplain and a social worker. Other Health Centre professionals are brought in as needed including a dietitian, physiotherapist, occupational therapist, speech-language pathologist, pharmacist, clinical ethicist, child life specialist, respiratory therapist and interpreter services.

We treat palliative patients on units throughout the facility with an interprofessional approach to their care. For example, our hospital’s transitional care unit is where we treat our Alternative Level of Care patients who no longer need acute care treatment at our facility and are awaiting transfer elsewhere for example to a long care facility, palliative care facility or rehabilitation centre.

On the Health Centre’s 43-bed transitional care unit, at any given time about nine patients will be palliative, explains Sandra Dickau, the Patient Care Manager for this unit. Daily, the team on this floor will talk about all the patients including anyone who is palliative to assess patients’ needs.

“We prepare (palliative) patients for transfer to a more formal palliative care setting. However about 40 per cent of palliative care patients on this transitional care unit will get their end of life care at St. Joseph’s,” says Dickau.

Palliative patients on this transitional care unit are very involved in directing the care they want and need. Families are active participants in the care plan with no restriction on visiting hours.

As a Catholic hospital, the Health Centre offers religious and spiritual care 24/7 for all our patients and their loved ones.

Cindy Elkerton is one of our Chaplains for patients on the transitional care unit. “In some cases, patients ask for help reaching out to a relative or loved one they have lost touch with and want to see before they pass on,” says Elkerton.

There’s also grief support for family and loved ones of a patient who is close to the end of life or who has passed on.

“If they (patients’ loved ones) haven’t experienced a loss, they have all kinds of fears about what they are supposed to do. I normalize the grieving. There is no right or wrong way to grieve,” explains Elkerton.

“Although journeying with a patient during those last days of life can be difficult, it is also a great honour. Palliative patients and their families often have many fears and concerns, by helping them through some of that we feel like we were able to really serve that family,” she adds.

Another service is our Palliative Care Volunteer Program, which we first launched in 2009. These volunteers help palliative patients on various units throughout the hospital. In order to prepare them for this role, the volunteers complete 30 hours of education and training and 70 volunteering hours. They also participate in off-site visits at the Toronto Rehabilitation Institute and Dorothy Ley Hospice where they attend information sessions and have individualized training with volunteers at those sites. The Health Centre’s palliative care volunteers also received infection control education and complete interprofessional mentor/preceptor workshops.

Marion McLaughlin has been a volunteer at the Health Centre for seven years and a palliative care volunteer since 2009. “We spend time talking with them (palliative care patients) and try to accommodate any special requests,” says McLaughlin. “I find it rewarding. You know you have helped someone and made them comfortable and helped them through a difficult time.”

For family members of a palliative patient, it can be a relief to know that a volunteer is with their loved one so the patient is not alone when the family takes a moment to get some rest or something to eat. “I find it rewarding because it is a wonderful program for patients and their families,” adds McLaughlin.

Joanne Britto, who is a 22-year-old palliative care volunteer agrees.

Britto grew up in New Zealand and Australia and moved to Canada in 2009. In 2010, she decided to give back to her new community in Toronto by volunteering at the Health Centre. She is considering going to medical school to become a doctor.

She said the Health Centre’s Palliative Care Social Worker Jose San-Pedro mentors the palliative care volunteers. He has written extensively on how to support patients and their families with weighty issues including mortality, grieving, the physicality of dying and spirituality. This literature is an extra resource for volunteers on how to help families and palliative patients, mentions Britto.

“I do very little talking and a lot of listening,” says Britto. “They like to talk about their past. It’s a time to celebrate their life. Volunteers play a role in lending an open ear and open mind especially those without family or friends to visit them.”

Britto realizes people often assume that being a palliative care volunteer is sad or depressing, but for her it’s an uplifting experience. “Some of the palliative care patients and their families are some of the happiest people. They are very enlightened about life. We rarely talk about death. We talk about celebrating life,” says Britto. “It’s the best place to learn about how we (should) live life to the fullest every single day.”