Effects of Paliative Care in the incial Phase of Cancer Treatment

Dr. Samantha Winemaker is an Associate Clinical Professor, Department of Family Medicine, in the Division of Palliative Care at McMaster University in Ontario, Canada. She teaches palliative care to health care professionals. She won the Ontario College of Family Physicians Award of Excellence in 2010, the Elizabeth J. Latimer Prize in Palliative Care in 2018, and the Dr. S. Lawrence Librach Award for Palliative Medicine in the Community in 2019.

What initially sparked an interest in palliative care, and after how many years of being in the field. How is it different from your inicial perception?

When I completed medical school, I trained to be a family doctor. During the training, I did a rotation in palliative care and never turned back. Palliative Care has all of the elements that I was looking for in a career; complexity, challenge, person/ family centered, interesting pharmacology, ethical decision making, team based care and a breadth of illnesses.

I enjoy the challenge of being tender at the bedside and yet fierce when advocating at a systems level. I have been practicing full time palliative care since I graduated 19 years ago. I have mostly worked providing care in people’s homes.

ing most of my time on symptom management. I was surprised that most of my time is actually spent on helping people understand their illness (the past, present and future) and helping them to navigate the health care system. I work almost like a medical interpreter.

When treating a patient with a terminal illness, what is your approach regarding sensitive information and how does it impact those last few days?

I always start with asking patients and families if I have permission to speak openly about their situation. Most of the time, they say ‘yes’. I then ask them if I can speak ‘straight up or do they need some sugar’. Again, most times they want communication ‘straight up’. I have come to understand that people are craving and wanting open, honest, truthful information for better or worse. The medical culture is one that embodies ‘toxic positivity’ and too often this hopeful vibe prevents communication about the reality of the person’s situation.

People assume that honest information will make a patient depressed and hopeless. This is actually not my experience. It more depends on how you share sad news. If it is done gently but truthfully, people appreciate the honesty and then plan accordingly. Too many people tell me ‘I wish someone had told me that sooner’.

The big lesson here is not to force people to know everything about their illness but to INVITE them to know more. And if they want to know, tell them in a way that balances hope and reality. When patient’s and families have factual information they can then decide what they want to do, how they want to spend their time. It gives them back the power to make informed decisions right up til the end.

As a physician, what does it mean to have a good communication and how can it empower patients and their families. What kind of differences does it make on your daily practice?

I alluded to this above. Good communica tion means that we explore the communi cation needs and style of the patients and families. People are all very unique and we need to respect their readiness for in fomation and they way they want it com municated. Good communication is an art that takes practice. It requires the doctor to be brave to share sad news and to re main engaged in communication even when it is difficult. Good communication requires good self awareness when we are starting to let our own perceptions, assumptions and biases interfere with open and realistic sharing of information. The main way to empower patients is to help them find their voice.

Invite them to share what is on their mind and to find their voice. They need to know it is their right to factual realistic informaiton about their illness, where they are at in the illness journey and what to expect in the future. It is their right to information about how the illness unfolds over time, their prognosis, what supports are available to them and them and the role that the family will take on as the illness changes.

There is so much information that can help patients and families have better illness understanding but often the physician just waits for questions and if they don’t come, it is falsley assumed that there aren’t any. It seems easier to avoid difficult conversations but this only makes things more complicated later in the illness.

In your opinion, what measures should be improved in the field of medicine in order to give more comfort to terminal patients?

What have you learned, as a human, from taking care of patients in their last days?

I have learned as a palliative care physician that dying is not just a few days. It is a chapter of life that is ignorned and feared. Dying is a phase not a moment in time.

It happens over the last year of life and has very distinct features. I am saddened that our society fears dying so much that we don’t talk and prepare for it like a normal phase of human life. This causes so much suffering. I have witnessed unbelievable bravery and strength that comes in many flavours. I am inspired and touched by people’s kindness, love and committment to eachother.

1. Palliative medicine is not just reserved as a speciality. It is a skill that all health care providers should know how to deliver.

2. Palliative medicine is not only for people in the last days of life. It is a type of care that should be part of the care right from the start of a serious life-limiting illness.

3. Palliative medicine is for all progressive life-limiting illnesses and not just for cancer.

4. Palliative medicine is not depressing, does not cause sadness or hoplessness.

5. Palliative medicine is about balancing truth and hope. It isn’t just about symptom management.

6. Palliative medicine is still active care. It doesn’t mean ‘giving up’.