Module 2: Direct Comprehensive Primary Care in the LTC Setting
57 2.7 Palliative Care
Content Warning: The following lesson includes a discussion of palliative care. This content is disturbing, so we encourage you to prepare yourself emotionally before proceeding. If you believe that the reading will be traumatizing for you, then you may choose to forgo it.
LTC residents have multiple chronic medical conditions with complex care needs. Many LTC residents will die within two years of admission. Many of them are not offered opportunity to discuss their care wishes prior to coming to live in LTC:
They experience significant burden of symptoms (e.g., pain, psychological distress, anxiety);
- Non-beneficial and unwanted treatments due to lack of prior discussions involving shared decision-making
- Better pain & symptom management and comfort identified as highest priorities
- Unmet needs are due to staff’s lack of knowledge, communication challenges and lack of interdisciplinary collaborations[1]
Palliative approach to care:
- Should be integrated with chronic disease management
- Support to meet the needs of residents and their care partners
- Include all stages of disease and not just the end-of-life.
Integrated palliative approach:
- Promotes a comprehensive, relational and person-centred care for residents and their care partners
- Starts at the admission with seamless transition to end-of-life care
- Aims to improve quality of life throughout the illness trajectory
- Utilizes principles of palliative care (i.e., dignity, quality of life, suffering, symptom management, hope and comfort)
- Care is provided by the most responsible provider (NP/MD) in LTC[2][3][4]
A palliative approach to care provides for residents’ needs from the time they enter into LTC and include:
- Advance care planning (ACP) discussions
- Management of distressing symptoms
- Psychosocial and spiritual care
- Grief and bereavement support for family, other residents and staff[5]