Q&A with Dr. Gil Kimel, head of palliative care, Providence Health Care

Mar 8, 2018 | News

Dr. Gil KimelDr. Gil Kimel

In light of recent media attention about end-of-life issues, Dr. Gil Kimel and members of the PHC palliative care team offer a primer on palliative care.

What services are provided by Providence Health Care under the banner of palliative care?
The interdisciplinary team and volunteers at St Paul’s Hospital palliative care unit have expert knowledge in how to assess and treat severe symptoms caused by life-limiting disease. Our team can help affirm personal dignity and improve the patient’s quality of life. Our scope of services includes a palliative consult service to consult on any patient at St. Paul’s Hospital, Mount Saint Joseph Hospital, St. John Hospice, or at our residential care sites. Regardless of the location, our goal is to always positively impact a person’s experience by managing pain and/or other distressing symptoms, using a person- and family-centred approach to care. 

Does palliative care hasten death?
The belief that palliative care hastens death and is reserved for patients who are actively dying is, unfortunately, a common misconception. The reality is that palliative care is for patients with advanced disease and symptoms. It’s where our health care professionals can get on top of those symptoms and send them back home. Whether it involves symptom management, psychosocial support, or help in navigating the health care system, palliative care has the right expertise to support patients and families during this time. We always advocate for our service to be involved early in someone's disease trajectory so that we can complement the care they are getting from other teams. We see patients over many weeks, months and even years.

Are there any positives associated with entering palliative care?
Yes, overwhelming clinical research has confirmed that, in appropriate cases (i.e. when patients have expressed a readiness and willingness about it), sooner is better for entering palliative care. The landmark clinical study by Jennifer S. Temel, MD, which appeared in the prestigious New England Journal of Medicine in 2010, confirmed that early referrals to palliative care may yield significant, improved outcomes for patients. Dr. Temel’s study has been supported by other research findings over recent years. She is considered a superstar in our world.

What sorts of improved outcomes?
Patients have better mood, quality of life, may live longer and even require less treatment (e.g. chemotherapy). In some cases, patients may enter palliative care with a prognosis of one to two or more years of life left. St. Paul’s Hospital probably sees some of the sickest patients in the province. Of all the patients we see, an estimated 30 to 40 per cent of them go home or to hospice to live their lives as best as they can after being introduced to palliative care.

What are other common misconceptions about palliative care?
Misconceptions exist that palliative care is only offered in the hospital or that it is only for cancer patients. Some think it’s all about pain and suffering when nothing could be further from the truth. Or that it’s only suitable for people expected to die within a few weeks or days, therein thinking that it is solely end-of-life care. Some erroneously believe it’s preferable to die in hospital, or that talking to a patient about palliative care is effectively giving up hope.

What kinds of patients enter palliative care?
Our palliative care unit is a tertiary care acute palliative care unit that has expertise in treating patients with advanced disease including malignancy, heart failure, COPD, renal failure and degenerative neurological disease. It focuses on the patient and family to ensure that any symptoms are treated as they arise and to help understand the patient's goals of care. This requires a multidisciplinary team approach including nurses, physicians, social workers, occupational therapists and physiotherapists, pharmacists, and dieticians.

What are you doing in the area of palliative care that is considered advanced?
St. Paul’s Hospital is unique in that its palliative care unit helps treat patients with end-stage cardiac disease who require inotropes or other cardiac devices such as automated implantable cardioverter defibrillators (AICDs) or left ventricular assist devices (LVADs). Inotropes are medications rarely seen outside of critical care. We also care for patients who need intrathecal devices (a special catheter that can deliver pain medication directly to the spinal cord) for pain management.

Are there any new developments on the horizon for palliative care at Providence Health Care?
Yes, at the end of April we will be launching our new, multidisciplinary outpatient palliative care clinic at St. Paul’s Hospital. The clinic will start as a pilot project and will be funded by our generous donors through our St. Paul’s Foundation.

Why are you talking about palliative care now when it’s been around for a while?
We want to clarify recent media discourse about palliative care by shedding light on what it is and isn’t. More importantly and given our rapidly aging population, we want to reassure people that entering palliative care is not a death sentence and is, instead, about optimizing quality of life and providing comfort. It involves physical, psychological, social, and spiritual care. 

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Rock star picture Dr. Kimel!

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