Western’s Centre for Palliative Care is an idea whose time has come

“What is the most resilient parasite? Bacteria? A virus? An intestinal worm? An idea. Resilient … highly contagious. Once an idea has taken hold of the brain, it’s almost impossible to eradicate. An idea that is fully formed – fully understood – that sticks; right in there somewhere.”

Prior to the pandemic, I enjoyed going to the movies. While many people have taken to binge-watching Netflix and other streaming services, there is simply no substitute for seeing a blockbuster movie in a theatre. The popcorn just tastes better (for that price it better!) and the sound is something that even the best home theatre can’t produce.

But I digress. I wanted to talk about Christopher Nolan. I am a big fan. For me, he is probably one of the greatest Hollywood movie directors of all time. I will admit that I put his Dark Knight trilogy at the top of my list, but right after that comes 2010’s Inception. If you have not seen it, do yourself a favour. If you have, consider watching it again. It’s brilliant theatre.

The synopsis: “Inception is a 2010 science fiction action film written and directed by Christopher Nolan. The film stars Leonardo DiCaprio as a professional thief who steals information by infiltrating the subconscious of his targets. He is offered a chance to have his criminal history erased as payment for the implantation of another person’s idea into a target’s subconscious.”

It’s a story about the power of an idea.

My favourite quote from Inception is at the top of this article. Given we are living in a global pandemic, it’s hard to imagine something more resilient than COVID-19. But there is.

It’s an idea.

I’ve written extensively about palliative care in Ontario and in Canada. While I celebrate the good, more often than not I lament the bad, highlighting the gaps and failures of our system to care for patients facing a life-threatening illness.

But it is one thing to yell, scream and kick to do more. It is another thing entirely to bring a solution to the table.

And we do have solutions.

One is gestating in London, Ont., at Western University (I am old enough to remember when it was the University of Western Ontario).

The idea is something called the Western Centre for Palliative Care, or WCPC. Many Bothans died to get me this information (ed. note: Darren showing off his pop culture knowledge with a Star Wars reference) but quoting from a proposal circulating at Western:

“The WCPC will be a collaborative hub of innovative thinkers from disciplines across Western, including the Schulich School of Medicine & Dentistry, the Faculties of Health Sciences, Engineering, Arts & Humanities, Education, Social Sciences, the Don Wright Faculty of Music, Ivey Business School and the King’s University College, among others. Palliative care providers from across London hospitals and community will be invited to participate. Western has a history of successful centres using models that blend education, research and practice within the campus community.”

Now, that is one heck of an idea. The WCPC, if fully realized, has the ability to transform health care in southwestern Ontario. From Tobermory to Windsor and everywhere in between, this is the type of health-care transformation that patients and families are dying for. Literally.

This is why I invited renowned palliative care physician Eduardo Bruera from MD Anderson, in Houston, Texas, as a visiting professor at Western University in 2022.  This opportunity has been made possible by the Dr. Balfour Mount Visiting Professorship through the Royal College of Physicians and Surgeons of Canada.  These are the kind of ideas that truly need to spread and scale, far and wide.

“You mustn’t be afraid to dream a little bigger, darling.”

But why stop there?

As a former OMA Section Chair for Palliative Medicine, I was pleased to see a vision put forward last August by our executive for the future state of palliative care in Ontario. It is bold. It is ambitious. And it is doable.

The vision states:

•   That Ontario provides the best supportive, palliative and end-of-life/hospice care in the world.
•   That every patient in Ontario receives the highest quality palliative and end-of-life care when facing a life-limiting illness.
•   That patients can receive supportive and palliative care immediately from the time of diagnosis with a life-limiting illness.
•   That every hospital in Ontario has access to a specialist palliative medicine team.
•   That every community in Ontario has access to a specialist community-based palliative medicine team.
•   That hospital and community-based palliative care is available equally and equitably throughout the province, including vulnerable, marginalized and pediatric populations.
•   That every patient receives end-of-life care in the setting of their choice (home, hospice, LTCH/RHH), whenever possible.

For the past four years, this OMA section has promoted a plan to build a better system for palliative care. It involves changes to OHIP but also how we train our doctors and nurses, promoting team-based care (such as Ontario Health Teams), scaling up centres of excellence (like the potential WCPC), programs integrated with home care services that provide 24/7 care, support for hospitals and LTC as well as emphasizing care for vulnerable and marginalized populations.

“They say we only use a fraction of our brain’s true potential.”

I won’t rehash all the evidence for the benefits of palliative care here but if you are interested, I have provided links at the end of this article that clearly demonstrate we are only using a fraction of palliative care’s potential to benefit patients specifically and our health-care system in general.

“An idea is like a virus.”

COVID-19 is probably one of the greatest challenges we have faced in the past 100 years. It is resilient, it is adaptable, it refuses to be contained. It has transformed everything from our economy and our borders to our governments and global travel. Essentially it has transformed our entire way of life.

Flip that concept on its head and this is the type of transformation we need to see in health care.  We have seen glimpses of this with the rapid change to virtual care. This shows change is possible with the appropriate application of force or willpower.

Now, let’s use that force and apply the appropriate amount of willpower to how we care for patients facing a life-limiting illness and build the type of system our patients deserve.

How’s that for an idea whose time has come?

Addendum: Once the pandemic is over, I look forward to my weekly outings to our local movie theatre. Like restaurants, movie theatres were hit very hard during the pandemic. Make sure to support your local theatre and their employees.

Links:

• “Australia offers lesson in palliative care,” Healthy Debate
• “Association between palliative care and healthcare outcomes among adults with terminal non-cancer illness: population based matched cohort study,” the BMJ
• “Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial,” The Lancet