Palliative care is not just for end of life – it’s an approach to care that helps individuals improve their quality of life and better understand their journey with chronic illness.
Photo: Tasenka Kushner, geriatric primary care nurse practitioner, at her office in Langley.
As a geriatric primary care nurse practitioner with Fraser Health, Tasenka Kushner is used to explaining her role, the work she does and the concept of palliative care as part of regular primary health care services.
“Not everyone knows what a nurse practitioner does,” she says. “Nor are they familiar with what a palliative approach to care looks like.”
For her, this means providing home-based primary care services to frail, older adults in Langley, with most of them managing chronic conditions and life-limiting illnesses.
“Most of my clients are over the age of 70 with multiple or advanced chronic diseases and many are near the end of their lives,” she says. “Because of this, treatment options may be limited – or more conservative.”
Part of her work includes conversations with clients around what their values and goals are, and how they inform their health care plan.
“A lot of them weigh the benefits and risks of medical treatment, in a way that a younger or a healthier person may not,” she says. “Some make their medical decisions in the context of how long they’ve lived or the amount of time they have already spent in the health care system accessing care. Many want to live as comfortably as possible for what years they may have left, without having to spend more time in health care environments on treatments that take time away from what’s more important to them.”
Supporting a patient and their decisions – especially ones that can potentially affect their life expectancy – is part of her job.
“I think a lot of people find it difficult to understand that,” she says. “I work with a lot of families and I think it can be hard to accept when people make choices that affect how long they may live for.”
Embedding a palliative approach to care across the health care continuum is ongoing work within Fraser Health.
“Our goal is to support health care providers and clients to embrace what a palliative approach is. It’s an approach to care that helps individuals improve their quality of life, reduce suffering and better understand their journey with chronic illness,” says Melissa Marriott, project lead, Palliative Care Network.
The Palliative Care Network partners with primary care providers – like Tasenka – and community health nurses, so that they are able to identify individuals who may benefit from a palliative approach to care earlier in their care journey.
This includes ongoing education, training and resource sharing.
Along with Dr. Julia Ridley, palliative physician educator, the Palliative Care Network has been providing education to community health nurses and primary care providers, including the divisions of family practice across Fraser Health.
“We encourage implementation of a palliative approach to care further upstream in a patient’s journey,” says Kya Milne, clinical nurse specialist, Palliative Care. “This collaborative approach will enhance best practice and strengthen partnerships.”
The goal and inspiration behind their work is to promote better outcomes and an improved quality of life for anyone with a life-limiting illness or chronic disease.
“Our objective is to support care providers to have the tools necessary to identify, assess, manage and plan for a person’s care needs,” says Kya. “This includes advance care planning, psychosocial and spiritual support, pain and symptom management and regular care plan reassessment.”
For Tasenka, working with her clients in this capacity informs her partnerships with a number of other Fraser Health teams, including Langley Home Health.
“I work closely with them and a wide variety of other allied health care providers,” she says. “We try to help clients meet their goals, and decrease risks associated with their situations.”
It’s the success of these relationships that have her excited for a future where a palliative approach to care is implemented into all care plans.
“At some point in all of our lives, we're going to be faced with a serious or life-threatening illness, either individually or through our family or friends. A palliative approach to care is not just a specialty, it’s good care that respects patient choice across their lifespan.”