On May 2nd, the Department of Family Medicine in collaboration with the St. James’ Literary Society hosted the Dr. Hirsh Rosenfeld Annual Distinguished Public Lecture, inviting Dr. Justin Sanders, the Kappy and Eric M. Flanders Chair at Palliative Care McGill, to speak about Relationships in Serious Illness and How to Build Them. The event was a great success with over 100 participants attending both in-person and online.
A fundamental principle of palliative care is that healing is possible through the course of serious illness, up until and beyond the time that one dies. Healing in this sense refers to an experience of integrity and growth that can occur along with and despite the functional decline that characterizes serious illness. Relationships - between clinicians and patients, between patients and their caregivers - are essential to healing, yet healthcare systems pay little attention to them.
Dr. Sanders spoke about the palliative care dichotomy that we often see in the public narrative, namely choosing between the duration or the quality of life. Is living as long as possible at the potential expense of comfort necessary? Or rather, is it better to focus on comfort at the potential expense of longevity? Dr. Sanders explains that healthcare system goals do not always align with those of the individuals they care for and suggests that goal-concordant care (the alignment of care to patient values and preferences) should be among the most important outcomes for people living with serious illness.
So, what does matter most for people living with serious illness? According to a study that Sanders published in 2020, the top category that mattered most was people and relationships (79%), the second most popular category was surviving important events (76%). Both of those categories were more valuable than the quality-of-life category (61%). Interestingly, this means that attempts to cure or prolong life may sometimes result in lost opportunities to provide care that helps people, and their families focus on what matters most.
To improve healthcare quality, Dr. Sanders spoke about the need to improve the structures within healthcare, in other words the physical and organizational characteristics where healthcare occurs. Since communication plays a significant role in many aspects of the care experience, one way of improving healthcare quality is by implementing training programs that support clinician education in communication approaches that promote relationships.
“Ultimately the secret of quality is love… If you have love, you can then work backward to monitor and improve the system.”