Historia de sus comienzos

a) 60% of adult Canadians (ages 16 and older) lack the capacity to obtain, understand, and act upon health information and services and to make appropriate health decisions on their own.

b)The proportion of adults with low levels of health literacy is significantly higher among certain groups: older adults, non-English/French speakers, aboriginal groups, and those with chronic illness and stress.

c) Seniors tend to have the lowest level of health literacy suggesting that the aging process amplifies initial levels of education-based inequality.30

Many of our end-of-life and long term care planning problems would be solved by better communication strategies, which make information accessible and comprehensible to patients, families, and health care proxies, during a period of great stress.

Palliative and Eldercare Education and Training:

"Given Canada's current shortage of geriatricians (there are fewer than 200 while the estimated need is for more than 600), it's essential to understand how we can better teach medical students the principles of elder care. As baby boomers move into their senior years, physicians will be spending half their time with patients over age 65." Dr. Laura Diachun – Schulich School of Medicine -- London Ontario 31

Presenters forcefully urged the government:

• To work in close collaboration with the various medical, nursing and other professional colleges, to develop and implement a strategy for encouraging young people to enter and train in the palliative/end-of-life and elder care professions.32

“At McGill, undergraduate medical students receive a mere 20 hours (approximately one-half of a three credit course) over 4 years in learning about palliative and end-of-life care. The educational programs for

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nursing, social work and other key disciplines that complete the interdisciplinary palliative care team offer equally limited attention to this area of health care.” Dr. Bernard Lapointe, Eric M. Flanders Chair of Palliative Medicine, McGill University33

Given the need for better palliative care training, presenters to the Committee urged the government to:

• Collaborate with various professional colleges and organizations, to meet the legitimate needs of Canadians; that doctors, nurses, and related professionals receive significantly more palliative/end-of-life and pain control training. The medical schools, nursing schools, pharmacy schools, and related professional schools need to significantly increase the number of hours spent on training in palliative care, pain and symptom management.

• Work for the establishment of protocols, which set substantive, enforceable, national standards of training, to be met by all our medical schools. Similar protocols need to be implemented; focusing on nursing, and other health care professionals.

• Fund the medical and other professional schools to transition into new palliative and pain control curricula.

• Work towards improving training of health professionals in communicating in a clear, understandable way, to the many patients, family members and caregivers who have a low level of health literacy. 34

• In addition the committee heard that medical colleges and physician organizations in collaboration with the various ministries of health need to develop specialist training in Palliative care, and official recognition of Palliative care as a specialty or sub-specialty.35

As a way of focusing the implementation of palliative care into the training, vision, and research of the entire health system, it would be beneficial to incorporate hospice palliative end-of-life care into Canada’s nine national health strategies. The federal government would play an important role in the discussion necessary for implementing palliative care principles into the national strategies on:

1) Heart Disease

2) Chronic Disease Management 3) Seniors

4) Canadian Partnership Against Cancer 5) HIV/AIDS

6) Diabetes 7) Lung Health 8) Aboriginal Health 9) Mental Health36

Palliative care principles have much to offer in the development of each of these health care strategies. As we move towards a future of Quality End-of-life care for all Canadians, this palliative care vision should be extended to all those in need.

“Central to the challenge of providing adequate and equal access to palliative care is the lack of medical expertise available to meet the needs of the growing number of chronically ill people with complex symptoms. Because people are living longer with one or more chronic diseases, the holistic management of their symptoms for a good quality of life has become more complex and often requires specialist care. Palliative medicine provides such specialist care to people who are nearing the end of their life. ... There simply are not enough palliative care experts to provide the care and training needed to meet the needs of our aging population. ...In order to improve access to palliative care, we need to attract physicians to palliative care and ensure that they have the necessary medical expertise to provide much needed specialized pain management, scholarship and leadership. ... It is time to move forward in the development of recognized specialists in palliative medicine. ...Palliative medicine is recognized as a specialty, or subspecialty in many countries

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including the United States, the United Kingdom, Ireland, New Zealand, and Australia.” Dr. Bernard Lapointe, Eric M. Flanders Chair of Palliative Medicine, McGill University37

Innovative program trains medical students as hospice Volunteers

Dr. Valerie Schulz of theSchulich School of Medicine in London Ontario has developed a simple and effective way to get medical students interested in palliative care. Each year 12 students from the undergraduate program become hospice volunteers. Undergoing 30 hours of training, each being mentored by an experienced hospice volunteer; they visit clients in their homes. The experience is priceless for the future doctors, as it gives them a chance to meet and converse with people outside the clinical environment, and without the need to bring a clinical perspective to the relationship. They relate to the hospice clients as persons, learning how they feel and react to the prospect of dying. Friendships are formed, and lessons learned, which will be of lifelong value to the future doctors in terms of person centred care. The clients also are transformed, touched that a future doctor would care enough to spend time with them in a companion role. This program is worth emulation, and broader application. If larger numbers of medical and other healthcare students across Canada were able to experience one on one relationships, as hospice volunteers, the positive effects on our medical culture would be immense.