Doctors are organizing plans to expand palliative care to cover chronic diseases beyond what's usually considered. Southern Health-Sante Sud Medical Director of Palliative Care Dr. Cornelius Woelk says there's an unbalanced comparison that's making doctors rethink the situation.

"Probably approximately 30 percent people die of cancer. That's a national statistic. Currently, approximately 75 percent of patients on palliative programs are cancer patients. That's also a national statistic. It varies from place to place. And it's actually quite consistent in our region. Last year three quarters of the patients referred to our palliative program had cancer diagnoses. So, that's a little bit of an interesting split. You would think that it would be similar. If 75% of our population is dying of non-cancer illnesses, then palliative care programs would be involved in a similar kind of proportion."

Woelk asks why shouldn't palliative care deal with other illnesses.

He admits, "There are probably a number of reasons. One of the most common is that it's harder to predict the trajectory in someone's chronic illness than it is in a cancer illness."

He adds patients who are referred to the program with other illnesses, and have life expectations longer than six months, tend to live longer than expected and enjoy a much better quality of life.

"Palliative care programs are provided roughly for the last six months of their lives. Many only get referred in the last few days, though. For many years the tendency was to admit people at the very end of their lives to palliative care. And it's given the program a bad name."

He says nobody wants to talk about dying, so naming it something else doesn't solve the problem, so palliative care will always be an issue, and it's hard to remove the stigma. Woelk notes hospice care started in England and then came to Canada in the 70's. They wanted to change the name to "palliative care" to remove the stigma from "hospice". He adds, the problem is we now we have the stigma of the term "palliative." Until we come to grips with the fact that we can talk about life ending at some point, Woelk says we won't accept it, regardless of name. So, it's not changing the name of the program that's required. A name will always be a name.

Woelk adds it's important we remember what palliative care is -- a mix of pain and symptom management, including psychological, social, and spiritual symptoms. And good communication skills are needed, including the willingness to talk about how long one has left. Woelk says it's hard to set goals when you don't know the context in which these things are involved. This means everyone has to become more comfortable talking about longevity and estimated length of survival so we can realistically set these goals. Then we have to coordinate care for patients with complex illnesses. He says this will involve a team approach.