Bearing witness effectively

Spirituality and aging seminar explores dignity in end-of-life care

Dave Rogalsky, Eastern Canada Correspondent

Dr. Harvey Chochinov and his team at the University of Manitoba have been working to quantify the effects of psycho-social interventions in the care of patients in palliative care situations. As UofM distinguished professor of psychiatry and director of the Manitoba Palliative Care Research Unit, he chaired the federally appointed panel on physician-assisted death struck this past summer by the former Conservative government. He spoke at the annual Schlegel-UWaterloo Research Institute for Aging’s spirituality and aging seminar held at Conrad Grebel University College on Nov. 13, 2015.

Through cross-country studies involving professionals in patient care, as well as patients and their families, Chochinov can show quantitatively that taking time to give patients dignity—by effectively bearing witness to their unique lives and needs, granting them personhood, and providing subjective as well as objective science-based medical care—patients do better, families are happier, and even healthcare staff are more effective and less stressed.

While, as a psychiatrist, he does in-depth interviews with patients, resulting in multi-page life stories, he stressed that this can be as simple as listening to a patient for a few minutes, or asking the question: “What do you want the healthcare team to know about you to take care of you?” The person’s answer can result in a few paragraphs that, with permission, gets attached to medical records for all caregivers to see. Such patients often want copies of this material to give to their families, he said.

If dementia has robbed a person of the ability to be articulate, family members can be invited to tell the story, with the person present. The bottom line is “real” communication—and not the pseudo-affectionate elder-speak that uses diminutive and overly affectionate terms like “dearie,” “honey” and “sweetie” for the elderly. Such phrases often lead to increased resistance to care by both sound-minded patients and those with dementia.

A seminar participant noted that, as a nurse-in-training some 35 years ago, she had been taught this patient-centred care. Chochinov noted that while that was so, in the intervening years the focus has been on the huge advancements to the science of medicine. He suggested a renewed focus on patients as unique persons, an approach that offers them dignity.

Many of the pastoral participants made other connections between Chochinov’s presentation and their work of caring for their congregants, whether or not they were ill or aged.

A piece of Chochinov’s presentation, “A model of therapeutic effectiveness,” suggested that to be most effective, caregivers must take care of themselves. Several caregivers saw this as difficult, as their caseloads are immense and the balance of care of others and self-care is hard to achieve.

The day after Chochinov’s presentation in Waterloo, the Liberal government announced that the committee he chaired “will no longer be asked to make recommendations to the government and will now simply report on its consultations on the issue,” according to The Canadian Press. See story at http://bit.ly/1kKOxDx.

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