Huge palliative retraining needed

Danielle van Dalen

Opinion

It's no secret that New Zealand has an ageing population. Projections show that in the 20 years between 2016 and 2036 there will be a 77 percent increase of New Zealanders aged over 65, and 132.4 percent increase of New Zealanders aged over 80.

Such significant demographic shift is already starting to impact our infrastructure, economy, and healthcare system — and that impact is only going to get bigger. To survive with the values of our society intact, we need to be active in respecting our elders right through to the very end of life — even, and especially, when it comes at a cost. One area this must include is the capacity of our hospice and palliative care services to support dying people well.

Palliative medicine is going to become much more necessary, with a large older population and cancers and chronic illnesses becoming more common at the end of life. This end-of-life medical care focuses on quality of life by relieving pain and suffering, whether physical, social, psychological or spiritual.

One of the big gaps in our ability to provide this kind of quality care is that we're currently not educating or training our medical staff so that every doctor and nurse feels equipped to walk alongside families and whanau right to the end of life.

Medical practitioners I've spoken to have highlighted this gap, saying that every medical student will have just a matter of days training in palliative care in comparison to months of training in obstetrics learning how to deliver a baby. This is despite the fact that almost every doctor will work with dying patients during their career, while a comparatively tiny percentage will go on to actually deliver a baby.

As it stands, the medical system will rely on doctors and nurses who don't specialise in palliative care. As palliative care experts explain, “the vast majority of people who die expected deaths will be cared for by health practitioners for whom managing dying is not their primary area of expertise and was often not part of their training”.

Workforce service forecasts already tell us that “there are not enough doctors training to become palliative care medicine specialists”.

We need more palliative care specialists, but to meet the huge coming need, palliative care must be a basic foundation of medical understanding across the profession. This will ensure that statements like “junior doctors still report that (palliative care) is the area in which they feel most unprepared and which causes them the greatest distress,” are no longer the norm.

To change this, our universities and medical schools need to ensure that every graduating nurse or doctor feels confident in their ability to not only cure patients well, but also to walk alongside them and their whanau right through to the very end of life.

Getting end-of-life care right is essential in an ageing population. It's a practical way of respecting our elders, and it's something each of us would hope for at the end of our lives.

■ Danielle is a researcher for Maxim Institute, currently focused on end-of-life care.