Early discussions for thoughtful care

• This Palliative Care Week (11 – 17 May), Eastern Health Clinical Director Supportive & Palliative Care, Dr Aaron Wong touches on the importance of having potentially challenging conversations about end of life care, when life is steady.
• Aspects such as culture, religion and world views, all influence the way we see life and death and what we might consider to be appropriate in our own context.
• A common misconception of palliative care is that it is strictly bound to end-of-life care. Palliative care can be involved at any stage when someone’s unwell, and its intensity can vary according to a person’s needs and stage of illness.

“I think life and health can be full of uncertainties, and that journey can certainly be windy and bumpy. I think it’s important for people to plan, so their wishes, preferences and values can be upheld, understood and respected.”

This Palliative Care Week (11 – 17 May), Clinical Director Supportive & Palliative Care, Dr Aaron Wong touches on the importance of having potentially challenging conversations, when life is steady.

Aspects such as culture, religion and world views, all influence the way we see life and death and what we might consider to be appropriate in our own context.

“Sometimes it’s something like seeing an accident that might prompt us to think about what we would want in a situation like that. Life can sometimes turn out with surprises that are not so pleasant and so we should be thinking about it early. It’s important that we capture those wishes and preferences in an advanced care directive that will help guide decision making when we are no longer able to convey that when we’re unwell.

“This allows people to convey what matters most to them and affirms what quality of life is important to them as they approach the end of life. Having a plan and communicating this with your loved ones and the professionals involved in your care enables decisions to be made in a way that best aligns with your wishes and goals, ensuring a dignifying, fulfilling end of life,” he said.

Dr Wong oversees a team of clinicians committed to delivering high quality evidence based palliative care across Eastern Health. His work ranges from clinical work to research activities, teaching and attending meetings representing Eastern Health to external community partners and organisations.

Dr Wong, a dual qualified geriatrician and palliative medicine physician explains his journey into palliative care was prompted by his own personal experience

Seeing the difference it made to help his own grandmother make it home to die, as per her wishes, Dr Wong’s trajectory was diverted.

“I had to fly to Malaysia and the whole family wanted her to go home to die, and it was incredibly challenging to make that happen, but I remember being in the ambulance and with my uncles we carried her into the house. Although she died within five minutes of getting back home, that meant the world to her and to all of them, culturally speaking.

“I remember doing that as a young doctor made me think about how we can work to really try and help people, to honor their wishes and try and deliver the best care in whatever circumstance to get them where they want to be. It’s been absolute privilege to be able to journey with patients from the start of diagnosis of certain conditions right to the end,” he said.

A common misconception of palliative care is that it is strictly bound to end-of-life care. Dr Wong explains that the service is useful in various stages of illness.

“Palliative care can be involved at any stage when someone’s unwell, and its intensity can vary according to a person’s needs and stage of illness. When someone receives a diagnosis or faces serious illness, palliative care is there to provide support, symptom management and to help journey with them as their illness impacts various facets of life.

“We work closely with their primary treating doctors, which might be the oncologist or the neurologist or the cardiologist, to ensure we complement and support care because it’s about the whole person,” he said.

With growing community demand for care at home, Eastern Health is developing pathways to make palliative care more accessible in the home setting.

“Here at Eastern Health, we have started two outpatient palliative care clinics this year, which is exciting. This means that we can integrate, introduce and engage with people earlier on. This comes back to the idea of planning ahead, because unfortunately the data shows that a lot of the referrals to palliative care occur way too late, probably in the last days or short weeks of life.

“Unfortunately, the best work we do isn’t going to be very effective if we don’t plan for care. Dying and being cared for at home is not the most straightforward for a lot of people; it does require a lot of planning, support and education. We also work very closely with our community partners, Eastern Palliative Care, to enable safe and continuous, coordinated transition home from hospital,” Dr Wong said.