The word "palliative" is often associated with end-of-life care, but a palliative approach describes much more than that. The stories below highlight the importance of goals of care conversations as a way to understand the values of our loved ones while they are still able to communicate them. At the core of goals of care conversations is the fundamental guiding principle that this newsletter strives to highlight - getting to know the person and what matters them. How might we normalize goals of care conversations so that every resident has the opportunity to tell us how they want to LIVE?
(Please note that the following story has been summarized from interview notes into a first person account.)
Leonard is a retired philosophy professor and playwright. We will have been married for 34 years in July. About 10 years ago, we started to notice signs that his speech wasn't quite right and he was diagnosed with progressive supernuclear palsy. I eventually had to make the tough decision to place him in long-term care, but the care and attention that he receives at Braddan is exceptional and I am grateful for that.
A friend of ours who is a palliative care doctor suggested we speak with the palliative care team. Our first thought was, "we're not really there yet" but it was worth a conversation. As it turns out, the goals of care conversation that we had with the team was not so much about Leonard's immediate physical care but about understanding our concerns and Leonard's wishes. I wanted to know what to do - what Leonard wanted to do - if his symptoms got really bad. As a philosopher, Leonard is very forebearing and meditative. His philosophy is that "life is a precious gift" and he is fully committed to being here. Knowing him as a person, I didn't think that he would want medical assistance in dying but I also wanted him to have the chance to decide. He made it clear that it is not something he's interested in right now. Having the palliative care team there to guide the conversation made all of the difference. It validated the conversation and made it real - it made Leonard's decision more meaningful rather than something we had discussed in passing.
The goals of care conversation was good for Leonard to be able to state his wishes, but it was also good for me. It gave me peace of mind because I knew that I had given him the opportunity to tell us what he wanted instead of trying to do guesswork at the end. I'm really glad that we did that. There were a lot of people wondering why we were talking to palliative care so early, but it wasn't about the logistics of care so much. It was about Leonard's wishes - not just filling out a form but having a conversation about it. It was empowering for both of us.
team consists of Umilla Stead (Team Lead), Dara Lewis (Vancouver Acute), Keara Graham (Vancouver Community), Patricia Reyes (Coastal) and Monica Kelly (Richmond). To learn more about the RPACE team and to request support, please visit the .png)
duals to consider their values and beliefs before having a goals of care conversation with a health care provider. This worksheet is available in several languages and can be found here: 
his three module course is designed to help health health care providers from all disciplines initiate and conduct culturally safe Advance Care Planning conversations with patients from diverse cultural background. 
This guide is adapted by the First Nations Health Authority and the BC Centre for Palliative Care to relfect cultural safety. Please contact the RPACE team (
r at the Scottish Government talks about why asking the question "what matters to you" is as important as measuring a person's vital signs. 
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approach to care and the benefits of integrating the palliative approach in care settings. It also describes the importance of goals of care and serious illness conversations and provides details about a Serious Illness Conversation Initiative implemented in BC. 