“Healthy Dying!” A view from the Wisconsin Capital.

Yesterday, I was privileged to participate in a briefing of the Wisconsin Cancer Council for Wisconsin’s legislators and their staff.  (Delighted to say a number of legislators attended. Thank you!!)  The Council serves as an advisory body for Wisconsin’s Comprehensive Cancer Control Program with representatives from all around the state.  The Program’s staff, funded through the State budget, with matching funds from the UW School of Medicine and Public Health (UWSMPH) and the Carbone Cancer Center, are located primarily within the Cancer Center. This provides a great opportunity for an NCI designated Cancer Center to have an impact on all aspects of Cancer Control within the state. I have participated in these efforts as the supervisory faculty and as leader of the Cancer Center’s Cancer Control research program over the past few years.  Confusing?  Yep a few too many C’s in there!

Wisconsin’s Cancer Control Plan addresses all aspect of cancer control:  Prevention, Early detection (screening), Treatment and Palliative care as well as the issues of quality of life and survivorship for people living with a cancer diagnosis, that cuts across all of these.  Yes, as involved faculty I had to have a greater handle on tobacco, cervical cancer screening and vaccines, mammography and chemotherapy treatment than I expected.  Not such a bad thing but more importantly for me, we have included and addressed issues of palliative care in cancer from the point of diagnosis in Wisconsin’s Cancer Control Plan. This has not been a neglected topic, in fact it has been given equal airplay with all other areas.  We used UWSMPH dollars to test a pilot study of academic detailing to improve rural MD’s attitude towards and knowledge of palliative care. This went onto to become a three year grant of $450,000 awarded to HOPE (Hospice Organization and Palliative Experts) Wisconsin.  The new plan is particularly looking at improving advanced directives in the cancer population.

So as I listened to colleagues address the overall issues yesterday and prepared a summary of their talks, my mind went back to the challenge of the first five year plan in 2005.

How do we incorporate issues of palliative care when every one is asking us to improve “the health” of the people of Wisconsin? How does palliative care, with it’s focus on those with a life limiting illness, fit with the notion of health?  Isn’t death, the antithesis of health?

In 1946, the WHO defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”  Even today there is no mention of dying, that stage of our existence we all live through, prior to our death on the WHO’s Health topics page.

Perhaps death and dying are unhealthy?

In the 2005 Wisconsin Cancer Control Plan, we incorporated the following in the palliative care chapter.

The concept of “healthy dying” must be promoted to the general public as well as health professionals. Appropriate end of life care to allow healthy dying from cancer requires a team of health professionals trained in palliative care. Training health professionals must be done when they are starting in a college or university program and must continue throughout their careers.

No we didn’t define “healthy dying” and I could do that now from a dictionary but I won’t.  Some had talked about the language of a “Good death.”  However I still recall the reaction of the woman whose husband was featured in a Madison Magazine article on End of Life Care.  Seeing the cover photo under the banner “Seeking a good death” she stated, there was nothing good about my husband’s death.  Perhaps not true but her honest reaction.

What we are trying to capture is that dying is indeed part our living and in fact a normal part of our overall health and therefore our health Care system.  Appropriate care near the end of life does involve palliative care trained professionals.  Unless we incorporate this into our concept of health and health care, palliative care’s integration into mainstream health care may always be an uphill battle.  When did you see an advertisement from a University Hospital saying we do great palliative care?  We need to promote the concept of “healthy dying.”

A final point.  It was a pleasure to see colleagues from around the state at yesterday’s briefing. I am always a little pleased within myself as to their ease in talking about cancer care across the spectrum of care, including Palliative Care. This in itself is a reason to engage in your Cancer Control plans, be they national or state!!

jfc