Chapter 03: Working "On the Fringe": Establishing Palliative Care as a New Area of Service

In this chapter, Dr. Bruera talks about his work at the Cross Cancer Institute in Edmonton, Canada. He talks about Dr. Neil MacDonald, the Institute Director, who brought him in on a fellowship to begin to establish palliative care.1 He explains that Dr. MacDonald wanted to put patient experience at the center of the Institute's services. He then describes the situation on the ground with attention to patient experience and how, through surveys and research, he and a team began to establish evidence based approaches for addressing pain and other dimensions of the cancer experience. He also talks about the pushback against these efforts and how publications documenting evidence were effective in building acceptance. Next, Dr. Bruera discusses why it has taken so long to develop the 'fringe area' of palliative care and to build acceptance for it. He then discusses his team's most significant accomplishments during his 15 years at the Cross Cancer Institute. He talks about the development of the Edmonton Injector for delivery of pain medication, the discovery of how effective it is to shift a patient's pain medications, the discovering of methadone's effectiveness as a pain medication. He also talks about the value of discovering that team work is the best way to deliver care.