Changing the Palliative Care Conversation

When you hear the words 'palliative care' what does it mean for you? If you're a patient or a caregiver you may fast forward to thinking that this is the end of the road for you or your loved one. If you're a physician, you may be steeling yourself for some difficult conversations. Whatever your perspective, research has shown that experiencing good palliative care at the right time, with open discussions along the way, is beneficial to all involved. 

The Impetus

When end of life journeys did not go well for families in Powell River, a local GP, Dr David May insisted "we need to do this better". With a higher than average seniors' population and no hospice or palliative care beds in the community, Dr. May and the Powell River Division of Family Practice recognized the importance of working together to ensure a coordinated, supportive palliative care experience for those who needed it. 

The Approach

So, in 2014, in partnership with Vancouver Coastal Health (VCH), and with funding from the Shared Care Committee, Dr May and a project team of the Powell River Division of Family Practice embarked on a project to change the conversation about palliative care — from scary and intimidating, to open, honest, and informed.

To fully understand the issue, the team conducted a physician survey, and mapped out a palliative care journey with caregivers, nurses and GPs.  This process revealed that many GPs were unclear about when to start the palliative care conversation with their patients, and, having been trained to cure, had difficulty defining and discussing goals of care to support patients on their journey from life to death.

Lack of timely local support was also identified, and discharge processes were stressful and confusing for everyone.

The Plan

In response, the team developed a comprehensive plan to assess and address gaps in the palliative care journey, and improve information flow. They created new protocols and materials to ensure earlier referral to Home and Community Care. New processes were also introduced to improve practices for ordering medications and to streamline transition of patients from hospital to home for those who wished to spend their last days there.

Education and training, such as the PSP End of Life Module, training of VCH staff, and tools such as the Palliative Performance Scale (PPS), encouraged common practices and language, and timing for end of life conversations.

These strategies coupled with a full public awareness campaign, helped to promote conversation in the community, and to spread the word of the benefits of palliative care in providing comfort and support; allowing more time to plan and have advance care conversations; and to make it more likely to fulfil a patient's wishes for where they wanted to die.

Results

As a result, many felt that there was a shift in the perception of palliative care for the better. One local family physician stated "More of my patients are aware of what's offered and what's not, and that it's okay to die at home." And a community survey showed that 60% felt their knowledge of palliative care had increased in the past year. Providers said they felt more confident talking to their patients and were more aware of resources and tools to support them.

Dr David May cites the collaboration with partners and key stakeholders, including VCH, Powell River Hospice Society, and other divisions of family practice, as a key element to the project's success and potential for spread to other communities. "By working together we were able to identify common themes to improve care in a more coordinated way and for larger impact. We're now seeing noticeable improvements in both the quality of conversations and quality of care for providers, caregivers, and patients," he concludes.

Over the coming months the project team will continue to focus on sustaining success and provincial spread of the initiative. 

Resources

Many resources were created for both patients and providers during the project - including a full resource binder, videos and pamphlets. You can find many of them here. Please contact powellriver@divisionsbc.ca for more information.