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Discussion 1.2: Integrated Approach to Palliative Care

6 months ago
CLOSED: This discussion has concluded.

Has your organization considered or adopted an integrated approach to palliative care?

If your organization has adopted an integrated approach to palliative care, how was this accomplished, and how is it working within your practice?

If your organization has not adopted an integrated approach to palliative care, what was the rationale for not doing so, and how does that impact your practice?


This consultation is now closed.


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  • JLM77 over 1 year ago
    I agree with the above comments by cancercareontario and RTTworks. Palliative radiotherapy is an underutilized - yet important aspect to palliative care. It is known to improve, and alleviate symptoms (including pain, bleeding, obstruction) therefore improving a person's quality of life; often the most important aspect at the end of life. The rural cancer centre where I work implemented a Clinical Specialist Radiation Therapist (CSRT) specializing in palliative care. This role has positively affected the cancer care program. The CSRT is able to closely work with the Radiation Oncologists (RO) to expedite treatment for patients requiring palliative radiation therapy. By training the CSRT to complete some of the roles traditionally only done by the RO, it allows the RO to focus on other tasks that may not be delegated; as well as improving the efficiency of the process. The CSRT is often a point of contact for the patient, as well as other health care providers. Anecdotal comments from ROs included that the RO is willing to see more patients at an outreach clinic, knowing that the CSRT will assist in "patient navigation"; coordinating the required information, booking scans and treatments as well as completing the necessary tasks required for treatment. The CSRT at our centre often triages the urgency of patients on the inpatient floors, seeing them before the RO is able to to express the urgency to the RO, and facilitate the radiation treatment as appropriate. Overall, the CSRT specializing in palliative care has greatly improved the quality of care of palliative radiotherapy. This role provides a unique set of knowledge and skills - and often most importantly - time to assist in improving palliative care in Ontario.
  • RTTworks over 1 year ago
    Cancer Care Ontario has led a 12 year project designed, in part, to increase access to radiotherapy services for patients with advanced cancer. The innovation focused on the training of an advanced practice radiation therapist (called a Clinical Specialist Radiation Therapist (CSRT) in Ontario), and their integration into the existing interprofessional health care team in radiation treatment programs in Ontario to improve access to radiation therapy for patients with cancer in the palliative phase of their disease. Radiation therapy is a highly effective and terribly underutilized treatment modality for treating the distressing symptoms of advanced cancer and getting access to this treatment is difficult for a number of reasons. Placing a CSRT on the palliative radiation therapy team can augment access by expediting referrals, implementing a rapid response approach that can allow patients to be referred and receive their first treatment on the same day. They can provide an improved and cost effective continuity of care not possible with a physician-based model of care and provide a "first point of contact" for patients that can reduce the number Emergency Department visits. With their unique and expert knowledge, they can identify patients on palliative care wards - previously not offered or considered for palliative radiation therapy - who would benefit from this treatment and accelerate the time from referral to treatment. This can lead to a reduction in inpatient hospital days. They can use existing technology to interview, consult, assess and support patients at a distance from the cancer centre reducing the travel requirements of these patients. They can provide outreach and education to catchment community about the indications for and the benefits of radiation therapy for treating cancer in its advanced stage. Taking an expert radiation therapist, providing the sufficient education and training to instill advanced practice competencies and integrating that CSRT into the palliative radiation therapy team has resulted in many positive changes in the palliative radiation therapy domain. This Ontario-based model should be considered for implementation across the country, in conjunction with a "rapid response" approach, to improve the type of, quality of and access to the care we provide to our palliative patients in Canada. Cancer Care Ontario is submitting a more complete detailing of this work.
  • cancercareontario over 1 year ago
    CLINICAL SPECIALIST RADIATION THERAPIST (CSRT)-FACILITATED MODEL OF CAREA new approach to enhancing access to palliative radiation treatmentBetween 2004 and 2016, Cancer Care Ontario (CCO) conducted a project focused on developing, implementing and evaluating an updated model of care that included a new health care professional role – the Clinical Specialist Radiation Therapist (CSRT). The CSRT is a registered radiation therapist in the province of Ontario that brings advanced clinical, technical and professional competencies to the radiation medicine enterprise. In Ontario, about 40% of the patients treated with radiation (on average) are receiving palliative radiation treatment. Given the acuteness of the palliative patients’ symptoms, timely access to high quality care is paramount. Increasing incidence and prevalence of cancer challenge the system to be able to provide the highest quality of care in a timely fashion to all of its patients. As noted in Canadian Partnership Against Cancer (“Palliative and End-of-Life Care”, CPAC, 2017), “...(radiation therapy is an) effective palliative therapy for patients with advanced disease that is causing pain and other discomfort...” yet, data indicate that access to palliative radiation therapy is inadequate in many areas of the country for many reasons including lack of knowledge in the referring community, long travel distance to a radiation facility for care/treatment, impaired access to timely care, among others. Strategies are constantly being sought to improve access, decrease wait times and improve care provided to cancer patients. Adding a CSRT to the existing palliative radiation therapy team is one strategy that has proven to be very effective for improving access and wait times. The focus of the new model of care is to share/redistribute activities between a radiation oncologist and the advanced trained CSRT called “task shifting” (“Treat, Train, Retain”, WHO, 2006), to alleviate gaps and bottlenecks in the system. Documented and published outcomes regarding the CSRT-focused model of care can address these issues and show promise for affecting further improvements in the palliative radiotherapy system (Harnett et al, 2018; Lee et al, 2013, Lee et al, 2012, Rozanec et al, 2017, D’Alimonte et al, 2017).The idea of task shifting is a well-documented strategy in the face of many global health care crises, most predominantly the HIV/AIDS crisis in Africa. The CSRT is another successful example of this strategy in practice. The focus of the CSRT is to help all patients, who require radiation treatment, obtain access to that treatment more quickly and ensure that patients receive the best care possible, in other words to maximize effectiveness and increase efficiency of the system. These benefits can be achieved within a traditional radiation treatment system but have their greatest impact when the CSRT facilitates the development of rapid response clinics that can have the patient seen and receiving their first treatment on the same day as opposed to waiting for days from initial consult to first treatment. Essentially, the CSRT can expedite the patients’ movement through the system from referral to consult, consult to simulation, simulation to planning and planning to treatment delivery. In addition, the CSRT is a cost effective addition to the existing interprofessional team that can use their unique expertise to add services previously not possible including patient follow up after the completion of treatment.Let’s look at the specific benefits of this novel model of care:CSRTs impact access to care and the capacity of the system in a variety of ways. When CSRTs see new patients, they provide a cost-effective way to add appointment spots to radiation consultation clinics. Their schedule can be more flexible and they are more available to visit inpatient wards to review urgent patient cases for indications for radiation treatment and expediting a referral. They can provide expert continuity of care for patients that enables patients to access rapid response clinics and get on to treatment more quickly and they are able to provide community outreach to increase awareness of the use of palliative radiation treatment. With their advanced radiation therapy competencies, the CSRT can use technology (ie. telemedicine platforms) to allow patients who live at a distance from the cancer centres, to be evaluated for eligibility for treatment and followed up after radiation treatment in their community. The activities described above result in patients having symptoms addressed more quickly potentially reducing the number of inpatient hospital days. They can decrease the number of Emergency Department visits as patients have direct access to expert oncology professionals. These can also reduce the number of times that patients have to travel to the cancer centre making the option of radiation treatment more acceptable for the patients and their families. The activities of the CSRTs also augment the quality of the care that patients receive. CSRTs have more time to spend with patients whether that be at first appointment explaining treatment options, dealing with side effects and/or questions during treatment, or following up with patients who have completed radiation treatment. They are more available to serve as the “first point of contact” for patients who are preparing for and receiving radiation therapy. And they have unique expertise to streamline and standardize radiation treatment approaches across a department.The combination of these activities results in improved emotional, psychological and physical well-being for patients preparing for, receiving or having completed radiation treatment. The personal attention can increase compliance with self-care measures and help patients address new symptoms/side effects in a more timely fashion and better tolerate treatment overall. The increased standardization of treatment techniques improves consistency of treatment, reduces risk of errors and makes it easier to monitor outcomes of treatment. In addition, as CSRTs assume responsibility for patients who are well and less complex, the Radiation Oncologist (RO) is available to deal with the more complex patients. This supports the CSRT to work to their full scope of practice and increases the ability to get patients the person-centred care they need and deserve.
  • Pallfan2018 over 1 year ago
    In Alberta, the focus of the Framework (2014) was on developing integrated programs opf care across the province, where they diod not already exist. The recommended actions in the Framework have been progressively implemented as resources have been avaialbale and the services are more rather than less integrated at this juncture, though with more work to do.
  • CFHI_FCASS over 1 year ago
    Integrated models of care support access to palliative approaches to care as early as is appropriate for the patient and family, including providing palliative care alongside other interventions. These models are person-centred, timely, based on patient need and provide continuous, high-quality care that is equitable in terms of access. CFHI programming supports and encourages integrated approaches to palliative care. For example, the Embedding Palliative Approaches to Care (EPAC) model that CFHI is spreading across Canada (https://www.cfhi-fcass.ca/WhatWeDo/epac) helps teams in long term care and personal care settings to engage in early, open conversations with residents to ensure that they receive care consistent with their wishes in the location of their choice. By better supporting residents at the end-of-life in long term care, EPAC prevents inappropriate transfers to the emergency department. Participating homes will leverage interdisciplinary improvement teams that include registered and non-registered staff, residents, families and other stakeholders such as social work and spiritual care providers. The Paramedics and Palliative Care: Bringing Vital Services to Canadians (https://www.cfhi-fcass.ca/WhatWeDo/palliative-care/paramedics-and-palliative-care) project by the Canadian Partnership Against Cancer and CFHI will expand access to 911 paramedic services that integrate palliative approaches to care into their practice, including treating the patient and family in the location of their choosing. The INSPIRED COPD Outreach Program™ that CFHI is scaling up across Canada (https://www.cfhi-fcass.ca/WhatWeDo/inspired-approaches-to-copd-scale) provides patients with access to supportive advance care planning discussions and psychological support concurrently with their active medical management. The program improves the quality of life and experience of care for both patients and families while decreasing unnecessary emergency department visits and hospital readmissions.CFHI programming is often delivered through quality improvement collaboratives that bring together interprofessional teams to address a common healthcare issue through a team-based quality improvement project and shared learning. These collaboratives support teams to create or strengthen the quality improvement culture within their organization and deliver measurable improvements in patient and family experience of care. Our organization supports the implementation of the collaborative by providing seed funding, an evidence-informed quality improvement model, peer-to-peer networking opportunities, measurement and evaluation support and access to a network of expert faculty and coaches.
  • Ruadh over 1 year ago
    I agree with Herron63:Integrated palliative care involves much more than palliative physicians and nurses. Clinical Specialist Radiation Therapist (CSRT).A new approach to enhancing access to palliative radiation therapy. We as a relatively new group are working to improve access to the rapid response programs for our palliative patients and improve their quality of life within the hospital environment. We work in a multidisciplinary team with physicians, nurses, surgeons and pain specialists. We try to ensure the patients have as few appointments as possible and they see as many specialists as they can in one visit. Palliative patients need a full team behind them and a contact person they know. We try to give them that.
  • musictherapist over 1 year ago
    I've been privileged to work for many years as a music therapist in a palliative care service with an excellent multidisciplinary team. Music therapy, psychology, spiritual care and massage - alongside great medical and nursing care of course - really help to address the 'whole person' in the patient, as well as their family's needs. I'm often amazed at how music opens doors, allowing us to touch the most profound places, bring solace, humor or joy, unite people, express faith/hope and facilitate life review...it underscores what is precious in life itself!
  • CanadianVirtualHospice over 1 year ago
    The Canadian Virtual Hospice (http://virtuahospice.ca) strives to provide resources and information that adopts an integrated approach to palliative care. Information provided on the website can assist health care providers in all aspects of their work related to palliative care. When developing new information or tools (such as http://MyGrief.ca, http://KidsGrief.ca, http://LivingMyCulture.ca), experts, family and patients are engaged in the process to ensure the information is relevant for the audience.
  • Heron63 over 1 year ago
    Integrated palliative care involves much more than palliative physicians and nurses. Our rehabilitation teams, psychology, social work, spiritual care and other therapeutic modalities are critical when we are talking about alleviating symptoms and improving or sustaining quality of life. End of Life lymphedema may be alleviated with good rehab therapy enabling mobility, self toileting etc. Our health care system overall undervalues the importance of clinical care that is not medical
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    • alliedhealthworker over 1 year ago
      Agree! Same can be said for other symptoms (e.g., pain, dyspnea, agitation/restlessnes, the list goes on!). There are many non-pharmacological interventions that can be used for symptom management, and lots of great and creative ideas come out of opportunities where interprofessional teams can brainstorm and troubleshoot.
  • yinyang over 1 year ago
    Il semble y avoir consensus autour des définitions des soins palliatifs généralement mises de l'avant. L'un des principaux enjeux est de trouver une façon de rendre opérationnelles ces définitions de façon à améliorer l'accès à des SPFV de qualité pour la population.Comme mentionné par plus d'un, la terminologie "Approche palliative intégrée" apparaît porteuse versus les soins palliatifs trop souvent associés à la mort et à la fin de vie et parce qu'elle permet de mettre l'accent sur "l'accompagnement" et de "façon précoce". De plus, l'intégration d'une approche palliative tôt dans la trajectoire de maladie de personnes améliore la qualité de vie des personnes atteintes d'une maladie à pronostic réservé ainsi que celle de leurs proches, tout en diminuant leurs souffrances.À cet effet et au terme d'un processus de consultation auprès d'experts et de répondants du réseau de la santé et des services sociaux du Québec, un consensus a été obtenu à l'effet que l'identification et la diffusion d'un guide sur l'approche palliative intégrée représentait le meilleur outil pour repérer de façon optimale les personnes susceptibles de bénéficier de soins palliatifs et de fin de vie (SPFV). Un tel guide devrait proposer une approche de soins palliatifs se déclinant en trois étapes :1. Identification (question surprise)2. Évaluation (avec une perspective d'évaluation en continue)3. planification/organisation des soinsL'informatisation de certains éléments du guide pourraient permettre d'assurer d'offrir aux personnes et à leurs proches les bons services, au bon moment dans une perspective de continuité.
  • rhetoric_ally over 1 year ago
    Our site has to some extent, although there is definitely more education around what Palliative Services provide and mean that needs to happen in other areas of the hospital. This is so that those considered the primary Medical Team don't dismiss having Palliative Services input on an infant, child or youth diagnosed with a life-limiting diagnosis until they deem that patient 'at the end' and discharge them from their service knowing they're now dying. This does everyone a disservice, and robs the patient (and their family) of a team member who througout their journey is focused soley on their quality of life through benefit to burden and symptom management. Perception around 'Giving up' when seeking Palliative Service input needs to change, or we all suffer from that ignorance.
  • arcticfox over 1 year ago
    Yes, we have recently shifted towards an integrated approach. Within my region the palliative care team focus on capacity building with the aim that all health care providers can provide patients with quality palliative care as only a small percentage of clients require specialized palliative care services.
  • acritch over 1 year ago
    I work in a rural community, with clients spread throughout a large geographical area. The regional health authority does take on an integrated approach to palliative care as all employees are encouraged and many required to completed training in LEAP core by Pallium Canada. There is a inter-professional palliative care team located in the major city center, however none are located in the rural centers. It is often the family physician who takes on the case management role for patients deemed palliative and often there is minimal communication between other team members (i.e. community support, counseling, nursing). The lack of resources for rural communities is significant factor.
  • KM_2018 over 1 year ago
    I am involved in an palliative radiation oncology clinic that has a palliative NP on our team so all of our patients are integrated into palliative care from the first meeting. As a whole, our cancer center is working on an early integration to palliative care project for cancer patients across the province. We are at the beginning stages of this project but our goal is to have more health care professionals trained in palliative care and palliative approaches, to help normalize these conversations and change the mindset around palliative care. We are also aiming to have more patients avail of palliative services at an earlier timeframe then the current state.
  • PallRNKaren over 1 year ago
    Our organization uses an integrated approach to palliative care; we have an excellent teams of palliative nurses who have the resources to reach out for support in pain and symptom management, referrals, transfers to hospice, pharmacist back up and support from upper management.
  • Ette over 1 year ago
    We do not have a integrated approach to Palliative care. It impacts our practice because we do not have a team to pull together to support the patient.The resources we need as nurses, we have to initiate. Whether it be OT, Dietician, etc. Because, we are in a rural area some of these supports only come to the facility once a month. Often, this is too long of a wait.We do not have Social Workers to help support the patient and family.
  • Kjpt11 over 1 year ago
    In our organization, palliative care if full integrated within our homecare interdisciplinary team and by also including other partners. These partners may include Hospice residences, hospitals, family physicians, palliative consultants and mental health specialists. We do have some gaps within the organization with regards to spiritual care.
  • livermore over 1 year ago
    Not fully
  • piglet over 1 year ago
    In my setting there is an integrated approach to palliative care, but there are some missing pieces for example not all of the teams have access to psychology/psychiatry or registered dietitian and nutrition support services.The big problem is that the integrated palliative care team is not well integrated in cancer care, or in the care of any other major life-limiting chronic disease. Part of this is a capacity issue; not enough palliative care doctors, nurses, researchers
  • melmay over 1 year ago
    Yes, our organization has an integrated approach. We have a diverse interdisciplinary team approach. We work collaboratively with community, hospital and residential hospice partners.Though not perfect, we have palliative care nurses who provide education, mentor ship and support along with Palliative Care Physicians who work as part of our team.
  • kott over 1 year ago
    My organization has no integrated approach to palliative care that I am aware of it.
  • DrDarkwingD over 1 year ago
    A truly integrated approach requires all team members to support each other. Currently, we all work independently but together. The doctor is on his own. The home care nurse is on his own. OT is on their own. Social work is on their own. Consultants are on their own. We never sit in the same room or support each other. Only in dire situations are we communication with each other. I began a practice of faxing all my notes to the home care nurse so they were up to date on the patient.
  • palliumcanada over 1 year ago
    For Pallium, an integrated and inter-disciplinary approach is central to our vision that every Canadian who requires palliative care will receive it early, effectively and compassionately. This philosophy has been tightly integrated into all our products and LEAP courses and is a major reason that our pedagogical approach is designed for inter-disciplinary team learning. This has helped health teams within an organization improve communication and collaboration. By improving communication and collaboration within a health team, health providers can reduce the risk of patients falling through the cracks and not receiving the care they need.For patients with cancer or non-cancer diagnoses to have consistent and appropriate access to an early palliative care approach, it is critical that palliative care education and training is provided to professionals across the health care system, not just to specialist teams. This is why Pallium has worked to engage all health care providers who provide generalist- or primary-level palliative care across all care settings, including paramedics, pharmacists, social workers, nurses, physicians across many specialty areas (including family physicians, oncologists, internists, cardiologists, amongst others), and other health care professionals caring for patients with serious illnesses. We have received positive feedback on this integrated approach from partners such as Cancer Care Ontario and the Ontario Renal Network, who have identified such as an approach as a priority, including preparing the whole workforce in this area. Integration across the health care system is also delivering key results with reduced transports to hospital in both Nova Scotia and Prince Edward Island as paramedics trained in those provinces are now able to alleviate patient symptoms at home.Furthermore, to support an integrated palliative care approach, caregivers and community members need to be included in the continuum of care. The addition of community members helps to create a wrap-around effect to better support the patient and family dealing with a diagnosis pertaining to a life-limiting and/or life-threatening illness.To guide its efforts in mobilizing communities around palliative care as a public health issue, Pallium Canada has adopted the Compassionate Communities theory of practice. Pallium supports the creation of additional compassionate communities as these groups will ultimately act as local change agents that will directly influence key areas for social change. In addition, Pallium will encourage collaboration, knowledge transfer and learning of best practices, to help Compassionate Communities grow stronger. To assist in this regard, Pallium will provide a number of tools and resources, including evaluation tools to measure impact.
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    • Karen over 1 year ago
      As a healthcare professional with family living in NS living with a life-limiting illness, I can appreciate the benefit of these wrap around services,... EHSNS working with the palliative service has been a god send. As an educator, I rely heavily on the pallium website with its resources for educating nurses who will be joining the healthcare team. And they are seeing the benefits of integrating palliative care earlier into the patient's illness journey...
  • Sunrise over 1 year ago
    We work in an integrated approach, it was a pilot project in the 90s and I have been fortunate to work with a group where there are resources to use. However there are new challenges as work gets busier with lack of realization that putting resources into community area (eg a social worker) can help prevent need for tertiary care
  • Community Hospice Champion over 1 year ago
    We are a community hospice care provider. In order to provide good integrated care in the community you have to adopt a collaborative and integrated approach. It requires dedicated effort to creating, maintaining and building relationships with other providers. You need to understand how the system works, who the partners are and what each persons role(s) are. You also have to appreciate and respect the different roles/jobs each organization has and work together to support each other in those roles. You need to be aware of the populations and people you serve and adapt your model to respond to those needs - mobilizing the specialist (Aboriginal Network, Autism) or the community partners that families have existing relationships with (Alzheimer, Supportive Housing, CAS) to provide continuity and person centered care. Hospice palliative care providers should where they can provide education, information and resources (to broader community/partners) to enable to give them skills to support existing persons and refer to hospice palliative specialist /others for support as complexity increases you add services, programs, resources...
  • snicolson over 1 year ago
    I work in Hospice care. We do have an integrated approach to palliative care.We actually run an outpatient clinic at our hospice whereby 3 of our physicians see community patients with life limiting illnesses.Our physicians are now seeing outpatients in our satelite dialysis unit in our hospital. WE are also in the beginning steps of setting up a rural out patient clinic in one of our rural areas.We have a PCCT team Our physicians have begun preliminary planning to do a pilot project with one of our local LTC homes.This all has happened by the hard work of the Palliative Care physicians and team we have in our community
  • Q321@# over 1 year ago
    We promote an integrated approach to palliative care. We aren't delivering this service, but advocate for an integrated approach and the adoption of this approach across the country.
  • jcruikshank over 1 year ago
    The Canadian Hospice Palliative Care Association (CHPCA) has adopted an integrated approach to palliative care as part of its mandate. The Quality End of Life Care Coalition of Canada (QELCCC), a committee run by CHPCA with 37 national groups as members, aims to expand the impact and adoption of an integrated approach through its work with key partners in the healthcare sector as well as Canadian Compassionate Companies.This work is based on the recommendations and findings of the Way Forward National Framework: Roadmap for an Integrated Palliative Approach to Care, which was managed by CHPCA. The QELCCC promotes palliative care at all levels of care, including Advance Care Planning and during illness - not only at end of life. It advocates for the needs of caregivers,advocates for a 2-week bereavement period at both the federal and provincial/territorial levels, and promotes the expansion of flexible service delivery approaches that are both culturally appropriate and widely accessible for all Canadians. The QELCCC includes an executive, advocacy, education, and research and KT committees to advance the work of the coalition.
  • Robin over 1 year ago
    As an educator, I ensure pre-licensure students receive education about an integrated palliative approach. I use "The Way Forward" document and the "CHPCA Square of Care" as guiding documents. I also use the Nova Scotia competency framework to guide curriculum development and the Palliative Care Matters Consensus document to guide student development of public service announcements. Students also apply relevant models and tools in class and in their clinical practice and are encouraged to educate others about this approach.
  • Pall-life over 1 year ago
    Although people routinely die my acute care organization has a reticence to have a palliative care program. Fortunately there are staff committed to the philosophy of palliative care and want to provide and promote it. The lack of leadership support makes it difficult to fully realize the potential of palliative care to optimize patient and family care. I am hoping that federal, provincial and territorial initiatives will compel institutions to provide comprehensive and integrated palliative care. I am a skeptic about accreditation, but maybe Accreditation Canada could take a critical look at what institutions are or are not doing?
  • veejay over 1 year ago
    In the Multi-Care Kidney Clinic at the Scarborough and Rouge Hospital, we have a pathway dedicated to an integrated palliative care approach. Our pathway is called the Comprehensive Conservative Renal care. They can be referred by a nephrologist into our pathway and/or the pathway is offered to pts and their families if they communicate their wish for no dialysis to the care team. They meet with a nephrologist who specializes in working with palliative care patients and/or they retain their MRP and they are followed in the clinic by a nurse, social worker and dietitian for follow-up until they can no longer attend clinic appointments and/or their care is transitioned to the community palliative care teams with Homecare or Scarborough Centre for Healthy Communities.This was accomplished by identifying the champions in the MCKC clinic and training them first. Champions then went on to train the rest of the MCKC staff and continue to work as a resource to staff for palliative care
  • alliedhealthworker over 1 year ago
    I see some challenges with respect to a truly integrated palliative care approach at my facility - I work in the LTC program at an academic teaching hospital. I see challenges with respect to transitions between programs (e.g., individuals who flow between acute care and LTC) and inconsistent use of terminology and inconsistent procedures between programs. Our LTC units do not expressly follow an integrated palliative care approach (i.e., we don't call it that) but we do follow the philosophy of striving to look at holistic care incorporating physical needs, social needs, spiritual needs, psychological needs, etc. from the time of admission through to the time of death. Our facility prefers the term "interprofessional" over "multidisciplinary". We interpret "interprofessional" to mean a group of individuals with varying roles who all have distinct expertise but may work together and collaborate for shared goals. Conversely, we interpret "multidisciplinary" to mean a group of individuals with varying roles who all work with the patient/individual, but don't necessarily collaborate on care plans. E.g., we would work interprofessionally by having team discussions of an individual's symptoms of anxiety to devise a care plan incorporating pharmacological and non-pharmacological strategies given that different roles have different lenses/expertise.
  • lisarc over 1 year ago
    I work in a hospital; the approach is multidisciplinary. The palliative care MD will request consults from physiotherapy, occupational therapy, speech pathology, and others, where appropriate. Knowing that the expertise is there, then the MD can call upon it. Spiritual care and rec therapy, among others can also be involved to provide holistic care. The LHIN can also be involved such as when the patient wishes to go home.
  • applebee1 over 1 year ago
    In the South Georgian Bay sub-region (NSM LHIN) we are currently piloting a Palliative Shared Care Team (SCT), now in Phase II rollout. This integrated approach to care is only possible through honest, strong and respectful partnerships. The initiative was 6 months in the planning. All agencies (including LHIN HCC, the local hospital CGMH, Saint Elizabeth Health Care and Hospice GT) have sat at the SCT table since day one. In conjunction with local physicians, this team's goal is to ensure that the medical AND psycho-social-emotional-spiritual needs of our patients are looked after, and that these services are available and offered to all individuals in our community who would benefit from a palliative approach to care! Feedback from physicians, patients and carers has been overwhelmingly positive. Our SCT members believe that this is the way forward for palliative care. By year end, all physicians (over 50) in our sub-region will be supported by the SGB SCT.
  • OPSWASylvia over 1 year ago
    My organization has developed an integrated approach through our collaboration with other healthcare professionals in our area of the NSM LHIN. This was accomplished through several collaborations within various healthcare organizations in which palliative care is so important. Non-profit partners, such as Hospice, have been essential to this framework. It is a multi-disciplinary approach to a whole-person centred plan of care for end of life.
  • PallMedDoc over 1 year ago
    Yes, we have adopted an integrated approach to palliative care with the strong support of palliative consultants (MD or CNS). We are now in the process of expanding dedicated palliative consultant support to each of the major chronic diseases and cancer (tumor group by tumor group) by joining their outpatient clinics. We already have successful examples through our support at ALS clinic and some of the outpatient cancer clinics.Our home care teams are all supposed to go through the family physician for palliative care help with the palliative consultants only there as needed for support (i.e. palliative physicians do not take over care). The variation in family physician practice, though, can be a challenge in their engagement in certain scenarios.Certain specialist physicians (nephrologist, respirologist) have done 6 months of extra palliative medicine training, and are now back with their groups and have started excellent primary palliative care focused clinics to support their colleagues and patients.Programmatically, the palliative program is situated with the Community portfolio which includes facility programs (ie LTC, Supportive living) and home care. We also report through Department of Family medicine and Department of Oncology which have allowed closer integration and networking with relevant stakeholders who provide primary palliative care.
  • erinmc over 1 year ago
    We teach best practices to health care providers across all sectors. This includes an integrated approach to palliative care. Many of the organizations that we work with have an integrated approach to palliative care, and within my practice it is sometimes necessary to bring awareness to what other types of providers/allied health/professionals could be involved in care planning to achieve an integrated approach.
  • Aprilshowers.1 over 1 year ago
    Approximately 1 year ago with the added authority in Ontario for NPs to prescribe narcotics and controlled substances, management of pain and symptoms has been expanded beyond the responsibilities of the physicians in my LTC facility. Updated protocols were developed in conjunction with our pharmacists, physicians, all levels of nursing staff, palliative care partners in the community and published best practices. These directives have equal focus on pharmacotherapy and nursing interventions such as mouth care and turning and positioning. Most recently we have developed a 1 page hand out for our RPNs and RNs to use as a guide to discuss the myths and strategies of palliative end of life care to families. This has increased the comfort of front line staff and facilitated consistency in the language we use and the explanations we give. This handout also has validated websites and separate information sheets on the medications if residents family or loved ones want more information. On this one page sheet we outline simple ways that families can participate in pain and symptom management if they wish to. Many families have expressed their deep gratitude for helping manage this difficult time with grace and dignity.
  • valoriem over 1 year ago
    Our community as an integrated approach with family doctors providing primary care, palliative consultative services provided in hospital, at home and in ambulatory clinic. We have home care nurses providing home based palliative care, supported by the family doctor and palliative specialist. We have our local hospice with provides a counsellor who is involved in our home consults and ambulatory clinic. We are working on the design of a 10 bed residential hospice opening in 2020 which will provide end of life and respite care.