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Enhancing family physician capacity to deliver quality palliative home care

An end-of-life, shared-care model

Doris Howell, PhD RN
RBC Financial Group Chair in Oncology Nursing Research for the University Health Network in Toronto, Ont, and Assistant Professor in the Faculty of Nursing at the University of Toronto

Kevin Brazil, PhD
Director of the St Joseph’s Health System Research Network in Hamilton and Associate Professor in the Department of Epidemiology and Biostatistics and Research Director in the Division of Palliative Care at McMaster University

Michelle Howard, MSc PhD
Research Coordinator in the Department of Family Medicine at McMaster University

Alan Taniguchi, MD FCFP
Palliative care physician for Hamilton Health Sciences and Education Director in the Division of Palliative Care at McMaster University

Correspondence: Dr Denise Marshall, McMaster University, Family Medicine, 1200 Main St W, HSC 2v14, Hamilton, ON L8N 3Z5; e-mail marshald{at}mcmaster.ca references

PROBLEM BEING ADDRESSED Family physicians face innumerable challenges to delivering quality palliative home care to meet the complex needs of end-of-life patients and their families.

OBJECTIVE OF PROGRAM To implement a model of shared care to enhance family physicians’ ability to deliver quality palliative home care, particularly in a community-based setting.

PROGRAM DESCRIPTION Family physicians in 3 group practices (N = 21) in Ontario’s Niagara West region collaborated with an interprofessional palliative care team (including a palliative care advanced practice nurse, a palliative medicine physician, a bereavement counselor, a psychosocial-spiritual advisor, and a case manager) in a shared-care partnership to provide comprehensive palliative home care. Key features of the program included systematic and timely identification of end-of-life patients, needs assessments, symptom and psychosocial support interventions, regular communication between team members, and coordinated care guided by outcome-based assessment in the home. In addition, educational initiatives were provided to enhance family physicians’ knowledge and skills.

CONCLUSION Because of the program, participants reported improved communication, effective interprofessional collaboration, and the capacity to deliver palliative home care, 24 hours a day, 7 days a week, to end-of-life patients in the community.