Frequency of providing a palliative approach to care in family practice: a chart review and perceptions of healthcare practitioners in Canada

Abstract

Background Most patients nearing the end of life can benefit from a palliative approach in primary care. We currently do not know how to measure a palliative approach in family practice. The objective of this study was to describe the provision of a palliative approach and evaluate clinicians’ perceptions of the results. Methods We conducted a descriptive study of deceased patients in an interprofessional team family practice. We integrated conceptual models of a palliative approach to create a chart review tool to capture a palliative approach in the last year of life and assessed a global rating of whether a palliative approach was provided. Clinicians completed a questionnaire before learning the results and after, on perceptions of how often they believed a palliative approach was provided by the team. Results Among 79 patients (mean age at death 73 years, 54% female) cancer and cardiac diseases were the top conditions responsible for death. One-quarter of patients were assessed as having received a palliative approach. 53% of decedents had a documented discussion about goals of care, 41% had nurse involvement, and 15.2% had a discussion about caregiver well-being. These indicators had the greatest discrimination between a palliative approach or not. Agreement that elements of a palliative approach were provided decreased significantly on the clinician questionnaire from before to after viewing the results. Conclusions This study identified measurable indicators of a palliative approach in family practice, that can be used as the basis for quality improvement.

Advance care planning conversations in primary care: a quality improvement project using the Serious Illness Care Program

“…Fourth, our objective was to evaluate whether there was a role for SICP in implementing ACP in primary care, and we did not undertake the study to increase the frequency of ACP conversations. However, a separate chart review of patients who died from January 2017 to December 2017 from the McMaster Family Health Team, found that 42% of decedents had a goals of care conversation, 32% discussed their illness understanding, 26% discussed patient values, beliefs and priorities going forward, and only 11% discussed prognosis [23]. A repeat chart review may be able to report on the potential impacts of SICP implementation on the frequency of ACP conversations.…”

Intersectoral communication amongst healthcare providers regarding care plans: a scoping review

“…4 In addressing these challenges, interdisciplinary medical teams worldwide are initiating, exploring, and providing palliative approaches to care. 5 – 7 …”

“…4 In addressing these challenges, interdisciplinary medical teams worldwide are initiating, exploring, and providing palliative approaches to care. [5][6][7] The palliative approach to care aims to improve quality of life and reduce suffering for people living with life-limiting conditions. 8 Typical provisions of the palliative approach include pain and symptom management, psychological, social,…”