The Context for Action:
In current practice, the patient’s primary care or chronic disease team is responsible for introducing palliative care and making referrals for more specialized services such as symptom control. The discussion document explores two models for integrating a palliative approach into patient care. The first option uses a collaborative approach: the primary care or chronic disease team continues to manage the illness and treatment while a palliative care team is responsible for symptom control, advance care planning, and assisting with decision-making. The second option uses a more integrated approach: the primary care or chronic disease team integrates palliative care skills into their disease management program and calls on a specialized palliative care team to consult as needed.
Both models have the potential to normalize palliative care planning, improve patient care and satisfaction, and reduce the use of more costly health-care services. For instance, the collaborative approach of the first model has been shown to improve individual choice and coordination of care, and facilitate transitions from one service to another (Myers et al., 2004). The second model has been used effectively in other jurisdictions and was shown to be acceptable to patients and did not overwhelm the service (Cochrane et al., 2008). It may also be more cost effective because it involves fewer practitioners and more fully integrates palliative care into chronic disease management.
Among the challenges inherent in these approaches: the first model may increase confusion given the number of providers a person and family sees, and create capacity issues for currently under-resourced palliative care staff; for the more integrated second model, the palliative care role in chronic disease management teams has not been clearly defined and there are no national standards to guide practice. As Canada moves to integrate a palliative approach earlier in the course of managing chronic, life-limiting diseases, it will be important to learn from other jurisdictions how to overcome these and other barriers to integrated care (discussion document, pages 12 to 14).
Areas of Opportunity:
Effectively integrating a palliative approach into the management of chronic, life-threatening diseases will require strong policy support to (discussion document, pages 14 and 15):
- Develop a national policy to significantly improve the quality, consistency and accessibility of palliative care;
- Research and evaluate new models of integrated care and translate effective models into practice;
- Expand accreditation standards across the health sector, focusing in areas such as symptom management and advance care planning;
- Educate practitioners and provide the training needed to work in various models that integrate a palliative approach into chronic disease management.
To access the full discussion document, as well as a glossary of terms, visit: http://www.hpcintegration.ca
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