Palliative Care in Residential Care a practice improvement module

Feburary 25th, 2016

Community Geriatrics

UBC Department of Family Practice

Tim Sakaluk, Medical Director Vancouver Home Hospice

Palliative Care Services

Umilla Stead Leader, End-of-life Care

Residential Care

28.4

33.8

29.3

% of Deaths in Canada by Disease Trajectory

Sudden Death

Terminal Illness

Organ Failure

Frailty

Other

Raising the Bar, S. Carstairs 2010

Introducing palliative care early has been shown to result in:

A higher quality of life

Fewer depressive symptoms (16% vs 38%)

Fewer received aggressive end of life care (33% vs 54%)

Longer median survival (11.6 months vs 8.9 months, P =0.02)

Temel, JS et al. Early palliative care for patients with metastatic non-

small-cell lung cancer. N Engl J Med 2010;363:733-42.

Palliative care: a population approach to care

Specialty

palliative

services

co-manage

Specialty support

to patient from

palliative services

Support to primary

physician from palliative

services

Primary physician manages

patient care needs

Vision Create a culture shift to improve the quality of living and dying for clients with advanced frailty and dementia

in residential care

Module objectives

Upon completion of the module, participants will be able to:

Identify residents who would benefit from a palliative approach to care

Facilitate Goals of Care conversations with residents and their families

Assess and manage end of life symptoms on-site

Who was involved?

Collaborative project between: – Practice Support Program (PSP)

– Vancouver Division of Family Practice

– Community Geriatrics, UBC Department of Family Practice

– Vancouver Home Hospice Palliative Care Services, VCH

Participating teams: one physician + two facility staff

Fifteen facilities agreed to participate – 14 completed.

Implementing learning

Start with residents who have hospital transfer

orders on file

Use Frailty and Dementia staging tools to facilitate

Goals of Care Conversations

1-hour Goals of Care staff education

Build in time at existing meetings for GOC practice

Teach tools for staging tools to staff so they can

identify residents appropriate for palliative approach

What has shifted?

What else has changed?

53% scored 4-5

62% scored 4-5

50% scored 4-5

87% scored 4-5

96% scored 4-5

96% scored 4-5

Staging frailty

Staging dementia

Communicating prognosis to families

Participants who rated confidence level as confident or very confident with:

Series6

Series7

Pre-module

6 months Post-module

photo via upsplash.com

This is just the beginning…

Further training and support

Establishing a community of practice

Reaching other physicians