A Palliative Approach in Your Family Practice: Part 1 – Early Identification

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SUMMARY

A palliative approach is when non-specialists adapt palliative care knowledge and expertise, integrate this knowledge into other systems and models of care, and apply it upstream in the care of patients with life-limiting illnesses. 1 In Canada and elsewhere, it is recognized that family medicine is a specialty in which a primary palliative approach would be ideally situated due to the provision of comprehensive, continuous care across the lifespan.

Identifying palliative care needs earlier in the course of disease significantly contributes to positive patient, family and system outcomes. Many preferred tools exist to facilitate in the process of early identification, outlined in the Ontario Palliative Care Network’s (OPCN) Tools to Support Earlier Identification in Palliative Care.2

For those of us with learners, it can be particularly helpful to introduce them early in their training to the surprise question.3 Coming into each clinic day with the lens of “Would I be surprised if this patient died in the next year?” can help to build a roster of patients that can be followed from diagnosis to death, ensuring attained competencies in delivering a palliative approach. Building this roster needs to be intentional, with problem-solving around how to deliver continuous care for the patient during an often fragmented learner’s program. 

TAKE AWAY TIDBITS

The Palliative Approach in Family Medicine

  • Identification
    o At time of diagnosis (most upstream approach)
    o The surprise question
    o Systematic tools incorporated into practice
    o Being intentional around learners building a roster and following these patients continuously

Links to Resources

  1. Pallium’s Taking Ownership Module: https://www.pallium.ca/eLearning/Taking_Ownership/story.html
  2. Ontario Palliative Care Network’s (OPCN) Tools to Support Earlier Identification in Palliative Care https://www.ontariopalliativecarenetwork.ca/resources/tools-support-earlier-identification
  3. Gold Standards Framework Prognostic Indicator Guidance: https://www.goldstandardsframework.org.uk/cd-content/uploads/files/General%20Files/Prognostic%20Indicator%20Guidance%20October%202011.pdf