SUMMARY
Once patients who would benefit from a palliative approach are identified, what the family practice can offer can be broken down into 3 overlapping, continuous and non-sequential processes: 1) ensuring illness understanding; 2) whole-person symptom management; and 3) planning for the future and potential outcomes. In contrast to how we often learn these skills in our training (concentrated into a speciality rotation), in family practice, these objectives can be “sprinkled in” over time with regular follow-up (the onus for this often being on the family physician). At times, we may have to “sell ourselves” to patients, reminding them of how we can help them as their illness progresses over time. Laying eyes on a patient is essential for appreciating significant changes and transitions throughout the illness trajectory.
For chronic, progressive conditions like cancer, organ failure, neurodegenerative conditions and frailty, illness understanding begins at the time of diagnosis and can often be enhanced by bi-directional communication with a specialist to supplement the often data-heavy nature of consultant or progress notes. Caregivers also benefit immensely from this information as they need to make arrangements for how their role will inevitably be impacted and often increased over time.
Patients and clinicians often struggle with the language and communication skills required for these important conversations. Below are a number of resources to help. I highly recommend Season 1 of The Waiting Room Revolution podcast for both clinicians and patients. Season 3 – Episode 20 (featuring yours truly) is about “the how” of delivering a palliative approach in family medicine.
TAKE AWAY TIDBITS
The Palliative Approach in Family Medicine
- Identification (see May 2022 Info-Morsel)
- Illness Understanding
- 2-way communication with specialist colleagues
- Regular, scheduled, in-person follow-up to witness important changes in the patient and their effect on prognostication and need for additional resources (frequency proportionate to the rate of change in the patient)
- Having resources for the patient, caregiver and clinician
LINKS TO RESOURCES
- Articles on having open and honest conversations with patients about their illness:
- Culturally appropriate resources for First Nations Communities: https://eolfn.lakeheadu.ca/project-results/culturally-appropriate-resources
- Empowering podcast for patients (also beneficial for clinicians in approaches and language) on unlocking the keys to a batter illness experience: https://www.waitingroomrevolution.com/season1
- An online resource that provides support and personalized information about advanced illness, palliative care, loss and grief, to people living with illness, family members, people working in healthcare, educators, and researchers: https://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home+Navigation/About+Us.aspx
- Prognostication (see also Gold Standards Framework from May Info-Morsel)