Dr. Erin Gallagher
Summary:
Primary-level, whole-person symptom management can be tackled through: formal and informal education; collaboration with allied health and community services; clinical resources and guidelines; and having a “phone-a-friend” for those more challenging issues or cases.
Medical training and comfort in providing a palliative approach is highly variable. Related competencies that all trainees should have upon completion of their residency have been described, including but not limited to, symptom management.
It is important to screen regularly for symptoms as many can go under-reported otherwise. Various tools exist to help with symptom screening, such as the Edmonton Symptom Assessment Scale (ESAS) and FICA tool for spiritual assessment.
It is important to zoom out to understand where a patient is in their illness trajectory. This is crucial for developing action plans that patients and caregivers can implement in the home, for potential (ex. seizures with brain metastases) and expected (lost oral access in final days) consequences of disease progression. Follow-up should be scheduled regularly and become more frequent as the patient declines.
Many bedside resources exist for symptom management, including Pallium’s Palliative Pocketbook and McMaster’s Palliative EZ Guide. Further tools and enhanced education opportunities are posted regularly through the Division of Palliative Care’s website.
System and community navigation a major component of whole-person care. Being familiar with Home and Community Care Support Services, regular contact with visiting nurses and case coordinators and knowing who to call in the event of a more complex issue or case makes this care efficient, effective and rewarding. A phone-a-friend may include a local community or hospital team as well as e-Consult.
Take Award Tidbits:
The Palliative Approach in Family Medicine:
- Identification (see May 2022 InfoMorsel)
- Illness Understanding (see August 2022 InfoMorsel)
- Whole-person Symptom Management
- Training (residency and continuing)
- Screening tools and bedside reference guides
- Collaboration with home and community resources
- Phone-a-friend for challenging cases
Links to Resources:
- Postgraduate Palliative Approach Competencies: https://www.cspcp.ca/wp-content/uploads/2019/09/Pall-Care-Competenices-Postgrad-FINAL-Sept-2019-EN.pdf
- ESAS Tool (common symptoms): https://www.cancercareontario.ca/sites/ccocancercare/files/assets/CCOESAS-English.pdf
- FICA Tool (spiritual assessment): https://gwish.smhs.gwu.edu/sites/g/files/zaskib1011/files/2022-06/FICA-Tool-PDF-ADA.pdf
- The Dignity Model (psychosocial assessment): https://www.dignityincare.ca/en/the-dignity-model.html
- Home and Community Care Support Services: https://healthcareathome.ca/home-care/palliative-care/
- Palliative Symptom Response Order Form: https://healthcareathome.ca/document/hnhb-palliative-symptom-response-order-form/ and Guideline https://healthcareathome.ca/document/hnhb-palliative-symptom-order-response-guideline/
- Pallium’s Palliative Pocketbook: https://www.pallium.ca/mobile-app-pocketbook/
- McMaster’s Palliative EZ Guide: https://palliativeezguide.ca/
- Division of Palliative Care: https://palliativecare.mcmaster.ca/education/continuing-education/
- Palliative Care Facilitated Access: https://hpcconnection.ca/wp-content/uploads/2014/03/PCFADeclaration.pdf