Whole Community Palliative Rounds
This award was formally named “Coping with End of Life”. Our Excellence in Quality category names changed in 2020 to reflect the updates to our BC Health Quality Matrix. Visit our Categories and Criteria page to find out more.
Palliative and end-of-life care is complex due to the unique, changing and increasing care needs of individuals living with advancing life-limiting illness. Addressing symptom burden requires highly effective communication and an interprofessional, holistic and clinical problem-solving approach between members of the person’s care team. Interior Health’s regional Palliative and End-of-Life Care (PEOLC) team has developed a system called Whole Community Palliative Rounds (WCPR): an innovative, inclusive approach to supporting shared clinical problem-solving, decision-making and communication within an expanded interprofessional care team.
A refined and extended circle of care was the first step to improved care collaboration. Supported by language within BC’s privacy legislation (FIPPA and PIPA), any person who is covered under these acts and actively contributes to a plan of care can do so through implied consent. This has opened the door to improved cross-sector and cross-program discussions among health professionals as well as external partners such as community paramedics and pharmacists, spiritual care providers, hospice volunteers and First Nations Health Authority or band-employed care providers.
Allocating resources within Interior Health is challenging due to its region’s vast geography, low population density and large aging population. In order to support equitable access to secondary palliative consultation, the regional PEOLC team designed a purposeful rural strategy harnessing the backbone of care delivery: primary care. Through WCPR, primary generalist providers can offer palliative and end-of-life care closer to home, while benefiting from access to specialized knowledge, skills and support through the broadened circle of care within the WCPR team and further consultation with specialized palliative services as needed.
There are currently 10 WCPR teams supporting 40 communities in a wide-reaching hub-and-spoke model. WCPR teams meet weekly to discuss presenting physical, psychosocial and spiritual symptom burden and distress reported by the individual and family. In this short one-hour meeting, team members engage in clinical problem-solving, discuss immediate care needs and support each other. A “next-steps” communication plan for relevant team and professional colleagues is then coordinated.
The team is evaluating the outcomes of their collaborative model of care. Initial evaluation was conducted in partnership with the Kootenay Boundary Division of Family Practice through surveys of care providers in September 2018 and March 2019. By March, providers reported their sense of support in delivering palliative care had risen from 27% to 58%. Communication scores of “good” rose from 38% to 83%, and teamwork scores of “good” and “very good” rose from 50% all the way to 92%.
Initial results support that, in the Kootenay Boundary region, WCPR communities have become safe places for exploring clinical situations, as team members share experiences, ask questions and learn together. Interior Health is now looking to evaluate all 10 hubs and their spokes by engaging in quality improvement activities that measure team growth and process/outcome measures.
WCPR is all about building strong interprofessional relationships and increasing the capacity of local teams to provide the best possible palliative and end-of-life care while also caring for each other. Together, internal and external providers support each other to provide consistently high-quality, person-centred palliative and end-of-life care for everyone living with advancing illness in BC’s Interior.