The Bruyère Academic Family Health Team (FHT) employs about 100 staff, including physicians, nurse practitioners, social workers, pharmacists, clerks and administrative professionals and more. As well, the FHT has a robust academic arm that trains residents early in their careers. Together the Bruyère FHT staff provides comprehensive health care to over 17,000 patients in the Ottawa region.
But when it came to delivering palliative care, the FHT ran into a number of challenges.
First, there was a tremendous amount of variability of knowledge among team members. Some nurses were uncomfortable with palliative care, whereas one nurse had 10 years of previous experience in a palliative care ward. The physicians and other providers also had various levels of familiarity in the area. While administrative staff and clerks didn’t have any medical training, some were able to draw upon personal experience with family members. Because of the variability of experience within the team, they lacked a common language to discuss palliative care effectively across different roles.
The FHT leadership—including Medical Director Dr. Jay Mercer and Executive Director Deborah McGregor—considered offering palliative care training to the entire team. “Dr. José Pereira planted the seed about LEAP Core training,” says Dr. Mercer. He liked that the program was designed to reflect the complexities of primary care delivery. “Pallium understands my world,” says Dr. Mercer. “There’s never enough time, we’re low on resources and you don’t always have all the information.”
After consulting with the FHT management committee, Dr. Mercer and Ms. McGregor decided to offer LEAP to the entire team. “You have to train the way you function,” says Dr. Mercer. “We do everything as a team, so we train as a team.” He says they encountered some resistance to the idea. The clerks and administrative staff thought it was too advanced and technical for them, while some of the physicians argued they already knew how to provide end of life care. Some of the staff didn’t want anything to do with palliative care.
The FHT closed for two days over two months so that the entire team could take the LEAP Core training. While some would argue this is a costly endeavour, Dr. Mercer saw value in the investment. Now, when patients who could benefit from a palliative care approach come to the FHT, they are surrounded by staff who have all trained together and have become an intuitive team that communicates effectively and provides better—and more consistent—care to patients and their caregivers.
One of the key benefits of this training is that all members of the FHT’s staff play a larger part in delivering patient care. A nurse can look at a patient’s chart and see that a physician wrote a new prescription. They can then follow up with the pharmacy and make sure the prescription is filled. All of this can be done without consulting the physician who wrote the prescription. “The training reduces bottlenecks and makes it possible for more health care professionals to deliver palliative care,” says Dr. Mercer. “Many knowledgeable hands make light work.”
As well as increasing practical knowledge, the LEAP Core training also gave the entire staff a common language for discussing palliative care internally—and for explaining it to patients and caregivers. Now, all FHT staff understand the dying process. They can explain, for example, that a patient’s lack of appetite is normal. “It can become a tug of war where caregivers try to get the patient to eat but the patient isn’t hungry,” says Dr. Mercer. “LEAP explains this is part of dying. If they don’t want to eat, it’s okay.” Educating patients and caregivers in a consistent manner reduces stress and improves quality of life for the patient.
The common language went beyond explaining concepts and fueled a deeper understanding of what was required to deliver palliative care. “It’s also about logistics,” says Dr. Mercer. “If I have the drugs in stock but not the equipment I need to administer them, I can’t do my job.” After taking the LEAP Core training, the FHT staff has a better understanding of the supplies and logistics the medical team needs to deliver care efficiently and effectively.
Although clerks and administrative staff initially wondered why they were included in the training, the experience has made them stronger in their roles. Before LEAP Core, a caregiver might call on a Friday afternoon asking for a refill of medication for a patient’s nausea. The admin who took the call would not have understood how important this was. Now that they have taken the training, the admins are familiar with drug names and what they do. They know they need to ask the patient’s physician to send a new prescription, so the patient doesn’t run out of medication over the weekend. And that could prevent a patient needing to visit the emergency room.
“The training did exactly what I expected,” says Dr. Mercer. “It moved everyone up to a higher level in their discipline and made them more willing to do—and teach—palliative care.”
The Learning Essential Approaches to Palliative Care (LEAP) Core training is a two-day course for health care professionals who care for patients with life-limiting illnesses, but whose primary focus is not palliative care. Certified by the College of Family Physicians of Canada for up to 28 Mainpro+ credits, LEAP Core was developed and peer-reviewed by a volunteer, pan-Canadian team of subject matter experts who are committed to promoting the palliative care approach. Participants learn the essential skills and competencies of the palliative care approach while building strong teams and fostering collaboration among providers in different agencies who work together.