Palliative Care as a Team Sport: Training Builds Alliances in Rural Ontario

The Petawawa Centennial Family Health Centre cares for 8,000 patients in the rural community near Ottawa. Dr. Declan Rowan is one of six doctors providing comprehensive medical care—including palliative care—to patients. Until recently, a retired family doctor had been offering palliative care in the region. She became an invaluable go-to resource for end-of-life care. But when she retired, family doctors in the region realized their palliative care expertise had declined and they needed to update their skills promptly.

In fact, many doctors at the health centre felt uncomfortable delivering palliative care, some claiming they didn’t provide it. Dr. Rowan notes that, in fact they were delivering palliative care—they just didn’t realize it because like so many health care professionals, they thought palliative care was synonymous with end-of-life care.

One of the key challenges the health centre faced was finding consistent coverage for palliative care patients when their doctors would be away from their practice. Furthermore, there were no formal protocols in place for communication between physicians and home care nurses, resulting in a disconnect that made it difficult to provide comprehensive care to patients.

The health centre team realized they had to be deliberate about addressing both the knowledge deficit as well as how palliative care was delivered. “We wanted to close the knowledge gap and have a common language,” says Dr. Rowan. “This would ensure that doctors and nurses are speaking the same language when talking to patients and help provide a consistent level of care.”

When the health centre was selected as a rural site for the INTEGRATE Quality Improvement Project, they were afforded the opportunity to offer Pallium’s LEAP™ Core training. The entire team—including the health centre’s Executive Director—took part in the training, as well as their partners in the home care sector. As the facilitator worked through the modules, individuals would bring up different challenges they experienced, and the group would work together to solve problems.

The training covers a great deal of content, and begins with an in-depth conversation about the learners’ own perspective on death. Discussing how learners feel about death and their own experiences uncovers personal discomforts, fears and challenges. Dr. Rowan remarked that he cannot think of any other course he has taken that begins by looking at the personal impact on a family doctor, and how that affects how they think about and deliver care. As well, the LEAP™ Core training dedicated a significant amount of time on developing communication skills and team building across disciplines and organizations. “Yes, we learned the core skills,” says Dr. Rowan. “But we also learned how to communicate effectively.”

Feedback from the training was overwhelmingly positive. Dr. Rowan reports that palliative care skills improved for all participants and that his team was impressed with the knowledge they had gained and their new-found confidence in caring for patients who could benefit from a palliative care approach.

After the training, the health centre team felt more comfortable caring for palliative care patients. They now had a common approach to managing and documenting care, as well as consistent protocols for when to involve home care professionals. Now, family doctors in this family health centre approach palliative care as an integral part of their practice. They take on new palliative care patients without hesitation and the entire staff is confident in their abilities to support them. “It’s become less stressful,” says Dr. Rowan. “It used to be that we thought palliative care required a special set of skills that we didn’t have.”

The training also led to the development of local partnerships. “LEAP™ Core training was the pebble in the pond,” says Dr. Rowan. “The ripple effect has been quite interesting.” The team worked with the Pembroke Hospital on an early intervention project, and they educated local residents on palliative care. They also collaborated with other family practices in the region to develop a primary care network that ensures all patients who could benefit from a palliative care approach get the care they need, when they need it.

The Petawawa Centennial Family Health Centre was fortunate enough to have received funding by the INTEGRATE Quality Improvement Project to offer LEAP™ Core training to its team and partners. Dr. Rowan believes the training was invaluable. “Some people think we need more palliative care specialists, but the vast majority of care can be handled by family doctors,” says Dr. Rowan. “LEAP Core training gives one the confidence and competence to provide excellent palliative care for your patients.”

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.

For more information on LEAP™ courseware, visit Our Courses page.