Implanted intrathecal infusion devices are a necessary part of a tertiary level cancer pain management service for the unfortunate minority with intractable pain. Practical recommendations for care are made for palliative care programs contemplating offering intrathecal infusions.
The Serious Illness Conversation Guide (SICG) has been shown to be an effective communication tool used by health care professionals when interacting with patients facing a life-limiting illness. However, Ariadne Labs, the originators of the tool, have not tested it with First Nations and Indigenous Peoples. In this project, the British Columbia Centre for Palliative Care and the First Nations Health Authority in British Columbia (BC), Canada collaborated to adapt the SICG to be more culturally safe for First Nations and Indigenous Peoples. Multiple feedback strategies were employed. Feedback was received from 35 older adults, Elders, and community members from two First Nations communities plus approximately 80 nurses serving in First Nations communities across BC. Key areas of focus for feedback on the clinical tool included setting up the conversation, involving family, closing the conversation, and using principles of health literacy to reduce power differences. Three questions were added in response to feedback received. By creating a safe space for dialogue, it is hoped that health care providers and family members will develop a deeper understanding of what is important to the person with a life-limiting illness. These conversations promote patient-centred health care that aligns with patient values and wishes. Findings from this project directly informed modification of the tool to support a more culturally safe conversation. Further research will inform whether this tool is culturally safe for all seriously ill people.
Communication is vital to quality palliative care nursing particularly when caring for someone with a chronic life-limiting illness and their family. Conversations about future decline and preferred care are considered challenging and difficult and are often avoided, resulting in missed opportunities for improving care. To support more, earlier, better conversations, health care organizations in British Columbia, Canada, adopted the Serious Illness Care Program inclusive of the Serious Illness Conversation Guide developed by Ariadne Labs. Workshops for interprofessional team members have been held throughout the province. Nurses and allied health identified the need for more guidance in using the guide in the contexts of their clinical practice. Specifically challenging has been prognosis communication that falls within the scope of practice for each profession. Informed by workshop feedback, an expert team of nurse clinicians and educators tailored an interprofessional clinician reference guide to optimize the guide's use across health care settings. In this article, we present the adaptations focusing on (1) the role of nurses and allied health in serious illness communication, (2) prognosis communication, and (3) a range of role-play scenarios specific to nonphysician practice for serious illness conversations that may arise within the process of care.
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