Objective Increasing numbers of Canadians living with complex, life-limiting conditions demand high-quality palliative care. Timely access to palliative care can help to reduce stress, improve quality of life, and provide relief for patients and their families. The purpose of this study is to explore the experiences of family physicians (FPs) regarding the decision and process of introducing palliative care to patients with chronic diseases. Methods Interpretive description methodology was used to guide the investigation of the research question. Thirteen Calgary Zone FPs participated in individual interviews. Data was collected iteratively and analyzed using constant comparative analysis. Results Analysis of interviews identified the overarching themes of dignity and empowerment, which describe the experience of FPs introducing palliative care to chronically ill patients. Four subthemes were woven throughout, including the art of conversation, therapeutic relationships, timing, and preparation of the patient and family. Discussion While the benefits of palliative conversations are widely accepted, a deeper understanding of how FPs can be supported in developing this aspect of their practice is needed. Understanding their experience provides knowledge that can serve as a framework for future education, mentorship, and competency development.
e24097 Background: Timely palliative care interventions can help to alleviate the distress people experience after a diagnosis of an incurable, life-threatening cancer. However, referrals to palliative care continue to be late due to various provider and patient barriers. The Palliative Care Early and Systematic (PaCES)-Automatic study was co-designed with patients and providers and implemented an early palliative care intervention for newly diagnosed stage IV non-small lung cancer (NSCLC). The objective of this study was to determine patient/caregiver-reported acceptability of a phone call from a supportive and palliative care (SPC) nurse offering consultation, automatically (without referral) after first oncologist appointment. Methods: Two SPC specialist nurses screened out-patient clinic lists at a tertiary cancer center weekly and called all eligible patients offering an in-home consultation. Eligibility: > 18 years, newly diagnosed/suspected Stage IV NSCLC and had first medical/radiation oncologist visit. Patients/caregivers were surveyed about the acceptability (5-point Likert scale) of the automatic phone call offering a palliative care consult, using Sekhon’s Framework of Acceptability domains. Results: Among the 113 patients screened, 81 patients/caregivers were contacted and offered SPC consultation and 72% accepted the in-home consult. Of 70 patients/caregivers that agreed to be contacted for the survey: 4 did not recall the call offering SPC, 3 declined participating in the survey, and 15 were not reached. Of 48 respondents, 93.6% rated overall acceptability of the automatic call offering SPC consultation somewhat/completely acceptable, with the other 6.4% rating it as neither acceptable nor unacceptable. Of 35 patients/caregivers that completed the full survey: 31% caregivers, 63% female, 57% ≤65 years, 29% ≤high school education, 67% (n = 27) < $60,000 household income, 80% spoke only English/French, and 71% Caucasian. Within the domains of acceptability, 94.7% were comfortable receiving the call, 91.9% understood why they received it; 86.5% thought the call was a valuable; 69.5% thought the call helped them; 65.7% learned about SPC from the call; no one expressed concern that the SPC nurse had access to their contact/health information; 97.2% thought the call didn’t take much physical/emotional effort and were confident in their ability to participate (ask questions/make decisions). Conclusions: Nearly all patients/caregivers found the automatic SPC call offering consultation to be acceptable. Most patients agreed to the consultation offer. Routine calls offering SPC consultation may be a timely alternative to awaiting conventional referral by oncologists.
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