Home-Based Palliative Care
Building Operational Excellence
Effective Communication with a Broad Health Care Team
“I [caregiver] became the information hub. There was a lack of accountability for sharing information (between members of the team).”
SISTER – Caregiver
“We were in a panic every time she went [to Moncton] that something would happen. Even though the directive went with her, we worried.”
SON – Caregiver
“Communication between allied health and nursing wasn’t the best. Documentation was kept in separate charts because they were from different service providers.”
“I don’t want to describe my illness journey over and over.”
“Feedback on the individual’s health changes was slow. Their health was poor and seemed to jump to terminal very quickly. The families could hardly adjust to the sudden change.”
“When you are told the news you’re not thinking clearly; it’s overwhelming and hard to take in. And then the whole care changes and the people change, and the supports change and you don’t understand any of it.”
WIFE – Caregiver
“I have an information binder they gave me. If I need anything I can go back and check. It is important to have something to go back to afterwards. You forget. You worry.”
HUSBAND – Caregiver
“As a same-sex couple, I can say I felt respected and the relationship was valued for what it was. Just like every other couple in home care.”
PARTNER – Caregiver
“Our family was not included in the conversations between providers which led to poor communication and decisions that were not in line with needs or care we required.”
SON – Caregiver
Experiences in Effective Communication with a Broad Health Care Team
The CHCA reached out to caregivers, patients and palliative care providers to learn how effective communication is influencing care planning and delivery. We asked what is going well and what needs to be improved. We gathered all the feedback and suggestions and created an Experience Map to visually show where improvement is needed for home-based palliative care, so that everyone has their wishes heard, respected and acted upon.
A palliative approach to care focuses on meeting a person’s and family’s complete needs – physical, psychosocial and spiritual – at all stages of a chronic progressive illness. Care can be provided at any time, not just in the last days of life. There are many options to where palliative and end of life care can be provided, in the home, hospital, long-term care facility or free-standing hospice.
An important part of home-based palliative care is effective communication with all the members of a person’s health care team.
Most people receive home-based palliative from their family and friends. This care is supplemented by services from the health care team including: nurses, home support workers, doctors, palliative care specialists, therapists, social workers, and paramedics.
Home-based palliative care requires effective and efficient communication, decision-making and care coordination. Service providers much consider several operational practices to ensure this happens. They include (but are not limited to): communication skills development; training in a patient-centered approach; practice-based interventions designed to improve interprofessional collaboration; electronic medical records; interdisciplinary team meetings; standardized documentation; and secure e-messaging.