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.”

SON– Caregiver

“I don’t want to describe my illness journey over and over.”

HUSBAND– Caregiver

“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.”

FATHER– Caregiver

“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.

EXPERIENCE MAP

Creating a Palliative Care Experience Map

The CHCA used a multi-phased engagement process consisting of four main activities:

Workshops with regional expert stakeholders

During the summer of 2018, four invitational stakeholder workshops were held across the country to develop Palliative Care Experience Maps. The purpose of these workshops was to discuss and explore current operational procedures, policies and processes for home-based palliative care. Through facilitated dialogue, participants representing a range of stakeholder organizations provided feedback on what is taking place currently as well as identifying potential solutions or innovations.

Key Informant Interviews

Cultural groups: Through direct contact, representatives from a range of cultural, religious and LGBTQ organizations were invited to participate in one-on-one interviews to provide insights into barriers and considerations for delivering culturally respectful home-based palliative care.
Patients and caregivers: A flexible approach was used to capture the voice of patients and their caregivers to accommodate their needs and circumstances. The CHCA scheduled telephone interviews and conducted an online survey to identify areas of improvement and innovative practices specific to home-based palliative care.

E-Delphi Validation

Based on the input from the workshops, interviews and online survey, an E-Delphi process was undertaken with a group of experts to validate and prioritize the key areas of improvement. Experts included all participants from the four regional workshops, representatives of leading home care provider organizations, relevant non-governmental organizations, and government agencies. Interested caregivers from the engagement phase were also invited to participate. The results of the e-Delphi were used to finalize the Palliative Care Experience Maps which highlight priorities for leading practices and will help to inform policies, programs and practices.

HOME CARE IN CANADA – Home care is an array of services for people of all ages, provided in the home and community setting, that encompasses health promotion and teaching, curative intervention, end-of-life care, rehabilitation, support and maintenance, social adaptation and integration and support for caregivers. Provincial, territorial and federally funded home care services are administered by care coordinators or case managers and delivered by regulated health care professionals as well as non-regulated health care workers (e.g. home support, personal care attendants).

LES SOINS À DOMICILE AU CANADA – Les soins à domicile consistent en un éventail de services destinés à des personnes de tous âges et administrés en milieu résidentiel et communautaire qui incluent la promotion et l’éducation en matière de santé, les interventions curatives, les soins de fin de vie, la réhabilitation, le soutien et l’entretien, l’adaptation et l’intégration sociale, ainsi que le soutien aux aidants. Les services de soins à domicile financés par les gouvernements provinciaux, territoriaux et fédéraux sont administrés par des coordonnateurs de soins ou des gestionnaires de cas et fournis par des membres d’une profession de la santé réglementée et des travailleurs de la santé non réglementés (travailleurs en soutien à domicile, préposés aux soins personnels, etc.).