[img_inline align=”right” src=”http://padnws01.mcmaster.ca/images/Denise.jpg” caption=”Denise Marshall”]Primary health care providers, particularly family physicians, are the first line of contact for patients and families. They play a critical role in facilitating access to effective palliative care for dying patients in a community.

Yet, most family physicians in Canada have received little or no training in palliative care and they have repeatedly identified difficulty in accessing interdisciplinary resources to address the complex issues faced by both patients and families at the end-of-life.

A new Ministry of Health funded project, which began this past January, involving three local family practice offices in the Niagara West area, is aimed at improving access to effective palliative care for patients within these practices who are living in the community.

This pilot project builds on the innovative work of the West Lincoln Palliative Care Team (WLPCT), which has been providing care to palliative patients in Niagara West for seven years.

The three practices involved are Beamsville Medical Center, Family Medical Center (Smithville), and Medical Associates (Grimsby).

Upwards of 100 patients in these three practices may be identified this year as needing and benefiting not only from the basic support of the WLPCT, but also from the enhanced services that can now be offered through this new palliative care project.

“The need to reform the primary health care system's delivery of effective palliative care is urgent since the demand for palliative care will increase with an aging population and a rising prevalence of cancer,” said Denise Marshall, one of the principal investigators on the project and a professor of family medicine at the Michael G. DeGroote School of Medicine, McMaster University.

Through the enhanced project, patients will receive extra nursing help, home care supports, social work support, equipment and medication support, including round-the-clock care in the home if needed. Family physicians will receive customized practice-based education, clinical support, clinical tools and expert physician and nursing support, to enable them to provide even better care for patients in their practice who are nearing end of life and living in the community.

A key component of this project is the new Advanced Practice Nurse, specialized in palliative care, who works full-time in the community alongside patients, nursing staff, Community Care Access Centre (CCAC) and family physicians, to help coordinate the entire care plan. A skilled social and spiritual advisor is also added to the team for this project to attend to the specific emotional and spiritual needs of patients and families.

As director of McMaster's Deptartment of Family Medicine, Division of Palliative Care, Marshall says: “The majority of Canadians express a preference to be cared for and to die in their own homes. Effective palliative care that supports care and death at home is not only achievable but also highly desirable and cost-effective.”

However, Marshall says: “It requires the application of palliative care knowledge and skills by primary care physicians, combined with a specialist palliative care physician and an interdisciplinary team working collaboratively to address complex patient and family needs through the integration of services and care approaches.”

“This project will be a marvellous template for the Province to use as it extends its end of life care mandate across all communities. It builds on existing palliative care strengths, identifies gaps and implements effective, efficient solutions. Most of all it supports the patient and the family physician.”

The project will measure how well the enhanced palliative care program addressed the end-of-life care needs of patients and families, the added benefits for family physicians, and follows such issues as to whether there was a reduction in emergency department visits, number of hospital deaths and improved quality of life for patients.

This study is sponsored by: the Ontario Ministry of Health and Long Term Care, Primary Health Care Transition Fund. The project is lead by a research team in the Department of Family Medicine at McMaster, as part of the work of its Division of Palliative Care.