Identifying individuals who could benefit from a palliative approach to their care using a multi-phase, consultative, iterative approach.

Abstract

Background: Access to a palliative approach to care improves the quality of life of individuals with a serious illness and their families. This paper describes the development of a decision-support tool that identifies individuals receiving home care and long-term care services who could potentially benefit from a palliative approach to their care based on information available in interRAI assessments used in those sectors as part of regular practice.

Methods: A consultative and iterative multi-phase approach was employed to develop the "Serious Illness Collaborative Action Plan" (or Serious Illness CAP), over an 18-month period. Criteria for triggering this CAP were established with 49 individuals across seven advisory groups; criteria were operationalized using items and measures available in interRAI instruments and tested using anonymized population-level data from home care (N = 568,586) and LTC (N = 35,713) sectors in three Canadian provinces were analyzed.

Results: The CAP is based on the presence of health instability and potentially modifiable exacerbating issues (i.e., severe/excruciating daily pain, moderate/severe mood problems, severe fatigue, self-reported loneliness or social isolation, and condition/disease that create instability in thinking, self-care, mood, or behaviour patterns). The CAP identifies three distinct groups: those at high priority for a palliative approach, those at moderate priority, and those who don't trigger the CAP. Among home care clients in Ontario, 42% triggered the CAP; 10% (n = 57,025) at a high priority, and 32% (n = 181,531) at a moderate priority. Within LTC homes in Nova Scotia and Saskatchewan, these equaled 12% (overall), 5.2% (n = 1,858 as high priority) and 6.8% (n = 2,411 as moderate priority).

Conclusions: The development of this new CAP will help support clinicians in home care and LTC settings to engage in conversations and promote awareness of the benefits of a palliative approach to care for individuals with serious or life-limiting illness and their families.