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

Abstract

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.