What have you learned about in terms of how you get buy-in from family physicians ?

Helen Pyle – Lead Physician Ian Anderson House, Oakville, ON:

I offer to do consults with a family physician to help them to understand the patients’ needs and what services are available and how to access them. I also make myself available by phone for advice about medications, treatment options and pumps. Some family doctors will look after their own patients and do a great job. Some need a lot of help. Some have no interest in dealing with patients at end of life and will not provide the types of support that’s needed for such a high needs group. I would suggest to family doctors in our area that if they have a knowledgeable palliative nurse that they should consider listening to his/her recommendations. The nurses on our team who deal with pain and symptom management problems every day can often guide them through the forest. But we also have APN and a nurse consultant whom the family doctors can call for help in caring for their patient. I would encourage all family doctors to stay involved in some way, until the end. When they do, they find it very rewarding for themselves. From the team’s perspective, family doctors often have a wealth of information about the patient and the family which is invaluable.

Palliative Nurse Practitioner:

Niagara North: I learned communication is the key. We fax our notes and orders. Family physicians see that the care provided by the team is very comprehensive and timely. I think there is a fear that, as the family physician, they will be left holding the bag should a patient get sick on the Friday afternoon of a long weekend. We maintain a shared care model. We anticipate and plan for potential outcomes/events and have tools in place at the bedside. We make good use of technology to stay in touch with the community nurses. We do what we say we are going to do.

Clinical Navigator – Niagara North: Physicians are very welcoming to have our team involved in the Palliative Care of their patients. They often will stop in, call or include a small note on the consent forms thanking the team.

Health Care Professional:

Central LHIN: We have found that the family physicians who are involved have a strong interest in palliative care. We provide 24/7 support as well as information and education as they begin to work with the palliative population.

Cheryl Moore, Director, Stedman Hospice: 

Going back 18 years, one by one doctors we worked with saw how well the team worked and wanted to get involved in the community. Currently we use a shared care model from Mon-Fri 9-4 and then take over primary care for after hours and on weekends.

Denise Marshall, Chair of Ontario’s Collaborative Palliative Care Clinical Council: 

Getting the physicians talking, and telling us what they need – or what they would like to see in a palliative care team. Allowing them that time and listening to their needs ensures that they have buy-in.

Health Care Professional: 

We started off with some areas with no palliative physicians and no family physicians providing palliative care. It has been a gradual evolution. With the community expert nursing team up and going, knowing that there is this 24/7 service in place has enticed some family physicians, particularly young physicians to the table and to remain involved with their patients, even after they have been identified as palliative. We also took the time to market the team heavily. We went out to different family practice groups and family health teams and provided presentations and offered our consultants to work collaboratively with them. There is still a lot of resistance but we’ve capitalized on the family physicians that have shown interest in trying to make referrals to them and also leveraged the support of palliative care physicians from other areas.

Health Care Professional: 

There are times I think that we take over care from a family physician, and that this is at a disadvantage to the patient who was comfortable with their family doctor. By taking over primary care patients think they are abandoning their family physician by having care being provided by the team. I am not sure if the family physicians don’t have the skills, or aren’t comfortable prescribing opioids, don’t do home visits or just assume that someone can do better by the patient, but they typically aren’t involved once we take over. We continue to provide fabulous care but there is a strain on resources because we just can’t face the growing population and growing needs in the community. Perhaps there needs to be a shift in thinking that the team is available for consultation and education and works as a collaborative part of the continuum of care and only takes over primary care in very special cases.