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Regional Clinical Programs Coordinator Report
A Strategic Planning Workshop was held on February 23, 2000, to establish future direction of the Regional Pain and Symptom Management (PSM) Consultation Program. The workshop was attended by the Regional and Neighbourhood PSM Team members, Community Care Access Centre and nursing agencies contracted by the CCAC, representatives from long term care facilities and PCSYR staff. The purpose of the workshop was to review a broad range of issues specific to the organization and the Regional PSM Program and those specific to the provision and delivery of palliative care services in York Region; to identify key priorities, next steps and to develop a plan of action.
The key priorities identified were to:
- Develop a Communication Strategy encompassing awareness, education and information components targeting health care professionals, service providers and the community-at-large through a broad range of communication and education initiatives.
- Review the Regional Pain and Symptom Management Consultation model focusing on services provided, community needs, improved utilization of Regional and Neighbourhood team members, and funding sources.
- Increase physician support by increasing education opportunities for family physicians, enhance communication strategies to physicians and improve physician reimbursement.
- Rebuild registered nurse palliative care expertise, particularly pain control and symptom management.
Next Steps included:
There was consensus among participants that a comprehensive communications strategy should be developed and implemented. Its objective would be to raise awareness of palliative care and the services available in the community and to position the PSM Program, particularly among health care providers, as the nucleus for palliative care in York Region. Strengthening the partnership with the Community Care Access Centre was seen as a critical factor in the process.
Discussion ensued regarding the Regional Pain and Symptom Management Consultation Programs role in a coordinated approach to the provision and delivery of palliative care services and its impact on the quality of care at the end-of-life for the residents of York Region. A clear priority for the PSM Program is the need to increase physician awareness and support of the program. Interaction between physicians and nurses was identified as a "stumbling block", yet key to a coordinated, team approach to palliative care services. Four factors cited as critical to the effectiveness of the Program are visibility, credibility, accessibility and secure funding.
Considerable discussion was devoted to physician reimbursement for palliative care services under the provincial health program or lack of the same. Lack of financial resources in this regard is seen as a major hurdle to future physician support to the program. Without action on this issue there is likely to be no change in physician attitudes or level of service.
Developing more of a "team approach" to increase the level of expertise in palliative care among physicians and registered nurses was discussed extensively. An audit of existing education programs for nurses and physicians was recommended, together with the need to advance a Mentorship Program for both nurses and physicians. The need to "rebuild" palliative care expertise among Registered Nurses and the urgent need to fund and recruit a Nurse Clinician Consultant was identified as a priority.
Action Plan
Marketing Committee and staff will develop and implement a communication strategy to enhance awareness of the services of the Regional Pain and Symptom Management Consultation Program, Palliative Care Educational Programs and the Resource Library. The plan will be completed by December 2000 and will be implemented during 2001-2002.
On going and formal evaluations of the Regional PSM Consultation Program services, palliative care community needs and utilization of the program will be conducted over the next two years.
To advance physician and nurse palliative care competence - PCSYR will offer the EPEC Project - Education for Physicians on End-of-Life Care Program. This program is designed to educate all physicians and nurses and other multi disciplinary team members on the essential clinical competencies required to provide quality end-of life care. Dr. Nancy Merrow, a member of our Regional and North Neighbourhood PSM Team, has agreed to be a trainer of this workshop for PCSYR.
The New Ontario Trillium Foundation has provided funding to hire a Nurse Clinician Consultant to provide expert palliative care pain control and symptom management consultation services to clients/families, palliative care service providers and the residents and staff of long term care facilities. This position will start on October 2, 2000.
We are currently investigating alternative physician funding to support the consultations provided by the physicians on our Regional PSM Consultation Program.
We are very confident about the future of our Regional PSM Consultation Program and believe that a National strategy on palliative care will help organizations such as ours to provide the level of care that is an essential part of life for all individuals living with a life threatening illness.
Marsha Hardwick, R.N., B.Sc.N.
Regional Clinical Programs Coordinator
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