Building capacity for a palliative approach to care for people with chronic, life-limiting conditions in the primary care context

A growing number of Canadian adults are living with chronic, life-limiting conditions such as organ disease, neurological or cognitive impairment, and frailty that impact their quality of life and death. Most Canadians are likely to need palliative care due to chronic conditions but few receive it outside of hospitals, often in the final days or weeks of life, or not at all. Within the literature, a palliative approach to care is increasingly being recognized as an exemplary approach to patient-centred chronic care. A palliative approach blends chronic illness management and palliative care principles to address a person’s care needs early and throughout the trajectory of a chronic condition and has been associated with better quality of life and death. Best practices suggest primary care could be an exemplary environment where a palliative approach is integrated ‘upstream’ and then followed throughout the course of their condition. Despite the evidence showing considerable benefits, several barriers to integrating this type of care approach routinely into primary care remain. Interpretive Description was employed as the methodological framework to better understand how to overcome barriers and build greater capacity for a palliative approach to care in a primary care context for this population. Twenty-six individual interviews were conducted and inductively analyzed to generate new knowledge and practical insight from practitioners and stakeholders with expertise using a palliative approach in a variety of locations in British Columbia, Canada. Participants identified practice and system level changes that could help overcome existing barriers and inspire primary care providers to integrate a palliative approach into practice. Suggestions include a team or shared-care approach, peer mentorship and support, better utilization of primary care nurses and nurse practitioners, and a stronger investment at practice and system levels. Practice implications include a more precise understanding of a palliative approach to care, greater equity and consistency across provincial healthcare structures and supports, and replicating practice models that have been shown to work. Areas for further research include exploring barriers and facilitators to integrating a palliative approach from patient and caregiver perspectives and active engagement of nurses as knowledge users to enable change.

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