Family physicians supporting patients with palliative care needs within the Patient Medical Home in the community: An Appreciative Inquiry qualitative study
Authors: Tan Amy , Spice Ronald , Sinnarajah Aynharan 
Published: January 2021

Objectives

Canadians want to live and die in their home communities. Unfortunately, Canada has the highest proportion of deaths in acute care facilities as compared to other developed nations. This study aims to identify the essential components required to best support patients and families with palliative care needs in their communities to inform system changes and empower family physicians (FPs) in providing community-based palliative care for patients.

Design

Appreciative Inquiry (AI) methodology with individual interviews. Interview transcripts were analyzed iteratively for emerging themes and used to develop “possibility statements” to frame discussion in subsequent focus groups. A conceptual framework emerged to describe the “destiny” state as per AI methods.

Setting

Family physicians, palliative home care providers, patients and bereaved caregivers were recruited in the urban and surrounding rural health authority zones of Calgary, Canada.

Participants

9 females and 9 males FPs (range of practice years 2-42) in interviews; 8 bereaved caregivers, 1 patient, 26 Palliative Home Care team members in focus groups. Interviews and focus groups were recorded digitally and transcribed with consent.

Results

The identified themes that transcended all three groups created the foundation for the conceptual framework. Enhanced communication and fostering team relationships between all care providers with the focus on the patient and caregivers was the cornerstone concept. The family physician/patient relationship must be protected and encouraged by all care providers, while more system flexibility is needed to respond more effectively to patients. These concepts must exist in the context that patients and caregivers need more education regarding the benefits of palliative care, while increasing public discourse about mortality.

Conclusions

Key areas were identified for how the patient’s team can work together effectively to improve the patient and caregiver palliative care journey in the community with the cornerstone element of building on the trusting FP-patient longitudinal relationship.

Strengths and limitations of this study

This study uses Appreciative Inquiry qualitative methods to identify the essential components required to best support patients and families with palliative care needs in their communities.

Multiple perspectives recruited including: community-based family physicians, palliative home care clinicians, patients, and bereaved caregivers.

Analysis was focused on the family physicians’ interviews to derive “possibility statements” and used to frame the focus groups with the other groups of participants.

Generalisability may be limited due to the lack of diversity in participants recruited for the patients and bereaved caregivers in terms of ethnicity, age, and gender.

Patients and caregivers may have been reluctant to volunteer for this study as it involved discussing palliative care.