End of Life Care Decisions in Focus

Most research on end-of-life care centers on patient decision making, improving communication between patients and clinical providers, and the development of advance directives to guide care. Very few researchers have examined the role transfer of information, from continuing care to the emergency department, plays and how patients’ end-of-life care choices are communicated in the process.

That’s where a team of SEARCH Classic participants (SEARCHers) comes in. A provincial project team from SEARCH V looked at issues in the communication of end-of-life care choices. Team members were: Rod Iwanow (Calgary Health Region), Adrian Panylyk (Edmonton EMS), Marie-Josée Paquin (Calgary Health Region & Alberta Cancer Board) and Carolyn Trumper (David Thompson Health Region). Their LOCATE project – Level Of Care And Transfer Of Information Effectiveness: Qualitative Analysis of Clinical Providers’ Experiences in End of Life Care Information Transfer – won the Outstanding Provincial Project Award at the 2007 SEARCH Canada conference and forum.

“Our team came together through a shared interest in an important clinical problem – ensuring the timely and appropriate transfer of information about end-of-life care decisions when patients are transported from continuing care facilities to emergency departments,” says Marie-Josée Paquin, leader, Clinical Special Projects at the Tom Baker Cancer Centre. “We all had direct experience with the issue and wanted to make a real difference to patient care.”

Project timing was perfect because it meshed with the work of the Calgary Health Region Care at the End of Life Initiative (CEOL) to replace multiple regional policies with a single policy on advance care planning. It will become the key regional tool to guide decision making about specific end-of-life care interventions for adults, including transfer to an acute care facility and life support interventions.

To support implementation of the new policy, the LOCATE project examined critical points, factors, and processes related to the current transfer of end-of-life care information between clinical providers and facilities. The team made recommendations for both clinical providers and decision makers in the regional healthcare system.

“We showed how inconsistent we can be with our communication tools,” notes Paquin. “At the end of the day, these are patients’ choices. We all need to be on the same page.

“Our project and the CEOL Initiative reflect a new paradigm in advance care planning. We’re moving from a situation where there was hardly any conversation about end-of-life care to a more formal communication process. This is often very difficult, we recognize this. But it is absolutely essential to have this information – and have it readily accessible. It is one of the keys to quality end-of-life care.”

Paquin notes that one of the exciting aspects of the LOCATE project is how well it has been received by various groups. LOCATE recommendations have informed the CEOL Initiative – the new policy will be implemented in the fall of 2008. The Tom Baker Cancer Centre has just begun a working group to align itself with the new policy. A partnership between the CEOL Initiative and the Health Quality Council of Alberta holds promise for province-wide changes.

“This is a real success story,” says Paquin. “We’ve gone above and beyond what we set out to do.”