March 2018

The Canadian Foundation for Healthcare Improvement (CHFI)’s EXTRA Training Program enabled four professionals from the CIUSSS du Saguenay-Lac-Saint-Jean to develop an innovative improvement project for palliative care (care and support services), which is already bearing fruit. The project, carried out by nurse clinicians working within Family Medicine Groups (FMGs), was intended to improve palliative care for people battling a potentially fatal disease, such as cancer.

“We all know the quality and effectiveness of palliative care, recognized as a comprehensive approach that considers all aspects of the person,” said Dr. Roberto Boudreault, physician and co-director of the project. “A literature review on the topic, as well as interviews with patients who were diagnosed with cancer, made us realize that palliative care is offered too late in the evolution of a pathology.”

“We wanted to explore the situation further through an improvement project, knowing that a person suffering from a potentially fatal disease, such as cancer, needs support much earlier,” said Isabelle Boulianne, co-director of the project. “This is how our project came into being.”

“When we started meeting with patients, one of our initial findings was that palliative care is associated with death and hopelessness,” said Nancy Houde, co-director of the project. “We decided to talk about care and support services because the term is more accurate and neutral.”

The project was conducted from November 2016 to May 2017. Eighteen patients benefitted from the care and support services provided by nurses from the FMG. They were trained to intervene appropriately with patients and were supervised by a team of nurse managers (Isabelle Boulianne, Nancy Houde, and Sylvie Massé) and Dr. Roberto Boudreault.

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(Left to right) Dr. Roberto Boudreault, Nancy Houde, Isabelle Boulianne and Sylvie Massé, all responsible for the improvement project.

“While we were building the project, we considered lessons learned from the EXTRA Program, namely that it is better to keep projects small and implement them quickly, with the goal of continuous improvement,” added Boulianne. “This is why we began with a single FMG, hoping to extend the service to others.”

“To launch the project properly, we took the time to consult our patients to learn what kind of care and support they wanted to receive,” continued Massé. “We spoke with ten people and their families. This is probably why we obtained such a high success rate. Their experiential knowledge was indispensable in preparing the project.”

The support provided to the patients varied greatly as it was based entirely on their needs. Care was offered for mental and physical health, such as anxiety caused by the reactions of family and friends, their financial situation, and more.

“After five months, we carried out an evaluation and the reaction of the patients was unanimous: the service was greatly appreciated,” recalled Houde. “The satisfaction rate of participating patients and families was 100 per cent.”

According to the patients, care and support services directly contributed to improving their quality of life.

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Andréanne Lebel is a clinical nurse at GMF les Myrtilles du Lac.

“The accompanying nurse doesn’t do everything,” said Massé. “Depending on the situation, the nurse can request other resources from the FMG for their patient. However, the nurse is always accessible to the patient and in communication with the physician. In fact, nurses within the FMG were available by phone almost every day, from 8:00 a.m. to 8:00 p.m.”

In June 2017, the team won CHFI’s Palliative and End-of-Life Care Innovation Award for their project, which took into account the literature, patient experience, and exemplary practices required to create an optimal front-line care model for patients recently diagnosed with cancer.

“We are now working to make the project sustainable and extend it throughout the thirteen FMGs in our region,” added Boulianne. The group has already been awarded the “Pour mieux soigner” $225,000 grant from the Ordre des infirmières et infirmiers du Québec (OIIQ) Foundation to extend their services and evaluate them with researchers.

CFHI's EXTRA approach is unique. In addition to offering training, it also encourages partnerships between teams across Canada and encourages experts, faculty members, and coaches to face concrete challenges in our healthcare system.

Sylvie Massé, Isabelle Boulianne, Nancy Houde, and Dr. Roberto Boudreault were Fellows of the 2016-2017 EXTRA Program.

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Andréanne Lebel, clinical nurse and Cathie Perron, clinical nurse and health advisor.