Collaborative Palliative Care Planning
What is Collaborative Palliative Care Planning (CPCP)?
CPCP is a weekly inter-professional forum, which can support an individual/caregiver(s) presenting with difficult physical/psychosocial/spiritual symptoms. The CPCP makes recommendations on a consultative/collaborative basis using a palliative approach.
The Inter-professional Team
- Regional Palliative Care Coordinator
- Palliative Care Physician Specialist
- Palliative Care Nurses
- Social Worker, Community Services
- Palliative Care Social Worker
- Home Care Case Coordinator(s)
- Senior’s Mental Health Worker
- Home Care Nursing Supervisor
- Client Services Manager, Rehabilitation Services
*Ad hoc members may be invited to participate as appropriate to the consultation request.
Who is CPCP for?
Any professional service provider including but not limited to: Physicians, Nurse Practitioners, Social Workers, Nurses, Home Care Case Coordinators, Home Care Direct Service Nurses, and Client Service Managers may request a consultation. Individuals may reside in long-term care, the community or an acute care setting.
Patients who could benefit from an inter-professional review are those whose care needs are ongoing and challenging and whose goals of care are comfort focused. This could be an early introduction of palliative care or simply an interdisciplinary consult.
Examples of possible cases may include but is not limited:
- End stage organ disease
- Neurological disease
- Cancer patients no longer receiving active curative treatment whose symptoms are complex and difficult to manage
- Patients whose care is demanding and/or difficult and whose family/care circle is struggling and frustrated
- Patients with dementia whose symptoms are difficult to assess and thereby, difficult to treat
- Service providers that are unfamiliar with patient’s cultural practices which differ from western medicine
- Patients with unmet psychosocial needs affecting their physical needs
- Situations of moral/ethical distress
When and Where is CPCP?
The weekly forum will take place every Thursday from 0900 am to 1030 am over teleconference.
Why Access CPCP?
The CPCP is:
- Patient-Centric – service providers work together for the patient to access the right care are the right time.
- Sustainable & efficient – a “one stop shop” for multiple providers to discuss the same case at the same time
- Simple & Clear – recommendations are made by the team during the consultative call which streamlines layers to deliver appropriate care
- Equitable and accessible to any area of region as consultation is conducted over the phone.
- Integrated & effective – increases collaboration and integration between care providers across the region.
How to Access CPCP?
Service providers must complete a CPCP Consultation Request Form by noon on Tuesday in order for the consultation to be reviewed on the Thursday morning of the same week. Otherwise, requests will be carried over to the following Thursday.
The service provider who made the request for consultation will receive, by Wednesday afternoon, the necessary information (time and phone number to call) to present the case on Thursday morning. The service provider(s) will disconnect from the call after the case has been reviewed.
A period of 10-20 minutes will be assigned to review each case, depending on the complexity.
For more information, please contact Brigitte Remillard, Regional Palliative Care Coordinator at 204-346-7063 or .