In the last year, 2800 Canadians died from opioid related causes and 16 Canadians are hospitalized each day. – CIHI Opioid Related Harms in Canada.
The opioid crisis has been a growing part of our public consciousness with the media, (both national and local) governments and health care institutions profiling and addressing the immeasurable suffering and loss it has caused to so many in our communities. The impact of this crisis is not limited to individuals using opioids but includes their families, caregivers and extends to their healthcare providers. For some family physicians the lack of supportive spaces to address their fears and anxieties about the crisis has led to a loss of focus on compassionate care at a time when their patients need it the most.
“My opioids work for my pain. I don’t think my family doctor hears me, he keeps bringing up reducing how much I am taking. I am afraid of what he might do, I don’t know what I would do without my pills. I hear what he is saying about this crisis but I use it as he has told me and only for pain.” – Anonymous Patient
“I am struggling to understand what is expected of me when it comes to using opioids for my patients. I see the reports about the opioid crisis and am worried that I am going to get into trouble for prescribing them inappropriately. At the same time I am also worried about how I am going to face my patients if I no longer agree to treat them with opioids.” – Anonymous Physician
With the pressing and public need to address the opioid crisis, many family physicians have fears and anxieties in making clinical decisions that balance safety, patients’ needs and values, regulatory expectations and shifting clinical perspectives on opioids (e.g. guidelines). Unfortunately, these growing pressures have resulted in difficult interactions between patients and clinicians leading to increasing stigma and a fracturing of the therapeutic relationship. As a result, for some patients, this has led to a loss of access to their primary care provider and a desperate turn to illicit opioid sources to relieve their pain and suffering. Sadly this further increases their risk for overdoses and possibly death.
The loss of a focus on compassion when interacting with complex patients has served to compound the opioid crisis and the associated suffering. This begs the question of what can be done to support a renewed focus on compassion in the face of these challenging interactions? Perhaps an answer to this question lies in the idea that compassionate environments for providers can support compassionate care for patients.
Inspired by this concept, my work as an AMS Phoenix Fellow will study a mentoring network for family physicians that uses compassionate spaces to build primary care capacity in caring for patients with mental illnesses, addictions and chronic pain. Over the last 10 years The Ontario College of Family Physicians, with funding from the Ontario Ministry of Health and Long-Term Care, have developed and refined a mentorship model for family physicians. The Collaborative Mentoring Networks (CMN) connects family physicians across Ontario (a mentee) with mentors that have a clinical expertise in mental health, addictions or chronic pain that are practicing near the mentee.
The mentor and mentee interact mostly through email and a secure online forum, and also connect in person and by phone. These interactions mainly focus on the translation of knowledge around medications and guidelines. However there is also a focus on dialogue to address the fears and anxieties of family physicians, creating a compassionate space for these sensitive conversations. Family physicians in these networks report an increased sense of safety, knowledge, competence and confidence in working with patients in clinically complex spaces. Ultimately, the goal is to support family physicians to sustain their role as the primary care provider for patients with mental health, pain and addictions issues who need access to continuity of care in a therapeutic relationship.
A key premise of this work is that the compassionate spaces found in mentoring networks (particularly electronic spaces) can help providers to focus on compassionate care for patients. The proposed work will look to develop insights from the participants in the CMN on what elements of these networks support a focus on compassion and to also understand what compassionate care looks like from the patient perspective.
Once gathered, these insights will be used to strengthen elements in the mentoring networks and shared with continuing professional development partners to incorporate in their offerings. Finally, these insights will inform the CMN’s advocacy work with provincial policy implementation partners as we work together to address the suffering that our communities are facing in the opioid crisis.
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