A Framework for Palliative Care

Deep concern that MAiD has been introduced to palliative care centres, adding a dimension of stress to already stressed patients.

MAiD SERVICE IN PALLIATIVE CARE

Protect the right to palliative care

In an overburdened health care system the prospect of the cost saving of lives ended through euthanasia can easily become a juggernaut causing a commensurate loss of palliative care services. I never want the day to come when I feel that I must end my life to avoid unconscionable suffering, but I fear that day is well on its way already.

Empower Hospices as hubs for Compassionate Communities in PC.

Patients, families, and HCPs could reach out to hospice if they want to connect with (or offer) a particular resource.

Create networks, forums or communities of practice to support healthcare providers

Empower HCPs so that they can in turn better support individuals with life-limiting disease. Encourage conversations between professionals to get them talking more about palliative care and create networks within the different professions so that HCPs know where to turn to best support their patients/clients.

Religious People Have Access to Morally Acceptable Care (according to their religion) and their Spiritual Communities

Standardize palliative care competencies

Standard framework to guide education across professions. This could (and should!) be incorporated into the standard training programs for all health professionals, so that all providers have at least a basic entry-to-practice understanding (so that even if they don't feel comfortable providing direct care themselves, they can recognize when and how to refer to a skilled palliative care team).

Music therapy

A necessary component to transition from life, for bereavement, for memorials, for family support, for staff health

Systemic Change in Educational Institutions and Licencing bodies

Palliative Care needs to be a part of core curriculum in all health care fields. Palliative care, Death, End of Life Care will touch every single area of health care; thus does it not make sense that it is a core curriculum component in both the theoretical underpinnings of palliative care but also the practical application? We need to hold the education system accountable in curriculum development and delivery to educate on palliative care. We need to hold regulatory bodies accountable to ensure that health care providers have competencies in palliative care to ensure when they are licencing people to practice that there is an expectation that they have a knowledge base and skill set that meets good and basic palliative care competencies.

Palliative Care and Medical Assistance in Dying

With the new Medical Assistance in Dying legislation that has been enacted, it is important that people know about their options. With the legislation allowing health care providers to opt out of providing this assistance, there is a requirement for them to complete a successful referral to a practitioner that will respectfully assist the individual with this. I believe that Medical Assistance in Dying should be desensitized and incorporated into Palliative Care information for individuals.

Ensure that provinces are funding enhanced training in PC for both family physicians and specialists.

Physicians focused in palliative care will set and improve standards in PC, and act as resources to support all HCPs involved with PC. Two-year training for palliative medicine through the Royal College is new, and there is a lack of clarity for how residents will be funded across all provinces. Funding an extra year of training for family physicians remains vital. Funding for this training should be open to those graduating from core residency, and to physicians that wish to return from practice.

military members and their family members

Form strategic alliances with special interest groups that already service these populations

train service providers in cultural competency for LGBTQ2 individuals

Work directly with these communities/special populations to let them identify their specific needs

There is no better resource than people from special populations communicating their past experiences, identifying things that they appreciated and things that didn't work for them.

Palliative Care Canada Wide to be close to family

While my situation is dealing with an elderly mother with dementia in Nova Scotia, it had me discover a serious flaw in the system regarding continuity of care. When someone is terminally ill and moves provinces to be closer to family they lose their access to palliative care (in my mother's case home care) and must re-qualify all over again (3 month wait for provincial health insurance, and then more waiting to arrange services). This is sinful. When someone is dying and both wants and needs to be close to family they should not lose access to services by simply moving provinces. Are we one country or not? The current policy certainly does not reflect Canadian Values nor a proper use of our tax dollars. There should be an interprovincial billing process to ensure continuity of care. This should not be a difficult fix. The same rules should apply for families who are attempting to provide support for the elderly who are still living in their home and are on an excessively long list for a nursing home. Moving my mother to my province of Ontario to live with me from Nova Scotia would have her lose all her current home care including VON visits and any support that was provided to the family. She would also have to re-apply for services once receiving an OHIP card (3 month wait) and re-qualify her eligibility for a nursing home and end up at the back of the line. With the volume of both ill and elderly people in the hospital system, this country needs family supporting their elderly parents and dying loved ones as best as possible. Please do not make this so difficult for us. Rectifying this issue is beneficial for both the health care system and all involved.

Other options to be considered other than palliative

The availability of medically assisted dying to those who have chosen this as an option. Dignity in death should be more readily considered. Some prefer palliative, others the former.

Incentivize family and palliative care physicians to maintain 24/7 PC on-call groups.

MD coverage after hours is essential, in addition to other resources, to ensure patients can remain in the preferred place of care as long as possible. Providing 24/7 on-call coverage is a large ask of physicians. There must be adequate support in place to incentivize it and bolster team coverage.

Some pharmacies required to provide after-hours access for urgent PC medications.

Each region must be able to provide PC medications when urgently needed for patients in distress after hours. This need goes hand in hand with the availability of healthcare providers to assess patients after hours.

Start the conversation early!

Be proactive to anticipate concerns and manage symptoms. Start early stages of conversations at the time of diagnosis of chronic or life-limiting illnesses, on admission to LTC...

All residential hospices to help patients who are ill but not dying i.e. when they require stabilization of pain or symptoms or respite.

Expand Hospice Role

Support PC education for all interprofessional health care providers, so that everyone can provide a basic palliative approach to care.

All health care providers should have basic knowledge on providing a palliative approach to care. Specialists and those with extra training can then provide support and consultation for complex cases and at challenging transition points along the illness trajectory.

Rationalize how we spend our public health dollars

Do we spend too much money on fancy buildings, on research, on administrative staff etc., etc., when compared with what we spend on basic health care including palliative care?

Create networks of groups doing quality improvement work in palliative care to promote spread and share learning

Encourage the 'hospice hub' idea - all palliative healthcare providers working under one roof.

Create hospice hubs nationwide

Remove requirement for a time-based prognosis as criteria for service

Often people living with end stage diseases that have an unpredictable disease trajectory (ie, NOT CANCER) are neglected by our programs/services. They don't seem to fit in the check box of "this person has less than 6 months to live" and are denied. We preach a philosophy of introducing the palliative approach at diagnosis but actual forms of support/services are not allowed to be accessed until the last 3-6 months of life.

Have Palliative expert teams lead other specialties (Cardiology, Nephrology, Respirology) in capacity building.

Other specialty programs need to build capacity to manage their own patients. They need strong, expert leadership guiding, educating, and supporting a new model of care for an extensive period of time to allow for a culture shift and change that is actually sustainable and the "new normal".

Increase public/referrer knowledge of interprofessional team member roles in palliative care so that patients can access the right care

Define minimum interprofessional staffing requirements for palliative care units (acute and subacute) so that PCUs can provide the right care for the right patients.

It is important to define and fund staffing of PCUs to allow them to provide short-stay symptom management, and potentially longer stay end-of-life care for complex cases. Acute and subacute PCUs can then provide the right care for the right patients. Having the resources to manage patient and family needs with shorter stays would help to increase access. These resources should include, but are not limited to nurses, MDs, PT, OT, SW, spiritual care / counsellor, dietician, and SLP. Once a PCU stay has addressed the acute and/or complex needs, there must be adequate resources in the community to facilitate a safe and quality discharge.