A Framework for Palliative Care

What if we as Canadians all had health coverage and by age 65, we also all had an Anvanced Care Plan?

Longest retirement party ever!

Clarify consent and wishes with each hospitalization

It is shocking to see how many of my colleagues do not understand simple things like "allow natural death" can be seen about the process of dying and have nothing to do with CPR preferences once someone has already died. It is shocking to see how may of my colleagues weren't aware that only a capable patient can express 'wishes' (ie an advance care plan) and that despite wishes, consent needs to be obtained with each medical encounter. In having these conversations with my colleagues, we have designed a form that both educates and helps communicate the issues regarding resuscitation and goals of care and whether or not the conversations are about wishes or informed consent and what must be included to ensure that it is informed consent. We hope to use this tool to push ACP forward in our community and to ensure we are doing our utmost to provide care consistent with patients goals.

Require each province's MOH to have a fee code for physicians to bill for annual ACP conversations.

shift language from 'withdrawal' to 'protection'

I think in health care we talk to much from the negative (withholding/withdrawing) and not in the frame we really intend: PROTECTING people from interventions that will not help them, and may only hurt them (and their families) at end of life. So instead of saying why you won't "give" CPR or ICU admission, try saying you would recommend PROTECTING from these things...

Encouraging everyone to have discussions about death/dying, not just close to end-of-life

Death has moved away from being a natural life event to a more medicalized, less approachable topic. Campaigns like CHPCA's "Speak Up" help to spread the message that advance care planning should be started when a person is healthy and not limited to terminal illnesses or short prognoses. Reminders to speak to loved ones about wishes could come from various sources and should come from health care professionals that people have already established rapport with.

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.

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.

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

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".

Expand and increase funding to in-home community care

Community Care Needs Better Funding

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

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.

Provide sustainable family caregiver support, training and respite

Families living with a member who has a chronic mental or physical illness are aware that over time, their loved-one's and their own quality of life will face greater stress. As End of Life and death come closer, family needs and tensions naturally build. Acknowledging, equipping and supporting the family as the centre of coping and care, will improve the quality of life, and lessen stress on the family and on the medical system too with less emergency room visits, and greater ease through the transition of End of Life, death and bereavement. (The medical institutions are NOT the ones who will naturally reach out to support families. Medical systems first tend their own garden.) The imperative for family caregiver support has to come from the community at large, of which the medical system is a member, key partner and player. In the larger social and cultural community context- how and by who are family caregivers, and family units of caring, actually recognised and supported?

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...

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.

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...

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.

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.

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.

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

train service providers in cultural competency for LGBTQ2 individuals

military members and their family members

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).

Offering educational courses during basic training at colleges and universities

Canada has just gotten its feet wet when it comes to its framework on palliative care. Once it has developed a CLEAR mandate, all peoples training to be in the health field (from paramedics to pharmacists to psychologists) should be required to take a course on Canada's palliative care model during their formation. Current practitioners who disagree with end of life care should still have to take mandatory paid professional development, yet should be able to refer patients to others if they are uncomfortable with the practice. Those new to the field should not have that right.

Health Care Providers practicing having difficult conversations

I agree with other ideas that would like to see Palliative/End-of-Life care as more standard in education and clinical competencies for HCPs. I would like to see that include a component of practicing having different difficult conversations that could come up while working with people facing the end of their life. Videos showing conversations are great, but I've found that the only way to increase a professionals willingness to have difficult conversations is through situations that help them practice (I'm thinking of ASIST training through LivingWorks and how they include large role playing components for participants to help them have conversations about suicide)

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.

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.