The Canadian Institute for Health Information (CIHI) has released Access to Palliative Care in Canada 2023. This report builds on its 2018 version, and measures progress toward the goal of increasing Canadian’s access to palliative care services. While the report finds positive progress in that more people, including those dying at home, are receiving palliative care support, it also identifies areas for urgent improvement, including:
- Some people experience greater barriers to accessing palliative care because of their age, where they live or their disease diagnosis.
- There are still signs of poor-quality palliative care, including people not getting palliative care until just before they die, and people dying in hospital even when they have community supports such as long-term care or home care.
BCCPC is already working to address some of the urgent needs identified in the report by collaborating with experts across the spectrum to increase access to high-quality palliative care for British Columbians.
Action needed: One of the urgent calls to action in the report is for more robust tracking data which not only identifies who is receiving palliative care and who is facing barriers to access, but also more refined information such as how well patients’ symptoms are controlled, the level of stress patients and caregivers feel, and how satisfied they are with palliative care.
BCCPC is currently working with palliative care leaders in health authorities and with academic researchers in a project that aims to identify quality indicators that could be used by program administrators to assess palliative care delivery from the perspectives of patients and their families.
Action needed:Â CIHI consulted caregivers who told them that high quality palliative care:
– Honours the beliefs and wishes of the patient and their family
– Is discussed early with the patient and family so they can make plans and benefit sooner
– Takes a team-based approach by including the patient and family as integrated members of the team
– Ensures that patients and families are always given comprehensive information on the options available for palliative care
– Provides the resources needed to let patients die in their preferred setting with support for them and their families at the end of life
BCCPC has created a series of training modules for health care professionals on culturally safe conversations, specifically around advance care planning, serious illness and palliative care. These modules are a compliment to the Centre’s continuing progress in highlighting the need for more, and better, serious illness conversations as soon as a patient is diagnosed with a life-limiting illness. BCCPC works with health authorities, professional organizations and post secondary institutions to incorporate serious illness conversations into education curricula and ongoing professional development.
Action needed: Canadians would prefer to die at home with support, and more are doing so (13% in 2021/22 compared to 7% in 2016/17). For those who wish it, dying at home preserves a sense of community, and decreases unnecessary (or unwanted) medical interventions for patients admitted to hospital.
BCCPC was an instrumental partner in working with BC Ambulance Service, the Ministry of Health and the Regional Health Authorities to support the practice of paramedics providing in-home care for patients identified as palliative. This was a major step from their previous protocol, which mandated paramedics responding to 911 calls transport patients to emergency departments. This shift has resulted in care aligned with patient wishes, fewer hospital ER visits, quicker call times for ambulances and greater patient/family satisfaction with care.
