Canadian Atlas of Palliative Care - Pilot Study

Existence of Palliative Care Policy: Yes

There are several policy documents guiding palliative care service provision in Ontario/the Central East Region.

•  The Ontario Palliative Care Network's Palliative Care Health Services Delivery Framework 
•  The Declaration of Partnership and Commitment to Action 
•  Report by the Office of the Auditor General of Ontario 
• 2016-2019 Integrated Health Service Plan (IHSP 4) - Community Access to Palliative Care via Inter-professional Primary Care Teams Improvement Project

For more information about these classifications please refer to the  Data Dictionary .

The region had a relatively active palliative care network until provincial rearrangement occurred in 2019. New leadership structures for palliative care are under development at a provincial level (Ontario Health Regions).

Palliative care services and resources in acute and commuity settings (including rural and remote areas) within the Central East Region.

Note: The Catalonia formula ¹  for the organization of public health palliative care programs and services is used for benchmarking.

For more information about these classifications and their descriptions click the link below:

System performance indicators for this region are available elsewhere. For example:

•  Profiles for Central East Sub-region 
•  Health Quality Ontario (HQO) Palliative Care at the End of Life (2016) 
•  Health Quality Ontario (HQO) Palliative Care at the End of Life Update (2019) 

Queen’s-Lakeridge Health MD Family Medicine Program is a new, first-in-Canada medical education model specifically designed to address the shortage of family doctors. It aims to graduate practice-ready, community-focused physicians able to provide comprehensive care to patients in southeastern Ontario. Start Fall 2023 (20 spots).

There are a variety of training programs for nursing and social work at the undergraduate and postgraduate education levels.

This section contains domain information for Focused Populations, Professional Activities, and Community Engagement.

• Strong volunteer programs in several communities
• Hospice Peterborough is a Nav-CARE (volunteer care navigators) site and offers Death Cafés
• Several Compassionate Community (CC) activities underway in different communities, including a formal CC program being developed in Kawartha Lakes

Other services may be available across the region through organizations such as Bereaved Families of Ontario.

This section covers professional activities from the existence of a palliative care directory of services, dedicated resources to organize palliative care CPD (continuing professional development), palliative care conference/symposia, evidence of palliative care research activities, and evidence of palliative care quality improvement initiatives.

A Directory of Palliative Care Services is available below

There are numerous professional activities across the region with respect to palliative care.

• Annual education activities include the Lakeridge Health Annual Palliative Care Day.
• Dr. Gillian Gilchrist Chair in Palliative Care Research at Queen’s University is based at Lakeridge Health to improve palliative care within the Durham region.

The Canadian Atlas of Palliative Care for the Central East (CE) Region of Ontario provides mapping of the the current state of palliative care in the Central East Region across nine domains, that include demographics, policy, services, education and training, professional activities, focused populations, and community engagement across the region. The services mapped include availability of in-hospital and community palliative care teams, palliative care units, residential and community hospices, and the integration of the palliative care approach across different care settings (such as hospitals and long-term care facilities) and in primary care.

These results showcase areas of excellence for the purpose of scale and spread, and give opportunities for further enhancement in palliative care, providing policymakers, administrators, health care leaders, educators, researchers, and advocates a baseline assessment of the status of palliative care in the Central East Region that can be utilized to guide evidence-based decision making in Ontario's changing healthcare landscape and to inform further palliative care integration and development

The research team would like to thank all key informants for their time and support of the Canadian Atlas of Palliative Care - Pilot Study. A special thank you to Pallium Canada for the funding of this work and to Esri Canada for the support of the mapping.

Alternative Payment Models: Alternative payment models (APMs) such as Alternative Funding Plans (AFPs)/Alternative Payment Plans (APPs) are contractual arrangements set to counter some of the limitations of fee-for-service (FSS) payment approaches (see Fee-for-Service). For tracking purposes, physicians on alternative payment models typically still submit claims as though they are on fee-for-service (shadow billing). Claims may also be submitted for full fee-for-service payment when the claim is for an “out of basket” service (a service not covered by the APM).

Access to Specialist Palliative Care Teams (see Specialist Support) in the Community: Health regions have different forms of community specialist palliative care supports (see Specialist Support). Some see collaboration between them.

• Categories:
  • Full: 24/7 access to specialist-level palliative care (including after-hours coverage) across all parts of the sub-region
  • Partial: Access is only partial (some days of the week, not 24/7) across all parts of the sub-region
  • Minimal: Access is only limited (some days of the week, not 24/7) and only across parts of the whole sub-region.

Acute Care Hospital: For the purposes of this Atlas, we are mainly focussing on acute care hospitals. This includes Cancer Hospitals with in-patient and/or out-patient services. We recognize that patients with palliative care needs are also to be found in other types of hospitals such as complex continuing care hospitals, rehabilitation hospitals, and mental health hospitals. Acute care hospitals vary with the in-patient and out-patient services they provide. Acute care hospitals also vary in terms of their bed-numbers and patient days or patient visits, as well as in their case mix.

Hospital sizes: Some are small, community hospitals with fewer than 100 beds. Others are medium sized with 100 to 200 beds, and others are large with more 200 beds. Some are teaching centres and others, usually smaller community hospitals, do not provide teaching to medical students or residents. For the purposes of this Atlas, all hospital sizes, patient visits, and case mixes are included under the term “Acute Care Hospital”.

Catalonia Formula for the Organization of Public Health Palliative Care Programs and Services: Experts, including a WHO Collaborating Centre in Europe, have recommended ten in-patient palliative care beds/100 000 population, of which two are in palliative care units (PCUs; see Palliative Care Unit) and eight are hospice-type or continuing care beds (see Residential Hospice).

Community Hospice: Community hospice care programs support people in a number of ways through friendly visiting/volunteer services and programming. While this programming varies between communities, many provide day hospice/respite services, support groups, and grief and bereavement care.

Compassionate Communities: A compassionate community is a community-based program or initiative led by people who are passionate and committed to supporting persons with a serious illness or are caring for someone with a serious illness. Community members take an active role in supporting people affected by these experiences by connecting them to supports, raising awareness about end-of-life issues, and/or building supportive networks in the community. Compassionate communities are quite varied in their approaches and scope of work.

Consultation, Shared Care, and Takeover Models: These terms are used to describe three different approaches that palliative care support teams in community and hospital settings can apply relative to the patient’s most responsible provider (MRP) (see Most Responsible Provider), be it a physician or nurse practitioner. In the Consultation Model, the palliative care clinician or team provide consultation support while the patient’s MRP remains most responsible. In a Shared-Care Model, the palliative care team or clinicians are responsible for all palliative care-related needs while the patient’s clinician is responsible for other issues (e.g., managing diabetes, hypertension, etc.). In a Takeover Model, the palliative care team or clinician takes over from the patient’s physician and assumes all responsibility as the MRP.

Designated Public Funding: Proportion of public funding provision for services (such as (palliative) home care services) and or institutions (such as residential hospices).

• Categories:
  • Full: (full funding provided from public sources)
  • Partial: (partial funding provided from public sources, e.g., approximately 60% of operating costs of residential hospices)
  • None: (no funding provided from public sources).

Fee-for-Service (FFS): is a payment model where services are unbundled and paid for separately. In health care, FFS occurs when physicians and other health care providers receive a fee for each service such as an office visit, test, procedure, or other health care service. Payments are issued only after the services are provided.

Health Region: Provincial subdivision for health service provision. Ontario Health currently has six regions linking communities and providers. This version of the Atlas refers to the legacy Central East region (former Central East (CE) Local Health Integration Network (LHIN)). Findings will later be included in the mapping by the new Ontario Health regions as part of the Canadian Atlas of Palliative Care - Ontario Edition.

Integration of Palliative Care Approach (see Palliative Care Approach): Integration of palliative care approach means that the majority of staff (>50%) are trained on the palliative care approach and the service refers to the specialist palliative care team, and in a timely manner.

• Categories:
  • Full Integration: Most physicians and staff utilize a palliative care approach when it is needed.
  • Partial Integration: Some physicians and staff utilize a palliative care approach when it is needed
  • Inadequate Integration: Few physicians and staff utilize a palliative care approach when it is needed.

 Integration of Palliative Care Approach (see Integration of Palliative Care Approach) across Hospital Inpatient Units and Outpatient Clinics:

• Categories:
  • Majority of units and services (> 70%)
  • Most of units and services (51% to 70%)
  • Some of units and services (30% to 50%)
  • Few of units and services (< 30%).

 Integration of Palliative Care Approach (see Integration of Palliative Care Approach) into Long- term Care (LTC):

• Categories:
  • All or almost all (> 90%)
  • Most (51% to 89%)
  • Some (10% to 50%)
  • Few (< 10%)

Most Responsible Physician/Provider (MRP): The term generally refers to the health care clinician (physician or nurse practitioner) who has overall responsibility for directing and coordinating the care and management of an individual patient at a specific point in time.

Palliative Care: “[A]n approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual” (World Health Organization (2002).

Palliative Care Approach: Refers to palliative care that is delivered across different care settings by all health care professionals who are not palliative care specialists. It requires core competencies that allow these professionals, across many primary care and specialty care fields, to provide high quality, core palliative care themselves. The terms primary, primary-level, or generalist palliative care are often used synonymously with the palliative care approach. Specialist-level palliative care, on the other hand, is delivered by health care professionals and teams with advanced training and expertise in palliative care. The palliative care approach includes early identification of patients with palliative care needs, advance care planning and goals of care discussions, assessment of needs across different domains, implement plans to address these needs, among others (see Primary Palliative Care). It also includes timely referrals to a specialist palliative care service when patients’ and families’ needs exceed their competency levels in this area (see Specialist Support).

Palliative Care Unit (PCU): Dedicated hospital unit/ward or beds for the provision of palliative care. For the purposes of this Atlas, only a unit that is dedicated entirely (or in part) to palliative care can be considered a PCU; “floating” beds across the hospital that are occasionally or temporarily designated as “palliative” are not included. PCUs can be hosted in acute or complex continuing care hospitals. They may vary in terms of the types of patients they care for; e.g., “acute” (high acuity not limited to only end of life and shorts stays, alive discharge rates of >30%), “continuing” care (medium to longer stays), and “end-of-life care” (only for end of life stays (median 8 days), alive discharge rate <20%).

Population Centres: For the purposes of the Atlas, the following definitions by Statistics Canada are used:

• Large Urban Population Centre: High population density area (˃ 400 persons per square kilometre) with a population of ˃ 100,000. These can be further described as either inner city or suburban
• Medium Population Centre: High population density area (˃ 400 persons per square kilometre) with a population of > 30,000 but ˂ 99,999
• Small Population Centres: Population density of at least 400 persons per square kilometre and a population between 1,000 and 29,999
• Rural Area: Any territory lying outside of Small Population Centres with low population density (˂ 400 persons per square kilometre)
• Remote Area: Area located far from population centres with often limited access/infrastructure and providing a good representations of a natural region/wilderness area.

 Primary Palliative Care: Primary (or generalist) palliative care refers to the main palliative care competencies required of all physicians and health care professionals, including the ability to assist patients and their families in establishing appropriate goals of care (see Palliative Care Approach).

 Primary-level Palliative Care (see Palliative Care Approach/Primary Palliative Care) Provided by Family Physicians/Primary Care Clinics: Primary (or generalist) palliative care provided in the region.

• Categories:
  • Mainly provided by family physicians and primary care clinics
  • Some family physicians provide it, but often by palliative care physicians
  • Few if any family physicians and primary care clinics provide palliative care.

 Residential Hospice: A residential hospice provides individuals who cannot be cared for at home with compassionate care and comfort in the last stages of their life. It is a ‘home away from home’ where people can go to live their final days. Some residential hospices also offer short-term respite care to provide help to the caregivers.

 Specialist Support: Specialist support can mean any model of service provision from consultation and shared care to take over care (see Consultation, Shared Care, and Takeover Models) with the specialist becoming the most responsible provider (MRP) (see Most Responsible Provider).