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Evidence to Improve Care

Palliative Care

Care for Adults With a Progressive, Life-Limiting Illness

Click below to see a list of brief quality statements and scroll down for more information.


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.

Quality Statement 1: Identification and Assessment of Needs
People with a progressive, life-limiting illness have their palliative care needs identified early through a comprehensive and holistic assessment.


Quality Statement 2: Timely Access to Palliative Care Support
People with identified palliative care needs have access to palliative care support 24 hours a day, 7 days a week.


Quality Statement 3: Advance Care Planning—Substitute Decision-Maker
People with a progressive, life-limiting illness know who their future substitute decision-maker is. They engage in ongoing communication with their substitute decision-maker about their wishes, values, and beliefs, so that the substitute decision-maker is empowered to participate in the health care consent process if required.


Quality Statement 4: Goals of Care Discussions and Consent
People with identified palliative care needs or their substitute decision-makers have discussions with their interdisciplinary health care team about their goals of care to help inform their health care decisions. These values-based discussions focus on ensuring an accurate understanding of both the illness and treatment options so the person or their substitute decision-maker has the information they need to give or refuse consent to treatment.


Quality Statement 5: Individualized, Person-Centred Care Plan
People with identified palliative care needs collaborate with their primary care provider and other health care professionals to develop an individualized, person-centred care plan that is reviewed and updated regularly.


Quality Statement 6: Management of Pain and Other Symptoms
People with identified palliative care needs have their pain and other symptoms managed effectively, in a timely manner.


Quality Statement 7: Psychosocial Aspects of Care
People with identified palliative care needs receive timely psychosocial support to address their mental, emotional, social, cultural, and spiritual needs.


Quality Statement 8: Education for Patients, Substitute Decision-Makers, Families, and Caregivers
People with a progressive, life-limiting illness, their future substitute decision-maker, their family, and their caregivers are offered education about palliative care and information about available resources and supports.


Quality Statement 9: Caregiver Support
Families and caregivers of people with identified palliative care needs are offered ongoing assessment of their needs, and are given access to resources, respite care, and grief and bereavement support, consistent with their preferences.


Quality Statement 10: Transitions in Care
People with identified palliative care needs experience seamless transitions in care that are coordinated effectively among settings and health care providers.


Quality Statement 11: Setting of Care and Place of Death
People with identified palliative care needs, their substitute decision-maker, their family, and their caregivers have ongoing discussions with their health care professionals about their preferred setting of care and place of death.


Quality Statement 12: Interdisciplinary Team-Based Care
People with identified palliative care needs receive integrated care from an interdisciplinary team, which includes volunteers.


Quality Statement 13: Education for Health Care Providers and Volunteers
People receive palliative care from health care providers and volunteers who possess the appropriate knowledge and skills to deliver high-quality palliative care.


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Setting of Care and Place of Death

People with identified palliative care needs, their substitute decision-maker, their family, and their caregivers have ongoing discussions with their health care professionals about their preferred setting of care and place of death.


A person’s preferences for where to receive palliative care and where to die depend on an interplay of factors associated with the illness, the individual, and the environment. A person’s preferred setting of care and place of death should be part of a care plan (see Quality Statement 5) that reflects the person’s wishes, goals, and needs. Different care settings and places of death are considered, including the person’s home (usual place of residence), a long-term care home, a hospice residence, or an in-patient palliative care unit. Safety is a key consideration when discussing the setting of care and place of death. A number of factors increase the feasibility and likelihood of a home death, including the availability of interdisciplinary home palliative care, early referral to palliative care, patient preferences, having a caregiver, and the caregiver’s ability to cope. Discussions about the setting of care and place of death should be ongoing; a person’s choice may change depending on their status.

For Patients, Families, and Caregivers

Your care team should talk with you about where you would like to be cared for throughout your illness and at end of life (for example, at home, in a home-like environment called a hospice residence, in a hospital, or in a long-term care home). They should give you information about the care available in different locations to help you make the best choices for you, your family, and your caregivers. Your wishes may change over time, so you should have regular opportunities to discuss them. You may want to talk about:

  • Your preferences

  • How your disease affects your ability to perform normal daily activities

  • Whether you are living with someone who can help you

  • Whether other help you may need is available


For Clinicians

Provide information about options for the setting of care and place of death to people with identified palliative care needs, their family, and their caregivers. This information should include all of the factors outlined in the definitions.


For Health Services

Ensure that resources and tools are available to support discussions between health care professionals and people with identified palliative care needs about their preferred setting of care and place of death.

Process Indicator

Percentage of people with identified palliative care needs who have documentation of their preferred setting of care and place of death in their medical record

  • Denominator: total number of people with identified palliative care needs

  • Numerator: number of people in the denominator who have documentation of their preferred setting of care and place of death in their medical record

  • Data source: local data collection

  • Similar questions available in the CaregiverVoice survey:

    • “What was his/her last known preferred place to die?” (Response options: “At home; In a hospice; In a hospital; In a long-term care home; In a retirement home; He/she said that he/she did not mind where he/she died; Anywhere except at home; Anywhere except in hospital; Don’t know”)

    • “Did the health care providers have a record of this preference of where he/she wanted to die?” (Response options: “Yes; No; Not sure”)

  • Note: consider measuring the preferred setting of care and preferred place of death separately


Structural Indicator

Availability of a survey to capture caregiver experience in all care settings (e.g., CaregiverVoice Survey)

  • Data source: local data collection


Outcome Indicators

Percentage of people with identified palliative care needs whose medical records indicate that they died in their preferred place of death

  • Denominator: total number of people with identified palliative care needs who had their preferred place of death recorded in their care plan

  • Numerator: number of people in the denominator who died in their preferred place of death

  • Data source: local data collection (similar indicator is currently measured in the Client Health and Related Information System for palliative home care clients)


Percentage of caregivers of people who died of a progressive, life-limiting illness who think that the person they cared for died in the right place

  • Denominator: total number of caregivers of people who died of a progressive, life-limiting illness

  • Numerator: number of people in the denominator who think that the person they cared for died in the right place

  • Data source: local data collection

  • Similar question available in the CaregiverVoice Survey: “Do you think that he/she died in the right place?” (Response options: “Yes; No; Not sure”)

Setting of care

The setting of care is the place where palliative care is provided. Care settings may include the person’s home, a hospice residence or in-patient palliative care unit, a long-term care home, a correctional facility, or for a person who is homeless or vulnerably housed, a shelter or the street.


Preferred setting of care and place of death

Discussions with health care professionals about the setting of care and place of death should include the following:

  • Interdisciplinary palliative care in the person’s current place of residence
  • Time between referral to palliative care services and death
  • Type of underlying disease
  • Functional status
  • Frequency of hospitalizations during the last year of life
  • Living arrangements (e.g., living with someone, living alone)
  • Presence of a caregiver
  • Caregiver’s ability to cope
  • Patient or family preference for place of death
  • Consideration of previous advance care planning conversations
  • Availability of a long-term care home, hospital bed, or hospice residence bed
  • Availability of resources to support the patient’s physical and psychological needs, where they live, during the end-of-life period

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