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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.


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.


People with a progressive, life-limiting illness, families, and caregivers have complex needs; for this reason, those who provide care should have comprehensive palliative care education. Education that focuses on improving communication skills, knowledge, and attitudes about palliative care has a positive effect on a person’s experience of palliative care. Competency-based education materials and programs should be tailored to the health care provider’s role and responsibilities.

For Patients, Families, and Caregivers

You should have access to care providers who are knowledgeable about palliative care and who will work together to meet your needs and goals of care.


For Clinicians

You should receive education to effectively provide quality care for people with a progressive, life-limiting illness in accordance with your role.


For Health Services

Ensure that systems, processes, and resources are in place for health care providers and volunteers to receive the education necessary to provide high-quality palliative care.

Process Indicator

Percentage of health care providers and volunteers who provide palliative care who have evidence of receiving palliative care education appropriate to their role

  • Denominator: total number of health care providers and volunteers who provide palliative care

  • Numerator: number of providers in the denominator who have evidence of receiving palliative care education appropriate to their role

  • Data source: local data collection

  • Potential stratification: health care providers, volunteers


Outcome Indicator

Percentage of health care providers and volunteers who provide palliative care who state that they have the knowledge and skills to provide palliative care

  • Denominator: total number providing palliative care:

    • Health care providers

    • Volunteers

  • Numerator: number of people in the denominator groups who state that they have the knowledge and skills to provide palliative care

  • Data source: local data collection

  • Note: consider measuring the indicator separately for health care providers and for volunteers

Knowledge and skills

Education should include communication skills, assessment and care planning, advance care planning, and symptom management. It may also include the following:

  • Principles and models of palliative care

  • Care of the family and caregiver

  • Assessment and management of pain and other symptoms (see Quality Statement 6)

  • Assessment and management of psychosocial aspects of care, including spiritual and existential issues (see Quality Statement 7)

  • Effective and compassionate communication

  • Mediation and conflict management

  • Advocacy and therapeutic relationship-building

  • Ethical issues

  • Interdisciplinary practice and competencies (see Quality Statement 12)

  • Knowledge of relevant legislation

  • Advance care planning, goals of care, and informed consent as described in the Ontario Health Care Consent Act (see Quality Statements 3 and 4)

  • Self-care, including coping strategies, compassion fatigue, and self-exploration of death and dying

  • Cultural competency and cultural safety, including care for First Nations, Inuit, and Métis peoples

  • Palliative care issues in vulnerable populations (people with mental health issues, people who are homeless/vulnerably housed, and people who are incarcerated)

  • Social and cultural contexts of death and dying

  • Dying trajectories and signs of impending death

  • Grief, bereavement, and mourning

  • Roles of grief and bereavement educators, clergy, spiritual leaders, and funeral directors


Health care providers and volunteers

These include regulated health care professionals and unregulated care providers. In Ontario, regulated health professions (e.g., physicians, nurse practitioners, registered nurses, occupational therapists) are accountable to their regulatory colleges, which ensure that professionals provide health services in a safe, professional, and ethical manner. Unregulated care providers (e.g., palliative care volunteers, personal support workers) may assist with or perform certain aspects of care traditionally provided by regulated health care professionals, based on their role and employment setting, and are accountable to their employers.

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