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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.


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.


Management of pain and other symptoms is an important part of high-quality palliative care and an integral component of the individualized care plan. It is important to consider nonpharmacological and pharmacological management throughout a person’s illness.

Not all patients who receive palliative care will experience the same pain or other symptoms, so it is important to assess the level and range of severity. Possible causes of symptoms, the person’s preferences, management of side effects, and the benefits and harms of intervention should also be assessed. If pain or other symptoms are identified, they should be managed promptly and effectively, and any reversible causes should be treated using evidence-based practice.

An example of pain and symptom management in the community involves the use of “symptom relief kits,” which are standardized kits designed to provide the nurse and patient with a supply of commonly used palliative care medications. Pain and symptom management require ongoing reassessment to ensure the efficacy of any interventions and monitoring for changes.

For Patients, Families, and Caregivers

Your health care team should assess your pain and other health concerns, and manage them quickly and effectively.


For Clinicians

Assess patients for pain and other symptoms. Ensure the delivery of high-quality management of pain and other symptoms.


For Health Services

Provide adequately resourced systems and services to ensure that health care professionals can conduct pain and symptom assessments and offer nonpharmacological and pharmacological treatments. Ensure that systems, processes, and resources are in place so that patients have access to timely and effective pain and symptom management.

Process Indicator

Percentage of people who receive palliative care who have documented assessments of their pain and other symptoms in their medical record

  • Denominator: total number of people who receive palliative care
  • Numerator: number of people in the denominator who have documented assessments of their pain and other symptoms in their medical record
  • Data source: local data collection

Structural Indicator

Locally adopted appropriate tools to assess pain and other symptoms for people with identified palliative care needs

  • Data source: local data collection

Outcome Indicator

Percentage of people who receive palliative care (or their caregivers) who rate the level of support to relieve their pain and other symptoms as excellent

  • Denominator: total number of people who receive palliative care (or their caregivers)
  • Numerator: number of people in the denominator who rate the level of support to relieve their pain and other symptoms as excellent
  • Data sources: local data collection; alternative source is InterRAI [Resident Assessment Instrument] tools
  • Similar question available in the CaregiverVoice Survey: “During the last 3 months of his/her life, while he/she was receiving homecare services, what is your assessment of the overall level of support given in the following areas: relief of physical pain, relief of other symptoms?” (Response options: “Excellent, Very good, Good, Fair, Poor, Does not apply, Don’t know”)
Pain and other symptoms

Pain and other symptoms are the effects of illness or treatment. Common symptoms associated with progressive, life-limiting illness may include but are not limited to the following:

  • Agitation
  • Anxiety
  • Changes in respiratory patterns and increased secretions
  • Constipation
  • Dehydration
  • Delirium
  • Depression
  • Diarrhea
  • Dyspnea
  • Fatigue
  • Nausea
  • Pain
  • Poor appetite
  • Vomiting

Pain and other symptoms can also affect activities of daily living (e.g., bathing, mobility, continence).

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