Skip to main content

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.


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.


When people face a progressive, life-limiting illness, psychosocial issues may go undetected or untreated, and this can affect their quality of life. Pain and other symptoms may be the initial focus of treatment, but psychosocial well-being should also be assessed regularly. A holistic psychosocial assessment can facilitate the identification of any supports a person needs during their illness.

Psychosocial issues can manifest as physical symptoms (e.g., pain, constipation, nausea). Therefore, it is important that health care professionals be aware of a person’s total pain and the physiological symptoms that may be an indication of depression and anxiety. The concept of total pain describes the suffering that expands beyond physical pain by encompassing all of a person’s physical, psychological, social, spiritual, and practical struggles.

Illness and the prospect of dying affect and can also be affected by the meaning and purpose of a person’s life. A focus on spirituality may include questions about meaning, value, and relationships, and can lead to spiritual concerns, questions, or distress. Patients may draw on their spirituality as they make health care decisions and as they cope with illness and the experience of dying. No single individual is responsible for addressing all psychosocial needs; rather it requires expertise from an interdisciplinary team.

For Patients, Families, and Caregivers

Your care team should assess your mental, emotional, social, cultural, and spiritual well-being. Your needs should be addressed as part of your care plan and according to your wishes, values, and goals of care.


For Clinicians

Ensure that the overall psychosocial well-being of people with identified palliative care needs is assessed, and that their needs are incorporated into the care plan.


For Health Services

Ensure that resources are available for health care professionals to assess and meet the psychosocial needs of people with identified palliative care needs.

Process Indicators

Percentage of people who receive palliative care who have assessments of their psychosocial needs documented in their medical record

  • Denominator: total number of people who receive palliative care

  • Numerator: number of people in the denominator who have assessments of their psychosocial needs documented in their medical record

  • Data source: local data collection

Percentage of people who receive palliative care (or their caregivers) who state that they received timely psychosocial support to address their identified mental, emotional, social, cultural, and spiritual needs

  • Denominator: total number of people who receive palliative care who had identified psychosocial needs (or their caregivers)

  • Numerator: number of people in the denominator who state that they received timely psychosocial support to address their mental, emotional, social, cultural, and spiritual needs

  • Data source: local data collection

  • Note: consider measuring separately by each type of psychosocial need or group together as an overall measure of psychosocial support


Outcome Indicator

Percentage of people who receive palliative care (or their caregivers) who rated the level of support in addressing their psychosocial needs (mental, emotional, social, cultural, and spiritual) as excellent

  • Denominator: total number of people who receive palliative care with psychosocial needs (or their caregivers)

  • Numerator: number of people in the denominator who rated the level of support in addressing their psychosocial needs (mental, emotional, social, cultural, and spiritual) as excellent

  • Data source: local data collection

  • 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: spiritual support, emotional support, respect and dignity?” (Response options: “Excellent, Very good, Good, Fair, Poor, Does not apply, Don’t know”)

  • Note: consider measuring separately by each type of psychosocial need or group together as an overall measure of psychosocial support

Psychosocial support

Psychosocial support involves care related to a person’s state of mental, emotional, social, cultural, and spiritual well-being.


Mental and emotional needs

Mental and emotional needs relate to a person’s psychological and emotional well-being. Issues of concern for a person with a progressive, life-limiting illness may include fear, worry, insomnia, panic, anxiety, nervousness, paranoia, or lack of energy.


Social needs

Social needs relate to a person’s relationships with their family, community, and network (friends, acquaintances, and coworkers). Social needs may relate to family structure and location, family dynamics, communication, social and cultural networks, perceived social support, work and school settings, finances, sexuality, intimacy, living arrangements, caregiver availability, medical decision-making, access to transportation, medications, equipment and nutrition, community resources, or legal issues. Associated practical needs include pet care, child care, transportation, or meals.


Cultural needs

Cultural needs relate to the beliefs and preferences that come from one’s social and ethnic identity. Cultural needs may include linguistic needs, health beliefs and behaviours, traditions, rituals, or cultural barriers to accessing health care.


Spiritual needs

Spiritual needs relate to “the way individuals seek and express meaning and purpose, and the way they experience their connection to the moment, to self, to others, to nature, and to the significant or sacred.” Spiritual needs may include religious practices or philosophical reflection.

Let’s make our health system healthier

Join Our Patient, Family and Public Advisors Program

Patients, families and the public are central to improving health quality.


Man smiling

Sign up for our newsletter

Are you passionate about quality health care for all Ontarians? Stay in-the-know about the newest programs, reports and news from Health Quality Ontario and sign up for our electronic newsletter.

Health Quality Connect - Health Quality Ontario's newsletter - on an iPad and a cell phone