A National Palliative Care Strategy for Canada

Abstract

Objective: To identify barrier to achieving universal access to high quality palliative care in Canada, review published national strategies and frameworks to promote palliative care, examine key aspects that have been linked to successful outcomes, and make recommendations for Canada. Background: In 2014, the World Health Organization called on members to develop and implement policies to ensure palliative care is integrated into national health services. Methods: Rapid review supplemented by the author's personal files, outreach to colleagues within the international palliative care community, review of European Association for Palliative Care publications, and a subsequent search of the table of contents of the major palliative care journals. Results: Frameworks were found for 10 countries ranging from detailed and comprehensive multi-year strategies to more general approaches including laws guaranteeing access to palliative care services for ''dying'' patients or recommendations for the development of clinical infrastructure. Few formal evaluations were found minimal comparative data exist regarding the quality of care, access to palliative care services, timing of access in the disease trajectory, and patient and family satisfaction with care. Factors that appear to be associated with success include: 1) input and early involvement of senior policy makers; 2) comprehensive strategies that address major barriers to universal access and that involve the key constituents; 3) a focus on enhancing the evidence base and developing a national system of quality reporting; and 4) substantial and sustained government investment. Discussion: Comprehensive national strategies appear to improve access to high quality palliative care for persons with serious illness and their families. Such strategies require sustained government funding and address barriers related to infrastructure, professional and public education, workforce shortages, and an inadequate evidence base.

Diagnosing Gaps in the Development of Palliative and End-of-Life Care: A Qualitative Exploratory Study

“…This result is consistent with the Institute of Medicine in the report of Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life that various socio-cultural, economic, and health system factors hinder the quality of end-of-life care in the United States [20]. Owing to its inherent complexity, the effects of merely institutional policies and professional societies on improving the provision of palliative and end-of-life care are insignificant [19,21]. Collaboration across organizations and care sectors is imperative to ensure equitable access to quality palliative and end-of-life care and consistency in care practices [18].…”

“…The Irish experience suggested that the support of policymakers is crucial for maintaining a substantial government budget for service development to widen access [18]. After reviewing the national strategies and frameworks related to palliative care of four top-ranked countries, Morrison (2018) identified the following keys to success: involving policy makers in strategy planning to overcome challenges in the infrastructure, implementing a standardized monitoring system to uphold quality evidence-based care, and maintaining an ongoing government investment to ensure sustainability [19]. Therefore, the overarching theme is to formulate a government-led policy framework that demonstrates government leadership in guiding service development.…”

Quality of Life among Caregivers of Lower-Income Cancer Patients: A Single-Institutional Experience in India and Comprehensive Literature Review

“…Consequently, quality of care may be reasonably equitable among rich and poor, thereby mitigating feelings of frustration among lower-income caregivers. Second, palliative care services are more available to lower-income patients in North America and Europe [24][25]. The burden of responding to emergent symptoms is often reduced with the aid of medical management directed towards improving QOL.…”

Palliative Care Needs among Patients with Advanced Illnesses in Bhutan

“…Most were married and many had young children -some of them had their eldest child just as old as 6 years and youngest merely 1 year, indicating increased psychological and social needs. Parenthood is one of the major concerns when diagnosed with an advanced illness [56], however, the needs speci c to dying patients and their dependent children are not well met even in the developed countries with comprehensive PC [57][58][59].…”