A Public Health Approach to Palliative Care in the Canadian Context

Sirianni, Giovanna

doi:10.1177/1049909119892591

Cited by 7 publications

(8 citation statements)

References 13 publications

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“…Although our review did not highlight the infrastructure context, policies are needed at multiple levels in order to create health and social structures that will normalize and facilitate an upstream approach for palliative care. For example, the public health approach to palliative care advocates for policy development and implementation in the practice, health system, and societal contexts [ 86 ]. Societal contexts that embrace the public health approach to palliative care and align with the Compassionate Communities model [ 35 ] can catalyze social changes in attitudes that reinforce health system policies.…”

Section: Discussionmentioning

confidence: 99%

Engaging family caregivers and health system partners in exploring how multi-level contexts in primary care practices affect case management functions and outcomes of patients and family caregivers at end of life: a realist synthesis

et al. 2021

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Background An upstream approach to palliative care in the last 12 months of life delivered by primary care practices is often referred to as Primary Palliative Care (PPC). Implementing case management functions can support delivery of PPC and help patients and their families navigate health, social and fiscal environments that become more complex at end-of-life. A realist synthesis was conducted to understand how multi-level contexts affect case management functions related to initiating end-of-life conversations, assessing patient and caregiver needs, and patient/family centred planning in primary care practices to improve outcomes. The synthesis also explored how these functions aligned with critical community resources identified by patients/families dealing with end-of-life. Methods A realist synthesis is theory driven and iterative, involving the investigation of proposed program theories of how particular contexts catalyze mechanisms (program resources and individual reactions to resources) to generate improved outcomes. To assess whether program theories were supported and plausible, two librarian-assisted and several researcher-initiated purposive searches of the literature were conducted, then extracted data were analyzed and synthesized. To assess relevancy, health system partners and family advisors informed the review process. Results Twenty-eight articles were identified as being relevant and evidence was consolidated into two final program theories: 1) Making end-of-life discussions comfortable, and 2) Creating plans that reflect needs and values. Theories were explored in depth to assess the effect of multi-level contexts on primary care practices implementing tools or frameworks, strategies for improving end-of-life communications, or facilitators that could improve advance care planning by primary care practitioners. Conclusions Primary care practitioners’ use of tools to assess patients/families’ needs facilitated discussions and planning for end-of-life issues without specifically discussing death. Also, receiving training on how to better communicate increased practitioner confidence for initiating end-of-life discussions. Practitioner attitudes toward death and prior education or training in end-of-life care affected their ability to initiate end-of-life conversations and plan with patients/families. Recognizing and seizing opportunities when patients are aware of the need to plan for their end-of-life care, such as in contexts when patients experience transitions can increase readiness for end-of-life discussions and planning. Ultimately conversations and planning can improve patients/families’ outcomes.

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Section: Discussionmentioning

confidence: 99%

Engaging family caregivers and health system partners in exploring how multi-level contexts in primary care practices affect case management functions and outcomes of patients and family caregivers at end of life: a realist synthesis

et al. 2021

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“…Our first interest was to map and categorise the geographical locations of the reported work. Expressions related to varied jurisdictions; some global [32], some regional, like 'Central and Eastern Europe' [33] and 'Latin America' [34], whilst others focussed on individual nation states such as, Canada [35], South Africa [36] and Norway [37]. In wider terms, this distribution can be seen in relation to the six regions of the WHO (with an additional 'global' category).…”

Section: Geographical Contextmentioning

confidence: 99%

“…For example: the prominence of policy [21]; degrees of integration [112]; funding allocated to PC [33]; the extent of specialist services [20]; levels of access to medicines [9]; workforce 'capacity' [87]; and the extent of training and education [53]. These were expressed as either stand-alone variables or more systematically [35] as a suite of actions [113] and composites presented in various forms -'atlases' [114], 'mapping' exercises [115] or 'league tables' [116]. Beyond these pragmatic orientations, two contrasting 'policy logics' were visible in the form of ethically-based practice values [117].…”

Section: Grounded Problematisationmentioning

confidence: 99%

“…Beyond these pragmatic orientations, two contrasting 'policy logics' were visible in the form of ethically-based practice values [117]. At one end, the narrative was crafted around principled norms such as 'holism' [35], 'compassion' [105], 'human rights' [118], 'poverty reduction' [119], 'equity' [109], 'justice' [120] and 'needs' [112]. In contrast, an approach based on a narrower form of policy 'rationality' [120] was evident, expressed as notions like "evidence-based" [53] and "cost-effective" palliative care [56], using economistic principles to, "optimize resource allocation" [121].…”

Section: Grounded Problematisationmentioning

confidence: 99%

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The expression of ‘policy’ in palliative care: A critical review

2022

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“…Equity impact assessment of palliative care policies has been conducted in some countries such as the UK to identify equity needs and gaps, monitor inclusion progress, and to ensure that policies and initiatives do not inadvertently create inequity [ 18 , 20 ]. An analysis of palliative care policies in Canada found that although inequity is well-documented, the policy and political contexts hinder the incorporation of public health approaches in palliative care [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Equity consideration in palliative care policies, programs, and evaluation: an analysis of selected federal and South Australian documents

2022

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Background Inequity in access to palliative care and symptom relief is one of the greatest disparities in global health care. A public health approach to palliative care is underpinned by the social view of health that puts an emphasis on equity, community engagement and empowerment, a supportive policy environment, and social determinants of health. Consideration of equity in policy is critical so that it can be translated into equitable services. However, the extent to which Australian palliative care policies incorporate equity, and their translation into actual actions have not been extensively examined. This exploratory study aimed to examine the extent to which Australian federal and South Australian palliative care policies and initiatives incorporate equity, and to identify evidence gaps and research priorities that can inform equity-oriented policies and practices. Methods We reviewed 25 federal and South Australian documents relating to palliative care published over the past five years. Documents were publicly available from the Australian Government Department of Health website. We used search filter ‘Palliative care and end of life’ in the Department’s resource webpage to narrow down documents to those with palliative care and end of life in the document title and/or content. The initial list was discussed in the research team to ensure key documents are included. Supplementary to document review, we conducted five key informant interviews in South Australia. Interview participants were people from the policy sector, not-for-profit organisations, a funding body and a community advocacy group in South Australia who had knowledge and experience in palliative care policy, practice and research. Documents and interview transcripts were imported into the NVivo 12 software for coding. Content analysis looked at the frequencies of relevant terms, and then more detailed inductive and deductive thematic analysis was undertaken which was guided by an equity action framework. Results Overall, we found incremental steps forward over the past few years in considering equity in Australian palliative care policies. Key themes that emerged from the study were: identifying population groups experiencing poor access to palliative care, strategies to improve access including increased awareness of palliative care, flexible models of care, building workforce capacity, and the need for greater investment in palliative care research and evaluation. Strategies to address systemic barriers as well as social, political and cultural determinants of inequity was less evident in policy documents. There was little evidence of actions to engage and empower communities. Interviews provided insight on key areas of priority for future palliative care research. Conclusions Achieving the goal of equity in palliative care for all is complex and multifaceted. It requires strong commitment and actions at policy and government level but also in clinical practice, workforce planning and capacity building, community engagement and research investment to implement and evaluate public health approaches to palliative care.

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A Public Health Approach to Palliative Care in the Canadian Context

Cited by 7 publications

References 13 publications

Engaging family caregivers and health system partners in exploring how multi-level contexts in primary care practices affect case management functions and outcomes of patients and family caregivers at end of life: a realist synthesis

Engaging family caregivers and health system partners in exploring how multi-level contexts in primary care practices affect case management functions and outcomes of patients and family caregivers at end of life: a realist synthesis

The expression of ‘policy’ in palliative care: A critical review

Equity consideration in palliative care policies, programs, and evaluation: an analysis of selected federal and South Australian documents

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