This discussion paper reviews models of care in hospice palliative Care (HPC) in Ontario. It aims to provide insight into our state of readiness for the “next steps” in evolving to a new model of care.
This Part Three of the discussion paper focuses on the sector specific level. It uses the multidimensional sector specific model checklist (generated in Part One) to compare our current state with our aspirational model of care as described in the report from
Ontario’s recent engagement process Advancing High Quality, High Value Hospice Palliative Care in Ontario (1).
The multidimensional sector specific model checklist is used as a practical proxy for the narrative and diagrammatic descriptions of our aspirational model.
Outcomes from this Part Three review were positive in terms of specific aspects of readiness for next steps in the evolution of HPC in Ontario at the sector specific level, including the following:
1. Examples of HPC excellence within each sector / service
• Within each of the care settings (24/7 care settings) examined, examples of excellence in terms of HPC programming are evident. Within Ontario there are acute care facilities and complex continuing care facilities with HPC programs that demonstrate all the core components. Likewise there are communities where HPC in the home is well developed. A number of LTCHs have HPC as a focus and have made great strides in advancing care for their dying patients. Residential hospices show many examples of excellence in HPC provision. Regional Cancer Centres and their host hospitals have developed robust HPC programs in a number of regions.
• Similarly within the ‘other’ HPC services examined, much excellent work is evident. Palliative pain and Symptom Management Consultants, visiting hospice programs, primary care providers and many other services show excellent HPC programming.
These well-developed programs can all serve as examples for others within their own care settings / services.
2. Potential for cross sector capacity building
There are a number of examples of sectors with HPC as their core business, which demonstrate fulsome development of all core elements These sectors and services could help serve as capacity builders for other sectors and services.
3. HPC expertise in nearly every care setting
Almost every hospital, every long term care home, every Community Care Access Centre (CCAC) and every community service provider agency (CSPA), has some available HPC expertise (either internally or accessible from outside sources)2. Key
2 Note – Residential Hospices are excluded from this list as it is noted that they possess considerable HPC expertise in each of their facilities (HPC is their core business).
HPC leaders and clinicians are identified in many care settings and services.
Additionally each care setting has some awareness of the potentially positive role of HPC for their patients/clients. Few care settings will be starting completely from scratch.
4. Some investments in HPC have already been made
Almost all LHIN regions have made some investment in HPC. Identified service gaps are being filled, particularly investments in enhancing specialist level HPC for
patients in their own homes.
5. Participating in cross sector communication / planning / collaboration.
Across the province stakeholders from all care setting and services are already gathered and are actively communicating at collaborative tables. Much cross sector planning has taken place
6. Presence of related expertise in many sectors that could be segued into HPC expertise
While it may not be specifically focused on HPC similar expertise is available in many care settings. For example:
• Available membership for interprofessional teams
Most acute care and complex continuing care facilities and CCACs have access to full interdisciplinary teams. LTCHs have access to spiritual care providers, dietician, physiotherapists etc. These professionals may not yet have specific training in HPC, but are available and could be mobilized to be part of a HPC team.
• Well-developed philosophy of team
Many care settings/services already have well-functioning teams (e.g.
Rehabilitation teams). While these teams may not currently serve a HPC population they will have developed skill sets in terms of collaborative care approaches.
• Well-developed project management skills
All of these sectors have planned and implemented many projects and new programs.
7. Some Experience with Cross Sector Projects/Initiatives
Almost every care setting/service has some experience with cross sector projects/initiatives related to HPC.
From a provincial perspective examples specifically related to HPC include:
• the Ontario Cancer Symptom Management Collaborative (OCSMP),
• roll out of Cancer Care Ontario’s Symptom Management Guides and Collaborative Care Path,
• the Integrated Client Care Project (ICCP) – currently being piloted in several regions and seeking to engage cross sector partners.
At a regional and local level significant cross sector HPC work is evident in terms of:
• defining right patient, right place, right time elements (i.e. criteria of each care setting etc., advancing use of common tools)
• cross sector HPC education,
• cross sector planning for the system,
• cross sector patient specific rounds (in a few regions)
Additionally much knowledge transfer about the basics of HPC has already occurred.
There are care providers and leaders in every sector who have already agreed that the
‘new model’ is the ‘right model’ and have worked together to produce system level and sector level planning documents that support these key concepts.
Certainly gaps in service provision and in practical application of concepts and models of care are evident. This Part Three of the review reiterates the need for stronger linkages between/among sectors and the need to continue to promote the creation of HPC access to patients in every care setting where patients die. This review also points to the possible efficiencies that can be realized through provincially shared approaches to efficient tools & resources (e.g.: data collection / standardized education).
As each care setting and service continues to enhance its HPC provision many synergies between care settings and services will be realized.
Works Cited
1. Advancing High Quality, High Value Palliative Care in Ontario - DECLARATION OF
PARTNERSHIP AND COMMITMENT TO ACTION. December, 2010. Consensus Report.
Report compiled by over 80 stakeholders from across Ontario, The process was collectively lead by:
Ministry of Health and Long Term Care, Local Health Integration Networks and Quality Hospice Palliative Care Coalition of Ontario.
2. Champlain Hospice Palliative Care and End-of-Life Care Network; Planning Council.
Champlain Regional Hospice Palliative Care Program Plan. s.l. : Champlain Hospice Palliative Care and End-of-Life Care Network, 2010.
3. Erie St. Clair End-of-Life Care Network; Beth Lambie. Hospice Palliative Care in Erie St.
Clair, Report on Current Services and Recommendations for Future Systems. Erie St. Clair End-of-Life Care Network. [Online] 2008. [Cited: July 10, 2010.]
http://www.esceolcn.ca/AboutUs/documents/CurrentServicesRecommend.pdf.
4. Hamilton Niagara Haldimand Brand Hospice Palliative Care Network; Julie Darnay.
HNHB HPC Network Assessment and Analysis of Palliative Care Needs in Hamilton Niagara Haldimand Brant. s.l. : Hamilton Niagara Haldimand Brand Hospice Palliative Care Network, 2008.
5. Southwest End-of-Life Care Network; Paul Cavanagh. Southwest End-of-Life Care Network Annual Report. s.l. : Southwest End-of-Life Care Network, 2008.
6. Southeastern Ontario Palliative & End-of-Life Care Network. Towards a Hospice Palliative and End-of-Life Care System Design for Souteastern Ontario - A Foundation Report for Future Discussion and Planning. s.l. : South East Hospice Palliative Care Network, 2009.
7. Toronto Central Hospice Palliative Care Network; Siu Mee Cheng. Strategic Plan. s.l. : Toronto Central Hospice Palliative Care Network, 2010.
8. Waterloo Wellington Hospice Palliative Care Network; Andrea Martin. Waterloo Wellington Hospice Palliative Care System Design. s.l. : Waterloo Wellington Hospice Palliative Care Network, 2008.
9. North East Project Steering Committee North East Ontario End-of-Life Network - Prepared by David Paquette Summit Consulting. A Review of Hospice Palliative Care Programs and Services in Northeastern Ontario - Summary Report. November 17,2011.
10. Central East Hospice Hospice Palliative Care Network; Kirsten Schmidt-Chamberlain.
Creating System Integration for Hospice Palliative Care Services in the Central East LHIN. s.l. : Central East Hospice Hospice Palliative Care Network, 2010.
11. MH LHIN. Palliative Care Initiative - October 2009 - summary Document. [Online] [Cited:
Dec. 21, 2011.]
http://www.mississaugahaltonlhin.on.ca/uploadedFiles/Public_Community/Health_Service_Provi ders/PCI-%20Summary%20document%20Oct%20%202009-website.pdf.
12. CW LHIN. Palliative Care: Essential to our Local Health System. [Online] November 8, 2010.
[Cited: December 20, 2011.]
http://www.centralwestlhin.on.ca/SearchPage.aspx?searchtext=palliative%20care.
13. NSM Hospice Palliative Care Netwrok. NSM Hospice Palliative Care lService Delivery Model. [Online] http://www.palliativecarenetworknsm.ca/about_sdm.aspx.
14. NW EOLC Network. Rural and Remote Palliative Care Teams and Providers. [Online]
http://www.nwoendoflifecare.ca/index.php?pid=65.
15. Central Palliative Care Network. Enviromental Scan. [Online] April 2011. [Cited: Dec. 20, 2011.] http://centralhpcnetwork.ca/reports/CHPCN_Environmental_Scan_Apr_2011.pdf.
16. Shobbrook, Cindy and Johnston, Julia. Building a Community of Palliative Care Providers:
the Role of the APN. January 16, 2012. Presentation for Nursing Rounds - CCO.
17. Central West Palliative Care Network. Comprehensive Integrated Systems Design Framework. 2011.
18. Provincial End of Life Care Network - Ontario. A Provincial System Design Framework (A Primer on Possible Components of Ontario's Hospice Palliative Care System. [Online] September 2010. [Cited: January 2, 2010.] http://www.esceolcn.ca/Reports/ProvSysDesFramework.pdf.
19. Ferris, FD, et al., et al. A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice. Ottawa, ON : Canadian Hospice Palliative Care Association, 2002. ISBN: 1-896495-17-6.
20. Cancer Care Ontario. Regional Models of Care for Palliative Cancer Care: Recommendations for the Organization and Delivery of Palliative Cancer Care in Ontario. [Online] December 2009.
https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=77326.
21. Provincial End of Life Care Network - Ontario. Preliminary Inventory/Review of Hospice Palliative Care in Ontario. s.l. : Provincial End of Life Care Network , 2009.
22. Provincial End of Life Care Network for the Quality Hospice Palliative Care Coalition of Ontario. Hospice Palliative Care in Ontario: The Way Forward - Survey Results. March 2010.
23. Palliative care for older people: better practices. World Health Organization - Regional office for Europe. [ed.] Sue Hall, et al., et al. Copenhagen, Denmark : WHO Regional Offi ce for Europe, Scherfi gsvej 8 DK-2100 Copenhagen Ø (http://www.euro.who.int/pubrequest). ISBN 978 92 890 0224 0.
24. Fraser Health. Fraser Health Acute Care Capacity Initiative: ACCI Service Plan for Acute Palliative Care. s.l. : Fraser Health, March 2005.
25. Centre to Advance Palliative Care. s.l. : Archives of Internal Medicine, September, 8, 2008.
26. Palliative Care Australia. A Guide to Palliative Care Service Development - A Population Based Approach. [Online] 2005. [Cited: January 15, 2009.] www.pallcare.org.au.
27. Accreditation Canada. Accreditation Canada Hospice Palliative And End of Life Care Services.
[Online] http://www.accreditation.ca/accreditation-programs/qmentum/standards/hospice-palliative-and end-of-life-services/.
28. Provincial End-of-Life Care Network - Ontario; Paul Cavanagh. Annual Report - Provincial End-of-Life-Care Network . s.l. : Provincial End-of-Life Care Network, 2008.
29. Provincial Life Care Network - Ontario. Governance Document. s.l. : Provincial End-of-Life Care Network - Ontario, 2009.
30. Cancer Care Ontario. Improving the Quality of Palliative Care Services for Cancer Patients in Ontario.
s.l. : Cancer Care Ontario, 2006.
31. Auditor General of Canada. Principles of Effective Accountability. Report of the Auditor General of Canada. s.l. : (as cited by P. Cavanagh - presentation to SouthWest End of Life Care Network - Fall 2006), December 2002.
32. Ontario Association of Community Care Access Centres. Reference Document to Support the Development of Interdisciplinary and Integrated End-of-Life Care Service Delivery Models in Ontario. s.l. : David Paquette, Summit Consulting, 2005. p. 6.
33. Erie St Clair End of Life Care Network; Beth Lambie. Review of Foundational Concepts Related to Hospice Palliative Care Service Delivery. Erie St. Clair End-of-Life Care Network. [Online]
May 2009. [Cited: June 10, 2010.]
http://www.esceolcn.ca/AboutUs/documents/FoundationalConcepts.pdf.
34. —. System Design Framework - Developing a Regional System of Hospice Palliative Care Delivery in Erie St.
Clair. s.l. : Erie St. Clair End of Life Care Network, 2009.
35. Canadian Hospice Palliative Care Association. The Pan-Canadian Gold Standard for Palliative Home Care. Ottawa : CHPCA, 2007.
36. Ontario Hospice Palliative Care Coalition of Ontario. Towards an Integrated Hospice Palliative Care System in Ontario . s.l. : Ontario Hospice Palliative Care Coalition of Ontario, 2010 (work still in progress as of Sept 2010).
37. Brazil, K, et al., et al. Building Primary Care Capacity in Palliative Care: Proceedings of an Interprofessional Workshop. Summer 2007, Vol. 23, 2.
38. Suter, E, et al., et al. Health Systems Integration; Definitions, Processes & Impact; A research Synthesis.
Calgary, Alta : s.n., October 2007.
39. Cochrane Database of Systematic Reviews,. End-of-life care pathways for improving outcomes in caring for the dying. Cochrane Database of Systematic Reviews. 2010, 1.
40. Hospice Palliative Care Service Delivery Model . [Online] [Cited: December 20, 2011.]
mhtml:file://C:\Documents%20and%20Settings\beth.lambie\My%20Documents\regional%20pla
ns\Service%20Delivery%20Model%20-%20North%20Simcoe%20Muskoka%20Palliative%20Care%20Network.mht!http://www.palliativec arenetworknsm.ca/about_sdm.aspx.
41. BEYOND THE RHETORIC: WHAT DO WE MEAN BY A ‘MODEL OF CARE’?
Davidson, P, et al., et al. 3, s.l. : Australian Journal of Advanced Nursing, 2006, Vol. 23.
42. P.M., Davidson and Elliott, D. Managing approahes to nursing care delivery. In Preparation for professional for professional nursing practice,. Sydney : Maclennan and Petty, 2001. p. p. 121.
43. Queensland Health,2004. Changing models of care Framework 2000. [Online] [Cited:
December 21, 2011.]
http://www.health.qld.gov.au/publications/change_management/Care_Framework.pdf.
44. Doyle, D. and Woodruff, R. The IAHPC Manual of Palliative Care - 2nd Edition. [Online]
2008. [Cited: November 02, 2011.] http://www.hospicecare.com/manual/principles-main.html#MODELS. ISBN 0-9758525-1-5.
45. Canadian Institute for Health Information.
46. The Change Foundation. Winning Conditions to Improve Patient Experiences: Integrated Healthcare in Ontario. Toronto,ON : The Change Foundation, November 2011.
47. Department of Health, Western Australian. Palliative Care model of Care,. Perth : WA Cancer &
Palliative Care Network, 2008.
48. Provincial End of Life Care Network. The Way Forward - Survey Report. March 2010.
49. [Online] http://en.wikipedia.org/wiki/Blind_men_and_an_elephant.
50. Pereira, Dr. Jose. The Consultation and Shared Care Role in Palliative Caare. 2010. Presented as part of Ontario's engagement process of HPC: Advancing High Quality, High Value Palliative Care in Ontario .
51. Seow, Hsien. HPC in Ontario: A first draft t articulating a vision of the future and a roadmap to get there. Oct. 4, 2011. Presentation as part of Ontario's HPC engagement process "Advancing High Qulaity, High Value Palliative Care in Ontario .
52. Julie Darnay for Ontario College of Family Physicians. 2012.
53. The Change Foundation & Waterloo Wellington Palliative Care Network. Setting the Stage for Change - Hospice Palliative Care in Ontario - Final Report . 2010.