Articoli di riviste: "Palliative care, Canada"

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Smyth, Dion. "Politics and palliative care: Canada". International Journal of Palliative Nursing 17, n. 4 (aprile 2011): 205. http://dx.doi.org/10.12968/ijpn.2011.17.4.205.

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Heidemann, Elma G. "Palliative Care in Canada: 1986". Journal of Palliative Care 5, n. 3 (settembre 1989): 37–42. http://dx.doi.org/10.1177/082585978900500308.

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Ajemian, Ina Cummings. "Palliative Care in Canada: 1990". Journal of Palliative Care 6, n. 4 (dicembre 1990): 47–50. http://dx.doi.org/10.1177/082585979000600410.

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Wodinsky, Harold B. "Palliative care in Canada: An overview". American Journal of Hospice Care 6, n. 6 (novembre 1989): 44–47. http://dx.doi.org/10.1177/104990918900600623.

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Costante, Alicia, Christina Lawand e Clare Cheng. "Access to Palliative Care in Canada". Healthcare Quarterly 21, n. 4 (31 gennaio 2019): 10–12. http://dx.doi.org/10.12927/hcq.2019.25747.

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Kristjanson, Linda J., e Lynda Balneaves. "Directions for Palliative Care Nursing in Canada: Report of a National Survey". Journal of Palliative Care 11, n. 3 (settembre 1995): 5–8. http://dx.doi.org/10.1177/082585979501100302.

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This paper reports the results of a national survey of palliative care nurses conducted following a meeting of nurses at the Fifth Canadian Palliative Care Association Conference in 1993. The intent of the survey was to obtain information about Canadian palliative care nurses's perceptions of practice and professional issues. Eighty percent of respondents believed that palliative care nurses should form a palliative care nurses’ organization, with the majority recommending that this occur under the auspices of the Canadian Palliative Care Association. Key issues of importance to palliative care nurses were identified. The two major issues of concern were (a) the need to develop standards of practice and (b) educational needs of palliative care nurses. Respondents also emphasized the importance of maintaining and fostering an interdisciplinary approach to palliative care. Results of this survey are to be further discussed at the Sixth Canadian Palliative Care Association Conference to be held in Halifax in October 1995.

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Czarkowski, Wiktor Maria, Dominika Agnieszka Kmita e Marcin Janecki. "The palliative care in Australia and Canada". Palliative Medicine 14, n. 1 (2022): 9–17. http://dx.doi.org/10.5114/pm.2022.118722.

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Roy, David J. "Palliative Care Canada 1999 — A Question Period". Journal of Palliative Care 15, n. 1 (marzo 1999): 3–5. http://dx.doi.org/10.1177/082585979901500101.

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Morrison, R. Sean. "A National Palliative Care Strategy for Canada". Journal of Palliative Medicine 21, S1 (gennaio 2018): S—63—S—75. http://dx.doi.org/10.1089/jpm.2017.0431.

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Widger, Kimberley, Dawn Davies, Danielle J. Drouin, Laura Beaune, Lysanne Daoust, R. Peter Farran, Nago Humbert et al. "Pediatric Patients Receiving Palliative Care in Canada". Archives of Pediatrics & Adolescent Medicine 161, n. 6 (1 giugno 2007): 597. http://dx.doi.org/10.1001/archpedi.161.6.597.

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Ley, Dorothy C. H. "Palliative Care in Canada: The First Decade and Beyond". Journal of Palliative Care 1, n. 1 (marzo 1985): 32–34. http://dx.doi.org/10.1177/082585978500100106.

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The first decade of palliative care in Canada has witnessed a rapid increase in programs. Originally institutional, they are now becoming community oriented. The major issues in palliative care are education, planning, development of standards and evaluative procedures, funding, and certain ethical dilemmas. The need for a sound academic base for future development is stressed. The role of the Palliative Care Foundation, both current and future, is briefly described.

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Lou Kelley, Mary. "Developing Rural Communities’ Capacity for Palliative Care: A Conceptual Model". Journal of Palliative Care 23, n. 3 (settembre 2007): 143–53. http://dx.doi.org/10.1177/082585970702300304.

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The population in Canada and other developing countries is aging, increasing the need for palliative care services. In rural communities, care of dying people is normally provided by health care professionals as part of a generalist practice, not by palliative care specialists. Despite a lack of specialists and resources, some rural communities have developed local palliative care programs. The goal of this research was to conceptualize rural communities’ process of developing palliative care programs using a theoretical perspective of community capacity development. Data were from nine focus groups of interdisciplinary rural health care providers who provided palliative care in seven provinces/territories of Canada. The outcome is a theoretical model that conceptualizes the process of developing palliative care programs in four sequential phases: antecedent community conditions, a catalyst, creating the team, and growing the program. The activities of each phase are outlined. This research offers practical and theoretical knowledge to guide practitioners and planners seeking to develop palliative care programs in other rural communities.

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Pilkey, Jana, James Downar, Deborah Dudgeon, Leonie Herx, Doreen Oneschuk, Cori Schroder e Valerie Schulz. "Palliative Medicine—Becoming a Subspecialty of the Royal College of Physicians and Surgeons of Canada". Journal of Palliative Care 32, n. 3-4 (luglio 2017): 113–20. http://dx.doi.org/10.1177/0825859717741027.

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The discipline of palliative medicine in Canada started in 1975 with the coining of the term “palliative care.” Shortly thereafter, the provision of clinical palliative medicine services started, although the education of the discipline lagged behind. In 1993, the Canadian Society of Palliative Care Physicians (CSPCP) started to explore the option of creating an accredited training program in palliative medicine. This article outlines the process by which, over the course of 20 years, palliative medicine training in Canada went from a mission statement of the CSPCP, to a 1 year of added competence jointly accredited by both the Royal College of Physicians and Surgeons of Canada (Royal College) and the College of Family Physicians of Canada, to a 2-year subspecialty of the Royal College with access from multiple entry routes and a formalized accrediting examination.

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Brown, Catherine RL, Amy T. Hsu, Claire Kendall, Denise Marshall, Jose Pereira, Michelle Prentice, Jill Rice et al. "How are physicians delivering palliative care? A population-based retrospective cohort study describing the mix of generalist and specialist palliative care models in the last year of life". Palliative Medicine 32, n. 8 (11 giugno 2018): 1334–43. http://dx.doi.org/10.1177/0269216318780223.

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Background: To enable coordinated palliative care delivery, all clinicians should have basic palliative care skill sets (‘generalist palliative care’). Specialists should have skills for managing complex and difficult cases (‘specialist palliative care’) and co-exist to support generalists through consultation care and transfer of care. Little information exists about the actual mixes of generalist and specialist palliative care. Aim: To describe the models of physician-based palliative care services delivered to patients in the last 12 months of life. Design: This is a population-based retrospective cohort study using linked health care administrative data. Setting/participants: Physicians providing palliative care services to a decedent cohort in Ontario, Canada. The decedent cohort consisted of all adults (18+ years) who died in Ontario, Canada between April 2011 and March 2015 ( n = 361,951). Results: We describe four major models of palliative care services: (1) 53.0% of decedents received no physician-based palliative care, (2) 21.2% received only generalist palliative care, (3) 14.7% received consultation palliative care (i.e. care from both specialists and generalists), and (4) 11.1% received only specialist palliative care. Among physicians providing palliative care ( n = 11,006), 95.3% had a generalist palliative care focus and 4.7% a specialist focus; 74.2% were trained as family physicians. Conclusion: We examined how often a coordinated palliative care model is delivered to a large decedent cohort and identified that few actually received consultation care. The majority of care, in both the palliative care generalist and specialist models, was delivered by family physicians. Further research should evaluate how different models of care impact patient outcomes and costs.

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Fassbender, Konrad, Wonita Janzen, Michelle Sims, Carleen Brenneis e Karen Macmillan. "Palliative Care Matters: Commitment to Action Toward an Integrated Palliative Care Strategy for Canada". Journal of Pain and Symptom Management 56, n. 6 (dicembre 2018): e24-e25. http://dx.doi.org/10.1016/j.jpainsymman.2018.10.014.

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Novik, Nuelle. "The Role of Social Work in Palliative Care". Journal of Comparative Social Work 7, n. 1 (2 aprile 2012): 71–80. http://dx.doi.org/10.31265/jcsw.v7i1.81.

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A qualitative research study was conducted in northern Canada in 2007 which examined the realities and issues surrounding palliative care with seniors in remote northern settings. As a profession with a recognized role in supporting those who are dying and those who are bereaved, social work has been integral to the development of palliative care support services in northern Canada. However, in regions of the North where the social work profession is less developed and less recognized, the role for social work remains understated.

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Claxton-Oldfield, Stephen, Jennifer Tomes, Michelle Brennan, Catherine Fawcett e Jane Claxton-Oldfield. "Palliative care volunteerism among college students in Canada". American Journal of Hospice and Palliative Medicine® 22, n. 2 (marzo 2005): 111–18. http://dx.doi.org/10.1177/104990910502200206.

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Collier, R. "Access to palliative care varies widely across Canada". Canadian Medical Association Journal 183, n. 2 (10 gennaio 2011): E87—E88. http://dx.doi.org/10.1503/cmaj.109-3763.

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Gallagher, Romayne, e Michael J. Passmore. "Canada needs equitable, earlier access to palliative care". Canadian Medical Association Journal 192, n. 20 (18 maggio 2020): E559. http://dx.doi.org/10.1503/cmaj.74961.

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Mount, Balfour M., John Scott e S. Robin Cohen. "Canada: Status of cancer pain and palliative care". Journal of Pain and Symptom Management 8, n. 6 (agosto 1993): 395–98. http://dx.doi.org/10.1016/0885-3924(93)90061-y.

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MacLean, Gillian, Alessia Gallipoli e Ayla Raabis. "23 Current Trends in Canada in Neonatal Palliative Care". Paediatrics & Child Health 25, Supplement_2 (agosto 2020): e8-e9. http://dx.doi.org/10.1093/pch/pxaa068.022.

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Abstract Background The area of palliative care in pediatrics has been expanding, as evidence emphasizes the benefits of providing pediatric patients and their families with optimized care in cases of chronic illness and end-of-life. The majority of pediatric deaths occur in infants under one year, with significant portions of these deaths taking place in Neonatal Intensive Care Units (NICU). The expansion of palliative care into neonatal medicine is of significant importance, as symptom management and end-of-life care plays a vital role in providing complete care to these infants. Guidelines that have been put into place can vary significantly between centers. Published studies in neonatal palliative care (PC) describe these challenges, however little data currently exists specific to Canadian NICUs. Objectives The primary objective was to gather information about current practice trends and themes around barriers in neonatal PC. Design/Methods An anonymous survey was distributed to Canadian Level 3 NICU staff, including neonatologists, neonatal nurse practitioners (NP), and neonatal fellows through the Qualtrics platform. Surveys were distributed through email and responses tracked in the Qualtrics system. Results The survey response rate was 57. The majority of respondents were neonatologists (50%), with many having more than 5 years of experience. Provision of palliative care was common with 20/57 respondents being involved in 5 or more cases in the past year. Only 40% of respondents reported that neonatologists and neonatal NPs received palliative care training at their center. When education did exist, lectures (31%) and workshops (26%) were most common. 97% said their centre would benefit from more education. 53% of respondents said their center had an established guideline around neonatal PC, 20% did not know and 27% answered no. Only 8% of respondents who work at centres with a guideline found that it was consistently followed. Respondents were asked to identify barriers to implementation at their place of practice. Common responses noted challenges in NICU collaborations with maternal-fetal medicine and palliative care teams, as well as lack of education and providers’ personal beliefs. Lastly, respondents provided details of their guidelines or common practices in PC which has been collated and summarized. Conclusion The results provide a snapshot of the current palliative care practices in academic NICUs across Canada. Overall the results were positive with many centers having a guideline and some provider education. The perceived barriers highlight focus areas for future education and policy development, and emphasize the importance of improved collaboration moving forward.

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Pugh, Arlanna, Heather Castleden, Melissa Giesbrecht, Colleen Davison e Valorie Crooks. "Awareness as a dimension of health care access: exploring the case of rural palliative care provision in Canada". Journal of Health Services Research & Policy 24, n. 2 (aprile 2019): 108–15. http://dx.doi.org/10.1177/1355819619829782.

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Objectives In Canada, the rural elderly population is increasing in size, as is their need for palliative care services in these settings. This analysis aims to identify awareness-associated barriers to delivering rural palliative care services, along with suggestions for improving service delivery from the perspective of local health care providers. Methods A total of 40 semi-structured interviews with various formal and informal health care providers were conducted in four rural and/or remote Canadian communities with limited palliative care resources. Interview data were thematically coded using Penchansky and Thomas’ five dimensions of access (i.e. availability, (geographic) accessibility, accommodation, acceptability and affordability). Saurman’s recently added sixth dimension of access – awareness – was also identified while coding and subsequently became the primary focus of this analysis. Results Identified barriers to palliative care awareness and suggestions on how to enhance this awareness, and ultimately palliative care delivery, corresponded with three key themes arising from the data: limited palliative care knowledge/education, communication and coordination. Participants recognized the need for more palliative care education, open lines of communication and better coordination of palliative care initiatives and local resources in their communities. Conclusions These findings suggest that identifying the barriers to palliative care awareness in rural communities may be foundational to addressing barriers to the other five dimensions of access. A thorough understanding of these three areas of awareness knowledge, communication and coordination, as well as the connections between them, may help enhance how rural palliative care is delivered in the future.

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Baylis, Jared, Devin R. Harris, Charlie Chen, Daniel K. Ting, Kevin Clark, Anthony Kwan, Skye Crawford e David Williscroft. "Palliative and end-of-life care education in Canadian emergency medicine residency programs: A national cross-sectional survey". CJEM 21, n. 2 (30 gennaio 2019): 219–25. http://dx.doi.org/10.1017/cem.2018.470.

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ABSTRACTObjectivesEmergency physicians play an important role in providing care at the end-of-life as well as identifying patients who may benefit from a palliative approach. Several studies have shown that emergency medicine (EM) residents desire further training in palliative care. We performed a national cross-sectional survey of EM program directors. Our primary objective was to describe the number of Canadian postgraduate EM training programs with palliative and end-of-life care curricula.MethodsA 15-question survey in English and French was sent by email to all program directors of both the Canadian College of Family Physicians emergency medicine (CCFP(EM)) and the Royal College of Physicians and Surgeons of Canada emergency medicine (RCPSC-EM) postgraduate training programs countrywide using FluidSurveys™ with a modified Dillman approach.ResultsWe received a total of 26 responses from the 36 (response rate = 72.2%) EM postgraduate programs in Canada. Ten out of 26 (38.5%) programs had a structured educational program pertaining to palliative and end-of-life care. Lectures or seminars were the exclusive choice to teach content. Clinical palliative medicine rotations were mandatory in one out of 26 (3.8%) programs. The top two barriers to implementation of palliative and end-of-life care curricula were lack of time (84.6%) and curriculum development concerns (80.8%).ConclusionsPalliative and end-of-life care training within EM has been identified as an area of need. This cross-sectional survey demonstrates that a minority of Canadian EM programs have palliative and end-of-life care curricula. It will be important for all EM training programs, RCPSC-EM and CCFP(EM), in Canada, to develop an agreed upon set of competencies and to structure their curricula around them.

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Gaudette, Leslie A., Fan Shi, Tammy Lipskie, Pierre Allard, Robin L. Fainsinger, David Maxwell e Mike Harlos. "Developing Palliative Care Surveillance in Canada: Results of a Pilot Study". Journal of Palliative Care 18, n. 4 (dicembre 2002): 262–69. http://dx.doi.org/10.1177/082585970201800403.

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Objective A pilot study compiled data from six palliative care centres across Canada to assess the feasibility of developing a national surveillance system. Methods Data provided for the three-year period between 1993–1997 were combined into a comparative minimum data set. Analyses included 6,369 care episodes from five centres, plus 948 patients from one centre. Results Care was provided in various settings including acute care wards, dedicated palliative care units, tertiary care, chronic care, and at home. Palliative care patients comprised equal numbers of men and women, with a median age of 69 years; 92% had cancer diagnoses. Median length of stay (LOS) for each care episode was 13 days, increasing to 40–43 days for a patient's entire time in care. LOS varied greatly, by care setting, from seven days (dedicated unit), to 19 days (tertiary unit), 37 days (home), and 54 days (chronic care). Our findings are similar to those reported from national surveys in Australia and the United Kingdom. Summary This study generated useful baseline data and identified key issues requiring resolution before establishing a national surveillance system, including the need to track patients across care settings.

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Panarella, Michela, Olli Saarela, Ali Vahit Esensoy, Ahmed Jakda e Zhihui (Amy) Liu. "Regional Variation in Palliative Care Receipt in Ontario, Canada". Journal of Palliative Medicine 22, n. 11 (1 novembre 2019): 1370–77. http://dx.doi.org/10.1089/jpm.2018.0573.

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Fainsinger, Robin L., Carleen Brenneis e Konrad Fassbender. "Edmonton, Canada: A Regional Model of Palliative Care Development". Journal of Pain and Symptom Management 33, n. 5 (maggio 2007): 634–39. http://dx.doi.org/10.1016/j.jpainsymman.2007.02.012.

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Turner, C. J. "P135: Canadian emergency medicine residents’ training and competency in end-of-life care: a needs assessment". CJEM 18, S1 (maggio 2016): S123. http://dx.doi.org/10.1017/cem.2016.309.

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Introduction: Emergency Physicians (EPs) face growing numbers of palliative care patients presenting to the emergency department (ED). Formal training for EM residents across Canada in this area is not well described. We sought to describe the training Canadian emergency medicine (EM) residents receive in end of life care issues, their attitudes toward it, self-reported knowledge and skills, and the importance they place on further training in this domain. Methods: We conducted an electronic survey across Canada. We collected demographic data, previous education in palliative care, attitudes toward end of life care, and a self-assessment of competency and desires for further training in the main components of palliative care pertinent to EM. We used simple descriptive statistics, a Mann-Whitney test to assess whether previous formal training in palliative care affected current comfort level, and a combination of self-reported knowledge and importance levels placed on key areas. Results: We received 112 responses from 17 different Universities in Canada, with 42% from the CCFP training stream, and 58% from the FRCP stream. Fifty-four percent of respondents had not completed a palliative care rotation during residency or fellowship, which was overwhelming accounted for by FRCP residents (13%, vs. 82% among CCFPs). Having completed formal training in palliative care was significantly associated with general comfort in managing terminally ill patients (p<0.0001). Sixty percent of subjects felt a lack of knowledge and skills was their main limiting factor in providing ideal care for terminally ill patients in the ED. The skills deemed highest priority with lowest comfort level among residents included discussing withdrawing and withholding care, prognosticating, pharmacology and other symptom control. Preferred methods of receiving palliative care teaching included simulation, bedside teaching and small groups. Conclusion: The care of acute illness among palliative care patients is substantially underrepresented in the Canadian EM curriculum, particularly for FRCP trainees. Formal training is associated with increased comfort in caring for patients at the end of their life. High yield teaching interventions could be directed toward knowledge of withdrawing, prognosticating and symptom control. Simulation, bedside teaching and small groups are the preferred method for receiving such teaching.

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Sutcliffe, Simon B., Puneet Bains, Fraser Black, Sandra S. Broughton, Stuart Brown, Simon Colgan, Megan E. Doherty et al. "The Two Worlds of Palliative Care: Bridging the Gap with Nepal". Nepal Journal of Science and Technology 20, n. 2 (31 dicembre 2021): 125–30. http://dx.doi.org/10.3126/njst.v20i2.45802.

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Despite past geo-political turbulence, Nepal has made significant progress in societal and economic initiatives, particularly in relation to social determinants of health. These improvements, however, belie the suffering of those with life-limiting disease due to pain, stigma, social and financial distress, consequent upon low patient, caregiver and health professional awareness of the need for, and availability of, appropriate care and support. Two Worlds Cancer Collaboration (INCTR-Canada) has been working with partners in Nepal to build capacity for palliative care by: (a) organizational and administrative support – establishing the Nepal Association of Palliative Care (NAPCare), and the creation of the Nepal Strategy for Palliative Care, approved by government in 2017; (b) “twinning” between 2 hospital palliative care units in Nepal and the Nanaimo Hospice and Victoria Hospice, BC, Canada; (c) sustainable growth of palliative care according to WHO foundational measures, implementing facility-based clinical programs, and home-based care aligned with the cultural, social, and economic environment of Nepal; (d) training of health professionals in adult and paediatricpalliative carethrough interactive on-line “distance learning” (Extension of Community Healthcare Outcomes, ECHO);(e) leveraging palliative care training and expertise across the government health system, and (f) local and international support to build a newfacility for Hospice Nepal to provide more support for more patients in a rural ambience on the outskirts of Kathmandu. Palliative care needs to become standard-of-care, providing peace, comfort and dignity for adults and children. Working collaboratively with partners in Nepal, the collective vision is a capable professional Nepali community leading palliative care services for all in need, wherever in need.

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Qureshi, Maryam, Maggie C. Robinson, Aynharan Sinnarajah, Srini Chary, Janet M. de Groot e Andrea Feldstain. "Reflecting on Palliative Care Integration in Canada: A Qualitative Report". Current Oncology 28, n. 4 (19 luglio 2021): 2753–62. http://dx.doi.org/10.3390/curroncol28040240.

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Studies have identified integrated interdisciplinary care as a hallmark of effective palliative care. Although models attempt to show how integration may function, there is little literature available that practically explores how integration is fostered and maintained. In this study we asked palliative care clinicians across Canada to comment on how services are integrated across the healthcare system. This is an analysis of qualitative data from a larger study, wherein clinicians provided written responses regarding their experiences. Content analysis was used to identify response categories. Clinicians (n = 14) included physicians, a nurse and a social worker from six provinces. They identified the benefits of formalized relationships and collaboration pathways with other services to streamline referral and consultation. Clinicians perceived a need for better training of residents and primary care physicians in the community and more acceptance, shared understanding, and referrals. Clinicians also described integrating well with oncology departments. Lastly, clinicians considered integration a complex process with departmental, provincial, and national involvement. The needs and strengths identified by the clinicians mirror the qualities of successfully integrated palliative care programs globally and highlight specific areas in policy, education, practice, and research that could benefit those in Canada.

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Wales, Joshua, Sumeet Kalia, Rahim Moineddin e Amna Husain. "The Impact of Socioeconomic Status on Place of Death Among Patients Receiving Home Palliative Care in Toronto, Canada: A Retrospective Cohort Study". Journal of Palliative Care 35, n. 3 (16 giugno 2019): 167–73. http://dx.doi.org/10.1177/0825859719855020.

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Background: Socioeconomic disparities in home death have been noted in the literature. Home-based palliative care increases access to home death and has been suggested as a means to decrease these disparities. Aim: Our study examines the association between socioeconomic status and other demographic factors on place of death in a population receiving home palliative care in Toronto, Canada. Design: This is a retrospective chart review of patients who died between August 2013 and August 2015 when admitted to a home-based palliative care service. Multivariate multinomial regression examined the relationship between the place of death (home, palliative care unit [PCU], or acute care) with age, gender, primary diagnosis, and income quintile. Bivariate logistic regression was fitted to calculate the odds ratio (OR) and probability of preference for home death. Setting/Participants: Patients receiving home-based palliative care services from the Latner Centre for Palliative Care in Toronto, Canada. Results: A total of 2066 patients were included in multivariate analysis. Patients in the lowest income quintile had increased odds of dying in acute care (OR = 2.41, P < .001) or dying in PCU (OR = 1.64, P = .008) than patients in highest income quintile. Patients in the next lowest income quintiles 2 and 3 were also more likely to die in acute care. The rate of preference for home death was significantly lower in the lowest income quintile (OR = 0.47, P = .0047). Conclusions: Patients in lower income quintiles are less likely to die at home, despite receiving home-based palliative care, although they may also be less likely to prefer home death.

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Kortes-Miller, Kathy, Sonja Habjan, Mary Lou Kelley e Marilyn Fortier. "Development of a Palliative Care Education Program in Rural Long-Term Care Facilities". Journal of Palliative Care 23, n. 3 (settembre 2007): 154–62. http://dx.doi.org/10.1177/082585970702300305.

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In North America, people 85 years and older are the fastest growing age cohort and long-term care homes are increasingly becoming the place of end-of-life care. This is especially true in rural communities where services are lacking. Staff in long-term care homes lack education about palliative care, but in rural areas, accessing education and the lack of relevant curricula are barriers. The focus of this paper is to describe an approach to developing and delivering a research-based palliative care education curriculum in rural long-term care homes. The approach included conducting a detailed assessment of staffs’ educational needs and preferred educational formats; developing a 15-hour interprofessional curriculum tailored to the identified needs; and delivering the curriculum on site in rural long-term care homes. Staff confidence and participation in delivering palliative care increased. Based on work in northwestern Ontario, Canada, this approach can serve as a model for palliative care education in other rural areas.

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Johnston, Grace, e Frederick Burge. "Analytic Framework for Clinician Provision of End-of-Life Care". Journal of Palliative Care 18, n. 3 (settembre 2002): 141–49. http://dx.doi.org/10.1177/082585970201800302.

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Four dimensions for the provision of end-of-life care by clinicians were identified from a review and synthesis of the Canadian family physician and palliative care literatures. These dimensions are: clinician-patient continuity, timing and location of care, community-centred services, and multidisciplinary care. Indicators of each dimension are presented along with criteria for indicator selection. The analytic framework was refined during the linkage of population-based administrative databases to identify patterns of family physician service provision in the last months of life for persons dying from cancer in Nova Scotia, Canada. Data analysis was framed to inform palliative care policy and programs, as well as to enable comparison among geographic areas within and beyond Canada.

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Kerba, Marc, Ayn Sinnarajah, M. Sarah Rose, Lynn Nicholson, Barbara Wheler e Bert Enns. "End-of-life cancer care: Health service delivery in the last 12 months of life in Calgary, Alberta, Canada." Journal of Clinical Oncology 33, n. 29_suppl (10 ottobre 2015): 171. http://dx.doi.org/10.1200/jco.2015.33.29_suppl.171.

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171 Background: In Calgary, Alberta, the Calgary Zone Palliative Care Collaborative (CZPCC) undertook a study to examine the current state of cancer and palliative services and to recommend steps to address gaps in service delivery. We hypothesized that early access to palliative care services would reduce utilization of active cancer treatments and services for individuals nearing the end of life. Our study objectives were to determine the utilization and timing of acute, palliative and oncology-related services in Calgary. Methods: This retrospective study examined cancer registry and administrative data for patients > 18 years, who died in 2012. Measures of aggressive end of life care (EOL) were also collected. A combination of descriptive statistics, tests of association and multivariate regression analysis were conducted. Results: N = 1909 died of cancer in 2012: median age 73 years (IQR: 62-82 years) and median disease duration 364 days (IQR: 92-1114 days). 40.6% of patients received systemic treatment in last 12 months of life. 29.9% received radiotherapy and 13.0% received psychosocial/spiritual care. Palliative care contact was 80.7%, inclusive of 20.6% who had an intensive palliative care unit admission. 5.2% had EOL chemotherapy and 3.8% received EOL radiotherapy. Up to 10.4% of patients had one or more hospital admission. There was no significant effect of age on those who received aggressive EOL care. Men had an increased probability to receive aggressive EOL care (p = 0.015). Tumor group was also associated with receiving aggressive EOL (p < 0.001), with the highest utilization in Head and Neck and hematological malignancies. In patients with a disease duration of > 4 months those who received palliative care at least 2-3 months prior to death were less likely to receive aggressive EOL care (P < 0.001). Patients whose disease duration was < 1 month were less likely to receive aggressive EOL care if they received palliative care services (p = 0.02). Conclusions: The provision of palliative care services at the end of life is most needed among men and certain tumor groups who are the highest users of aggressive EOL care.

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Sorensen, Anna, Lisa W. Le, Nadia Swami, Breffni Hannon, Monika K. Krzyzanowska, Kirsten Wentlandt, Gary Rodin e Camilla Zimmermann. "Readiness for delivering early palliative care: A survey of primary care and specialised physicians". Palliative Medicine 34, n. 1 (18 dicembre 2019): 114–25. http://dx.doi.org/10.1177/0269216319876915.

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Background: Evidence supporting early palliative care is based on trials of specialised palliative care, but a more sustainable model might involve mainly primary providers. Aim: The aim of this study was to compare the characteristics of physicians providing primary and specialised palliative care, their attitudes towards early palliative care and their perception of having sufficient resources for its provision. Design: Survey distributed by mail and e-mail. Specialised providers were defined as both receiving palliative care referrals from other physicians and not providing palliative care only for their own patients. Setting/participants: A total of 531 physicians providing palliative care in Canada (71% participation) participated in the study. Results: Of the participants, 257 (48.4%) provided specialised and 274 (51.6%) primary care. Specialists were more likely to have palliative care training (71.8% vs 35.2%), work in urban areas (94.1% vs 75.6%), academic centres (47.8% vs 26.0%) and on teams (82.4% vs 16.8%), and to provide mainly cancer care (84.4% vs 65.1%) (all p < 0.001). Despite strongly favouring early palliative care, only half in each group agreed they had resources to deliver it; agreement was stronger among family physicians, those working on teams and those with greater availability of community and psychosocial support. Primary providers were more likely to agree that renaming the specialty ‘supportive care’ would increase patient comfort with early palliative care referral (47.4% vs 35.5%, p < 0.001). Conclusion: Despite strongly favouring the concept, both specialists and primary providers lack resources to deliver early palliative care; its provision may be facilitated by team-based care with appropriate support. Opinions differ regarding the value of renaming palliative care.

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Mak, Ernie, Patricia Murphy-Kane e Camilla Zimmermann. "Assessing caregiver satisfaction with care on an acute palliative care unit." Journal of Clinical Oncology 35, n. 31_suppl (1 novembre 2017): 51. http://dx.doi.org/10.1200/jco.2017.35.31_suppl.51.

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51 Background: Accreditation Canada has adopted four main values for hospice, palliative, and end-of-life services: dignity and respect; information sharing; partnership and participation; and collaboration . These domains, as well as communication and joint decision-making, are important for satisfaction of caregivers for patients with cancer, and can be measured using the FAMCARE questionnaire. We aimed to assess satisfaction of caregivers for patient admitted to an acute palliative care unit at a comprehensive cancer center in Toronto, Canada. Methods: The FAMCARE questionnaire was administered by a trained volunteer to self-identified caregivers of patients who were admitted for more than five days on the acute palliative care unit. A short, anonymous demographic survey accompanied the FAMCARE questionnaire to gather information on relationship to patient, ethnicity, patient length of stay, and location of residence. The survey package either was completed in the presence of the volunteer, or was left to be completed by the caregiver alone and collected later by the volunteer. Results were reviewed regularly at the quality committee of the palliative care service. Results: From September 2014 to March 2017, 90 caregivers completed the questionnaire. Most caregivers were female (69%), identified as Canadian or Caucasian (57%), and lived in Toronto (63%). In all, 57% were spouses while 31% were children of the patient. Most patients had been admitted between a week and a month (67%). Care was rated as “Satisfied” or “Very satisfied” most of the time on all items (range 81-100%). The availability of nurses and doctors (100% satisfied/very satisfied) and the way tests and treatments were followed-up (99%) were rated highest. Information given about side effects (81%) and referral to specialists (83%) were rated lowest. Conclusions: Despite the nature of the acute palliative care unit, where patients admitted tend to be very ill with complex symptoms and psychosocial issues, caregiver satisfaction was high. Future research will examine whether caregivers of different ethnicities value different aspects of cancer care.

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Mak, Ernie, Patricia Murphy-Kane e Camilla Zimmermann. "Assessing caregiver satisfaction with care on an acute palliative care unit." Journal of Clinical Oncology 36, n. 30_suppl (20 ottobre 2018): 180. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.180.

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180 Background: Accreditation Canada has adopted four main values for hospice, palliative, and end-of-life services: dignity and respect; information sharing; partnership and participation; and collaboration . These domains, as well as communication and joint decision-making, are important for satisfaction of caregivers for patients with cancer, and can be measured using the FAMCARE questionnaire. We aimed to assess satisfaction of caregivers for patient admitted to an acute palliative care unit at a comprehensive cancer center in Toronto, Canada. Methods: The FAMCARE questionnaire was administered by a trained volunteer to self-identified caregivers of patients who were admitted for more than five days on the acute palliative care unit. A short, anonymous demographic survey accompanied the FAMCARE questionnaire to gather information on relationship to patient, ethnicity, patient length of stay, and location of residence. The survey package either was completed in the presence of the volunteer, or was left to be completed by the caregiver alone and collected later by the volunteer. Results were reviewed regularly at the quality committee of the palliative care service. Results: From September 2014 to May 2018, 116 caregivers completed the questionnaire. Most caregivers were female (66%), identified as Canadian or Caucasian (56%), and lived in Toronto (66%). In all, 52% were spouses while 27% were children of the patient. Most patients had been admitted between a week and a month (68%). Care was rated as “Satisfied” or “Very satisfied” most of the time on all items (range 77-99%). The availability of nurses and doctors (99% satisfied/very satisfied) were rated highest. Information given about side effects (77%) and referral to specialists (84%) were rated lowest. Conclusions: Despite the nature of the acute palliative care unit, where patients admitted tend to be very ill with complex symptoms and psychosocial issues, caregiver satisfaction was high. Developing adequate support for the spouses of patients is important. Future research will examine whether caregivers of different ethnicities value different aspects of cancer care.

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Williams, Allison M., Michelle V. Caron, Maria McMillan, Anne Litkowich, Noreen Rutter, Arlete Hartman e John Yardley. "An evaluation of contracted palliative care home care services in Ontario, Canada". Evaluation and Program Planning 24, n. 1 (febbraio 2001): 23–31. http://dx.doi.org/10.1016/s0149-7189(00)00044-6.

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Gilbar, Peter, e Kimberley Stefaniuk. "The Role of the Pharmacist in Palliative Care: Results of a Survey Conducted in Australia and Canada". Journal of Palliative Care 18, n. 4 (dicembre 2002): 287–92. http://dx.doi.org/10.1177/082585970201800407.

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A survey was conducted to determine what pharmaceutical services are provided to palliative care sites in Australia and Canada, and the pharmacist's role on the interdisciplinary team. Questionnaires were sent to 100 selected sites in each country. Questions pertained to demographics and the level of duties performed. Australian 42/76 (55.3%) and Canadian 59/69 (85.5%) sites employed palliative care pharmacists. Most Australians (83.3%) and Canadians (69.8%) worked under 20 hours/week on the palliative care service. Administrative duties and basic drug supply functions were more common in Australia, whilst Canadians had greater participation in team meetings and rounds. Medication review was the most common clinical duty; approximately 70% of respondents in each country provided specific advice on pharmacotherapy, administration, treatment, adverse effects, and incompatibilities. Education was universally important, but active participation in conferences, publication, and research was infrequent. Pharmacists in both Australia and Canada are important members of the palliative care team, and provide a similar high level of unique and valuable services to patients and their families.

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Spicer, David, Sonia Paul, Tom Tang, Charlie Chen e Jocelyn Chase. "Survey evaluations of University of British Columbia residents’ education and attitudes regarding palliative care and physician assisted death". Canadian Medical Education Journal 8, n. 1 (24 febbraio 2017): e6-21. http://dx.doi.org/10.36834/cmej.36860.

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Background: Little prior research has been conducted regarding resident physicians’ opinions on the subject of Physician Assisted Death (PAD), despite past surveys ascertaining the attitudes of practicing physicians towards PAD in Canada. We solicited British Columbia residents’ opinions on the amount of education they receive about palliative care and physician assisted death, and their attitudes towards the implementation of PAD.Methods: We conducted a cross sectional, anonymous online survey with the resident physicians of British Columbia, Canada. Questions included: close-ended questions, graded Likert scale questions, and comments. Results: Among the respondents (n=299, response rate 24%), 44% received ≥5 hours of education in palliative care, 40% received between zero and four hours of education, and 16% reported zero hours. Of all respondents, 75% had received no education about PAD and the majority agreed that there should be more education about palliative care (74%) and PAD (85%). Only 35% of residents felt their program provided them with enough education to make an informed decision about PAD, yet 59% would provide a consenting patient with PAD. Half of the respondents believed PAD would ultimately be provided by palliative care physicians.Interpretation: Residents desire further education about palliative care and PAD. Training programs should consider conducting a thorough needs assessment and implementing structured education to meet this need.

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Kaasalainen, Sharon, Lynn Mccleary, Shirin Vellani e Jose Pereira. "Improving End-of-Life Care for People with Dementia in LTC Homes During the COVID-19 Pandemic and Beyond". Canadian Geriatrics Journal 24, n. 3 (13 luglio 2021): 164–69. http://dx.doi.org/10.5770/cgj.24.493.

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COVID-19 pandemic has resulted in a significant increase in deaths in long-term care homes (LTCH). People with dementia living in LTCHs represent one of the most frail and marginalized populations in Canada. The surge of COVID-19 cases in LTCHs and rationing of health-care resources during the pandemic have amplified the pre-existing need for improvements in palliative and end-of-life care in LTCHs. This position statement, created by a task force commissioned by the Alzheimer Society of Canada, provides recommendations for a multipronged coordinated approach to improving palliative and end-of-life care of people with dementia living in LTCHs during the COVID-19 pandemic and beyond.

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Sussman, Jonathan, Lisa Barbera, Daryl Bainbridge, Doris Howell, Jinghao Yang, Amna Husain, S. Lawrence Librach, Raymond Viola e Hugh Walker. "Health system characteristics of quality care delivery: A comparative case study examination of palliative care for cancer patients in four regions in Ontario, Canada". Palliative Medicine 26, n. 4 (10 agosto 2011): 322–35. http://dx.doi.org/10.1177/0269216311416697.

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Background: A number of palliative care delivery models have been proposed to address the structural and process gaps in this care. However, the specific elements required to form competent systems are often vaguely described. Aim: The purpose of this study was to explore whether a set of modifiable health system factors could be identified that are associated with population palliative care outcomes, including less acute care use and more home deaths. Design: A comparative case study evaluation was conducted of ‘palliative care’ in four health regions in Ontario, Canada. Regions were selected as exemplars of high and low acute care utilization patterns, representing both urban and rural settings. A theory-based approach to data collection was taken using the System Competency Model, comprised of structural features known to be essential indicators of palliative care system performance. Key informants in each region completed study instruments. Data were summarized using qualitative techniques and an exploratory factor pattern analysis was completed. Results: 43 participants (10+ from each region) were recruited, representing clinical and administrative perspectives. Pattern analysis revealed six factors that discriminated between regions: overall palliative care planning and needs assessment; a common chart; standardized patient assessments; 24/7 palliative care team access; advanced practice nursing presence; and designated roles for the provision of palliative care services. Conclusions: The four palliative care regional ‘systems’ examined using our model were found to be in different stages of development. This research further informs health system planners on important features to incorporate into evolving palliative care systems.

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Brown, Catherine R. L., Colleen Webber, Hsien-Yeang Seow, Michelle Howard, Amy T. Hsu, Sarina R. Isenberg, Mengzhu Jiang, Glenys A. Smith, Sarah Spruin e Peter Tanuseputro. "Impact of physician-based palliative care delivery models on health care utilization outcomes: A population-based retrospective cohort study". Palliative Medicine 35, n. 6 (22 aprile 2021): 1170–80. http://dx.doi.org/10.1177/02692163211009440.

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Background: Increasing involvement of palliative care generalists may improve access to palliative care. It is unknown, however, if their involvement with and without palliative care specialists are associated with different outcomes. Aim: To describe physician-based models of palliative care and their association with healthcare utilization outcomes including: emergency department visits, acute hospitalizations and intensive care unit (ICU) admissions in last 30 days of life; and, place of death. Design: Population-based retrospective cohort study using linked health administrative data. We used descriptive statistics to compare outcomes across three models (generalist-only palliative care; consultation palliative care, comprising of both generalist and specialist care; and specialist-only palliative care) and conducted a logistic regression for community death. Setting/participants: All adults aged 18–105 who died in Ontario, Canada between April 1, 2012 and March 31, 2017. Results: Of the 231,047 decedents who received palliative services, 40.3% received generalist, 32.3% consultation and 27.4% specialist palliative care. Across models, we noted minimal to modest variation for decedents with at least one emergency department visit (50%–59%), acute hospitalization (64%–69%) or ICU admission (7%–17%), as well as community death (36%–40%). In our adjusted analysis, receipt of a physician home visit was a stronger predictor for increased likelihood of community death (odds ratio 9.6, 95% confidence interval 9.4–9.8) than palliative care model (generalist vs consultation palliative care 2.0, 1.9–2.0). Conclusion: The generalist palliative care model achieved similar healthcare utilization outcomes as consultation and specialist models. Including a physician home visit component in each model may promote community death.

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Sirianni, Giovanna. "A Public Health Approach to Palliative Care in the Canadian Context". American Journal of Hospice and Palliative Medicine® 37, n. 7 (4 dicembre 2019): 492–96. http://dx.doi.org/10.1177/1049909119892591.

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Palliative care helps improve the quality of life of individuals facing life-limiting illness throughout the course of their disease. In Canada, delivery and access to palliative care has been fraught with challenges including differential availability of services based on geography, funding, language, and socioeconomic status. Many groups, including the World Health Organization, have advocated for a public health approach to palliative care as an antidote to fragmented service delivery. Multiple scholars, academics, and public health advocates have suggested that a public health approach to palliative care can help with issues of access, equity, and cost. Through the lens of Kingdon’s Multiple Streams Framework, this commentary will explore potential reasons why a public health approach to palliative care has not been adopted in the Canadian context and why this is an opportune time to consider this policy innovation. The Compassionate Communities concept is discussed as a potential solution to a public health approach to palliative care delivery.

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Gofton, TE, S. Stewart, J. Yeung Laiwah, VN Schulz e A. Sarpal. "P.082 An evidence-based supportive and palliative care curriculum for Canadian neurology residents". Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 45, s2 (giugno 2018): S38. http://dx.doi.org/10.1017/cjn.2018.184.

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Background: Graduating residents require general palliative care skills. In Canada, there is no standardized palliative care curriculum for specialty trained residents. The objective of this research is to develop an evidence-based palliative care curriculum designed to provide neurology residents with the general palliative care skills required for providing patient care along the continuum of life. Methods: A needs assessment was performed in Neurology at Western University using qualitative analysis techniques. Residents completed the following:. A curricular outline was developed based on the Kolb learning style inventory (LSI), a knowledge pre-test, the Palliative Medicine Comfort and Confidence Survey and a review of the literature. Two iterations of the curriculum have been developed. Results: Residents identified a need for additional training in supportive and palliative care skills. Based on the Kolb LSI, 9/16 (56.3%) of neurology residents are “accommodators”. General principles identified for inclusion included: symptom management, communication, psychosocial aspects of care, care coordination and access, and myths and pitfalls in palliative care. Conclusions: This project is designed to identify the current palliative educational needs for Neurology residents. The results suggest that specialty trained residents are receptive to embedding training in the principles of palliative care within their training programs.

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Bélanger, Emmanuelle, Anna Towers, David Kenneth Wright, Yuexi Chen, Golda Tradounsky e Mary Ellen Macdonald. "Of dilemmas and tensions: a qualitative study of palliative care physicians’ positions regarding voluntary active euthanasia in Quebec, Canada". Journal of Medical Ethics 45, n. 1 (30 ottobre 2018): 48–53. http://dx.doi.org/10.1136/medethics-2017-104339.

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ObjectivesIn 2015, the Province of Quebec, Canada passed a law that allowed voluntary active euthanasia (VAE). Palliative care stakeholders in Canada have been largely opposed to euthanasia, yet there is little research about their views. The research question guiding this study was the following: How do palliative care physicians in Quebec position themselves regarding the practice of VAE in the context of the new provincial legislation?MethodsWe used interpretive description, an inductive methodology to answer research questions about clinical practice. A total of 18 palliative care physicians participated in semistructured interviews at two university-affiliated hospitals in Quebec.ResultsParticipants positioned themselves in opposition to euthanasia. Their justifications were framed within their professional commitment to not hasten death, which sat in tension with the value of patients’ autonomy to choose how to die. Participants described VAE as unacceptable if it impeded opportunities to evaluate and alleviate suffering. Further, they contested government rhetoric that positioned VAE as a way to improve end-of-life care. Participants felt that VAE would diminish the potential of palliative care to relieve suffering. Dilemmas were apparent in their narratives, about reconciling respect for patient autonomy with broader palliative care values, and the value of accompanying and not abandoning patients who make requests for VAE while being committed to neither prolonging nor hastening death.ConclusionsThis study provides insight into nuanced positions of experienced palliative care physicians in Quebec and confirms expected tensions between an important stakeholder and the practice of VAE as guided by the new legislation.

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Lee, Victor, Edward Yu e Krzisch Claude. "Palliative Care for Chest Tumors – Hong Kong, France and Canada". Current Cancer Therapy Reviews 14, n. 2 (12 luglio 2018): 167–80. http://dx.doi.org/10.2174/1573394714666180208143101.

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Scott, John F. "Palliative Care Education in Canada: Attacking Fear and Promoting Health". Journal of Palliative Care 8, n. 1 (marzo 1992): 47–53. http://dx.doi.org/10.1177/082585979200800111.

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Cyr, Claude, e Marie-Hélène Maisonneuve. "Paediatric palliative care in Canada: A national survey of paediatricians". Paediatrics & Child Health 20, n. 3 (aprile 2015): 153–54. http://dx.doi.org/10.1093/pch/20.3.153.

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Dudgeon, Deborah, Vida Vaitonis, Hsien Seow, Susan King, Helen Angus e Carol Sawka. "Ontario, Canada: Using Networks to Integrate Palliative Care Province-Wide". Journal of Pain and Symptom Management 33, n. 5 (maggio 2007): 640–44. http://dx.doi.org/10.1016/j.jpainsymman.2007.02.001.

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Sévigny, Andrée, Serge Dumont, S. Robin Cohen e Annie Frappier. "Helping Them Live Until They Die: Volunteer Practices in Palliative Home Care". Nonprofit and Voluntary Sector Quarterly 39, n. 4 (26 giugno 2009): 734–52. http://dx.doi.org/10.1177/0899764009339074.

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Volunteers traditionally play an essential role in palliative care. Without them, many community and institutional programs would not survive. Despite the significant number of volunteers involved in palliative care, the nature and scope of their actions remain ambiguous. The blurred boundaries of their contribution create tensions between professionals, families, and volunteers with regards to patient care and sharing of responsibilities. This article reports on a comprehensive and descriptive qualitative study aimed at understanding volunteer practices in home palliative care in Canada through analysis of volunteers’ discourse. The conceptual framework not only allows for a description of volunteer practices but also for an understanding of those practices in terms of the meaning volunteers ascribe to their actions and interactions. The information gathered provides a better understanding of the place of volunteers within the palliative care system, thereby allowing communities to optimize their contribution to the palliative care mission.

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