1 The Evolution of Hospice Palliative Care Policy and Practice in Ontario, Canada
2 Introduction Ontario: Demography & Geography Urban vs. Rural South vs. North Local Health Integration Networks (LHINs) Figure 1: Ontario Local Health Integration Network Boundaries. Map available at:
3 Methods Review of academic & grey literatures Preliminary timelines Review of timelines by key informants (n=8) Follow-up semi-structured interviews with key informants Thematic content analysis of interview data (Aronson, 1994) & revision of timelines by research team
4 Chronological list of provincial hospice palliative care (HPC) key milestones from 1979 to 2009 ◦ 1. Late1970s & 1980s: The Foundational Years ◦ s: Increased Provincial Government Involvement ◦ : Union of Stakeholders Influence of federal government Role of associations and advocates Rural lag: “Rural care is like a big black hole.” Results
5 Late 1970s and 1980s Origin of HPC in Canada 1979: 1st community-based hospice Provincial associations established 1. The Foundational Years
6 2. ON Gov’t Takes Notice of HPC 1990s: Few HPC milestones Education funding provided by Ministry of Health Health Care Services Restructuring: Shift to community care Rural health service delivery challenges acknowledged National senate committee report
7 3. Stakeholders Unite for HPC National report: Quality End of Life Care: The Right of Every Canadian; HPC funds through 2003 Canadian Federal Health Accord End-of-Life Care Strategy enacted in 2005; Networks established Rural education initiatives through Pallium ( ) & federal support for residential hospices Two provincial associations host first collaborative HPC conference in 2009 HPC Provincial Think Tank in 2009 & stakeholder group forms
8 HPC in Ontario has evolved over the last 30 years and continues to move forward Rural areas continue to lag behind but there is movement taking place Increased efforts on integration and coordination of care HPC Networks & unity of stakeholders holds potential Conclusion