1. Palliative Care in Canada: History, Vision and Challenges
S. Lawrence Librach MD,CCFP,FCFP
Professor and Head, Division of Palliative Care,
Sun Life Financial Chair and director Joint Centre for Bioethics, University of Toronto

2. The Canadian Context

3. Geography
Canada is a large country 10 provinces & 3 northern territories
90% of the Canadian population lives within 10 km of the American border

4. Dr. Larry Librach Temmy Latner Centre for Palliative Care4

6. Canadian Population Data
33,000,000
60% in largest provinces of Ontario & Quebec
Our population is aging
Multicultural population
We have areas of population that are quite remote with access only by air or sea

7. Political Structure
British parliamentary system nationally and provincially
Prime minister & federal cabinet
Provincial premiers & cabinets
Elections every 4 years

8. Health Care System
Federal government responsible for overall policy & transfer of some tax revenue
Provincial ministries of health responsible for implementation & adding provincial tax revenue
Regionalized care
About 50% of provincial budgets spent on health care

9. Health Care System National health care scheme
Private health care not “legal”
Costs about 50% of provincial budgets
Drug costs covered over age 65 & those who are poor or disabled

10. Health Care System

11. Health Care System-Physicians
# of active physicians 65,440 in 2009
About ½ family physicians but shortages
Overall physician-to-population ratio 195 per 100,000 in 2008, though ratios and growth rates varied among provinces, territories and health regions
17 medical schools
#of new medical students 9,640 in 2007

12. Health Care System-Nursing
250,000 nurses in Canada
Numbers decreasing & aging
Significant shortages particularly in community care
91 nursing schools

13. Health Care System Institutions All hospitals publicly owned & funded
Nursing homes-half privately owned & partially funded by government & patient
All accredited

14. Health Care System Other disciplines Occupational therapy
Physiotherapy
Pharmacy
Social workers

15. Health Care System Home care Not part of Canada Health Act
Varies from province to province but most provide a wide range of services & equipment
Medications provided with special palliative care formularies
Wide variety of opioids available

16. Palliative Care System
Began in 1976
Now over 1200 programs or services
Limited government funding but improving
Donated funds important
Based in hospitals, cancer centres & community
All hospitals must have palliative care services

17. Palliative Care System
Specialist physicians
Recognized specialty
Residency & fellowship programs
About 250 full and major part-time
Need is increasing rapidly
Nursing certification
Over 800 nurses have taken certification
Need for clinical nurses specialists

18. Palliative Care System
Community volunteer hospices
Palliative care units
Most in hospitals
Residential hospices

19. Palliative Care System
About 25-30% of dying cancer patient access palliative care
In some well organized regions, this reaches almost 100%
80% of palliative care patients are cancer patients
Those dying of non-cancer illnesses just starting to be part of the system

20. Dr. Larry Librach Temmy Latner Centre for Palliative Care
Dr. Larry Librach Temmy Latner Centre for Palliative Care 22

21. Why a Standardized Approach?
To ensure that all Canadians have access to consistent, high quality care
Ensure all caregivers and staff are knowledgeable and skilled, and have the support they need to fulfill their roles

22. Why a National Model for Hospice Palliative Care?
Guide for:
patient and family care provided by both primary & expert caregivers
development & function of hospice palliative care organizations
educational competencies
accreditation & QI
research

23. Dr. Larry Librach Temmy Latner Centre for Palliative Care25

24. Dr. Larry Librach Temmy Latner Centre for Palliative Care26

25. Dr. Larry Librach Temmy Latner Centre for Palliative Care27

26. Practical Outcomes from the Model
Adopted across Canada by consensus building
Used by national & provincial health planners
Services
Funding
Used by Accreditation Canada, national hospital & health agency accreditors

27. Practical Outcomes from the Model
Framework for the Quality End of Life Care Coalition of Canada, a group of 30 influential organizations, to use to approach governments
Framework for educational efforts like the Educating Future Physicians in Palliative & End of Life Care Project, new nursing curriculum effort

28. Common or Core Competencies
Address & manage pain and symptoms
Address psychosocial & spiritual needs
Address end of life decision-making and planning
Collaborate as a member of an interdisciplinary team
Communicate effectively
Attend to suffering

29. Remaining Challenges for Canada
Care coordination
Pain management needs improvement
Symptom management priority
Psychosocial & spiritual care
Preparation for dying
Enhancing home care
ACP
Increasing awareness of HPC

30. Awareness of Palliative Care
Canadians more aware than even 5 years ago
More exposed to palliative care
More media attention
Living Lessons campaign

31. Summary Our system has the right components
We do have the basic foundations of the Model
Not perfect but growing stronger quickly