Canada's National Framework for Hospice Palliative Care

The Way Forward is a collaborative initiative to create a roadmap for an integrated palliative approach to care in Canada.
The initiative engaged healthcare sectors, professionals, and governments in creating a roadmap for an integrated palliative approach to care.
The framework was funded by the Government of Canada and supported by the Canadian Hospice Palliative Care Association.

Vision: All people in Canada who are aging and/or have chronic life-limiting conditions will have the opportunity to benefit from an integrated palliative approach to care.
Goals:
- Canadians will talk with their care providers about advance care planning.
- People who are aging, frail, and/or have chronic illnesses will receive hospice palliative care services integrated with their other care in the setting of their choice.
- People who are aging, frail, and/or have chronic illnesses will receive consistent, seamless integrated care if/when they must change care settings.
Impact:
- All care settings will be able to provide holistic care that respects the person's values and preferences.
- More people in Canada and their families will have access to high-quality integrated palliative care services.
- People can move seamlessly from one care setting to another if their needs change.

Ensuring that all people in Canada have access to an integrated palliative approach to care requires significant shifts throughout the healthcare system.
To achieve this, we must:
- Promote and support a shift in practice culture.
- Establish a common language.
- Educate and support providers.
- Engage Canadians in advance care planning.
- Create caring communities.
- Adapt an integrated palliative approach to provide culturally-safe care, including with and for Canada's First Peoples.
- Develop outcome measures and monitor the change.

Dying is Part of Living: Treatment advances have helped extend our lives, but we will all still die.
The Challenge: Only 10% of people die suddenly, and 90% of us will require care and support at the end of life.
The Opportunity: Only a small proportion of Canadians (about 15%) will need complex hospice palliative care services, while the rest can benefit from integrating a palliative approach into their care.### The Changing Face of Death and Dying
In the past, many Canadians died suddenly from infectious diseases, heart attacks, strokes, or organ failure, or had a recognizable terminal phase.
Today, most people die with chronic illnesses, such as heart disease, cancer, and AIDS, which have no specific terminal phase.
70% of all deaths are due to chronic diseases.
Six in ten Canadians either suffer from a chronic illness or have someone in their immediate family with a chronic illness.

People with chronic illnesses may live for months or years in a state of fragile health or "vulnerable frailty."
As they age, they become more frail and vulnerable to infections or falls that could lead to death.
Their complex health needs can lead to sudden deterioration or periodic crises.

An integrated palliative approach integrates key aspects of hospice palliative care into regular care.
This approach acknowledges that people want to be informed about their illness and prognosis, and have open and honest discussions about their health and care goals.
It recognizes that people's care goals and preferences may change over time, and encourages them to revisit these goals and discuss how they may change.
An integrated palliative approach provides active comfort-focused care, reduces suffering, and promotes understanding of loss and bereavement.

People report fewer symptoms, better quality of life, and greater satisfaction with their care.
The healthcare system reports more appropriate referrals, better use of hospice care, fewer emergency room visits, and less use of ineffective intensive interventions in the last days of life.

Palliative care is an approach that improves the quality of life of patients and their families facing life-threatening illnesses.
It relieves suffering through early identification and impeccable assessment and treatment of pain and other problems.
Palliative care engages individuals and families in planning for their care based on their own goals and values.

An integrated palliative approach will be provided in all settings in the community, including primary care providers' offices, homes, long-term care facilities, hospitals, and shelters.
Care teams will include community resource people, Elders, and cultural advisors as fully recognized members of the care team.
The same practitioners providing care will provide an integrated palliative approach, with expert palliative care teams providing support and guidance.### Palliative Care
Palliative care should be culturally responsive and align with a patient's goals, including basic symptom management.
Some skills in palliative care, such as negotiating difficult family meetings, require years of training and experience.

In an integrated palliative approach, expert hospice palliative care teams take the lead only when people have complex, intensive, or tertiary end-of-life needs.
Primary care providers in different settings should have the confidence and skills to integrate palliative services into their patients' care.
The expert team shifts to a shared-care role, including educating providers, assessing individuals, and providing advice to primary and community care providers.

Improves health and quality of life for people who are aging, frail, or have a chronic illness.
Gives people a greater sense of control over their lives and care.
Makes more effective use of health resources.
Provides seamless transitions between care settings.
Enables people to receive consistent care, even when they have to move from one setting to another.

The US Institute of Medicine has proposed a mixed management model that allows for active, life-prolonging treatment and hospice palliative care to occur in parallel.
The World Health Organization has called for palliative care to be integrated across disease trajectories and settings.

Studies have shown that an integrated palliative approach to care leads to better outcomes, including fewer symptoms, better quality of life, and greater patient satisfaction.
An integrated palliative approach is associated with positive effects on emotional wellness, less suffering, and greater longevity.

An integrated palliative approach to care can reduce the use of intensive care services and hospital stays.
A study in the United States found a net cost saving of $4,855 per patient when palliative care services were integrated with other care.
A study in Canada found that providing enhanced palliative care team-based homemaking and nursing services for people dying at home cost $117.95 a day, significantly less than the $1,100 cost per day for hospital care in Ontario.

The National Framework for an integrated palliative approach to care will vary depending on local needs, resources, systems, and jurisdictions.
The framework includes goals, principles, and a vision for all people in Canada who are aging or have chronic conditions to receive the benefits of an integrated palliative approach to care.
The goals include encouraging Canadians to talk about their wishes and care plans, receiving consistent and seamless care, and having equitable access to health services.