Pressing Health Issues in the Federal Election: Palliative Care

by Alex Kilian, Student Leadership Team Logistics and Evaluations Coordinator

THE ISSUE

Palliative care is an approach that aims to improve the quality of life of patients and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.¹

The World Health Organization (WHO) indicates that health systems should include palliative care in the continuum of care for people with chronic and life-threatening conditions, linking it to prevention, early detection and treatment programmes.¹

Spotlight on Canada: As compared to other countries, Canada has been slow to implement a coordinated and comprehensive palliative care strategy that would support effective and respectful end-of-life care. Across the country, only four provinces have developed strategies and frameworks.² As such, there is a need for coordinated action in provincial and territorial health systems, as well as for an overarching national strategy to strengthen palliative care. This is especially important given the aging population which is expected to place additional financial strain on health systems in Canada. Given this and that end-of-life care is a complex issue, the need for solutions to strengthen palliative care is becoming increasingly evident.

BY THE NUMBERS

• The cost of dying: $10,000+³
• 259,000 Canadians deaths each year
• Each death affects others: an average of five loved ones and family members affected significantly by each individual death⁴
• Only 16% to 30% of Canadians who die currently have access to or receive hospice palliative, and end-of-life care services³
• Average cost of hospice care is $460/day⁵
• Average cost of acute care is $1100/day⁵

A POTENTIAL SOLUTION

• A long-term, sustainable, sufficiently funded and cost-effective palliative care strategy that includes an integrated hospice care program

Hospice palliative care is a care model aimed at individuals and families affected by progressive life-limiting illnesses. Palliative care is focused on the individual and the family and is designed to address physical needs such as pain management, while taking into account psychosocial considerations.^2-5

THE EVIDENCE/FEASIBILITY

Hospice care has been found to be cost-effective in comparison with acute care and is most effective when integrated with existing programs and services within health systems.^3,5 A key component of such an approach would be to support coordination by providing clinicians in various settings with training in palliative care and enabling them to refer patients hospice palliative care teams where they would receive the care and support they need. A systematic review examining both patient experience and cost-effectiveness concluded hospice programs improve patient satisfaction.⁶ Furthermore a review of the literature has concluded that hospice care is cost effective when compared to acute care.³ Specifically, integrated approaches to palliative care are able to control and reduce health system costs by decreasing the number of hospital admissions, inappropriate interventions and the length of hospital stays.^2-5

While hospice care is not currently accessible for the majority of Canadians, it allows patients to receive care in a home or community setting that emphasizes comfort and dignity and may be preferable to patients and family. As such, education aimed at improving awareness about the benefits of palliative care could empower the population to make evidence-based choices that will give them a sense of autonomy and peace in the final stages of their lives.

References

1. World Health Organization. Palliative Care [Internet]. Available from: http://www.who.int/mediacentre/factsheets/fs402/en/
2. Canadian Hospice Palliative Care Association. Palliative Care in the Community: An Environmental Scan of Frameworks and Indicators [Internet]. The Way Forward Initiative: An Integrated Palliative Approach to Care; 2013. Available from: http://www.hpcintegration.ca/media/43475/TWF-Environmental%20Scan%20Report%20EN%20FINAL.pdf
3. Canadian Hospice Palliative Care Association. Cost Effectiveness of Palliative Care: A review of the Literature [Internet]. The Way Forward Initiative: An Integrated Palliative Approach to Care; 2013. Available from: ttp://hpcintegration.ca/media/24434/TWF-Economics-report-Final.pdf
4. Quality End-of-Life Care Coalition of Canada (QELCCC). Blueprint for Action 2010-2020: A progress report [Internet]. 2010. Available from: http://www.qelccc.ca/media/3749/eng_progress_report_20102012-07-10_2.pdf
5. Officer of the Auditor General of Ontario. 2014 Annual Report , Ministry of Health and Long-Term Care – Palliative Care. Auditor General; 2014 p. 258-288.
6. Candy B, Holman A, Leurent B, Davis S, Jones L. Hospice care delivered at home, in nursing homes and in dedicated hospice facilities: A systematic review of quantitative and qualitative evidence. International Journal of Nursing Studies. 2011;48(1):121-133