Models of Care Toolkit

Integrated palliative care

patient in a hospital bed a nurse looking over herAn integrated care model involves palliative care from the time of a cancer diagnosis. It focuses on the importance of early referral to palliative care and educates patients that palliative care is part of the care they receive rather than a service to support end-of-life planning.

Key elements include:

  • Provider education and competency training
  • Symptom assessment tools and guidance on advanced care planning
  • Patient Reported Outcome measures to identify patients who would most benefit from early palliative integration
  • Outpatient palliative care improves symptom burden and quality of life and reduces unnecessary health care use in patients with cancer.

Early integration of palliative care enables:

  • Informed decision-making by patients and their primary care teams
  • An enhanced feeling of engagement and ownership in care decision-making by patients and their families
  • Reduced re-admissions or unnecessary health care use at the end of life, decreasing overall healthcare expenditures and improving quality of life

The role of primary care in palliation

Primary care teams located in or easily accessible to communities play a major role in providing palliative care. Their broad knowledge, long-term patient relationships and ability to carry out home visits, as well as capacity to communicate and coordinate with other health-care resources, means primary care providers can address complex issues faced by patients.

Challenges faced by primary care providers when integrating palliative care include:

  • Acquisition of counselling skills
  • Lack of standard guidelines for medications
  • Keeping abreast with new knowledge
  • Lack of support from their team
  • Time constraints

The Paramedics and Palliative Care program, which has been implemented in a number of jurisdictions across Canada, equips paramedics and other healthcare providers to provide appropriate, patient-centred palliative care closer to home and community, resulting in improved efficiencies in the healthcare system and better care for patients.

As of 2024, the program has

  • trained 7,500 paramedics and 200 other health care providers across Canada to deliver palliative care closer to home
  • provided services to 7,000 people wishing to access palliative care in their homes
  • allowed 53% of people receiving palliative care who call 9-1-1 to receive care at home
  • saved 31 minutes per 9-1-1 call by treating palliative care patients at home compared to taking them to the emergency department19

Evidence demonstrates that the program is both acceptable to patients, their families and health providers and cost effective for the health system. An economic analysis published in 2024 found that the program was estimated to save an average of $2800 per 9-1-1 call with a positive return on investment of more than $4 for each $1 invested.22

The program is available in Ontario, Alberta, Nova Scotia and Prince Edward Island and is rolling out in Manitoba.

This cross-jurisdiction program supports the early integration of palliative care initiatives in several jurisdictions including British Columbia, Ontario, Saskatchewan, Nova Scotia, Prince Edward Island, Newfoundland and Labrador, the Yukon and Northwest Territories. It includes three main components:

  • Inter-professional palliative care education that provides practical knowledge and skills to primary care and cancer care teams and supports a connected and collaborative approach to decision-making
  • Early identification of patients with palliative care needs through routine symptom screening, functional assessments and patient consultations
  • Planning and management activities including working with patients to incorporate goals of care and advanced care planning discussions and implementing routine symptom management and functional assessments.

Linkages to community, primary care and specialized palliative care enhance the value and impact of this approach.

  1. Lavis JN, Hammill AC. Care by sector. In Lavis JN (editor), Ontario’s health system: Key insights for engaged citizens, professionals and policymakers. Hamilton: McMaster Health Forum; 2016, p. 209-69.
  2. Tremblay D, Latreille J, Bilodeau K, et al. Improving the transition from oncology to primary care teams: A case for shared leadership. J Oncol Pract. 2016;12(11):1012-1019.
  3. Kang J, Park EJ, Lee J. Cancer survivorship in primary care. Korean J Fam Med. 2019;40(6):353-361.
  4. Cancer Quality Council of Ontario. Programmatic Review on the Diagnostic Phase: Environmental Scan.; 2016.
  5. Gorin SS, Haggstrom D, Han PKJ, Fairfield KM, Krebs P, Clauser SB. Cancer care coordination: A systematic review and meta-analysis of over 30 years of empirical studies. Ann Behav Med. 2017;51(4):532-546.
  6. Mittmann N, Beglaryan H, Liu N, et al. Examination of health system resources and costs associated with transitioning cancer survivors to primary care: A propensity-score–matched cohort study. J Oncol Pract. 2018;14(11):e653-e664.
  7. Zhao Y, Brettle A, Qiu L. The effectiveness of shared care in cancer survivors-A systematic review. Int J Integr Care. 2018;18(4):2.
  8. Tremblay D, Prady C, Bilodeau K, et al. Optimizing clinical and organizational practice in cancer survivor transitions between specialized oncology and primary care teams: a realist evaluation of multiple case studies. BMC Health Serv Res. 2017;17(1).
  9. Meiklejohn JA, Mimery A, Martin JH, et al. The role of the GP in follow-up cancer care: a systematic literature review. J Cancer Surviv. 2016;10(6):990-1011
  10. Angus Reid Institute. (2023). Health Care Access Priorities. Angus Reid Institute. Accessed December 4 2023. Available: https://angusreid.org/cma-health-care-access-priorities-2023/
  11. Kiran, T. (2023). Our Care National Survey. Our Care. Accessed October 13 2023. Available: https://data.ourcare.ca/all-questions.
  12. Watson L, Qi S, Delure A, et al. Virtual cancer care during the COVID-19 pandemic in Alberta: Evidence from a mixed methods evaluation and key learnings. JCO Oncol Pract. 2021;17(9):e1354-e1361.
  13. Canadian Residency Matching Service. 2023 CaRMS Matching Results. Accessed December 12 2023. Available: https://www.cfpc.ca/en/education-professional-development/2023-carms-match-results.
  14. Walsh J, Young JM, Harrison JD, et al. What is important in cancer care coordination? A qualitative investigation: What is important in care coordination? Eur J Cancer Care (Engl). 2011;20(2):220-227.
  15. Wong WF, LaVeist TA, Sharfstein JM. Achieving health equity by design. JAMA. 2015;313(14):1417-1418.
  16. Canadian Partnership Against Cancer. Leading Practices to Create a Seamless Patient Experience for the Pre-Diagnosis Phase of Care: An Environmental Scan. 2018. Accessed November 22, 2021. https://canimpact.utoronto.ca/wp-content/uploads/2018/04/Leading-Practices-to-Create-a-Seamless-Patient-Experience-for-the-Pre-Diagnosis-Phase-of-Care-CPAC-2018.pdf
  17. Cancer Council Victoria. Optimal Care Pathway for Aboriginal and Torres Strait Islander People with Cancer Draft for National Public Consultation.; 2017. Accessed November 22, 2021. https://apo.org.au/sites/default/files/resource-files/2017-09/apo-nid108366.pdf
  18. Jefford M, Koczwara B, Emery J, Thornton-Benko E, Vardy JL. The important role of general practice in the care of cancer survivors. Aust J Gen Pract. 2020;49(5):288-292.
  19. Healthcare Excellence Canada, the Canadian Partnership Against Cancer, and Paramedics and Palliative Care teams. How Paramedics and Palliative Care contributed to better healthcare in Canada. August 2023.
  20. JE Terride, D Stennett, AC Coronado R Shaw Moxam, JHE Yong et al. Economic Evaluation of the “paramedics and palliative care: bringing vital services to Canadians” program compared to status quo. Canadian Journal of Emergency Medicine. 2024 26: 671-680.
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