A new Canadian Cancer Society report says critically ill Canadians are falling through the cracks when it comes to palliative care and calls for action to improve care across the country. Canada’s patchwork of palliative care services is costly and inconsistent, which is bad for patients and for the sustainability of our healthcare system. Read the report entitled: Right to Care: Palliative care for all Canadians.
The Canadian Cancer Society recognizes that facing life-threatening illness, especially in relation to pain and suffering, can cause great concern and severe hardship for some people. The Society promotes and supports the need for improved development and delivery of early, active, competent and compassionate palliative care, which includes: expert pain management; skilled psychosocial, emotional and spiritual support; and comfortable living conditions with the appropriate level of care – whether at home, in a hospital or any other settings of patients’ choice. The Society believes that all Canadians should be able to choose the best care for them throughout their cancer journey.
The Society also recognizes that assisted dying is a controversial issue that evokes strong opinions and emotional responses for Canadians.
Recently the Supreme Court of Canada ruled that the existing law against physician-assisted dying must be changed, but it is not yet clear what this means for those seeking assistance in dying, or for those who may assist them. While laws across the country are reviewed over the coming year, talk with your healthcare team about what’s best for you and allowed in your province or territory.
As a national organization, we are closely following the discussions around physician-assisted dying. The Society’s efforts remain focused on ensuring that dying cancer patients spend their final days with dignity, free of pain and in a setting of their choice.
What is palliative care?
Palliative care focuses on the quality of life of people who have a progressive, life-altering illness. Palliative care includes pain and symptoms management, skilled psychosocial, emotional and spiritual support and comfortable living conditions with the appropriate level of care – at home, in hospice, in hospital or in any other setting of the person’s choice.
Palliative care is a critical component of the cancer continuum of care and healthcare overall. Palliative care should be provided earlier in the course of advanced cancer, introduced progressively and with other therapies, using a multidisciplinary team approach. End-of-life care is a component of palliative care that focuses on the specific needs of someone who is dying.
Importance of palliative care
The impact of palliative care has been studied extensively. Research shows that palliative care:
- improves quality of life and satisfaction with care for people with cancer and their family caregivers
- means less use of hospital emergency departments at the end of life
- increases the likelihood that people with cancer will die in a setting of their choice
Palliative care has been shown to be particularly effective when delivered early, before the last stages of life. However, the quality and availability of palliative care differs between and within provinces and territories. Accessibility and availability of care is not consistent even in large cities and can be even scarcer in rural and remote areas. Even when palliative care services are available, not all Canadians know about these services or how to access them.
While palliative care is often thought of as an option that is only available for people who are nearing the end of their life, palliative care can and should be delivered throughout the cancer journey.
Guaranteed access to palliative care for all Canadians
Medically necessary services are not defined in the Canada Health Act. It is up to each provincial and territorial government to determine which services are medically necessary. This means services are covered differently by each public health insurance plan.
Several provinces have programs or laws that either partly cover or provide financial assistance for care and services related to palliative care at the end of life. But programs vary across the country.
Some issues exist nationwide – services and systems are not integrated, data collection across provinces is inconsistent in measuring key indicators, lack of common tangible standards or frameworks that define an acceptable level of care, and an inconsistent definition of who needs palliative care.
Invest to improve access to high-quality palliative care
Improving palliative care in all settings - including outside the hospital - should result in more efficient use of healthcare dollars, but there will be upfront costs to facilitate the change. Federal and provincial/territorial governments should work together to establish a financing plan and create a national palliative care transition fund to ensure the changes needed to improve palliative care in Canada can take place.
Support patients and family caregivers
Few programs and policies exist to support family caregivers. At the federal level, the Employment Insurance (EI) Compassionate Care Benefit provides job protection and income support for up to 26 weeks. And some caregivers may be eligible for tax measures, such as the new family caregiver tax credit and the medical expenses tax credit.
There also still exists a general misconception about palliative care. Some people believe that palliative care is only end-of-life care. This can lead to patients being referred to specialized palliative care later in their disease course, sometimes not until the last days of life.
Without advance care planning and honest discussions about their care wishes, an individual is less likely to have their future care aligned with their wishes.