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Advancing palliative care

Providing palliative care when and where It’s needed.

People with advanced illnesses often share the same hopes: To be comfortable and free of pain and other symptoms, close to loved ones and well cared for in their own home. By providing this type of care, called palliative care, RPNs and other healthcare providers and caregivers can give our most vulnerable patients care that is catered to their preferences.

With significant gaps in palliative care education and training, many healthcare providers are uncomfortable initiating conversations to explore a person’s goals of care and are unaware of how to access palliative care services. Although there are pockets of excel-lence in the province, there is no road-map to guide the scale and spread of models that deliver good palliative care across Ontario’s healthcare system.

When patients do not have access to well-organized, high-quality palliative care, they are more likely to have uncontrolled pain and symptoms, higher levels of stress, and poorer quality of life. They are also more likely to have an unplanned emergency department visit in their last days of life and to die in hospital.

All Ontarians deserve the best palliative care that we can provide.


Framework for Advancement

The Ontario Palliative Care Network (OPCN) is a partnership of community stakeholders, health service providers and health system planners (including CCO as a lead partner) from across Ontario. Since 2016, we have been working together to develop a coordinated and standardized approach for delivering hospice palliative care to patients across this province.

Our Health Services Delivery Frame-work, released in April 2019, outlines a model of care that will help adults with a life-limiting illness who are living at home or in community settings, and their family/caregivers, to remain at home as long as possible.

Delivery Framework Highlights

  • Makes 13 key recommendations to guide future organization and delivery of palliative care, from identification of patients who would benefit from palliative care through to end of life
  • Emphasizes patient and family/care-giver needs
  • Provides flexibility to support regional and local contexts and geographies
  • Makes tailored recommendations to improve access and care provided to the following groups:
    • Francophones
    • First Nations, Inuit, Métis and urban Indigenous peoples
    • People experiencing homelessness and/or who are vulnerably housed – People living in long-term care homes
  • Clarifies roles for members of interdisciplinary palliative care teams

Key among the framework’s recommendations is the call to ensure that patients and their families/caregivers have seamless 24/7 access to an interdisciplinary palliative care team. Importantly, patients and their families/caregivers should be active members of this team, with care decisions aligned to their specific goals and wishes.

To support implementation of the Health Services Delivery Framework, and to address known gaps in palliative care, the OPCN has also created additional resources including the Ontario Palliative Care Competency Framework, Tools to Support Earlier Identification for Palliative Care, and Goals of Care Resources.

The Ontario Palliative Care Competency Framework describes the knowledge, personal attributes and skills that providers need to deliver high-quality palliative care in Ontario. We appreciated the valuable feedback that RPNAO contributed to the section on Palliative Care Competencies for Nurses to help ensure the Competency Framework was relevant to RPNs across Ontario. Applying these competencies in practice will lead to better care for people with a life-limiting condition, and encourage collaboration among professionals and organizations providing palliative care.

Competency Framework Highlights

  • Includes key professions commonly involved in palliative care delivery in Ontario
  • Describes profession-specific and shared competencies
  • Organizes competencies into 13 domains essential to palliative care practice
  • Includes competencies for those caring for patients or family with life-limiting conditions, plus additional ones for those specializing in palliative care
  • Incorporates competencies specific to caring for First Nations, Inuit, Métis and urban Indigenous peoples
  • Validated by health professional col-leges and associations
  • Adapted from the Nova Scotia Competency Framework, and Ireland’s Palliative Care Competence Framework

Confidence to Remain at Home

Too often, people worry that the only place they can receive care is in the hospital or in an emergency department.

With the Health Services Delivery Framework, and its accompanying resources, we envision a model that provides high-quality palliative care services when and where they are needed. Patients and their families will have confidence that Ontario’s healthcare system will support them throughout their entire lives.

For more information about the OPCN Delivery Framework, Competency Frame-work and other tools and resources visit

Article was adapted from the CCO Blog.


About the authors

Dr. Ahmed Jakda and Susan Blacker are the provincial clinical co-leads of the Ontario Palliative Care Network.