Palliative Care Tools and Resources

The Palliative Care Health Services Delivery Framework outlines recommendations to guide future organization and delivery of palliative care. 

Focus Area 1: Adults Receiving Care in Community Settings

The Palliative Care Model of Care for community settings will ensure:

• palliative care is provided by an interprofessional palliative care team so that the right care is provided by the right provider
• the patient and their family/care partners are actively engaged as members of the interprofessional palliative care team and make decisions about their care
• the patient and their family/care partners have seamless access to palliative care and support 24/7. To ensure services are integrated, every patient will have a designated care coordinator
• high-quality, person-centred palliative care is provided to patients wherever they are

Specific attention is paid to priority populations such as First Nations, Inuit, Métis and urban Indigenous people, francophones, homeless and vulnerably housed people, and those living in long-term care homes.

This model of care builds on existing capacity and supports local flexibility. Ultimately, it leads toward sustainable, equitable and coordinated palliative care.

Download: 

• Focus Area 1: Adults Receiving Care in Community Settings  
• Focus Area 2: Adults Receiving Care in Hospital-Based Settings (Pending)
• Focus Area 3: Pediatric Populations Receiving Care in all Care Settings (Pending)

This reference guide for health professionals and volunteers describes the knowledge, personal attributes and skills providers need to deliver high-quality palliative care in Ontario. Applying these competencies in practice will lead to better care for people with a serious illness and encourage collaboration among professionals and organizations providing palliative care. 

Download:

• Ontario Palliative Care Competency Framework 

Identifying palliative care needs earlier in the course of disease significantly contributes to positive patient, family and system outcomes. This document supports providers and system-level leadership in earlier identification of patients who would benefit from palliative care. The tools recommended in this document can:

• help providers determine when to introduce palliative care
• be integrated into all settings of care
• be integrated into digital platforms that support patient care
• help to promote the scale and spread of earlier palliative care

Download:

• Tools to Support Earlier Identification for Palliative Care 

Identify if the patient would benefit from palliative care earlier in their illness trajectory. The Tools to Support Earlier Identification for Palliative Care  recommends tools that can be used to determine when to introduce palliative care.

Visit:

• Proactive Identification Guidance, The Gold Standards Framework 
• Supportive & Palliative Care Indicator Tool , SPICT, University of Edinburgh
• Risk Evaluation for Support: Prediction for Elder-life in the Community Tool , RESPECT, Project Big Life
• Hospital 1-year Mortality Risk , HOMR, BMJ Quality & Safety journal article

Assess the person’s current and future needs and preferences across all domains of care. Include validated screening tools, an in-depth history, physical examination and relevant laboratory and imaging tests.

Use validated screening tools to identify if the patient, their family or caregiver have any needs that require urgent intervention. Type and timeliness of screening will depend on the severity, urgency and complexity of the symptoms or needs identified.

Visit:

• Palliative Performance Scale , PPS, Functional Status, Victoria Hospice
• Palliative Prognostic Index , Morita T, Tsunoda J, Inoue S, Chihara S. The palliative prognostic index: a scoring system for survival prediction of terminally ill cancer patients. Supportive Care in Cancer 1999; 7: 128-33
• Clinical Frailty Scale , CFS, Functional Status, Geriatric Medicine Research, Dalhousie University
• Distress Thermometer and Problem List , National Comprehensive Cancer Network

Download:

• Edmonton Symptom Assessment System, ESAS , depression, anxiety, and wellbeing, Ontario Health (Cancer Care Ontario)
• Eastern Cooperative Oncology Group Performance Status , ECOG, National Palliative Care Research Centre
• Changes in health, End-stage disease and Signs and Symptoms (CHESS) scale and the Personal Severity Index (PSI) , RAI-MDS

Assess the person’s current and future needs and preferences across all domains of care. Include validated screening tools, an in-depth history, physical examination and relevant laboratory and imaging tests.

Explore symptoms and needs across all domains in more detail through history and examination. Specific details on domains of issues associated with illness and bereavement are described in the Canadian Hospice Palliative Care Association’s Model to Guide Hospice Palliative Care. Continue to screen regularly for distress and other needs.

Visit:

• InterRAI Suite of Assessment Instruments , Includes Home Care, Palliative Care, Community Health Assessment, CHESS-MDS, DIVERT, eScreener
• Psychosocial Assessment , INCTR Handbook
• Patient Dignity Question , Dignity In Care
• Patient Dignity Inventory , Dignity In Care
• FICA Spiritual History Tool , GW School of Medicine & Health Sciences
• HOPE Questions for Spiritual Assessment , Anandarajah, G., & Hight, E. (2001). Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. American family physician, 63(1), 81. See section on HOPE Questions

Assess the person’s current and future needs and preferences across all domains of care. Include validated screening tools, an in-depth history, physical examination and relevant laboratory and imaging tests.

Use the results of screening and assessment to prompt further discussions about a person’s wishes, values, beliefs, understanding of wellness and any illnesses, and goals for current and future care. These conversations are ongoing and should be revisited regularly.                       

Visit:

• A Clinicians Guide to Substitute Decision Making, Hospice Palliative Care Ontario
• Online Advance Care Planning Workbook, Hospice Palliative Care Ontario

Download:

• Person-Centred Decision-Making Resource for Healthcare Providers, Ontario Palliative Care Network
• Making Decisions About Your Care: Patient Resource, Ontario Palliative Care Network
• Advance Care Planning, Goals of Care, and Treatment Decisions & Informed Consent , Frequently Asked Questions, Ontario Palliative Care Network
• Approaches to Goals of Care, Ontario Palliative Care Network

Plan and collaborate ongoing care to address needs identified during the assessment. This includes prompt management of symptoms and coordination with other care providers.

Visit:

• Inter-professional Palliative Symptom Management Guidelines , BC Centre for Palliative Care
• Symptom Management Guides , Ontario Health (Cancer Care Ontario)
• Cancer Pathway Maps , Ontario Health (Cancer Care Ontario)
• Trauma-Informed Care Awareness , Enclara Pharmacia
• Clinical Practice Guidelines for Quality Palliative Care, 4th Edition, National Coalition for Hospice and Palliative Care
• Pallium Palliative Pocketbook , Available in hard copy, or eBook, Pallium
• Ontario Drug Benefit Formulary/Comparative Drug Index , See Part VI-B Facilitated Access to Palliative Care Drug Products, Ministry of Health

Download:

• Hospice Palliative Care Program Symptom Guidelines - Psychosocial Care , Fraser Health Authority
• Clinical Practice Guidelines for the Psychosocial and Bereavement Support of Family Caregivers of Palliative Care Patients , Centre for Palliative Care, Australia

• Request for an Unlisted Drug Product - Exceptional Access Program, Government of Ontario
• Medical Certificate of Death - Form 16, Government of Ontario

• 2014 Annual Report of the Office of the Auditor General of Ontario – Palliative Care Section (December 2014) 
• 2016 Annual Report of the Office of the Auditor General of Ontario - Follow-Up on 2014 Annual Report Palliative Care Section (November 2016 
• Healthcare Consent, Advance Care Planning and Goals of Care Practice Tools: The Challenge to Get it Right – Law Commission of Ontario (December 2016) 
• Framework on Palliative Care in Canada (December 2018) 
• Ontario’s Provincial Framework for Palliative Care (December 2021)
• Declaration of Partnership and Commitment to Action: Advancing High Quality, High Value Palliative Care in Ontario (December 2011) 

Current State and Access to Palliative Care in Ontario/Canada

• Access to Palliative Care in Canada   – Canadian Institute for Health Information (April 2023)
• Update 2019 on Palliative Care at the End of Life Report   – Health Quality Ontario (now part of Ontario Health) (October 2019)
• Palliative and End-of-Life Care  – Canadian Partnership Against Cancer (September 2017)