Nova Scotia Department of Health; Prince Edward Island Department of Health and Social Services
The demand for home-based palliative care services is growing, particularly in rural areas. The goals of this project were to develop, implement, and evaluate a model for improving access to integrated palliative care services to people in such areas, and to develop and implement educational programs to support the health care workers and volunteers who provide these services.
The project took place in three rural regions of Atlantic Canada: the East Prince and Southern Kings Health Regions in Prince Edward Island, and the Northern Health Region in Nova Scotia. Activities focused on assessing needs and strengthening existing resources. Over an eight-month period, an interdisciplinary group developed standards for palliative care and a framework for delivering services. The project also developed two training programs to meet the needs of volunteers, nurses, physicians, and others.
The project leaders identified the following outcomes:
- Some 76 percent of clients surveyed indicated that they preferred to spend their last days at home rather than in an institution, suggesting that home-based palliative care should be considered an essential core service.
- The financial burden on some caregivers suggested a need for some form of income assistance and/or job security for those providing palliative care at home to a family member.
- Data suggested that patients aged 65 and older were not using the program in proportion to their mortality rates.
- Clients and caregivers were generally satisfied with the care provided, and especially its improved coordination.
- Factors that contributed to the success of the model included:
- close collaboration among disciplines and agencies;
- common standards for care;
- a single access point for services;
- a clinical team with expertise in palliative care; and
- coverage for medications in cases of financial need (Nova Scotia site only).
- The project team also noted various factors which prevented this model from developing into a fully integrated program.
These barriers included a lack of:
- 24-hour access to referral services;
- funding for respite and nursing visits (Prince Edward Island sites only);
- a funding formula to reimburse physicians for palliative-care services; and
- an integrated information system.
-The educational component was of critical importance. Feedback was highly positive, and before-and-after test results consistently demonstrated increased knowledge among participants in the training sessions.
The project leaders indicated that their findings are important because, in their view, the project shows that more research is needed to answer important questions about palliative care. For example, why are the elderly not accessing palliative care services in proportion to their mortality rates? What supports would enable patients to be more readily discharged from hospital to their homes? The answers to such questions would apply to most other jurisdictions, and particularly to rural areas. Any resulting recommendations would be of interest to federal and provincial governments interested in developing policies that would lead to better palliative care services in rural Canada and other areas.
- Evaluators used repeated measure surveys, satisfaction surveys, and one-on-one interviews with patients and caregivers to get feedback on quality of care, satisfaction, etc.
- Health care providers participated in focus groups to assess the effectiveness of the training sessions with respect to both improving their knowledge of palliative care, and determining how the delivery of home palliative care had changed after implementation of the model.
- A Rural Palliative Home Care Model: The Development and Evaluation of an Integrated Palliative Care Program in Nova Scotia and Prince Edward Island
- Rural Palliative Home Care Project: Evaluation Supplement to Final Report
- Rural Palliative Home Care Project: Education Supplement to Final Report
HTF Contribution to the Project: $997,800
The full report for this project is available on the HTF website.
Colchester Regional Hospital
207 Willow St.
Truro, NS B2N 5B1
Tel: (902) 893-5554 ext 2149
Fax: (902) 893-5839
This project was supported by the Health Transition Fund, which was created in 1997 to provide support for evidence-based decision-making in health care reform by supporting pilot and evaluation projects which test innovative approaches to health care delivery. The views expressed herein do no necessarily represent the official policy of federal, provincial, or territorial governments.