Paramedics and Palliative Care: Bringing Vital Services to Canadians
Healthcare Excellence Canada (HEC) and the Canadian Partnership Against Cancer (the Partnership) partnered to deliver the Paramedics and Palliative Care program, bringing vital in-home palliative approaches to care to people in Canada living with cancer and other life-limiting conditions – when they need it and where they want it.
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- Topics
- Long-term care
- Aging in place
- Primary and community care
- Audience
Healthcare leader
Point of care provider
Quality or safety improvement lead
Paramedics and Palliative Care: Bringing Vital Services to Canadians
Healthcare Excellence Canada (HEC) and the Canadian Partnership Against Cancer (the Partnership) partnered to deliver the Paramedics and Palliative Care program, bringing vital in-home palliative approaches to care to people in Canada living with cancer and other life-limiting conditions – when they need it and where they want it.
About the Program
It's not uncommon for patients and families to call paramedic services when they experience sudden changes in care or gaps in accessing home care services and supports. While traditional emergency medical service response is based on assessing, treating and transporting patients to the hospital, it’s not designed to meet the needs and wishes of patients requiring palliative treatment options for care.
This matters because three-quarters of people indicate they would prefer to die in their home.1 However, this doesn’t happen as often as it could. Sixty-two percent of people living in Canada who receive palliative care do so in an acute care hospital and often in their last month of life.2 As part of this program’s four-year collaboration, more than 7,500 paramedics and 200 additional healthcare providers across seven provincial teams were trained to provide patients with in-home support when they have a palliative emergency, require pain and symptom management or have an unexpected health event.
The Partnership
Through the program, paramedics were trained to assess people with palliative care needs (for example, pain management) and treat them on the spot at home. Paramedics are trained to provide this care without a transfer to hospital, if appropriate. Paramedic services are using a variety of training approaches and supports including LEAP (Learning Essential Approaches to Palliative Care) which is provided by Pallium Canada, MyGriefToolbox.ca developed by Canadian Virtual Hospice, and other education developed by teams as part of the program.
Participating teams received:
Seed funding to support implementation
Tailored learning opportunities through webinars and coaching calls
Opportunities to share, learn and problem-solve with peers
Support to measure and evaluate the success of their project
Teams engaged patient and family/caregiver advisors to ensure that the program met their needs. Patient and family/caregiver advisors also helped develop evaluation tools, such as patient and family surveys, to help measure the impact of the program and inform ongoing improvements.
This approach to person-centred care was identified through an open call for innovations in 2017 as the Paramedics Providing Palliative Care at Home Program in Nova Scotia and Prince Edward Island, and Alberta Health Services’ Provincial Emergency Medical Services Palliative and End-of-Life Care Assess, Treat and Refer Program. HEC and the Partnership worked closely with the original innovators to drive the adoption of this approach to teams in other areas of the country.
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Paramedics and Palliative Care: Bringing Vital Services to Canadians Change Package
The Paramedics and Palliative Care: Bringing Vital Services to Canadians change package provides core principles and elements required to develop and implement a palliative approach to care for paramedic services. It brings together the experiences and learnings from 10 teams across nine provinces and territories who have successfully implemented this approach to home care services.
The change package includes examples of how teams participating in the Paramedics and Palliative Care program implemented a palliative approach to care for paramedics in their jurisdiction. It also includes tips from program coaches and project team members, and recommendations for engaging patients, family members and essential care partners.
Teams
Ten teams across nine provinces participated in the Paramedics Providing Palliative Care: Bringing Vital Services to Canadians program.
The original innovator sites in Nova Scotia, Prince Edward Island and Alberta formed three of the teams. They participated as coaching jurisdictions and worked with HEC and the Partnership to spread and scale the Paramedics and Palliative care program to other areas of Canada.
Newfoundland and Labrador, New Brunswick, Ontario, Manitoba, Saskatchewan, and British Columbia participated as implementation teams. They were supported to successfully implement the program.
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Advisors
The Paramedics and Palliative Care: Bringing Vital Services to Canadians program was supported by several advisors, subject matter experts, patient and family advisors and coaches. Advisors shared their experiences either as individuals and families who had lived experiences of receiving palliative care, or as professionals who had expertise in palliative approaches to care as well as healthcare improvement. For a full list of contributors, see the Paramedics and Palliative Care change package.
Paramedics and Palliative Care Program Outcomes
The Paramedics and Palliative Care program equipped 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.
How Paramedics and Palliative Care contributed to better healthcare in Canada
Decreased transports to hospital in both rural and urban areas
52.8 percent of calls enabled people receiving palliative care to remain in their homes, diverting patients from the emergency department
Improved access to patient-centred care closer to home and community
Almost 7,000 calls were received from people wishing to access palliative care in their homes
Over 92 percent of surveyed patients and families were satisfied with the care they received by paramedics and 86.6 percent of calls improved the presenting complaint
Improved efficiency in the healthcare system
An average of 31 minutes were saved per call by treating palliative patients at home compared with transporting them to the emergency department
Improved comfort and confidence for paramedic team members delivering palliative care
71.3 percent of paramedics felt more comfortable and confident providing palliative care
More than 7,500 paramedics and 200 additional healthcare providers were trained to support palliative patients at home
Suggested Citation
These outcomes are informed by data collected by HEC, the Partnership, and the seven teams in six provinces, representing 31 paramedic services, that participated in the program. When citing this information, we ask that you use the following reference:
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.
Resources
The resources below are from organizations that participated in the Paramedics and Palliative Care: Bringing Vital Services to Canadians program, including teams, coaches, Healthcare Excellence Canada and the Canadian Partnership Against Cancer.
See the Paramedics and Palliative Care program in action in some of the participating jurisdictions:
Alberta
British Columbia
Nova Scotia
Prince Edward Island
Palliative Care Competency Frameworks
The following frameworks detail the competencies required by paramedics to provide palliative care:
The following frameworks detail the competencies required by paramedics to provide palliative care:
The following resources were used to develop and deliver education to participating teams:
The following resources were used by participating teams to help form meaningful partnerships with patient, family and caregiver advisors:
7 Quick Tips for Working with Patient, Family and Caregiver Partners in Co-design
Patient Voices Network (British Columbia) Engagement Resources
The Manitoba Institute for Patient Safety Patient Engagement Resources
The Manitoba Institute for Patient Safety Declaration of Patient [Person] and Family Engagement
Canadian Institutes of Health Research Patient Engagement in Research Resources
The following resources were used by participating teams for program evaluation, data collection and research and publication:
The following resources were used by participating teams to support change management strategies:
1 Canadian Institute for Health Information. Access to Palliative Care in Canada. Ottawa, ON: CIHI; 2018.
2 Canadian Institute for Health Information. Access to Palliative Care in Canada. Ottawa, ON: CIHI; 2018.
3 Carter AJE, Arab M, Harrison M et al. Paramedics Providing Palliative Care at Home: A Mixed-Methods Exploration of Patient and Family Satisfaction and Paramedic Comfort and Confidence. CJEM 2018 in press.
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