Palliative Care

Care for Adults With a Serious Illness

Resources Quality Statements Working Group About

1

Identification and Assessment of Needs

People with a progressive, life-limiting illness have their palliative care needs identified early through a comprehensive and holistic assessment.

Background

Palliative care focuses on the person and their family, and on enhancing their quality of life throughout their illness, not just at the end of life. The initiation of palliative care should not be delayed for people with a progressive, life-limiting illness if they have physical, psychological, social, or spiritual needs during treatment.

General considerations for identifying people who would benefit from palliative care include the following: diagnosis of a progressive, life-limiting illness; disease progression; functional decline; presence of pain or other symptoms; or other effects on their full range of needs. A comprehensive, holistic assessment allows health care professionals to determine the physical, psychological, social, linguistic, cultural, legal, ethical, and spiritual needs of people with a progressive, life-limiting illness and their family or caregivers, and the services required to meet those needs. The initiation of palliative care is not determined by prognosis; it can begin as early as the time of diagnosis of a progressive, life-limiting illness, and it can be initiated during treatment.

Assessment can be conducted by any knowledgeable and skilled member of the interdisciplinary health care team (see Quality Statement 4). After the initial assessment, palliative care needs should be reassessed regularly, because they can change over time.

What This Quality Statement Means

For Patients, Families, and Caregivers

Your care team should assess what palliative care or supports you need:

They should ask questions about your physical and mental health, your support system, and any other needs you feel you have, to understand how best to help you
They should assess your pain and other health concerns, and manage them quickly and effectively
They should assess your mental, emotional, social, cultural, and spiritual well-being
They should ask your family members and caregivers about the help they need

For Clinicians

Assess people with a progressive, life-limiting illness to determine whether they would benefit from palliative care. Perform and document a comprehensive, holistic assessment that considers the individual’s diagnosis; disease progression; functional decline; presence of pain or other symptoms; and other effects on their full range of needs. Assessment should be repeated regularly.

For Health Services

Ensure that systems, processes, and resources are in place in all health settings for clinicians to identify and assess people’s palliative care needs. This includes access to screening or assessment tools and timely access to palliative care.

Quality Indicators

Process Indicators

Percentage of people with identified palliative care needs who have a documented assessment of their palliative care needs including physical, psychological, social, linguistic, cultural, legal, ethical, spiritual, and other needs

Denominator: total number of people with identified palliative care needs
Numerator: number of people in the denominator who have a documented assessment of their palliative care needs including physical, psychological, social, linguistic, cultural, legal, ethical, spiritual, and other needs
Data source: local data collection
Note: consider measuring separately by each palliative care need and/or grouping them together as an overall measure

Number of days between receiving first palliative care service and death

Calculation: can be measured as mean, median, or distribution
Data sources: National Ambulatory Care Reporting System (NACRS), Discharge Abstract Database (DAD), Continuing Care Reporting System (CCRS), Home Care Database (HCD), Ontario Health Insurance Plan (OHIP), Registered Persons Database (RPDB)

Structural Indicator

Evidence of locally adopted tools to:

Identify people in need of palliative care
Assess their needs
Data source: local data collection

Definitions Used Within This Quality Statement

Progressive, life-limiting illness

A progressive, life-limiting illness is one that affects a person’s health and quality of life, that gets worse over time, and that can lead to death in the near future. Examples of illnesses that require a palliative approach to care include cancer, Alzheimer disease and other types of dementia, heart failure, chronic obstructive pulmonary disease, kidney disease, and cirrhosis of the liver. The frail elderly can also benefit from a palliative approach to care.

Palliative care needs

Palliative care needs can stem from any part of a person’s full range of needs (physical, psychological, social, linguistic, cultural, legal, ethical, or spiritual) at any stage of illness. The goal of palliative care is to help people achieve their best possible quality of life in the face of a progressive, life-limiting illness.

Identified early

Identifying the need for palliative care can occur as early as the time of diagnosis of a progressive, life-limiting illness. Palliative care is not limited to the end-of-life phase, and it is not restricted to specific diseases or conditions.

Comprehensive and holistic assessment

This includes a full examination of the domains of care associated with illness and bereavement, including:

Examples of validated tools used for assessment may include the Edmonton Symptom Assessment System, and the Palliative Performance Scale. The comprehensive and holistic assessment considers a person’s socio-cultural context and initial assessments should include inquiry about a person’s mother tongue and language of preference.

Evidence to Improve Care