Nova Scotia’s doctors makes recommendations on palliative care

Doctors Nova Scotia has released ten recommendations it feels will improve palliative care in the province.

The group says with an aging population in Nova Scotia, high rates of chronic disease and an expanded definition of those who can benefit from a palliative care approach, the demand for such services will increase significantly.

Doctors Nova Scotia President, Dr. Manoj Vohra, says if the health care system is going to be successful in providing palliative care, they must work together to ensure resources are adequately distributed and responsive to need.

These are the 10 recommendations, which were informed by physicians from across the province:

Recommendation #1: Define the roles and core competencies of all health professionals providing palliative care, determine workforce needs, and ensure the system is robust and responsive to changes in demand.
Recommendation #2: Ensure all primary care physicians have access to a multidisciplinary palliative care team including palliative care specialists for support, consultation and/or shared care, if and when required.
Recommendation #3: Develop guidelines to help identify patients who would benefit from a palliative care approach earlier. These guidelines will assist physicians in determining when and how to transition from chronic care management to a coordinated approach with palliative care.
Recommendation #4: Provide ongoing support to providers providing care to people with life-limiting illnesses, including most of the chronic diseases, helping them to recognize and transition to a palliative care approach when appropriate.
Recommendation #5: Ensure that palliative care services are distributed equitably and can adjust to meet the changing needs of the population.
Recommendation #6: Expand access to residential hospice facilities in areas large enough to support them, and to palliative care or hospice beds to provide an alternative to hospitalization for people whose end-of-life care needs cannot be met at home.
Recommendation #7: Provide adequate multidisciplinary training to ensure the provision of excellent palliative care and support for patients and physicians.
Recommendation #8: Palliative care education needs to be supported, enhanced and incorporated at all levels, including:
o       Ongoing development and integration of palliative care curricula at the undergraduate level using the CanMEDS framework 
o       Implementation of a mandatory four-week palliative care rotation in family medicine residency programs
o       Education for primary care providers and specialists who care for people with life-limiting conditions, regarding the integrated palliative care approach and existing services within Nova Scotia
o       Providing opportunities for primary care providers to enhance their skills through various levels of training, including those provided within Nova Scotia, by the College of Family Physicians and by other nationally standardized programs
o       Introduction of the palliative medicine certification by the Royal College of Physicians and Surgeons of Canada, expected to produce qualified specialists in 2019
Recommendation #9: Implement physician compensation models that reflect the complex care physicians provide in palliative medicine and support an effective palliative care system.
Recommendation #10: Consult physicians about the monitoring of the province's Physician Resource Plan (PRP) to ensure palliative care resources are distributed equitably, based on population demographics and increased need. The allotment of FTEs within the PRP needs to reflect the role that palliative care specialists play in providing education and mentorship to support palliative care provision in Nova Scotia.