Palliative care aims to improve the quality of life for patients and families facing the problems associated with a life-limiting and/or life-threatening illness through the prevention and relief of suffering by means of early identification, comprehensive interdisciplinary assessments and appropriate interventions.
End-of-life care is care provided to patients and their families when they are approaching a period of time closer to death, which may be exemplified by an intensification of inter-disciplinary services and assessments such as anticipatory grief support, and pain and symptom management.
PEOLC is a philosophy and an approach to care that enables all individuals with a life-limiting and/or life-threatening illness to receive integrated and coordinated care across the continuum. This care incorporates patient and family values, preferences and goals of care, and spans the disease process from early diagnosis to end of life, including bereavement.
A dashboard visually shows us how well we are performing over time. The provincial palliative and end-of-life care dashboard will help us evaluate the provincial program, and will provide information on services across the province.
The provincial practice and development team and stakeholders have chosen 10 service quality indicators and 9 parameters. View the indicators list.
The dashboard currently contains the following data from Vital Statistics:
AHS staff can access the dashboard via Tableau on Insite, which is available through the AHS intranet. Tableau will direct you to sign up for login access.
Analyzing data and adding prioritized indicators to the dashboard. This is dependent on obtaining access to necessary data across zones. Data for the 9 key advance care planning and goals of care designation indicators identified by the ACP/CRIO research group will also be obtained, analyzed and published on the dashboard.
For questions about palliative and end-of-life care:
palliative.care@assistedlivingalberta.ca
We would like to hear from you. Take a few minutes to complete a brief online survey.
The information below is zone specific. Find your zone by viewing the zone map.
For patient-facing information you can share with families in any zone, see palliative and end of life care for the public.
Referrals can be sent to Continuing Care Access. Call 1-855-371-4122 or fax 1-855-776-3805.
For after-hours questions call Edmonton Palliative Care Consultant at 780-496-1300.
Palliative care in Edmonton is provided in any setting; home, hospice, care centres or hospitals.
The Palliative Care Consultation Service provides support to doctors and/or Nurse Practitioners in managing difficult palliative care needs. This service is available in all care settings in the Edmonton Zone. A doctor or Nurse Practitioner referral is required and each team has a referral process. Physicians and nurses are members of these teams.
The community consult team also provides consultative support to the hospices as needed. Learn more
In the Edmonton Zone there are Palliative Consultation teams that serve:
Referral Process: Community Care Access will determine eligibility for Palliative Home Care.
Clients that are in acute care can be referred through Transition Services within that acute site. View Palliative Care Community Consult Team
Existing Home Care clients can be referred by their case manager and/or their primary provider.
Referral Process: All referrals for hospices come through the consultation services to the Bed Hub operated by the Edmonton Zone Continuing Care Transition Services. View a list of hospices in the Edmonton Area.
Referral process: New clients need to call the toll free intake line at: 1-855-371-4122 weekdays from 8:15 a.m.to 9:30 p.m. and weekends from 8:15 a.m. to 4:30 p.m. Existing clients should contact their local office as normal.
This service is located at the Central Alberta Cancer Centre or Red Deer Regional Hospital Centre. People dealing with end-of-life issues, grief, and loss of a loved one can request support and counselling. Call 403-343-4832.
Palliative care in Calgary can be provided in any setting; home, hospice, care centre or hospital. Palliative Care also provides psychosocial and spiritual support to assist with grief and bereavement.
Palliative Care Consult Teams are available to give expert advice for complex issues in all settings of care in the Calgary Zone. Doctors and nurse specialists, and sometimes other health care professionals such as social workers, are members of these teams.
In the City of Calgary, there is a Palliative Care Consult Team that serves:
Outside the City of Calgary, a Rural Palliative Care Consult Team serves patients, families, and staff in all care settings in the rural areas. In addition, at each Calgary Zone hospice there is a palliative care doctor who provides consultation as needed.
Learn more about the palliative care consult service
Referral process: Community Care Access will determine eligibility for Palliative Home Care at 403-943-1920.
Clients that are in acute care can be referred through Transition Services. Home Care clients can be referred by their primary provider.
Learn more about palliative home care.
Referral process: Patients require a referral from the Hospice Access Office at 403-944-1614 or the Palliative Home Care team to be admitted to a Calgary Zone hospice.
Learn more about residential Hospice Calgary Zone.
The AHS Calgary Zone Grief Support Program offers grief counseling to adults 18 years and older who are grieving the death of someone in their life. The program offers individual or group education sessions. You can call the program at 403-955-8011.
Learn more about Grief Support
For inquiries call 403-388-6380 or 1-866-388-6380.
Referral process: An assessment is required to access this service.
This service gives physicians anywhere in Alberta access to an on-call palliative physician specialist, 24 hours a day, 7 days a week, 365 days a year, through RAAPID. It is designed for physicians who do not have direct access to a palliative care consultant, especially primary care physicians and those in rural settings, and covers adult and pediatric palliative and end-of-life care patients.
It gives physicians who treat patients at home or in the community the option of receiving expert palliative physician consult support as an alternative to relocating patients and their families to urban areas or other health care facilities for palliative specialist care. The aim is to increase palliative and end-of-life care capacity in communities across Alberta while providing quality services in every care setting, including patients' homes.
Assistance is available for physicians in:
Physicians can access this service from anywhere in Alberta through RAAPID, 24 hours a day, 7 days a week, 365 days a year. Use it at your discretion whenever you need palliative and end-of-life care support.
For the Edmonton Zone, additional on-call palliative physician specialist consultation information can be found through the Edmonton Zone Palliative Care Program admission and referral information.
These protocols are designed to support people and their families who have chosen to remain at home for palliative and end-of-life care. For a general overview of the service, view the service listing.
Clinicians should call 911 and answer the call taker's questions as best they can. Clinicians may advise the call taker that the patient is palliative, but it is not necessary. An ambulance will be dispatched based on the answers provided. The service may be accessed for any palliative or end-of-life care patient in the community.
Access this service when you need front line paramedics' assistance during a palliative emergency, such as increased pain, shortness of breath, delirium, nausea or vomiting, and when you are available to coordinate any follow-up care required.
Paramedics will work with the clinician, in the home or over the phone, to determine a potential course of treatment. They will help administer emergency medications, oxygen and other supports as required to assist in managing symptoms. Front line paramedics can liaise with online medical consultation physicians, and the patient's family or palliative physician can also be consulted by phone regarding treatment.
If the patient can be managed in the community setting, paramedics and the home care clinician will work together to support the patient's goals of care and wishes. If transfer to an acute care setting is wanted or required, paramedics will facilitate appropriate transport in consultation with the patient's care team. The clinician coordina tes follow-up care, such as prescription updates, arranging medical supplies including oxygen, and advising the patient's responsible physician of the event.
If the clinician is not available, paramedics will make every attempt to connect with the patient's most responsible health care provider, or make arrangements to follow up with the clinician after providing appropriate treatment.
Ambulance response and transport is covered for patients on Alberta Blue Cross Palliative Coverage. Patients are encouraged to apply for this coverage as soon as possible.
This Palliative and End-of-Life Care (PEOLC) Provincial Framework has been written by experts in PEOLC across Alberta. The primary audience for this document is PEOLC interdisciplinary team providers, policy makers and service administrators. Additionally, the framework is a resource for clinicians who are not familiar with PEOLC and want to offer high quality PEOLC services.
Download framework
These tools are currently in use by one or more Zones or PEOLC programs in Alberta, and/or are built into the Connect Care integrated electronic health record.
The ESAS is a tool that was developed to assist in the assessment of nine symptoms that are common in palliative care patients: pain, tiredness, drowsiness, nausea, lack of appetite, depression, anxiety, shortness of breath, and wellbeing.
The ESAS has been revised to improve ease of understanding and completion for patients and is known as the ESAS-r. The ESAS-r is intended to capture the patient’s perspective on symptoms. However, in some situations it may be necessary to obtain a caregiver’s perspective. The ESAS-r provides a profile of symptom severity at a point in time. Repeated assessments may help to track changes in symptom severity over time. The ESAS-r is only one part of a holistic clinical assessment. It is not a complete symptom assessment in itself.
Tools
The Symptom Assessment Acronym is a tool to aid in a detailed systematic approach to assess palliative or end of life symptoms. This tool guided a consistent and comprehensive symptom assessment in palliative or end of life care.
Tool: OPQRSTUV Evaluations
Algorithms used for specific symptom management available at cancercare.on.ca
The Palliative Performance Scale was developed by Victoria Hospice and used to measure performance status in palliative care. It measures five key areas: ambulation, ability to do activities, self-care, food/fluid intake, and level of consciousness.
A brief delirium screening instrument that provides continuous cognitive status assessment as well as delirium symptom monitoring.
Tool: Cancer Care Ontario's Symptom Management Guide-to-Practice: Delirium
CAM was intended to provide a new standardized method to enable clinicians not trained in psychiatry to identify delirium quickly and accurately in both clinical and research settings. Both a long and short version of the CAM are available. The long version is a comprehensive assessment instrument that screens for clinical features of delirium and correlates to DSM IV criteria. The short version includes only those four features that were found to have the greatest ability to distinguish delirium from other types of cognitive impairment. There is also a CAM-ICU version for use with non-verbal mechanically ventilated patients.
Tool: Hospital Elder Life Program: Confusion Assessment Method (Short CAM)
A scale designed to quantify the severity of delirium symptoms and to allow for objective measurement of changes in delirium severity in response to medical changes or clinical interventions. Although not designed as a diagnostic tool, the MDAS may also be useful in establishing a delirium diagnosis in medically ill patients.
Constipation is highly common among cancer patients. Malnutrition, poor mobility, decreased oral intake, autonomic failure, and opioid analgesics are all causes of severe constipation. Unfortunately, the problem is often very poorly assessed. Additional methods, other than a history and examination, are occasionally required to assist in adequately assessing the extent of constipation.
The constipation score is one such tool. It consists of a plain, supine x-ray of the abdomen which is then divided into four quadrants. The four quadrants being representative of the ascending, transverse, descending and rectosigmoid colon segments respectively. Each quadrant is assessed for the amount of stool present and is scored from 0 to 3; 0 being the absence of stool and 3 being complete impaction of stool. The scores for each quadrant are totalled. The maximum score being 12 out of 12. A score of 7 or more indicates more aggressive constipation management is necessary.
There are seven types of stools (feces) according to the Bristol Stool Chart. The Bristol Stool Chart or Bristol Stool Scale is a medical aid designed to classify feces into seven groups.
Tool: Continence Foundation of Australia: Bristol Stool Chart
A scale designed to quantify the severity of delirium symptoms and to allow for objective measurement of changes in delirium severity in response to medical changes or clinical interventions. Although not designed as a diagnostic tool, the MDAS may also be useful in establishing a delirium diagnosis in medically ill patients
Dyspnea is one of the most common symptoms at the end of life, yet it is common to find patients who are unable to quantify their respiratory distress. The RDOS is a practical tool to quantify the level of respiratory distress in a population with severe cognitive impairment.
The Edmonton Classification System for Cancer Pain is a validated assessment instrument for pain classification in cancer patients. It consists of five pain features: mechanism of pain, incident pain, psychological distress, addictive behavior, and cognitive function. It is a clinician-rated assessment, based on an integration of clinical findings including but not limited to the patient history, patient reports, physical examination, medical record, objective assessments, available diagnostic imaging and collateral history. The ECS-CP helps to predict which cancer pain patients will be more difficult or time consuming to manage, enables physicians and the inter-disciplinary team to better manage patients’ cancer pain, and better allocate resources. It also provides useful information for training palliative medicine and pain specialists in the assessment of pain staging/classification in cancer patients.
Tools
This pain behavior tool is used to assess pain in older adults who have dementia or other cognitive impairment and are unable to reliably communicate their pain. It can be used by a nurse or assistant to screen for pain related behaviors.
Tool: Pain Assessment in Advanced Dementia Scale (PAINAD)
The Morphine Equivalent Daily Dose (MEDD) is used to translate the dose and route of each of the opioids the patient has received over the last 24 hours to a parenteral morphine equivalent using a standard conversion table.
Guideline: Instructions for Morphine Equivalent Daily Dose (MEDD)
The Brief Pain Inventory is a medical questionnaire used to measure pain, developed by the Pain Research Group of the WHO Collaborating Centre for Symptom Evaluation in Cancer Care.
The purpose of the BPI is to assess the severity of pain and the impact of pain on daily functions. Originally developed to assess cancer pain, the BPI has been validated for use in the chronic nonmalignant pain population. It provides an important and widely used diagnostic tool for the clinician treating chronic pain.
Tools
Guidelines: BPI User Guide
The CAGE Questionnaire is a reliable, easily administered acronym screening tool that can aide in assessment and management of problem alcohol use. The CAGE Questionnaire was developed in 1970 by Dr. John A. Ewing as a tool for identifying individuals with undisclosed alcohol misuse.
Tool: CAGE Questionnaire
The Opioid Risk Tool - Revised (ORT-R) is an office-based, assessment designed to predict which patients may develop aberrant, drug-related behaviours based on known risk factors associated with substance use disorders. The ORT-R can either be self-administered by the patient (patient form) at the initial clinic visit or completed by the physician as part of the patient interview (clinician form).
The FICA Spiritual History Tool was an acronym developed by Dr. Puchalski and a group of primary care physicians to equip physicians and other health care professionals with a tool to address spiritual issues with patients. Spiritual histories are taken as part of the regular history during an annual exam or new patient visit, but can also be taken as part of follow-up visits, as appropriate. The acronym follows as a guide for conversations in the clinical setting by addressing: F - Faith and Belief; I – Importance; C – Community; A – how can the clinician Address this in the patient’s care.
The Support Needs Approach for Patients (SNAP) is a person-centred intervention that aims to identify the needs of patients with chronic or progressive conditions. The tool provides a method for patients to identify and express their support needs and discuss them with their health care team. Please note that all practitioners using the SNAP tool must complete the training referenced below. This is an essential requirement to deliver this intervention.
Tool: SNAP Training
Resources to share with patients and families as they learn more about Palliative and end-of-life care.
Learn more
These Palliative Care Tips may be zone specific. Consider your program and institution’s policies, procedures and protocols prior to using these tips. Special thank you to the Edmonton Zone Palliative Team and all clinicians who were involved in the development of the Palliative Care Tips.
These materials were created only for use by Alberta Health Services and is intended for general information only and is provided on an "as is", "where is" basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information.
This material is not a substitute for the advice of a qualified health professional. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.
The provincial guideline outlines a standard approach and practice for health care providers, leading to improved quality of care for patients and families during an already difficult time. It provides direction for regulated and unregulated home care providers on how to prepare for and approach an expected or unexpected death of a home care patient. The scope covers all ages and focuses on home care patients residing in either a private home or a seniors' lodge setting.
Resources are updated as needed and new resources are added as they become available. Always work from this page rather than a saved copy.
Bereavement care refers to ways of conveying genuine care and compassion when offering support at or near the time of death. See the care for the family: preparing to talk to family algorithm to help guide the process.
As families leave the care setting, health care providers can:
An information package given to families after a death. It contains information on what to do in the immediate hours and days after death, and what to expect in grief responses and layers of grief.
Local sites may add loss resources specific to the type of death, local bereavement care resources, and a care facility business card so families can contact the manager or an alternate should they have questions following the death.
The White Rose Program is a way of showing respect by creating a quiet and calm environment for those who are dying and their families. When a person is in the last hours to days of life, a White Rose poster is placed at the entrance of their bed or room. This visual reminder increases staff awareness to help provide a calm and quiet environment respectful of the unique needs of the dying person and those most important to them.
The health care provider explains the program to the person or their family and obtains consent before posting the sign on the door or curtain. If they prefer not to have the sign posted, their wishes are respected and documented.
For expected and unexpected deaths, the health care provider shall complete documentation requirements for the patient's health record.
Tara Wren Phone: 780-407-7825 / Email: tara.wren@ahs.ca
Resources to share with families, caregivers, and supporters to help them navigate a loss.
Learn more
Physicians, resident physicians, and medical students deserve the freedom to seek support with full confidence in confidentiality.
Learn moreTo ensure all health care providers are competent in providing patients and their families the best care possible, it is important to cultivate compassionate attitudes while equipping providers with standardized core knowledge and technical skills related to palliative care.
Palliative care is enhanced when delivered by collaborative interprofessional care teams whose members possess the standardized competency proficiency needed to deliver consistent, high-quality care. Providers are responsible for continually reevaluating their palliative care competency to identify learning gaps and, where necessary, engaging in continuing professional development education.
The framework is a standardized resource to inform and guide team-building activities, professional development, continuing education programs, accreditation, regulated professional and employer standards, and academic curricula.
These 14 discipline-specific competency frameworks enable health care providers and volunteers to self-assess their knowledge, skills, behaviours and attitudes toward palliative care. They complement the interprofessional framework above and serve the same purposes.
This course is for doctors wishing to improve their knowledge and develop core competencies in methadone prescribing for pain management in palliative care. It is an accredited educational program carrying Mainpro- M1 and Royal College CME credit (Section 1).
NOTE: This course is for learning purposes only. Physicians are required to obtain a methadone license from Health Canada prior to prescribing methadone.
Access courseThis one-day workshop in the Edmonton Zone focuses on the care of the palliative patient. It includes case studies. The topics presented include: pain, dyspnea, GI complications, depression/anxiety/wellbeing, communication, delirium/palliative sedation and end-of-life care. The topics are presented with a focus on nursing environments in community and acute care practice.
Status: on hold
