Palliative Care Toolkit

Identify if the patient would benefit from palliative care earlier in their illness trajectory using one of the following tools:

• Supportive & Palliative Care Indicator Tool
• Gold Standard Framework Prognostic Indicator Guide (Adapted for Ontario use by Mississauga Halton Palliative Care Network)
• NECPAL CCOMS-ICO Tool and Program
• RADboud Indicators for Palliative Care Needs
• Risk Evaluation for Support: Prediction for Elder-life in the Community Tool (RESPECT)
• Hospital One-year Mortality Risk (HOMR)

Refer to our Tools to Support Earlier Identification for Palliative Care for more information about each of these tools.

Assess the person’s current and future needs and preferences across all domains of care. Assessment should include validated screening tools, an in-depth history, physical examination and relevant laboratory and imaging tests.

Screening Tools

Use validated screening tools to identify if the patient, their family or caregiver have any needs that require urgent intervention. Type and timeliness of screening  will depend on the severity, extent of life interference, urgency and complexity of the symptoms or needs identified.

• Edmonton Symptom Assessment System (ESAS, Cancer Care Ontario)
• Palliative Performance Scale (PPS, Cancer Care Ontario)
• Clinical Frailty Scale (Ken Rockwood)
• Patient Reported Functional Status (PRFS/ECOG, Cancer Care Ontario)
• Eastern Cooperative Oncology Group Performance Status (ECOG)
• InterRAI (HC, PC, CHA, CHESS-MDS, DIVERT, eScreener)

Holistic Assessment

Explore symptoms and needs across all domains in more detail through history and examination. Specific details on domains are described in Domains of Issues Associated with Illness and Bereavement (PDF). Continue to screen regularly for distress and other needs.

Conversation and Consent Tools

Use the results of screening and assessment to prompt further discussions about a person’s wishes, values, beliefs, understanding of wellness and any illnesses, and goals for current and future care. These conversations are ongoing and should be revisited regularly.

• Practical Guide to Health Care Consent and Advance Care Planning in Ontario (Hospice Palliative Care Ontario)
• The Substitute Decision Maker Hierarchy (Hospice Palliative Care Ontario)
• Advance Care Planning in Ontario: Summary (Advocacy Centre for the Elderly)
• Advance Care Planning Workbook: Ontario Version (Speak Up Ontario)
• Making Decisions About Your Care: Patient Resource (OPCN)
• Person-Centred Decision-Making: Resource for healthcare providers (OPCN)
• Advance Care Planning, Goals of Care, and Treatment Decisions & Informed Consent (Frequently Asked Questions)(OPCN)
• Approaches to Goals of Care (OPCN)

Plan and collaborate ongoing care to address needs identified during the assessment. This includes prompt management of symptoms and coordination with other care providers.

• Symptom Management Guides (Cancer Care Ontario)
• Hospice Palliative Care Symptom Guidelines (Fraser Health Authority)
• Cancer Pathway Maps (Cancer Care Ontario)
• Expected Death in The Home Protocol example (Waterloo Wellington Local Health Integration Network)
• Ontario Drug Benefit Formulary/Comparative Drug Index (Ministry of Health and Long-Term Care)
• Billing and Payment Guide for General Practitioner Focused Palliative Care Physicians (Ministry of Health and Long-Term Care)
• Billing for Palliative Care in Primary Care in Ontario (Palliative Care Innovation)

The following documents and forms are Ontario-specific resources that may be required as part of the care provided.

• Request for an Unlisted Drug Product - Exceptional Access Program (Government of Ontario)
• Request for Death Certificate (Government of Ontario)

These are additional palliative care tools created by Cancer Care Ontario and other organizations.

• Palliative Care Toolkit for Aboriginal Communities (Cancer Care Ontario)
• End-of-Life Care Module (General Practice Services Committee)