CIHR - Team in community care and health human resources
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Theme 1: Community Care

Theme 2: Health Human Resources

Theme 3: Cross-Jurisdictional, Integrative Policy Analysis

Theme 3: Cross-Jurisdictional, Integrative Policy Analysis

Project Leads:
Raisa Deber, Paul Williams, Mike Saks & David Challis

Synopsis of Project:

Despite national strategies or frameworks for care at the end of life, many terminally ill patients still do not die at the preferred location or under the form of care desired.
Christopher Klinger’s dissertation project examines system-level characteristics in four target countries (Canada (Provinces of Alberta and Ontario), England, Germany and the United States of America) and their influence on the delivery of community-based palliative care. While core elements of disease management and bereavement care are addressed by various models, the extent varies between countries and disease trajectories such as cancer. The availability of financial and health human resources (HHR) for end-of-life care is identified as one critical barrier to service provision – alongside a home-based care infrastructure, education and training for service providers and the general public alike.

An embedded case study centers on resource utilization, care outcomes and costs of enhanced palliative care service provision under a shared-care approach in the Niagara West region of Ontario (Canada). Following an initial screening in physician offices, regular Community Care Access Centre (CCAC) services were supplemented with:

- further homemaking and nursing support,
- 24 hour access to palliative medicine consultation, and
- psychosocial/bereavement counseling, alongside
- medication, equipment and transportation services,
- under the navigation of an experienced advance practice nurse (APN)
to improve the overall quality of life for patients and families.

The costs of enhanced home-based palliative care service provision under the shared-care approach are well within the parameters of the (US) Medicare Hospice Benefit for both cancer and non-cancer patients - even in this less urban region - and significantly lower than costs for long-term or hospital-based care.

Project Status:
All data for the project has been collected – including key informant interviews with academics, bureaucrats, national association leaders and provider organizations in the four target countries. Data analysis of the embedded case study is completed and an overview on results is available in the Ressources section below for review.


Research Team:
Raisa Deber
Doris Howell (PhD, University of Toronto, Lawrence S. Bloomberg Faculty of Nursing)
David Zakus (PhD, University of Alberta, Faculty of Medicine and Dentistry)


Christopher Klinger (PhD-Candidate, University of Toronto, Institute of Health Policy, Management and Evaluation (IHPME) alongside the Collaborative Program in Aging, Palliative and Supportive Care Across the Life Course)

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