About PaCES

Palliative Care Early and Systematic (PaCES) is a province-wide team of researchers and knowledge end-users working together to implement evidence-based practices for delivering early and systematic palliative care for Albertans living with serious illness. We are funded by grants from the Canadian Institutes of Health Research (CIHR), Alberta Health, and the MSI Foundation. We aim to improve patient outcomes and health system inefficiencies, by increasing the number of patients receiving earlier palliative care.

Early palliative care may encompass an early palliative approach to care as well as early access to specialist palliative care.

What is a palliative approach to care?

Palliative care is defined by the World Health Organization as "an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:

• affirms life and regards dying as a normal process;
• intends neither to hasten or postpone death;
• offers a support system to help patients live as actively as possible until death;
• offers a support system to help the family cope during the patient's illness and in their own bereavement;
• uses a team approach to address the psychosocial needs of patients and their families, including bereavement counselling, if indicated;
• will enhance quality of life, and may also positively influence the course of illness through symptom management;
• is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications." (World Health Organization, 2007).

When is palliative care defined as "early"?

Early palliative care starts close to the initial diagnosis of advanced illness; specifically, the "Integration of palliative care into standard oncology care: ASCO clinical practice guideline update" suggests within 8 weeks of diagnosis of an advanced cancer. Palliative care continues as an added layer of support throughout a disease trajectory, including concurrently with disease modifying therapy (e.g. cancer chemotherapy), or when patients choose to not have disease modifying therapy, or when there are no disease modifying options available. Palliative therapy options may include best supportive care, systemic therapy or radiation therapy.

We define early access to specialist palliative care as comprising at least one of the following: a consultative visit by a specialist palliative care provider, and/or palliative homecare service ≥ 3 months before death. There is strong evidence that early palliative care improves patient quality of life, reduces caregiver distress, and leads to fewer aggressive, costly and inappropriate end of life interventions.

Why is early palliative care important?

Living with serious illness creates significant distress for patients and their families, especially when care transitions abruptly from a focus on life-prolonging therapies to a focus on palliative care at home (supportive care for enhancing quality of life). Patients and their families have told us that to improve these transitions they need: (1) a sense of continuity in their care, (2) opportunities to discuss preferences for future care, and (3) prompt access to specialized palliative care when needed. We know that patients who receive palliative care supports earlier, e.g. while still being treated with disease-modifying therapy, tend to use less aggressive interventions at the end of their lives. This is associated with improved quality of life, reduced family distress and decreased costs for the health system. Currently, our systems struggle to provide early palliative care, with most patients only receiving palliative care services two months before death.