Not Just What We Do but How We Do it: Creating Equity-Oriented Palliative Care

Categories: Care.

The “Improving Equity in Access to Palliative Care” (IEAPC) initiative is a uniquely Canadian collaborative supported by Healthcare Excellence Canada and the Canadian Partnership Against Cancer.

On October 17th at the McGill International Palliative Care Congress, a panel of dynamic speakers, including Naheed Dosani and Holly Prince, will discuss the experiences to date of over 20 diverse communities who are actively initiating positive change, with particular attention to the needs of structurally vulnerable populations.

Holly Prince, MSW, Ph.D (Cand.)

Holly Prince is an Anishinaabekwe and a member of Opwaaganisiniing in Northwestern Ontario. She has a master’s degree in social work and is a Ph.D. Candidate in Educational Studies at Lakehead University. Holly’s research focus is on decolonial and Indigenist education and Indigenous health, and community-based research. She is the Lead for the Indigenous People’s Health & Aging Division at the Centre for Education and Research on Aging & Health, Lakehead University, where she works as a Project Manager.

A part of her role involves planning, implementing, and evaluating palliative care education and health equity initiatives for Indigenous peoples across Canada. She has devoted the last 20 years to advancing the right of Indigenous peoples’ access to culturally appropriate and equitable palliative care and has mobilized her efforts as a national champion of human rights and dignity for people preparing to journey back to the spirit world.

Dr. Naheed Dosani

As a palliative care physician and health justice activist, Dr. Naheed Dosani is dedicated to advancing equitable access to healthcare for people experiencing structural vulnerabilities like poverty and homelessness. These efforts include founding and leading the Palliative Education and Care for the Homeless (PEACH) Program, serving as the Medical Director of Kensington Hospice, as Health Equity Lead at Kensington Health, as Health Equity Expert Advisor at CPAC and as a palliative care physician at
St. Michael’s Hospital at Unity Health Toronto.

Dr. Dosani is an Assistant Professor with the Department of Family and Community Medicine at the University of Toronto. His research interests include improving care models for people experiencing structural vulnerabilities and access to palliative care for culturally diverse communities.

Dr. Dosani has received many prestigious honours for his trailblazing work. These awards include the Meritorious Service Cross for Humanitarianism from Canada’s Governor General (2018), a humanitarian award from the CSPCP (2019) and the Early Career Leader award from the CMA (2020). Dr. Dosani received an Honorary Degree (Doctor of Laws) from Ontario Tech University (2022).

Holly Price and Naheed Dosani were interviewed by Devon Phillips, Programme Manager, Palliative Care McGill.

Devon Phillips (DP)
Your session is entitled, Equity-Oriented Care: A Pan-Canadian Discussion on Innovating Palliative Care Access for People Experiencing Homelessness & Vulnerable Housing. For some people, the need for equity in an advanced, developed country like Canada seems strange. Who are our vulnerable people and why do we need to be thinking about equity when it comes to palliative care?

Naheed Dosani (ND)
When we’re talking about who lacks equitable access to palliative care, we’re talking about structurally vulnerable populations… people who are often marginalized by various interacting factors power/privilege, political and social hierarchies that exist in our society.

What we see in our practices and in our experience (and also through a large body of established scholarly knowledge), is that for people who experience homelessness, poverty, mental illness and people who are using drugs – these factors really do impact who can get access to high quality palliative care and who can’t.

It goes without saying that structurally vulnerable populations are our sickest populations. For example, in countries like Canada, people experiencing homelessness have an average life expectancy of 34 to 47 years old, which is half that compared to people who are housed. Palliative care is an essential part of the care that this population really needs.

Holly Prince (HP)
When discussing structurally vulnerable populations, it is imperative to acknowledge the unique challenges faced by Indigenous peoples. Indigenous peoples around the world are consistently ranked lower in almost every social determinant of health when compared to their non-Indigenous counterparts.

This leads to significant health disparities, including higher rates of chronic illnesses and lower life expectancy. Additionally, they experience inequitable access to healthcare, including palliative care.

It is crucial to acknowledge the impact of colonization in creating these disadvantages for Indigenous peoples. As a result, structural inequities and vulnerabilities create systems where Indigenous peoples lack equitable access to culturally safe care.

DP
At the Congress on October 17th, the two of you together with your colleagues will present the work underway through the Improving Equity and Access to Palliative Care Collaborative. How did this collaborative come about and what are the main goals?

ND
In 2018, Health Canada released its Framework on Palliative Care in Canada. In it, there is a description of why there is a need to enhance equity -oriented palliative care for everyone in Canada.

To respond to this need, two national healthcare organizations came together, to inspire a change, and a different way of doing things. Healthcare Excellence Canada and the Canadian Partnership Against Cancer teamed up to design the Improving Equity in Access to Palliative Care (IEAPC) Collaborative.

This is a four-year funded collaborative that aims to foster and cultivate knowledge exchange, innovation and sharing, across the country, to produce new and improved models of care to support structurally vulnerable populations, and particularly people experiencing homelessness.

The program is supporting 23 initiatives across Canada that aim to improve equity in access to palliative care, with over $100,000 in funding for each initiative. But the collaborative is about much more than the funding – it’s about knowledge exchange. It’s about coaching and mentorship and empowering the voices of people with lived and living experiences.

The result has been that we have 23 incredible initiatives that have been launched or are in the process of launching across Canada.

What kind of initiatives are we seeing?

We have mobile palliative care programs that are meeting the needs of unhoused people where they are at. We have hospice and bed-based programs that are being created to support this population. We have programs that are focused on engagement, building capacity and creating new innovative clinical pathways. We also have a hub that is focusing on providing models of palliative care for Indigenous peoples.

It’s just a really exciting, forward-thinking program that showcases what equity and palliative care can and should look like. Our hope is that this collaborative inspires changes that will last for many generations to come.

DP
This is a ground-breaking initiative. Holly, do you have anything to add to that?

HP
This process is deeply rooted in community engagement. Mentorship is not only fostered between coaches and teams, but also across different teams. In the first cohort, we had 10 teams that started in 2022. They spent just over a full year of learning and implementing innovative models of care. And now we have another 13 teams coming this year.

Cohort one will serve as mentors to cohort 2, sharing their learnings from the past year and reflecting on the development and implementation of work plans.

What makes these models truly innovative is that they are driven by community. They place a strong emphasis on engaging individuals with lived experience to identify their needs and develop appropriate responses.

DP
That’s excellent. It sounds like there’s tremendous leadership and collaboration generated through this initiative. People are coming to the congress from all over the world, from about 65 countries.

How do you think the learnings from this program will apply to people from other countries and cultures?

HP
This session will definitely inspire people from other countries. The presentations will showcase several community-based initiatives and teams, demonstrating innovative models of care and practices. These teams have valuable insights to offer and can provide lessons to other communities interested in working with structurally vulnerable people within their nations as well. We will also address common challenges and strengths that are relevant on a global scale.

DP
Is there anything else you would like to share with people about your session?

ND
I think Holly really hit it on the nail about where this collaborative sits on the international scale. We want to emphasize how unique this is and showcase how Canada is a leader in inspiring equity-oriented palliative care.

I think international audiences will have lots to take back to their local audiences. I want to emphasize that there’s often a tendency to just focus on the outputs of an initiative like this (i.e. the 23 initiatives that have been spawned across this country and the impacts that they are having and will have in the future). But we have to remember, it’s not just what we do, it’s how we do it, and I think the process that we created is important to talk about; it’s called a collaborative and a knowledge-sharing
exchange for a reason.

This is a grassroots community-driven initiative that exemplifies what a public health approach can look like in palliative care. We’ve created such incredible connections through this collaborative; through coaching, mentorship, and the sharing of lived experiences. This needs to be celebrated.

 

This article is republished from Palliative Care in Action with permission. 

ehospice – official partner of the McGill International Congress on Palliative Care” 
“ehospice – partenaire officiel du Congrès international de McGill sur les soins palliatifs.”

Leave a Reply

Your email address will not be published. Required fields are marked *