Authors: Dr. Kelli I. Stajduhar and Dr. Naheed Dosani
Disparities in health equity play a significant role in shaping health outcomes in Canada. This is especially true for individuals experiencing homelessness and precarious housing in Canada. Palliative care, a comprehensive approach that considers the whole person and facilitates quality-of-life care for individuals with serious life-limiting illnesses, is vital in these spaces. Unfortunately, people who experience homelessness often lack equitable access to palliative care.
Recognizing the challenges in accessing high-quality palliative care, Healthcare Excellence Canada (HEC) and the Canadian Partnership Against Cancer (the Partnership) launched the Improving Equity in Access to Palliative Care initiative in 2023. Working with groups from across Canada, this collaborative aims to make measurable improvement in access to palliative care with and for people experiencing homelessness or vulnerable housing. Now in its second year, a total of 23 communities are participating in this work. Their journeys and experiences are being shared as Promising Practices that summarize innovative, leading practices in palliative care.
The collaborative is being supported through the guidance and support of advisors and coaches like Dr. Kelli I. Stajduhar and Dr. Naheed Dosani. Dr. Stajduhar is a professor in the School of Nursing and Canada Research Chair of Palliative Approaches to Care in Aging and Community Health at the University of Victoria. Dr. Dosani is a palliative care physician at St. Michael's Hospital at Unity Health Toronto. He is also a health equity advisor with the Partnership.
The promising practices summaries have been co-developed with communities and groups that are delivering equity-oriented palliative care. “The summaries and stories aim to foster dialogue and encourage the adaptation of similar approaches across the country,” says Dr. Stajduhar. “While not prescriptive, they can serve as models of care and inspire social care leaders, policymakers, clinicians, advocates and communities to meaningfully engage with and implement equitable access to health care.”
A wide range of research and testimonies have demonstrated that people who are able to access safe, high-quality, integrated palliative care have improved quality of life and better satisfaction with care. Their caregivers are also able to provide better care and experience less distress.
The development of these promising practices reflects the dedication and resilience of individuals committed to improving care and effecting change. “Despite the diversity of lived experiences and circumstances, these practices offer a pathway for achieving structural change essential for ensuring universal access to safe, high-quality health care in Canada,” says Dr. Dosani. “They demonstrate the transformative impact of compassionate, person-centred and trauma-informed care, while also integrating other principles such as harm reduction, anti-oppressive practice, interprofessional collaboration and culturally safe(er) care.”
Ultimately, addressing the needs of individuals experiencing homelessness requires a holistic approach that tackles the underlying structural determinants of health, including housing, income, social support and equity.
“For us, this work and the journey of the communities captured through these promising practices have been truly inspiring,” says Dr. Stajduhar. Dr. Dosani agrees. “They poignantly demonstrate how we can work in new and innovative ways to improve care, together,” he says.
Learn more: Promising Practices for Improving Equity in Access to Palliative Care
