Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

The Edmonton Palliative Care Program is the name of an integrated web of services housed across a number of different institutions that are now available to patients and families in greater Edmonton, a catchment area of approximately 840,000 people. In 1999, there were 1,400 cancer deaths in this region. Five different facilities have inpatient palliative care beds. Specifically, specialist palliative care physicians admit and care for patients with the most intractable physical and/or psychosocial symptoms at a 14-bed tertiary palliative care unit at Grey Nuns Hospital. Fifty percent of the patients at Grey Nuns die there, with the remainder discharged to other settings, including the 57 hospice beds that exist in four other facilities with continuing palliative care units. Family physicians are able to continue to look after their patients with the support of an interdisciplinary palliative care team in these inpatient hospice units. Most of these patients can no longer manage at home, and remain in these units for the rest of their lives. All of these palliative care beds are usually at 95-98 percent capacity.

In addition to these designated inpatient beds, the program boasts three palliative care consult services: two at acute care hospitals, the University of Alberta and the Royal Alexandra, and another at the Cross Cancer Institute, a freestanding building for outpatient and inpatient cancer services. The Edmonton Regional Palliative Care Program is the name given to the administrative structure for these efforts, which include a roving team made up of four palliative care physicians and four specialized nurses who consult to family doctors and their at-home patients as well as to patients in nursing homes, on the continuing palliative care units, and in smaller hospitals in the area. The Edmonton Regional Palliative Care Program provides clinical leadership, teaching, and research standards to staff in all of the different settings in which palliative care is available.

In Canada, the terms "hospice" and "palliative care" are used interchangeably, with no time restrictions on access to either. In contrast, in the United States, the term "hospice" refers to the Medicare Hospice Benefit, which requires physicians to certify that a patient is likely to die within six months in order to gain access to a specific set of end-of-life services and benefits. Physicians in Edmonton make referrals to these inpatient beds based on severity of symptoms and the availability of family caregivers at home. In general, patients who wish to die at home do so, if they have a family member able to provide care or can afford to hire round-the-clock care.

In spite of its decentralized make-up, the physicians in all of these settings know one another and one another's programs very well. They participate in the activities of the Division of Palliative Care Medicine at the University of Alberta Medical School, and work together in the postgraduate training program in palliative care, which draws international leaders who wish to develop programs in their own settings. Financed by one payer—the Canadian national health system—but administered independently by each province, the Edmonton Palliative Care Program provides a unique example in North America of an integrated community-based program, which aims to meet the palliative care needs of patients seamlessly across all possible settings, as well as being an internationally acclaimed center for research and teaching in this field.