This award was formally named “Coping with End of Life”. Our Excellence in Quality category names changed in 2020 to reflect the updates to our BC Health Quality Matrix. Visit our Categories and Criteria page to find out more.
Patients with advanced chronic kidney disease face many issues with quality of life in their final years. The majority of these patients are over 65 years old, and their survival rates and quality of life on dialysis are lower than those of patients with metastatic breast or lung cancers. In response to the needs of this patient population, the BC Provincial Renal Agency (BCPRA) created a Palliative Care Committee with the goal of ensuring all individuals with chronic kidney disease have access to comprehensive, patient-centred, integrated palliative support in the continuum of kidney care and at the end of their lives.
The Committee was created in response to an End-of-Life Framework published by the BCPRA in 2009. The evidence-based framework articulated four pillars of palliative care:
- patient identification;
- advance care planning;
- symptom assessment and management; and
- care of the dying patient and bereavement.
Implementation of the framework was initially led by champions from the five regional renal programs, and this group evolved into the current Palliative Care Committee. The Committee is chaired by Gaylene Hargrove, a nephrologist from Island Health, and consists of over 30 members from all health authorities in BC: patients, physicians, nurses, allied health professionals and a spiritual care specialist. These champions for palliative and end-of-life care are committed not only to building capacity for the subject matter but also to distributed leadership.
In recent years, administrative and clinical fellowships were also established to train, develop and mentor young professionals to become future leaders in this aspect of chronic care. The trainees are members of the Palliative Care Committee and gain hands-on experience by leading initiatives with guidance from senior leaders in advancing a palliative approach to the continuum of kidney care.
The Committee has led to the adoption of formal strategies to facilitate palliative care improvements and advances in all five regional renal programs. An environmental scan and staff survey five years after the inception of the Committee, in 2014-2015, found that the four pillars of the End-of-Life Framework were being successfully adapted across the province, in ways that matched local needs and resources. Additionally, the survey found:
- 61% of respondents had end-of-life care training and the majority felt that it had increased their knowledge in providing care to patients.
- 83% were aware of the advance care planning strategies within their renal programs.
- 57% had received training in advance care planning and the majority of them “strongly agree” or “agree” that their training has equipped them with the necessary skills to have advance care planning conversations with patients.
The Committee released its first provincial renal palliative care quality metrics report in November 2016, and will publish reports biannually to identify and share efforts to improve quality of care for patients with chronic kidney disease.
The Palliative Care Committee is an alliance for change and a platform for patient and health care professional champions from across BC to share new ideas and lessons learned in advancing palliative and end-of-life care for patients with chronic kidney disease. The patient voice is deeply integrated into its work, both through consultation and the inclusion of patients as Committee members. Through its coordinated and concerted efforts to promote and share best practices, implement change and improvement ideas, and mobilize culture change, the Committee is continuing to improve palliative and end-of-life care for patients across the province.