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Palliative Care Committee (PPCC)

POGO′s Palliative Care Committee began as POGO′s Palliative Care Initiative in 2004.  The group was formed in response to requests from several of POGO′s Provincial Satellite Program partners for guidelines and resources to aid them in managing pediatric palliative care patients in their hospitals and communities.  

The original membership was multicentred and multidisciplinary with inpatient, outpatient, and interlink nurses and physicians from HSC, CHEO, CHWO, KGH, HHSC, GRH, CVH, and POGO.

Committee Goal: 
To mobilize and enhance the quality of community services and support in Pediatric Palliative Care and in so doing, ensure the availability of these services to pediatric oncology patients and their families closer to home.

The steps identified to meet this goal included:

• Identify:
  • Standards of Practice for pediatric palliative care
  • Unique aspects related to pediatric oncology palliative care.
• Compare the guidelines and practices currently in place in the tertiary hospitals across Ontario, Canada, and internationally.
• Review existing Pediatric Palliative care guidelines for provincial adoption
• Identify gaps in regional services and resources.
• Develop, support, implement, and evaluate a model for Pediatric Palliative Care delivery in community hospitals and homes that would assist in filling these gaps
• Create a standing committee at POGO to be the voice for Pediatric Oncology Palliative Care in Ontario and ensure representation on related local or provincial initiatives.
• Ensure knowledge transfer mechanisms are developed related to the work of this initiative.

Work to date:

• The Task Force identified barriers to effective management of Pediatric Palliative Care in the community.  These include:
• Reluctance of local healthcare providers, to accept pediatric palliative care patients because of gaps in resources and services.
• These gaps include:
  • Guidelines
  • Underdeveloped referral and case management processes
  • Education
  • Access to Expert advice
  • Appropriate financial resources to develop and sustain these much needed services
• Standards of Practice and guidelines for Pediatric Palliative Care are being developed institutionally, provincially, and nationally.
• It was decided that this group would not look at creating new guidelines, but wait until the process at HSC and CHEO was farther long and be guided by their recommendations.
• The Pediatric Palliative Care Tree model was developed in response to the identified barriers related to referral process and case management.
  • The Model identifies
    • Roles to manage pediatric palliative care in the community
    • A process to ensure seamlessness and continuity of pediatric palliative care including:
    • Identifying an initial community contact person and team facilitator who would in turn, identify the appropriate team members, based on patient and family needs, and develop contact list and facilitating Team meetings to clarify roles and communication pathways.
       
• Barriers to implementation of the model:
  • Funding
  • Website development and a maintenance
  • Education
  • To maintain access to expert advice around the clock
  • Unavailability but ongoing development of provincially or nationally accepted standards of care and guidelines.
• A Palliative Care Web page was added to the POGO website, which includes:
  • The Pediatric Palliative Care Tree Model.
  • Resources for professionals and families.
  • Contact information to experts in specific areas of symptom management as it pertains to pediatric oncology
  • The Palliative Care Task Force presented the work to date at POGO′s Satellite Education Day in April 2004 and developed a Poster Presentation for the POGO Symposium in November 2004.
• The group was expanded to ensure representation from each of the POGO Satellite centres either as sitting members or corresponding members a long with representation from the five tertiary hospitals in Ontario that care for pediatric oncology patients.
• As a part of the larger POGO Provincial 5 year Planning Process the work of this group became part of the Palliative Care Cluster report, which when completed may have funding implications.

Ongoing work of the group:

• As recommended by the PPOP Palliative Care Cluster group and this group, advocate within POGO for the development of a Pediatric Oncology Palliative Care committee to identify areas where discussions and work is being done related to Palliative Care and attempt to ensure that there is a pediatric voice, in the healthcare, political, and educational arenas.
• Continue to work with local communities as they develop their processes and practices and develop teams of healthcare workers who are interested in working with Pediatric Palliative Care patients and their families
• Continue to update and expand the Palliative Care page of the POGO website
• Build the resource team list and plan for next year (October 2005-September 2006).
• Quarterly Newsletter is proposed