Thank you very much.
Honourable members, good afternoon, and thank you for the opportunity to make the case for health workforce preparedness in palliative and end-of-life care.
I'm Dr. José Pereira and I've been a palliative care physician, educator and researcher in Canada for over 25 years. I'm currently professor and director of the division of palliative care in the department of family medicine at McMaster University. I'm also scientific officer and co-founder of Pallium Canada.
Advanced progressive cancer and non-cancer illnesses continue to exact a very high toll on Canadians in terms of quality of life, suffering and health care costs. A large body of evidence shows that palliative care can reduce this burden by improving quality of life, reducing hospital admissions and emergency room visits, and reducing health care costs.
While there have been noteworthy improvements over the last two decades with respect to access to palliative care services and the integration of palliative care in the curricula of health professionals, many gaps remain. Despite what some may say, not all Canadians have access to timely, high-quality palliative care when they need it. One of the main reasons for this is the lack of health workforce preparedness to provide palliative care.
These workforce issues relate to both specialist-level palliative care and primary-level—also known as generalist-level—palliative care. If equipped with core palliative care competencies, clinicians and other professionals across many fields, such as primary care, long-term care, cancer care, cardiology and nephrology, to name just a few, are also able to initiate a palliative care approach.
There are currently not enough palliative care specialists and funded positions for palliative care clinicians in many Canadian jurisdictions. Moreover, many palliative care clinicians, including me, are nearing or contemplating retirement. In a study that I co-authored in 2015, we found only 265 physicians in Ontario who practised mainly palliative care. Emerging standards call for at least double that number.
There are not enough funded training positions for palliative care physicians. In my own division of palliative care at McMaster University, for example, we have the capacity to train up to six or eight new palliative care specialists every year but receive funding for only one trainee a year.
In my clinical work, I often see palliative care being activated only in the last days or even hours of life, when it's too late. This is demoralizing when there are evidence and experience to support early palliative care initiated many months before that, alongside treatments to control the diseases. Again, a root cause is lack of core palliative care knowledge and competencies across the health workforce.
In a large 2015 study involving primary care professionals across several OECD countries, only 42% of Canadian primary care doctors said that their practices were prepared to provide primary palliative care to their own patients, largely related to lack of education or experience. This was one of the lowest rates across the 10 countries studied, and it's not only in primary care. We see similar findings across studies and different speciality areas.
In a recent Canadian study, palliative care clinical rotations were mandatory in only two medical schools, not offered at all in two and only optional in 13. At the postgraduate level, only 60% of family medicine trainees and only 31% of internal medicine residents completed such rotations.
The good news is that there is evidence that core training can make a difference. In a large study that we did involving over 4,000 doctors, nurses, social workers and pharmacists who completed Pallium Canada's LEAP courses, we found that these courses improved advance care planning and goals of care discussions, improved pain and symptom management, improved opioid use and improved teamwork for up to four months after the courses.
We look forward to a future where these workforce training needs are addressed and long-term investments are made in palliative care training to increase specialist-level and generalist-level palliative care in Canada, and to spread and scale up across all care settings existing, proven, Canadian-made education programs.
Thank you very much.