Twelve domains of practice in the palliative care framework
Competency tables and professional domains
The Canadian Interdisciplinary Palliative Care Competency Framework comprises a set of tables that provide detailed information about the skills healthcare providers and volunteers must have to meet a minimum national standard for palliative care competency.
The tables are organized under six disciplines for people providing palliative care – nurses, general physicians, social workers, personal support workers*, volunteers, and spiritual care professionals – and further divided under 12 professional domains.
These domains were adapted from existing palliative care competency frameworks. Practitioners are expected to demonstrate the competencies only as appropriate for their professional scope of practice, jurisdictional and organizational policies, and specific job and role descriptions.
The domains of practice include:
1. Principles of a palliative approach to care
Palliative care aims to improve the quality of life of people with life-limiting conditions and their designated families or caregivers. This person-centred care ideally begins at diagnosis, continues into bereavement, and is for people of any age.
2. Cultural safety and humility
This domain is built on a foundation of seeking to understand and address power differentials and inequities in the social, political, and historical context of health care. Through self-reflection and consideration of the concepts of racism, discrimination, and prejudice, healthcare providers can practice relationship-based care.
Communication is essential in care of those affected by life-limiting illness. The person, their designated family or caregivers, and team may experience uncertainty and strong emotions. Effective communication helps to establish therapeutic relationships, ensures that people, and families and caregivers understand and participate in decision-making, enables interdisciplinary teamwork, and facilitates smooth transitions between care settings. Communication may be verbal or written, and may include the use of technology.
4. Optimizing comfort and quality of life
Optimizing comfort and quality of life as defined by the person and their designated family or caregivers by addressing their holistic needs. This is an ongoing, dynamic, and proactive process, aimed at relieving and preventing suffering. The process includes effective symptom management in alignment with the person’s and their designated family or caregivers’ goals of care.
5. Care planning and collaborative practice
Care planning and collaboration enables integrated, coordinated, person-centred care that optimizes comfort and quality of life. Collaboration involves the person and their designated family or caregivers, interdisciplinary team, and often multiple agencies or sectors. Care planning includes assessing current needs, planning for future illness deterioration, and possible transitions between care settings.
6. Last days and hours
Particular care should be paid to addressing the person’s and their designated family or caregivers’ care needs that are unique to the last days and hours of a person’s life.
7. Loss, grief, and bereavement
People, and families and caregivers, may experience loss and grief from the time of diagnosis, during the illness, into bereavement, and after death. Healthcare providers assess needs, identify issues, and provide information and support.
Self-care is paramount for healthcare providers. It encompasses a spectrum of knowledge, skills, and attitudes, including self-awareness and reflection, maintaining professional boundaries, and practising holistic wellness strategies for the individual provider and the team.
9. Professional and ethical practice
Ethical care is focused on the person’s and their designated family or caregivers’ values, needs, and wishes, while the healthcare provider maintains professional and personal integrity. This domain guides decision-making as life-limiting illnesses progress and healthcare needs change.
10. Education, evaluation, quality improvement, and research
Palliative care education, as well as consistent evaluation and research, are important for all parties. Care providers participate in palliative care continuing education initiatives, and lead or participate in the evaluation of palliative care services, including the person’s and their designated family or caregivers’ experiences. In doing so, they contribute to ongoing quality improvement. They promote, contribute to, or lead research, keeping abreast of current evidence, and invite potential participants to research studies.
Individuals advocate for funding and access to palliative care services and associated educational opportunities, contribute to policy development, and address the social determinants of health.
12. Virtual care
Virtual care is the application of technologies to expand the provision of health care beyond traditional in-person encounters and healthcare settings. It can include synchronous and asynchronous communication, remote monitoring, messaging, phone, video visits, e-consults, and other modalities. Virtual care is meant to complement rather than replace in-person care.
*Across Canada, in different provinces and territories, and in different settings, personal support workers may be identified as continuing care assistants, healthcare assistants, nursing assistants, and by other similar titles. In this Framework, the title of personal support workers has been used for simplicity; however, this title is referring to all titles that refer to this discipline.