Registered Nurses' Association of Ontario

Key Concepts

End-of-life care: Care for persons who are expected to die in the foreseeable future and for their families. It includes helping persons and their families prepare for death, ensuring their comfort and supporting decision making that is consistent with the person’s prognosis and goals of care (3).

Family: “Those closest to the [person] in knowledge, care and affection. The person defines his or her ‘family’ and who will be involved in his/her care and/or present at the bedside. May include:

  • the biological family;
  • the family of acquisition (related by marriage/contract); and
  • the family of choice and friends (including pets)” (4).

Family caregiver: “Any relative, partner, friend or neighbor who has a significant personal relationship with, and provides a broad range of assistance for, an older person or an adult with a chronic or disabling condition. These individuals may be primary or secondary caregivers and live with, or separately from, the person receiving care” (5).

Health provider: Refers to both regulated workers (e.g., nurses, physicians, dieticians and social workers) and unregulated workers (e.g., personal support workers) who are part of the interprofessional health team.

  • Regulated health provider: In Ontario, the Regulated Health Professional Act (RHPA), 1991, provides a framework for regulating 23 health professions, outlining the scope of practice and the profession-specific controlled or authorized acts that each regulated professional is authorized to perform when providing health care and services (6).
  • Unregulated health provider: Unregulated health providers fulfill a variety of roles in areas that are not subject to the RHPA. They are accountable to their employers but not to an external regulating professional body (e.g., the College of Nurses of Ontario). Unregulated health providers fulfill a variety of roles and perform tasks that are determined by their employer and employment setting. Unregulated health providers only have the authority to perform a controlled act as set out in the RHPA if the procedure falls under one of the exemptions set out in the Act (7).

Interprofessional model of care: “Teams with different health-care disciplines working together towards common goals to meet the needs of a patient population. Team members divide the work based on their scope of practice; they share information to support one another’s work and coordinate processes and interventions to provide a number of services and programs” (8). In palliative care and end-of-life care, interprofessional health teams include patients, family members, volunteers and family caregivers, along with regulated and unregulated health providers.

Medical Assistance in Dying (MAiD): While there is an intersection between MAiD and palliative care, and each may be part of the person’s care path, MAiD and palliative care are both distinctive practices. MAiD specifically refers to “circumstances where a medical practitioner or nurse practitioner, at an individual’s request: (a) administers a substance that causes an individual’s death; or (b) prescribes a substance for an individual to self-administer to cause their own death” (145).

Palliative care: Palliative care is a philosophy and an approach to care. Palliative care aims to improve the quality of life of persons facing life-limiting illness and their families through the prevention and relief of suffering by means of early identification, assessment and treatment of symptoms (9). It is also referred to as hospice palliative care.

Palliative care aims to:

  • Relieve suffering and improve the quality of living and dying.
  • Address the physical, psychological, social, spiritual (existential) and practical issues of persons and their families, and their associated expectations, needs, hopes and fears.
  • Prepare persons and their families for self-determined life closure and the dying process and help them manage it.
  • Help families cope with loss and grief during the illness and bereavement experience.
  • Treat all active issues, prevent new issues from occurring and promote opportunities for meaningful and valuable experiences, personal and spiritual growth, and self-actualization (10).

Person: For the purposes of this BPG, this term refers to those experiencing the last 12 months of progressive life-limiting illness. The term is used interchangeably with patient, resident, and other terms found in the literature.

Clinical Management
A Palliative Approach To Care In The Last 12 Months of Life
Background Information