Equity in Palliative Care Research Program

Who we are:

We are a group of university and community-based partners engaged in research and community mobilization to improve access to quality care at end-of-life for people who are made vulnerable by poverty, homelessness, racialization, and exclusion. Our aim is to inform the development of equitable health services and policies in order to improve access to care at end-of-life for people living with life-limiting conditions.

Our aims:

The aim of this research program is to shine a light on barriers to care for vulnerable and marginalized people, identify models of care to promote equitable palliative care, and capacitate health systems, healthcare providers, and inner city providers to integrate a palliative approach to care for their clients living with chronic life-limiting conditions, including cancer, lung disease, and organ failure. This means adapting principles of palliative care (i.e., alleviation of symptoms, advance care planning, psychosocial support, quality of life) to reflect the expertise and resources of inner city providers, and embed these principles into care provision where people live in the community.

Why are we doing this?

  • People living in poverty, on the streets or without adequate or stable housing, and impacted by stigmatization as a result of mental health or behaviour issues and/or criminalization of drug use, experience barriers to accessing health care services.
  • These experiences are exacerbated by the presence of life limiting conditions such as diabetes, cardiovascular disease, COPD, diabetes, cardiovascular disease and cancers.
  • Current models of palliative care have largely not been designed to serve vulnerable and marginalized populations. People are often admitted to hospitals that do not provide them with quality care and as a result they may avoid or delay accessing care. They often access social service agencies (e.g., shelters, soup kitchens, community health clinics, harm reduction facilities) that have limited staffing, scope and funding to provide adequate care to people with complex needs. 
  • Many spend their final days in shelters, transitional, or supportive housing cared for by workers who are highly compassionate, but have limited training, resources, and support to ensure high quality palliative care. In these settings, death is often unplanned and people’s wishes go unmet.
  • People who are dying are often separated from their ‘chosen’ family; workers and street family are left grieving with questions about how they could have done more, or regrets for having to send someone out of their community in their final days of life.
  • There have been recommendations to improve the quality of care for structurally vulnerable people but little evidence to inform the development of services.
  • In this program of research, we seek to pay close attention to the survival skills and resiliency that individuals employ amidst structural challenges, and the ways that  street family and workers in social service agencies strive to provide care within organizational and structural constraints.

Who funds our work?

Canadian Institutes of Health Research

Canadian Cancer Society Research Institute

Saint Elizabeth Health

The Sovereign Order of St. John of Jerusalem Knights Hospitaller Victoria Commandery

Principal investigator

Kelli Stajduhar

Publications

Stajduhar, K., Mollison, A., Giesbrecht, M., McNeil, R., Pauly, B., Reimer-Kirkham, S., Dosani, N., Wallace, B., Showler, G., Meagher, C., Kvakic, K., Gleave, D., Teal, T., Rose, C., Showler, C., & Rounds, K. (2019). “Just too busy living in the moment and surviving”: Barriers to accessing health care for structurally vulnerable populations at end-of-life. BMC Palliative Care 18(11). doi: 10.1186/s12904-019-0396-7

Giesbrecht, M., Stajduhar, K., Mollison, A., Pauly, B., Reimer-Kirkham, S., McNeil, R., Wallace, B., Dosani, N., & Rose, C. (2018). Hospitals, clinics, and palliative care units: Place-based experiences of formal healthcare settings by people experiencing structural vulnerability at the end-of-life. Health and Place, 53(September), 43-51. doi:10.1016/j.healthplace.2018-06-005

Stajduhar, K.I., Mollison, A., Gleave, D., & Hwang, S.W. (2017). Editorial: When cancer hits the streets. Current Oncology, 24(3), 1-2. doi:10.3747/co.24.3698

Reimer-Kirkham, S., Stajduhar, K., Pauly, B., Giesbrecht, M., Mollison, A., McNeil, R., & Wallace, B. (2016) Death is a social justice issue: Perspectives on equity-informed palliative care. Advances in Nursing Science, 39(4), 293-307. doi: 10.1097/ANS.0000000000000146

Op-eds and media

Stajduhar, K. (2018, September 28). Comment: Housing crisis makes sick people sicker. Times Colonist. https://www.timescolonist.com/opinion/op-ed/comment-housing-crisis-makes-sick-people-sicker-1.23445228

Meissner, Dirk. (2018, September 26). BC cancer patient’s cases exposes gaps in care for homeless people, advocates say. The Globe and Mail. Also picked up by the National Post, Toronto Star, and Global News and across several BC’s Black Press publications. https://www.theglobeandmail.com/canada/article-bc-cancer-patients-case-exposes-gaps-in-care-for-homeless-people/

Cheung, Simon. (2018, September). Final Indignity. Megaphone Magazine. file:///C:/Users/learn/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/7CRAP5LJ/Megaphone211_Web.pdf

Stajduhar, K., & Mollison, A. (2017, July 10). Opinion: Community workers, street family hit hard by B.C.’s opioid crisis. The Globe and Mail. https://beta.theglobeandmail.com/opinion/community-workers-street-family-hit-hard-by-bcs-opioid-crisis/article35651815

Stajduhar, K., & Mollison, A. (2016, August 14). Comment: Homeless deserve end-of-life care, but aren’t getting it. Times Colonist. http://www.timescolonist.com/opinion/op-ed/comment-homeless-deserve-end-of-life-care-but-aren-t-getting-it-1.2322386

Nair, R. (August 15, 2016). Dying on the streets: UVic study examines palliative care for the homeless. CBC News. http://www.cbc.ca/news/canada/british-columbia/palliative-care-homeless-victoria-1.3721373

Stajduhar, K. (August 15, 2016). UVic researcher Kelli Stajduhar on end-of-life care for homeless patients. CBC’s On the Island. http://www.cbc.ca/news/canada/british-columbia/palliative-care-homeless-victoria-1.3721373

Stajduhar, K. (October 29, 2015). CFAX interview with Terry Moore. (recording unavailable)

Stajduhar, K. (November 2, 2015) CBC interview with Robyn Burn's from All Points West (recording unavailable)

Presentations

Jakubec, S., Stajduhar, K., Buzath, E., Mollison, A., Holyoke, P., & Trudge, S. (2018, November). Rights to palliative care have no address: Integrating palliative approaches to care for those experiencing structural vulnerabilities. Abstract accepted to the American Public Health Association 2018 Annual Meeting & Expo, San Diego, CA.

Giesbrecht, M., Stajduhar, K., Mollison, A., Pauly, B., Reimer-Kirkham, S., McNeil, R., Wallace, B., Rose, C., & Dosani, N. (2018, October). Place-based experiences of formal healthcare settings by people experiencing vulnerability at the end-of-life. Presented at the Research Forum at the 22nd International Congress on Palliative Care, Montreal, QC.

Stajduhar, K., Dosani, N., & Colgan, S. (2018, October). Achieving equity in palliative care: Researchers and practitioners from three Canadian cities discuss what it takes. Workshop presented at the 22nd International Congress on Palliative Care, Montreal, QC.

Stajduhar, K.I. (2018, October). Access and Equity in Palliative Care. Workshop presentation at the Centre for Education and Research on Aging & Health Palliative Care Conference, Thunder Bay, ON

Dosani, N., Colgan, S., & Stajduhar, K. (2017, September). Social determinants of health – What are the biggest challenges to the social determinants of health. Challenging Issues Panel: Marginalized populations at the Canadian Hospice Palliative Care Conference, Ottawa, ON.

Stajduhar, K., Dosani, N., Colgan, S., & Jakubec, S. (2017, September). The social determinants of health in life and death: Research and promising practices in three Canadian cities to improve access to palliative care for structurally vulnerable people. Workshop presentation for the 5th International Public Health & Palliative Care Conference, Ottawa, ON.

Stajduhar, K., Mollison, A., Giesbrecht, M., McNeil, R., Pauly, B., Reimer-Kirkham, S., Dosani, N., Wallace, B., Rose, C., Gleave, D., Kvakic, K., Meagher, C., Showler, G., Teal, T., Showler, C. & Rounds, K. (2017, May). How the social determinants of health shape end-of-life experiences for vulnerable populations and their care providers. Poster presentation at the 15th World Congress of the European Association for Palliative Care, Madrid, Spain.

Stajduhar, K., Mollison, A., McNeil, R., Pauly, B., Wallace, B., Reimer Kirkham, S., Dosani, N., Rose, C., Gleave, D., Kvakic, K., Meagher, C., Showler, G., Teal, T., Showler, C., & Rounds, K. (2016, October). Barriers to accessing palliative care for structurally vulnerable populations. Research paper presented as part of the Research Forum at the 21st International Congress on Palliative Care, Montreal, QC. 

Community events

Symposium on integrating a palliative approach for structurally vulnerable people in Victoria. (October 17, 2017). Victoria City Hall, Victoria, BC. Report back.

A PORT in the Storm 2: “Lunch & learn”. (October 27, 2016). The Victoria Event Centre, Victoria, BC. Report back.

A Port in the Storm: A day of education and discussion about equitable access in palliative care for structurally vulnerable people in Victoria. (December, 2015). Ambrosia Centre, Victoria, BC.