Project Description
This is a systematic project, which contains information about Palliative Care in Ontario, Canada. The information was collected using primarily research, provided by the World Health Organization (WHO), sources from the Ontario providential government, and published Canadian articles and case-studies. The project highlighted several problems using different techniques, research methods, and design tools.
Techniques, Methods and Tools
Several visual tools have been used in order to help us understand and connect all complex factors with in this topic in Ontario health care system. To provide design interventions within the Palliative Care system in Ontario, we made interative inquiry, Actors Map, Casual Loops, Systemigram, Journey Maps, Iceberg principle and Synthesis maps.
Palliative care (PC) is the type of care provided for those who live with a life-limiting illness, despite their age, illness/disease they were diagnosed with, nor how much time they have left; with the aim to reduce suffering and improve the quality of life. According to WHO, palliative care services work to provide relief from pain and other distressing symptoms, affirm dying as a normal process, intend neither to hasten nor postpone death, integrate the psychological and spiritual aspects of the patient care, offer a support system to help family cope during patient care, help patients live as actively as possible, uses a team approach to address the needs of patients and their families, and enhances quality of life.
Patients, families and friends who are expecting to receive the PC services at home, should understand that the setting should be accessible or have space for medical equipments; should have basic awareness about what PC services offer; understand that it is a team work collaboration between them and PC healthcare workers; and differentiate what is covered by the public and the private insurance.
Accessing Palliative Care Challenges
As much as PC seems easy to get. The system has several challenges, which linger the process of receiving PC services, such as: not enough specialized PC healthcare workers; the stress levels which affect caregivers decisions; limited amount of patients receive PC, thus its not that popular; and the stereotype that PC is likely to be provided for cancer patients only.
Visual Research Process
Combining the primary research into visual techniques, methods and tools into maps helped seeing the overview problem that exists in the Palliative Care system. The visuals made were causal loops, actors Map, interative inquiry, systemigram and synthesis map.
Interative Inquiry
The iterative inquiry map helped in creating the overview idea of palliative care system in Ontario. We framed our understanding of the problems by exploring what activities are needed, who delivers those activities and where and how are the services delivered within the system. Moreover, we set three different levels of “context”; P1: primary care, P2: specialized/acute-care, and P3: palliative care. Two main issues during the process were discovered. First, there is no one single level that integratively understands the patient’s needs and goals; small assessments are done on different levels and moments of the illness. Second, an integral team does not work together since the beginning of the diagnosis.
Mapping Process
Final Inquiry
Actors Map
To fully gather the actor’s roles and power hierarchy within receiving palliative care at home system; the actors map was made, scaling the actors across power and knowledge in relation to all other stakeholders. It came clear that the health seekers have a lot of knowledge of their needs; however, they do not have much understanding of the palliative care services offer nor how much power they have. On the contrary, the provincial government does have the most power in the health system and knowledge of PC services; nevertheless, they usually have limited knowledge of the patient’s experience.
Mapping Process
Final Actors Map
Causal loops
The causal loops depict the dynamics that happen around palliative care at home, showing how different educational, social, economical, physical and psychological aspects have positive or negative feedback between each other. Quality of life is one of the main goals of palliative care services. The loops demonstrated show aspects and the negative psychological symptoms of a patient can have a great impact at an educational, social, economical, physical, and psychological level. Intervening in any of these big spheres would have an effect on the patient and family member experience.
Looping process
Final loop
Syatemigram
The systemigram gave a broader view of how palliative care at home works and how complex the back-end process is. It also shows the boundaries within the system and the relationships and interdependencies between the actors involved. The systemigram shows different gaps within the healthcare system. Perhaps, it's clear that there is no sufficient public awareness, and education spread among the community and health professionals. Also, there is no communication between community-based health services and palliative care home care providers, which might make some difficulties in the interaction between stakeholders and an integrative delivery of care.
Gathering and Designing Info
Final Systemigram
Several challenges has been found within the process of receiving PC at home and during receiving PC services at home. Four main challenges were spotted together as they lead to the highlighted challenge, which is focused on in the synthesis map. First challenge is the lack or miscommunication between stakeholders. Second, the number of physicians aware, experienced or/and specialized in PC (no pubic awareness campaigns. Third, lack of team management in organizing, providing or/and regulating PC services at home. Forth, it is hard to find information about the exact process of accessing PC, for both patients, family/friends and medical workers
Synthesis Map
Synthesis mapping, is a method used to combine several conceptual maps together, which utilizes embedding to layers of different information. The map present the use both depth as well as distance to show connections between data, ideas, and concepts. The map combines visual illustrations of the causal loops, actors Map, interative inquiry as a form of journey maps and landmarks.
Highlighted Challenge
The most common challenging point found across the four challenges within the process of reaching PC, is the lack of education across physicians. If physicians were more educated during their M.D. and residency about PC, aware of the difference between types of end of life care and PC, practice or are comfortable to talk with patients about before-death-care, and if there was enough funding for more research around PC; these four challenges wouldn't exist as much as they do now. The synthesis map shows several proposed interventions and innovations that may enhance the current process of receiving PC system at home.
Metaphor
Toronto city was used as a metaphor as it represents the diverse cultures and conceptual topics related to death. Also, Toronto is considered to be one of the modern cities worldwide and have a high cultural acceptance rate; and so is Palliative Care, it has been introduced in the mid-70s and provided to everyone, despite their age or illness. Using different kinds of transportations shows how fast, slow or long journeys may take. In terms of color theme, green represents the quality of life, showing care, psychological calmness, and breaking the myths' boundaries.
Gathering Research and Visualizing the Metaphor Process
(Team-Work-Project)