Decision Making Process

Once a week the multidisciplinary Intake team comes together at Canuck Place to review completed referrals to the program. The team includes physicians, nurse practitioners, nurses, counsellors and nurse managers across both hospice locations, as well as the Medical Director and the Clinical Program Director. The information collected is shared and discussed.

A key deciding factor for children and families accepted to the CPCH program is the presence of a progressive, life-threatening serious illness.


  • Progression meaning that the illness/condition is actively changing/declining ongoing, affecting the health/function of the child in phases
  • Life-threatening means the “child” due to their serious illness the child has an increased possibility that they may  not live into full adulthood (defined as early 20’s).  This is explored and considered based on what is known about the specific illness/condition and clinical experiences.  The diagnosis itself does not provide the full answer, therefore each referral requires individual attention and review.

The decision making process also considers the following factors:

  • Presence of a serious illness.
    • A serious illness includes all children with a life-threatening/ life-limiting condition that live with a high likelihood of death before full adulthood AND negatively impacts a child’s daily function OR quality of life OR excessively stresses their caregivers. This may include other factors such as uncertainty around prognosis, a prolonged/multiple hospitalizations/ICU stays and/or where there is complex care coordination, fragility, instability, presence of complications and medical technology dependence.
  • What is known about the diagnosis and the serious illness according to best evidence in the literature, expert opinion and current known disease progression. The child’s current health condition in the context of known populations in the field of Pediatric Palliative care, also known as care quadrants
  • The fragility and instability of the child’s individual health course and/or health condition
    • Fragility is the child’s risk of their health to worsen or their health condition to progress. For many conditions it is impossible to predict, but often predictions can be made of what is likely and not likely to improve in the future.
    • Instability is the how quickly changes are occurring to a child’s well-being, which could include changes to their symptoms, function, development and care needs. Some factors considered include complications of multiple systems, severity of symptoms, symptoms specific to the child and the impact of technology and care interventions on the future.
  • And the expressed needs of the referral, including the needs and known care goals of the child and family, an openness to engage with our team.