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Half of all patients dying in Ontario receive some form of palliative care, usually in hospital


A study from the Institute of Clinical Evaluative Sciences (ICES) and the Bruyère Research Institute (BRI) provides new and detailed information about when and how end-of-life care is delivered, across all Ontario healthcare sectors.

The study found that 52 per cent of all patients dying in Ontario had at least one palliative care encounter in the last year of life. The vast majority of these patients (85 per cent) received that care in hospitals, while a minority received care in the home. About half of this care was delivered in the last two months of life, with one quarter of palliative patients receiving only one or two encounters.

The study, published today in the journal Palliative Medicine, is the first in Canada to comprehensively examine the provision of palliative care across multiple health sectors population-wide. The authors say the Ontario findings could serve as a model for other provinces in assessing the quality of palliative care delivery across sectors.

“We know from Ontario’s recent Palliative and End-Of-Life Care Provincial Roundtable Report (pdf) and other investigations that many patients wish to stay in their homes as long as possible at the end of life, and that they want choice when it comes to palliative care. However, this study shows that only 20 per cent of dying patients are receiving publicly-funded palliative home care, and only 1 in 10 have a doctor make a palliative care house call in their last year of life. This is sobering, and makes it doubtful that this choice is being made available for all,” says Peter Tanuseputro, the lead author of the study who is research project lead at BRI and a family physician at The Ottawa Hospital. “We also see that patients dying of cancer are more than twice as likely to receive palliative care, which raises the question, why are patients dying from other causes less able to access this type of care?”

Using secure patient health records housed at ICES, the researchers looked at all 177,817 deaths in the province of Ontario in a two year period from 2010 – 2012. Of those deaths, 92,276 patients (52 per cent) received at least one palliative care service in any of the settings examined, including in hospital, in nursing homes, or in the patient’s home.

Among the study’s findings:

  • Publicly-funded palliative home care only reached 20 per cent of dying patients, and less than 10 per cent of dying patients received a palliative home visit from a physician.
  • Patients with cancer were two and a half times more likely to receive palliative care, compared to people dying from non-cancer causes.
  • Female patients and patients living in wealthier and urban neighborhoods were more likely to receive palliative care.
  • Some health issues make palliative care less likely: Patients with dementia were less likely to receive palliative care, as were those with congestive heart failure or multiple serious health complications.
  • About half (49 per cent) of the palliative care was delivered in the last two months of life, with half of these patients receiving their first encounter in this period. The researchers note that the World Health Organization recommends initiation of palliative care early in the disease trajectory.
  • One quarter of patients receiving palliative care received only two or fewer encounters, lower than what the researchers say constitutes meaningful end-of-life care.

“As Canada continues to improve our care for patients at the end of their lives, it is vital that palliative care be a central part of that discussion,” comments Walter Wodchis, the senior author of the paper who is an adjunct scientist at ICES and associate professor, Institute of Health Policy, Management and Evaluation at the University of Toronto. “Until now, we have lacked strong cross-system data about exactly how and where that palliative care is being provided. This study will be important in filling those knowledge gaps as our governments, professional associations and patient advocacy groups work together to improve compassionate end-of-life care for all patients in Canada.”

“Palliative care delivery at the end-of-life across health sectors: a population-level observational study” was published today in the journal Palliative Medicine.

Author block: Peter Tanuseputro, Suman Budhwani, Yu Qing Bai, Walter P Wodchis.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

The Bruyère Research Institute supports investigators who contribute to a better, more responsive healthcare system that delivers the best care to patients and families. The Institute is a proud partner of Bruyère Continuing Care, the University of Ottawa and others and provides solutions to improve the health and healthcare of aging and frail Canadians. The Institute’s research focuses primarily on evidence, health system evaluation, brain health, geriatrics and rehabilitation, and primary care. www.bruyere.org/bri


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