Quality of End-of-Life Cancer Care in Canada: A 12-Year Retrospective Analysis of Three Provinces' Administrative Health Care Data Evaluating Changes over Time.
Amanda Farah KhanHsien-Yeang SeowRinku SutradharStuart PeacockKelvin Kar-Wing ChanFred BurgeKim McGrailAdam RaymakersBeverley LawsonLisa BarberaPublished in: Current oncology (Toronto, Ont.) (2021)
This retrospective cohort study of cancer decedents during 2004-2015 examined end-of-life cancer care quality indicators (QIs) in the provinces of British Columbia (BC), Ontario, and Nova Scotia (NS). These included: emergency department use, in-patient hospitalization, intensive care unit admissions, physician house calls, home care visits, and death experienced in hospital. Ontario saw the greatest 12-year decrease in in-hospital deaths from 52.8% to 41.1%. Hospitalization rates within 30 days of death decreased in Ontario, increased in NS, and remained the same in BC. Ontario's usage of aggressive end-of-life measures changed very little, while BC increased their utilization rates. Supportive care use increased in both NS and Ontario. Those who were male or living in a lower income/smaller community (in Ontario) were associated with a decreased likelihood of receiving supportive care. Despite the shift in focus to providing hospice and home care services, approximately 50% of oncology patients are still dying in hospital and 11.7% of patients overall are subject to aggressive care measures that may be out of line with their desire for comfort care. Supportive care use is increasing, but providers must ensure that Canadians are connected to palliative services, as its utilization improves a wide variety of outcomes.
Keyphrases
- healthcare
- palliative care
- emergency department
- quality improvement
- end stage renal disease
- intensive care unit
- affordable care act
- primary care
- ejection fraction
- chronic kidney disease
- mental health
- newly diagnosed
- advanced cancer
- peritoneal dialysis
- physical activity
- pain management
- case report
- acute care
- health insurance
- zika virus
- chronic pain
- squamous cell carcinoma
- extracorporeal membrane oxygenation
- deep learning
- big data
- social media
- insulin resistance
- artificial intelligence
- mechanical ventilation