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Dr. Joshua Tepper

How Are We Serving Those Nearing the End of Their Lives?

HQO’s latest report looks at palliative care. We look at the care and services people received during their last month of life to understand how the health care system is serving people as they near the end of their lives.

Conversation around end-of-life has been at the forefront of public discussion recently, in part due to the Federal Parliament’s focus on medically assisted death. However, this conversation should not overshadow the important evolution of our healthcare system to focus on palliative care. Our healthcare system takes responsibility for ‘cradle to grave’ care but far more attention has been placed on the beginning of life and the events during life than at the end.

Perhaps because of this traditional focus our report on palliative care found room for improvement.

Of the 95,000 people who died in Ontario in 2014-15, only just over half received some form of palliative care. And of those 54,000 people, half did not begin receiving this care until their last month of life.

This statistic alone is revealing. Modern medicine has extended our lives in ways that once would have been unimaginable. With the changing nature of disease, and chronic illness at the root of most deaths, we often now have the ability to better anticipate end-of-life. This means tremendous opportunity for palliative care to begin much sooner, and for people to understand its benefits - care that not only helps patients with their pain and symptoms, but also helps patients and their families through a difficult time of loss and grief.

We also report that nearly two-thirds of those who’d received palliative care had unplanned emergency department visits in the last month of life. While it is unlikely the number should be zero, the current rate is almost certainly higher than a high performing health system would anticipate. Another area for improvement is our finding that nearly two-thirds died in hospital although we know most people’s preference is to die at home.

Getting care when it’s needed, where it’s needed, and by well-trained people are hallmarks of quality health care. We need to build a health system that provides quality care at the end of people’s lives.

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