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In Search of a Good Death

This week, Health Quality Ontario releases its latest report, End-of-Life Health Care in Ontario, with key recommendations to improve the quality of care for all Ontarians.

Discussing death with the people we love and the health professionals we trust is difficult. We may feel reluctant to bring it up because it can be such an emotionally laden topic. Some health care providers may also feel reluctant to engage in these discussions for fear of upsetting the family, not considering it their role, feeling unprepared for the discussion or simply not recognizing its importance. Fortunately I’ve been noticing more conversations about the need to improve end-of-life care in the media and among health system leaders. There’s a new conversation starting.

In May 2013, the Ontario Medical Association announced that it would lead the charge in promoting the development of a provincial end-of-life strategy. More recently our Premier Kathleen Wynne, with the support of the other political parties called for more in-depth discussions about end-of-life care. Cancer Care Ontario’s (CCO) report on regional models of care is another great example of our health system prioritizing patient-centred care across all care settings; and the Local Health Integration Networks declaration of partnership with the Quality Hospice Palliative Care Coalition of Ontario and the Ministry of Health & Long-Term Care suggests a major effort to advance a new vision for palliative care in Ontario. Another thorough report from the Registered Nurses’ Association of Ontario stresses the importance of integrating the palliative philosophy of neither hastening nor postponing death earlier into a patient’s course of care. The report emphasizes the unique therapeutic relationship nurses share with patients as a way of ensuring continuity of care.i

Health Quality Ontario (HQO) is contributing to this discussion with the release of its latest report, End-of-Life Health Care in Ontario, an exhaustive, evidence-based analysis involving multiple studies. This mega-analysis report is a first of its kind for the province and addresses specifically what needs to improve to bring the best quality end-of-life care to all Ontarians.

End-of-Life Health Care in Ontario provides evidence to support the need for a broader public discussion about the normalization and de-medicalization of death and dying.

Our report and the work being undertaken are timely. By 2026, the number of Canadians dying each year will increase by 40 percent to 330,000 people, with each of those deaths affecting the well-being of an average of five other persons or in excess of 1.6 million people.ii The personal, social and economic impact of these deaths will place immense pressure on individuals, their families, and the health system.

While Canada ranks relatively high on the Economist Intelligence Unit’s international quality of death index, there are still hundreds of thousands of Canadians without access to coordinated end-of-life care.iii

In fact, it is estimated that just 30 per cent of people with chronic illnesses have access to dedicated end-of-life care – and most of the 30 percent are those living with cancer.iv The HQO mega-analysis report outlines the need to improve end-of-life care for all people nearing the end of life, irrespective of the disease.

Talking about end-of-life care and adopting better strategies across the province is everyone’s concern. We’re all responsible – those within the health system who provide care and those of us outside the health system who want to look after our loved ones.

I invite you to review the key recommendations from our report. Please let us know what you think by joining the discussion on Twitter by following @HQOntario or myself @DrJoshuaTepper.

iRegistered Nurses’ Association of Ontario. (2011). End-of-Life Care During the Last Days and Hours. Toronto, ON: Registered Nurses’ Association of Ontario. [online] Available at: http://rnao.ca/sites/rnao-ca/files/End-of-Life_Care_During_the_Last_Days_and_Hours_0.pdf.
iiQuality End-of-Life Coalition of Canada. Blueprint for action 2010 to 2020. 2010. 19
iiiFowler R, Hammer M. End-of-life care in Canada. Clin Invest Med. 2013; 36(3):E127-E132.
ivLocal Health Integration Networks, Quality Hospice Palliative Care Coalition of Ontario. Advancing high quality, high value palliative care in Ontario: a declaration of partnership and commitment to action [Internet]. [updated 2011]
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