Palliative care (also known as hospice palliative care) refers to the relief of suffering and improvement of the quality of living and dying, using a holistic approach. Palliative care addresses people’s physical, psychological, social, spiritual, and practical needs, as well as their associated expectations, hopes, and fears. It helps people with a progressive, life-limiting illness and their family prepare for and manage end-of-life choices, the process of dying, and coping with loss and grief. Palliative care does not focus just on end-of-life care; a palliative approach to care can begin upon the diagnosis of a life-limiting illness. People can receive palliative care while actively receiving treatment for their disease.
Despite the clear benefits of palliative care, there are many gaps in its delivery in Ontario, including access to palliative care services. Of the about 94,500 people who died in Ontario between April 2015 and March 2016, about 56,000 (59%) received palliative care services on at least one occasion in their last 12 months of life.
Among people who died in Ontario in 2015/2016, about a quarter (24.1%) received physician home visits, and about one-third (27.5%) received palliative-specific home care in their last month of life. Receiving palliative home care has been associated with a 50% reduction in the likelihood of dying in hospital. Furthermore, more than half (54.8%) of people who died in Ontario had unplanned visits to the emergency department in their last month of life.
Whether or not people are able to die in the place they choose also reveals gaps in the provision of palliative care across the province. In surveys of patients and caregivers, most say they would prefer to die at home. And yet, of the about 94,500 people who died in 2015/2016, 53.6% died in hospital. Increased access to palliative-specific home care and home visits from physicians could reduce the number of people who die in hospital.
Equity is also an issue in the delivery of palliative care. In 2015/2016, patients living in poorer neighbourhoods were less likely to receive palliative home care services in their last month of life (22.7%) than patients in the richest neighbourhoods (32.2%).
Income is one equity issue, but there is also a need for culturally sensitive services to meet the diverse needs of all Ontarians. This includes access to culturally appropriate and safe palliative care across urban, rural, and remote communities, and includes various cultural, faith, and linguistic groups, and vulnerable populations.
The 13 quality statements that make up this quality standard are based on the best available evidence and guided by expert consensus from health care providers and people with lived experience. The statements provide guidance for areas identified by the Ontario Palliative Care Network and Health Quality Ontario’s Palliative Care Quality Standard Working Group as having high potential for improvement in the way palliative care is currently provided. Each statement has accompanying indicators to help health care providers and organizations measure the quality of the care they provide, and includes details on how successful delivery can improve palliative care and quality of life for people living with a progressive, life-limiting illness, their family, their caregivers, health care providers, and health services at large.