A National Comparison of Intensity of End-of-Life Care in Canada: Defining Changing Patterns, Risk Factors and Targets for Intervention
This project was the first to determine, in detail, our national delivery of end-of-life care.
Findings: Among our sample of approximately 1/3 of Canadians, approximately 56% of the population dies in hospital, spends on average 18 days in hospital and 75% see >10 doctors in the last 6 months of life. On their last hospital admission, 26% of patients admitted to an intensive care unit (ICU). These rates have been stable over the past decade. We initiated a standardized survey of the families of all patients dying in one hospital, we found that while nearly three-quarters of inpatients preferred an out-of-hospital death, ICUs were a common, but not preferred, location of death and satisfaction with care was strongly associated with dying in a preferred location.
Impact of findings: Canadians experience predominantly in-hospital and expensive end-of-life care, despite most Canadians preferring out-of hospital options and showing a strong association between location of death and family perception of satisfaction. These findings show a need to expand capacity for end-of-life care settings that match patient preferences and increase national attention to quality.
Publications, presentations and webinars
About the Project
Up to 70% of elderly patients are admitted to hospital and/or intensive care units at the end-of-life; however, when asked, most would prefer a less aggressive treatment plan focusing on providing comfort rather than a technologically supported, institutionalized death. This care that may be unwanted is also expensive.
Previously, there was no provincial or national system of reporting upon how end-of-life care is delivered by our medical system. Therefore our ability to recommend more patient-focused end-of-life care is limited.
For more details on the project hypothesis, objectives and research plan, click here.
Robert Fowler, MD, MSc -- Sunnybrook Research Institute
Daren Heyland, MD, MSc -- Queen's University/Kingston General Hospital
Jean-François Kozak, PhD -- University of British Columbia
Kenneth Rockwood, MD, FRCPC, FRCP -- Dalhousie University
Project Contact: Dr. Robert Fowler -- firstname.lastname@example.org
Key words: elderly; seniors; palliative care; end-of-life; technology; hospitalization; intensive care; health system; knowledge translation; decision-making