Use of an automated prospective clinical surveillance tool to drive screening for unmet palliative needs among patients in the final year of life

Anticipated Findings

We think implementing the mHOMR tool will increase the number of patients assessed for palliative needs and who receive palliative treatment such as pain management and palliative homecare. Across four hospitals in this project, up to 1,000 patients every year could receive better end-of-life care because of the mHOMR tool.

About the Project

A palliative approach to care can improve the quality of life of patients and families facing life-threatening illness by preventing and relieving suffering. Suffering may be caused by pain, nausea, anxiety and spiritual distress. To provide a palliative approach to care, physicians must first identify individuals who have life-threatening illnesses and unmet palliative needs.

People nearing the end-of-life often have unmet palliative needs. It can be hard for physicians to know when a person is close to death. Some tools exist, but these are difficult to use and not very accurate. Most physicians rely on their personal experience to make an educated guess about when their patient may be nearing the end-of-life. This method is unreliable and inaccurate for many illnesses. To address this problem, we created an electronic tool (mHOMR tool) that uses electronic medical information to automatically identify people who are likely nearing the end-of-life and notifies their treating team to assess for unmet palliative needs.

Implementing the mHOMR tool in hospitals will help physicians identify patients with unmet palliative needs and improve access to a palliative approach to care near the end-of-life.

Project Team

Principal Investigator:

James Downar, MDCM, MHSc – Ottawa Hospital Research Institute


Melanie Barwick, PhD – Hospital for Sick Children

Martin Chasen, MD – William Osler Health System

Leonie Herx, MD, PhD – Kingston Health Sciences Centre

Ahmed Jakda, MD, MBA – Ontario Palliative Care Network

Daniel Kobewka, MD – The Ottawa Hospital

Kwadwo Kyeremanteng, MD – Montfort Hospital

Peter Tanuseputro, MD, PhD – Bruyere Continuing Care

Peter Varga, BScN, MHSc – Headwaters Health Care Centre

Pete Wegier, PhD – Sinai Health System


Valerie Gratton, MD – Montfort Hospital

Paul Hebert, MD – Centre Hospitalier de l’Université de Montréal

Danielle Kain, MD – Kingston Health Sciences Centre

Peter Lawlor, MD, PhD – Bruyere Continuing Care

Mercedes Rodriguez, MD – Headwaters Health Care Centre

Mary Scott, BSc – Bruyere Continuing Care

Melissa Touw, MSc – Kingston Health Sciences Centre

Lori van Manen, BNSc, MSc – Kingston Health Sciences Centre

Colleen Webber, PhD – Bruyere Continuing Care

Knowledge Users:

Lee Fairclough – Health Quality Ontario

Elan Graves – Canadian Foundation for Healthcare Improvement (CFHI)

Lewis Park – Headwaters Health Care Centre

Mary Wheelwright, BSc, MBA – Headwaters Health Care Centre

Project Contact: Dr. James Downar –

Key words: palliative care; palliative medicine; end-of-life; quality of life; clinical surveillance; early identification; clinical trial; intervention-implementation research; implementation science


To see if implementing the mHOMR tool improves identification of patients’ palliative needs and leads to better care at the end-of-life.

Research Plan

We will implement the mHOMR tool in four Ontario hospitals. To measure the effect of the tool we will check hospital records and follow patients over time to see if their palliative needs were identified and what palliative care they subsequently received in the hospital and community.