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Up to 70% of older 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.
In partnership with the Institute of Clinical Evaluative Sciences in Ontario, and the Canadian Institute for Health Information, that collects health data from each province and territory, our team developed a health care “Atlas” that described interactions with the healthcare system for patients approaching the end-of-life. For all Canadians who have died in the past decade, we have “looked back” for 2 years prior to death at all admissions to hospital, to intensive care units (ICUs), to diagnostic tests, therapies, the costs of care and where people die: in hospitals, hospice care or at home.
This project was the first to determine, in detail, our national delivery of end-of-life care.
Robert Fowler, MD, MDCM, MSc hails from New Brunswick, undertook primary medical training at McGill University and completed postgraduate medical training at the University of Toronto. He subsequently entered subspecialty critical care medicine training and graduate studies in epidemiology at Stanford University. Since joining Sunnybrook Health Sciences Center and the University of Toronto Faculty of Medicine in 2002, he has treated critically ill patients and investigated the ability of our health care system to deliver the care these patients need and want. He has led provincial and international collaborations aimed at identifying barriers to appropriate and timely access to health care, including during periods of system stress, due to severe infectious respiratory syndrome (SARS) and pandemic influenza. This peer-funded research has been published in high impact medical journals, presented widely to academic audiences, the media and the public. Rob has received numerous teaching and research awards, including an Ontario Ministry of Health and Long-term Care Career Scientist Award, the Heart and Stroke Foundation Clinician Scientist Award and the Society of Critical Care Medicine Patient Safety Award.
Andrea Hill, PhD is a research associate at Sunnybrook Health Sciences. In addition to her work examining patterns and determinants of end-of-life care practices, her other research interests are focused on epidemiology and outcomes of critical illness and injuries, including long-term outcomes and health utilization patterns among the elderly following critical illness.