Abstract
This retrospective cohort study of cancer decedents during 2004–2015 examined end-of-life cancer care quality indicators (QIs) in the provinces of British Columbia (BC), Ontario, and Nova Scotia (NS). These included: emergency department use, in-patient hospitalization, intensive care unit admissions, physician house calls, home care visits, and death experienced in hospital. Ontario saw the greatest 12-year decrease in in-hospital deaths from 52.8% to 41.1%. Hospitalization rates within 30 days of death decreased in Ontario, increased in NS, and remained the same in BC. Ontario’s usage of aggressive end-of-life measures changed very little, while BC increased their utilization rates. Supportive care use increased in both NS and Ontario. Those who were male or living in a lower income/smaller community (in Ontario) were associated with a decreased likelihood of receiving supportive care. Despite the shift in focus to providing hospice and home care services, approximately 50% of oncology patients are still dying in hospital and 11.7% of patients overall are subject to aggressive care measures that may be out of line with their desire for comfort care. Supportive care use is increasing, but providers must ensure that Canadians are connected to palliative services, as its utilization improves a wide variety of outcomes.
Highlights
Quality indicators are measurable items of health care performance that can be used to identify effective health care interventions or pinpoint areas of concern
Of note is that British Columbia had a slightly lower percentage of patients with a score of at least 1 on the Deyo-Charlson comorbidity index (34% compared to 39.4% in Ontario and 41.1% in Nova Scotia), and Nova Scotians live in smaller-sized communities
We have found strong evidence that despite the shift in focus to providing earlier end of life (EOL) care to oncology patients with supportive care measures, approximately half of oncology patients are still dying in hospital, it is improving
Summary
Quality indicators are measurable items of health care performance that can be used to identify effective health care interventions or pinpoint areas of concern For those with cancer, patient-defined outcomes that are important at the end of life include being physically independent for as long as possible, having adequate symptom control, spending time with friends and family, and dying at home or outside of hospital [1]. Patients who experience poor end of life (EOL) care are those who suffer from pain, are subjected to treatments that are overly burdensome, have their emotional/spiritual needs go unmet, or die in a setting outside of their home Their caregivers are often less able to move on after their death [1,2,3]. Excluded patients for Nova Scotia and British Columbia were not obtained due to the lack of access to this information in the data request process
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