How can geographic location affect patients access to hospice and palliative care services?

Ontario has a total population of just over 14.5 million. The majority of Ontarians live in metropolitan areas (88.7%)1 and the remaining population reside in less populated rural or remote locations. Ontarians who live in these rural areas often face inequitable access to health care services compared to citizens of metropolitan areas. These inequities can also extend to hospice and palliative care services.

Researchers Conlon et al. published a study in 20192 investigating the access to palliative care services for patients diagnosed with cancer living in northern and rural areas of Ontario. Using administrative data from all Ontario cancer decedents from 2007 to 2012, these researchers identified multiple barriers that hinder access to end-of-life care services and organizations.

Of their study sample of 129 107 Ontarian cancer decedents, approximately 8% lived in northern rural or northern urban areas. Some of the main results of the study are as follows:

  • Northern and rural residents were 0.82 times less likely to receive palliative care.
  • Likelihood further decreased if individuals were male, had shorter prognosis, or were within a lower income quintile.
  • Younger individuals were more likely to receive care.
  • Individuals that did not receive palliative care were:
    • 2.3 times more likely to receive aggressive end-of-life care
    • 3.4 times more likely to be admitted to ICU in the last month of life
    • 2 times more likely to die in acute care, and
    • 1.9 times more receive more chemotherapy in the last two-weeks of life

This study showed the differences between urban and rural palliative care delivery. Authors note evolving implementation unique strategies including telehealth, rural training and education, and frameworks specific to rural settings. These strategies along with healthcare professionals can minimize barriers to assessable, high quality rural palliative care services.


  1. Statistics Canada. (2017). Focus on geography series, 2011 census. Statistics Canada Catalogue no. 98-404-X2016001. Retrieved from:
  2. Conlon, M. S., Caswell, J. M., Santi, S. A., Ballantyne, B., Meigs, M. L., Knight, A., … & Hartman, M. (2019). Access to palliative care for cancer patients living in a northern and rural environment in Ontario, Canada: The effects of geographic region and rurality on end-of-life care in a population-based decedent cancer cohort. Clinical Medicine Insights: Oncology13,