What type of palliative care are Ontarians receiving in the last year of life?

There are numerous different health care providers that are involved in the delivery of palliative care. Physicians, nurses, pharmacists, volunteers, and other health care professionals all play important roles in the provision of comprehensive care.

Within these interdisciplinary palliative care teams, physicians often play a particularly influential role. However, given the diverse roles of physicians in the Canadian healthcare system, physicians from numerous specialities may be involved patient’s palliative care.

Across the literature, there are three categories used to describe the type of physicians providing palliative care. The categories are:

  1. Generalist palliative care: Physician whose practice is not focussed in palliative care.
  2. Specialist palliative care: Physician whose specializes in providing palliative care.
  3. Consultation palliative care: The collaboration of generalist and specialist physicians.

Using these categories, Ontario researchers Brown et al. examined 361,951 adult deaths in Ontario between 2011 and 2015 to gain insight into what physician palliative care services are provided during patients’ last year of life. This 2018 study can be freely accessed here.

The study revealed that during the last year of life, just over half of all Ontario decedents (53%) received no physician palliative care services. The other half of patients received care that fit into one of the three physician categories.

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Adapted from Brown et al. 2018

During the four-year study period, there were 29,343 Ontario physicians providing palliative care. Of this, only around 2% of the physicians were categorized as “palliative care specialists”. The remaining proportion were classified as “palliative care generalists”. Further, most of the physicians that provided palliative care, practice family medicine. Brown et al. concluded that the results from their study highlight the contributions of primary care providers and palliative care generalists.

However, it was also noted that not all physician visits in the last year of life were for the delivery of palliative care. In fact, only around 40% of the physicians provided palliative care services to the sample of Ontario decedents.

Given the distribution of physicians providing palliative care, authors Brown et al. suggest that to make services more accessible to patients, all physicians should be encouraged to provide primary-level palliative care. Increased opportunities to receive care could contribute to earlier involvement of palliative care providers, thereby maximizing the benefits of these services for patients and their families.

Work cited:

Brown, C. R., Hsu, A. T., Kendall, C., Marshall, D., Pereira, J., Prentice, M., Rice, J., Seow, H. Y., Smith, G. A., Ying, I., & Tanuseputro, P. (2018). How are physicians delivering palliative care? A population-based retrospective cohort study describing the mix of generalist and specialist palliative care models in the last year of life. Palliative medicine, 32(8), 1334–1343. https://doi.org/10.1177/0269216318780223.