Palliative care delivery across health sectors: A population-level observational study

Palliat Med. 2017 Mar;31(3):247-257. doi: 10.1177/0269216316653524. Epub 2016 Jul 10.


Background: Little population-level information exists about the delivery of palliative care across multiple health sectors, important in providing a complete picture of current care and gaps in care.

Aim: Provide a population perspective on end-of-life palliative care delivery across health sectors.

Design: Retrospective population-level cohort study, describing palliative care in the last year of life using linked health administrative databases.

Setting/participants: All decedents in Ontario, Canada, from 1 April 2010 to 31 March 2012 ( n = 177,817).

Results: Across all health sectors, about half (51.9%) of all decedents received at least one record of palliative care in the last year of life. Being female, middle-aged, living in wealthier and urban neighborhoods, having cancer, and less multi-morbidity were all associated with higher odds of palliative care receipt. Among 92,276 decedents receiving palliative care, 84.9% received care in acute care hospitals. Among recipients, 35 mean days of palliative care were delivered. About half (49.1%) of all palliative care days were delivered in the last 2 months of life, and half (50.1%) had palliative care initiated in this period. Only about one-fifth of all decedents (19.3%) received end-of-life care through publicly funded home care. Less than 10% of decedents had a record of a palliative care home visit from a physician.

Conclusion: We describe methods to capture palliative care using administrative data. Despite an estimate of overall reach (51.9%) that is higher than previous estimates, we have shown that palliative care is infrequently delivered particularly in community settings and to non-cancer patients and occurs close to death.

Keywords: Palliative care; cancer; end-of-life care; home care services; house calls; palliative medicine.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cohort Studies
  • Delivery of Health Care / organization & administration*
  • Delivery of Health Care / statistics & numerical data*
  • Female
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Neoplasms / therapy*
  • Observational Studies as Topic
  • Ontario
  • Palliative Care / organization & administration*
  • Palliative Care / statistics & numerical data*
  • Population Surveillance
  • Retrospective Studies
  • Sex Factors
  • Terminal Care / organization & administration*
  • Terminal Care / statistics & numerical data*
  • Young Adult