Home-based palliative care in Canada: time for this to be an option for everyone.

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Date: Sept. 26, 2022
From: CMAJ: Canadian Medical Association Journal(Vol. 194, Issue 37)
Publisher: CMA Impact Inc.
Document Type: Editorial
Length: 997 words
Lexile Measure: 1540L

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In Alberta and Ontario, only 1 in 6 people who died in 2016-2017 received publicly funded palliative home care. (1) Patients who had end-stage lung or heart disease, whose prognosis may have been as poor as that of patients with advanced cancer, were less likely to receive palliative care than those with cancer. (1)

Many patients with end-stage heart failure experience a gradual, progressive decline during their last years of life. However, their course of illness is usually punctuated by intermittent bouts of severe shortness of breath from which they often recover after medical treatment. These episodes frequently lead to presentations to the emergency department and admissions to hospital despite patients' wishes to remain at home if possible.

In a related article, Quinn and colleagues show that, among patients who died with heart failure, a home-based palliative care model that involved primary care providers, cardiologists and palliative care specialists, was associated with fewer visits to the emergency department, admissions to hospital and intensive care near the end of life, and a lower likelihood of dying in hospital (41% v. 78%) than usual care. (2) These findings underscore the importance of scaling up access to high-quality home-based palliative care.

The intervention that was studied emphasized advance care planning; home-based management of heart failure; standardized protocols for clinical care; ongoing education of patients, families and clinicians; (3) and collaboration among primary care providers, cardiologists and palliative care specialists.

The palliative care competencies needed to manage patients with heart failure at home...

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Gale Document Number: GALE|A719029250