Benchmarking End of Life Quality Indicators by Tumor Type & Describing models of palliative care across Canada

Lead Researcher(s): Aynharan Sinnarajah

Lead Institution: University of Calgary

Co-Investigators: Lisa Barbera, Hsien Seow, Peter Tanuseputro, Leonie Herx

ARCC Program Area(s): Health Systems, Services, and Policy

Funding Term: 2021-2022

Project Summary:

Problem: The quality of end-of-life (EOL) cancer care is variable across the country. Previous work has looked at EOL quality indicators (QI) by region and province (AB, BC, ON, NS) for home care and physicians visits in last months of life across 4 provinces. But they haven’t looked at whether these differ by tumor type and whether certain sub-types of tumor (e.g. Lung: Non-small cell vs Small cell) differ across tumor groups but also across regions.

Additionally, we need to start looking at phenotypes of ‘models of palliative care’, and it’s association with EOL outcomes (e.g. ED visits, hospitalisations). Ontario data shows that the phenotype of the physician and home care makes a difference. Specifically, they outlined 4 models of physician-based palliative care: 1. Low engagement; 2. Generalist palliative care; 3. Consultation palliative care; 4. Specialist palliative care. For home care, there are 3 types related to this: 1. No home care; 2. General home care; 3. Palliative focused home care. Various literature show an association between these types of palliative care and EOL outcomes. This work has not been done across Canada so far. Describing current models of these care across Canada is important for policy making provincially and federally, and to assess whether differences might impact EOL outcomes. But, first we need to build a clinically validated list of palliative care codes used by physicians and home care across Canada.

Objectives: We aim to describe these models of care for end-of-life cancer care across 4 provinces. Specifically, we will undertake 4 study objectives (in order of priority):

1. EOL QI indicators for tumor types (Top 4: lung, gastrointestinal, hematology): Update existing ON dataset (Seow et al.) data to benchmark. (0-12 months)
2. Build a list of province-specific palliative care codes for home care and physicians: Leveraging the Canadian Society of Palliative Care Physicians (CSPCP) (pan-Canadian membership of palliative care physicians) and research team, we will validate an expert-consensus list (0-6 months).
3. (Future work) Models of physician & home care-based palliative care with EOL QI indicators for each of these models: To develop a description of types of palliative care received by end-of-life cancer patients. Oncologist and cancer centre involvement will also be assessed.