Palliative home care in Ontario: what's the standard?

Researchers from Wilfrid Laurier University have looked at data from across Ontario to try to learn more about the quality of palliative home care.
Dawn Guthrie, left, and Lisa Harman, right, studied data collected by Community Care Access Centres across Ontario to look for information about the quality of palliative home care. (John Ternan, Wilfrid Laurier University)

Researchers from Wilfrid Laurier University in Waterloo saw a gap in knowledge when it comes to the quality of Ontario's palliative home care, so they started looking at data gathered by local care centres across the province to find out what kind of care patients are receiving.

Dawn Guthrie, a professor from the department of kinesiology and physical education, led the one-year research project, and was joined by Lisa Harman, a master's student Guthrie is advising.

"Gathering some information about how we're doing right now with some actual numbers paves the way for asking those questions about how do we do better, what does it look like across Ontario," said Guthrie in an interview with Craig Norris on CBC K-W's The Morning Edition on Tuesday. "What initiatives could we put in place, or strategies to improve the quality of care and then ultimately that leads to the best possible care provided."

The data was gathered through local Community Care Access Centres, which are mandated by the province to assess clients who receive home care every six months, or when a significant life change such a surgery has happened. The patients are assessed on their physical and mental health.

Harman and Guthrie looked at the responses of over 500,000 people and spoke to palliative care experts for their opinions on which factors can be used determine quality of care.

The list of preliminary indicators of quality of care they found include rates of shortness of breath, falling and daily pains, as well as caregiver distress.

"To me this is part of the continued quality improvement efforts that would be happening within the home care sector," said Guthrie.

Flying under the radar

However, Guthrie warned against making hasty conclusions about the quality of care based on indicator rates, such as rates of daily pains.

"The indicators that we've been working on don't necessarily tell you definitively about quality, but it's our best way to try to get something in terms of data, in terms of numbers, but you do have to be careful about how you interpret them," said Guthrie.

"Just because a particular place has a high rate of a thing that you'd want to avoid, like daily pain for instance, doesn't necessarily mean it's poor quality, it's just a flag, it's an indicator to start looking deeper," she said.

Guthrie said many palliative care experts mentioned the importance of better identifying people who could benefit from palliative home care.

She said that the people who are under the radar might be those who don't have cancer, and that other life-limiting and serious illnesses are candidates for a palliative approach to care, like heart failure and dementia.

"It shouldn't matter if you have cancer or some kind of illness, but it's the fact that you're experiencing shortness of breath, that really affects your quality of life," said Guthrie.

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