Grant: Partnerships for Health System Improvement (PHSI)

Publicly-financed home-based palliative programs have been established to provide community multidisciplinary care, including practical and emotional support, to individuals at home. Despite patients' preferences for home death and the establishment of specialized, home-based programs, which aim to support death at home, many individuals with cancer continue to die in institutional settings. Understanding the determinants of place of death and the associated burden on families may inform the targeting of services to those patients for whom interventions to support home death may be more useful and effective. Moreover, acquiring economic evidence pertinent to place of death is critical to highlight differences in resource utilization between institutional deaths and home deaths. The purposes of this study are to:1)to assess the economic, demographic, clinical, and psychosocial factors that predict whether cancer patients who are referred to a home-based palliative care program die at home or in an institution; 2)to assess the economic, demographic, clinical, and psychosocial factors that predict caregivers' burden, across sites of death; and 3)to estimate the societal costs associated with the entire episode of palliative care, including resource costs incurred by patients and their family/friends during hospitalizations, until the time of death. Family Caregivers will be recruited from two programs: Temmy Latner Centre for Palliative Care in Toronto and the Hamilton Niagara Haldimand Brant LHIN Community Palliative Care Teams. Family caregivers will be asked to provide information on health services resource utilization, functional status, symptom severity and psychosocial burden. All other required data will be obtained from existing regional databases maintained by the palliative care programs. It is hoped that the study findings will assist in the formulation of health planning and resource allocation initiatives pertaining to palliative care.