Project 458292

The COVID-19 pandemic has provided a test of whether the Canadian health care system can accommodate a health crisis and continue to deliver equitable, high-quality end-of-life cancer care. Although palliative care has been shown to improve outcomes for patients with cancer, there has been no large-scale study on how the COVID-19 pandemic has affected the delivery of care at the end of life. The use of acute care services at the end of life (emergency department visits, hospitalizations, intensive care admissions near the end of life, and death in a hospital rather than at home) is an indicator of poor quality of cancer care. In contrast, early involvement of palliative care for patients with cancer improves their quality of care at the end of life. Patients affected by poverty tend to have less access to palliative care and receive more end-of-life care in acute care settings. I believe that it is likely that during the COVID-19 pandemic, there has been less acute care services use, more deaths at home and less palliative care involvement. I also believe that patients affected by poverty will have even less palliative care involvement during COVID-19, but that that they will still tend to use acute services and have less home deaths, because they will be less able to access resources to organize care at home. I will conduct a study using Ontario's healthcare data, which are routinely collected for all patients receiving healthcare in hospitals or at home. I will compare acute care services use care near the end of life as well as use of palliative care services (e.g. whether and for how long a specialized palliative care team was involved in the patient's care), before versus during the COVID-19 pandemic, among patients from areas of Ontario that are, or are not, affected by poverty. This project will help inform strategies to improve end-of-life care for patients during the ongoing COVID-19 pandemic and future health emergencies.