Year: 2018
Type: dissertation
Study design: Observational Study
Abstract: With health care restructuring in Canada and a general preference by patients and their families to receive palliative care at home, attention to home-based palliative care continues to increase. However, little is known about the changing temporal trends in home-based palliative care in Canada during the past decade. This dissertation assessed three aspects of the temporal trends of home-based palliative care: the use of formal palliative care service, the relationship between informal and formal care, and place of death among patients receiving palliative care. The dissertation focused on informal care provided by relatives and friends, and three types of home-based formal palliative care services: home-based palliative care physician visits, nurse visits, and care by personal support workers. Using survey data collected in a home-based palliative care program by the Temmy Later Center for Palliative Care in Ontario from 2005 to 2016, a two-part utilization model was built to analyze home-based palliative care service utilization and the relationship between informal and formal home-based palliative care. A multivariate logistic regression model was used to assess the temporal trends in the place of death. The findings demonstrated increased use of home-based palliative care and a shift (or substitution) in care away from nurses to less expensive care provided by personal support workers over the last decade. Informal care was a substitute for care by personal support workers, but a complement to home-based physician visits and nurse visits. In the case of nurse visits, an increased complementary effect was observed in more recent years. The place of death for patients receiving home-based palliative care changed over time, with more patients dying at home over 2006-2015 when compared to 2005. Understanding the temporal trends in home-based palliative care is essential for effective improvements in home-based palliative care programs and the development of palliative care policies.
Source: TSpace (University of Toronto)
Author: Zhuolu Sun
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3156755698