A National Comparison of Intensity of End-of-Life Care in Canada: Defining Changing Patterns, Risk Factors and Targets for Intervention.

Examining the care received at the end of life is important. When studied, up to 70% of elderly patients, when provided with a choice, would prefer a less aggressive treatment plan than a technologically supported, institutionalized death. However during the last weeks to months of life, the majority of elderly patients are admitted to intensive care units that focus upon such aggressive care. In addition, critical care is costly - it consumes up to 1% of the entire gross domestic product. As our population ages and increasing numbers of seniors are faced with this issue of determining the kind of care they prefer at the end of life, it is important that we marry compassion and intensive technology in an appropriate fashion for individual patients. We believe that aggressive end-of-life care is escalating, and it is often not what patients desire. We will study and compare the care we deliver to all of our patients over age 65 years, and the costs of this care, during the last two years of life, in all regions of Canada, using data from the Canadian Institute for Health Information. We will determine if there are certain characteristics of patients (such as their age, where they live, their other medical conditions) and hospitals (whether in a small town or large city, how bit the hospital is, etc.) in each province or territory that influence whether patients receive more or less aggressive care. Certain regions may require more resources to provide hospice or palliative care; and, healthcare teams may need more education about the best care to provide. Ultimately, the aim of this study is to use information gathered and conclusions drawn to translate the knowledge towards improved quality end-of-life care capacity, and to plan future research.