Identifying Service Gaps in Virtual Palliative Care to Inform Health Policy Across Canada

IMPORTANCE: There are over 280,000 annual deaths in Canada, and relatively few home- based providers to deliver care to the majority who prefer to die there. The COVID-19 pandemic posed many challenges for healthcare delivery. This was especially important for those at the end of life who overwhelmingly prefer to die at home with the support of home-based palliative care. The use of virtual palliative care was rapidly upscaled across the healthcare system to address support gaps for patients while preventing transmission of COVID-19. However, there are concerns that certain people are not be able to use virtual palliative care, especially those that are older, have lower income or live in rural areas. This created a unique opportunity to study if virtual palliative care can improve how people die and their ability to access high quality end of life care. METHODS: We will use validated administrative data in Canada to conduct a population-wide study investigating increases in the volume of virtual palliative care, who received it, and where they died during and following the pandemic. We will align the findings from our analyses of big data using interviews with palliative care providers and health administrators to understand their perceptions on how policy initiatives related to virtual palliative care inlfuence disparities in access. RELEVANCE AND IMPACT: The successful adoption of virtual palliative care in the post pandemic era will rely on evaluation of its impact to ensure it is both accessible to all patients and effective in improving care at the end of life. Our partnerships with key stakeholders and decision-makers will inform the optimization of this rapidly emerging care model, align it with patient preferences to improve population health, and ensure its sustainable delivery across the healthcare system.