Identifying Disparities in Equitable Access to Virtual Palliative Care

IMPORTANCE: There are 280,000 Canadian adults who die each year and relatively few providers to deliver care to the majority who prefer to die at home. 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 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. This created a unique opportunity to study who received virtual palliative care and who did not, and 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 at ICES in Ontario to conduct a population-wide study investigating increases in the volume of virtual palliative care, who received it, and associated outcomes during and following the pandemic. We will align the findings from our analyses of big data using interviews with patients, caregivers and palliative care providers to understand their experience and the perceived facilitators and barriers to its use. 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 patients have access to the best possible end of life care when and where they need it.