Palliative Needs Among Home Care Clients from Underserved Groups: A Cross-Sectional Study

BackgroundPalliative care (PC) optimizes quality of life for individuals and their families by providing care that promotes dignity, respect, and comfort. Some groups experience inequities related to PC, including persons with mental illness, those living with dementia, linguistic minority groups, and living in rural, remote, or northern areas. There is little data on palliative needs among underserved groups in Canada.MethodsWe analyzed anonymized pan-Canadian population-level data on 1,451,135 home care clients. Palliative needs were defined as having a prognosis of six or fewer months to live, having palliative goals of care, or being offered or receiving hospice/palliative services. We examined the prevalence of palliative needs overall and among underserved groups, as well as whether membership in an underserved group was associated with recognition of palliative needs after controlling for other personal, social, functional, and clinical characteristics.ResultsOverall, 5.0% (n = 72,161) of home care clients had recognized palliative needs. Controlling for age, sex, social characteristics, functional, and clinical characteristics, persons aged 85 + years (0.85 OR), living with dementia (0.57 OR), mental illness (0.91 OR), and linguistic minorities (0.88 OR) had decreased odds of recognized palliative needs, while those living in rural areas had slightly increased odds (1.01 OR).ConclusionThese findings highlight that the palliative needs of certain groups may not be recognized, and therefore they may not be receiving the care that they need. Future work on promoting earlier identification and awareness of palliative needs is needed.