Canadian Medical Association

Significant variation in the provision of palliative care services in Canada has been confirmed by the first comprehensive survey of physicians offering such services.

The poll confirmed wide variations in the availability of palliative care and the type and training of physicians providing such services.

“Access to palliative care in Canada is highly variable: It depends on where you live, how old you are and what you are dying from,” a report on the survey findings noted, highlighting the relative lack of services for children and adolescents and the continued emphasis on providing palliative care to cancer patients.

“While there were few surprises, these survey data are very important because they clearly show what steps must be taken to ensure all Canadians have access to proper palliative care services,” said CMA President Chris Simpson commenting on the study findings.

The National Palliative Medicine Survey collected responses from 1,114 physicians who provide palliative care in Canada and was conducted by the CMA, Canadian Society of Palliative Care Physicians, College of Family Physicians of Canada, Royal College of Physicians and Surgeons of Canada and the Technology Evaluation in the Elderly Network (TVN).

The poll confirmed significant differences in the availability of palliative care services and the type and training of physicians providing such services.

While some respondents to the survey indicated they were family physicians with a focused practice in palliative care (12%) or specialists in palliative medicine (5%), the majority (84%) comprised a heterogeneous group of physicians who reported practising palliative care as part of their primary care practice. The survey showed most of this group (84%) work an average seven hours a week in palliative care.

The survey found 78% of those providing palliative care do not see patients under age 18, and only half of respondents said they could call on specialized pediatric palliative care services. Access to specialized palliative care services, in general, was reported to be far more common in urban than in rural or remote areas.

Few of the physicians providing palliative care have specialized training in this area, the survey found. The study authors said this raises questions about the standard of care and lack of evaluation of the quality and consistency of services being provided. Survey respondents said they felt compensation for providing palliative care did not match what is provided in other areas of medicine.

Despite recognition that many types of patients can benefit from palliative care, cancer patients remain the main recipient of such services, according to the survey. Fewer than 20% of their palliative care patients had a non-cancer diagnosis, noted just over half (57%) of responding physicians. “Having an adequate workforce to provide proper palliative care is a critical issue,” Simpson said, “and these physicians must be properly trained and have the necessary resources to do the work.”

“All Canadians in need deserve timely access to quality palliative medicine,” said Royal College President Kevin Imrie.

“This survey is important because it provides a baseline for policy-makers and medical organizations to plan to make the necessary changes to ensure this happens,” added Simpson.

“We now have baseline data to conduct deeper analyses, to develop research questions, and to inform policy, practice and workforce planning that will lead to improved access to palliative care for all Canadians. The real work is just beginning,” agreed Dr. John Muscedere, scientific director at TVN.

“The College of Family Physicians of Canada welcomes this valuable new data that supports enhanced attention to palliative care as part of the comprehensive training that family physicians receive,” said CFPC President Garey Mazowita.

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