Understanding Barriers to Access and Utilization of Palliative Care services for structurally vulnerable patients
Strong evidence points to the benefits of palliative care for patients with chronic serious illness, including improved symptom control and quality of life. While quality palliative care is accessible to many Canadians, not all persons with life limiting illness have access to palliative care. In fact, less than 15% of Canadians who need palliative care receive it at home in the last year of life. Most people who receive palliative care in Canada receive it late and often only in the final weeks of life.
For certain populations, accessing palliative care services when needed is even more difficult. People experiencing homelessness or precarious housing, for instance, may encounter additional barriers to accessing palliative care. Because of the co-existence of other problems such as mental illness, substance use or complex trauma histories, there may be a reluctance to engage with mainstream healthcare services even for palliative care needs. Structural vulnerability is a way of describing how both the social determinants of health such as housing, income and education intersect with society’s institutions, systems and power hierarchies (culture, race and colonialism) to affect a person’s circumstances, health and wellbeing.
People experiencing structural vulnerability are more likely to die in hospital or alone, on the street, in shelters or in transitional housing. While they fear dying alone or undiscovered, they also fear discrimination in health care at the end of life.
Making full use of strategies such as Harm reduction and Trauma informed care may help to engage and enable palliative care services to be delivered to structurally vulnerable people. Importantly, bringing palliative care services to places where structurally vulnerable people live and collaborating with existing social support agencies and non-traditional families may also enhance the delivery of palliative care services to these patients.
Dr. Donna Spaner
Donna Spaner MD, CCFP(PC), FCFP, MScCH
Clinical Director, Palliative Care Program Toronto Grace Health Centre Palliative Education and Care for the Homeless (PEACH) physician, Inner City Health Associates Assistant Professor, Department of Family and Community Medicine, University of Toronto.
RPN, Class 1 Funeral Director
Sasha Hill is a current Registered Practical Nurse and 4th year BScN student at Nipissing University. Her nursing background is in palliative care and she works as the community nurse coordinator for the Palliative Education and Care for the Homeless (PEACH) team through Inner City Health Associates and on the tissue recovery team with Trillium Gift of Life Network. Sasha has also spent 20 years as a licensed funeral director and still maintains her FD license.