End-of-life care in Canada

The recent study by Daren Heyland and associates1 provides excellent insight into the wishes and priorities of seriously ill patients and their family members. The authors note that the perception of “what matters most” in end-of-life care varies widely between different patient groups and their family members, which indicates the need for individualized care.

In our own medical oncology practice we find that this variability in “what matters most” exists not only between patient groups but also at different stages of a patient's illness. The large discrepancy between desired and actual place of death for patients with metastatic breast cancer may be an example of this. Our data for patients who died with this disease revealed that 71% wished to die at home, but only 33% were able to do so.2 This difference probably reflects a complicated combination of the difficulties in coordinating palliative care services and changing perceptions of and decisions about end-of-life care by patients and their caregivers as the patients' condition deteriorates. Therefore, decisions and communication about end-of-life care not only need to be individualized, but also need to be reassessed frequently.

Hopefully, through awareness of these key issues, we can improve the quality of end-of-life care for all terminally ill patients.