Assessing Urban Community-Based Palliative Care in Montreal: Identifying Gaps and Opportunities for Quality Improvement

BackgroundHealth systems increasingly recognize the value of community-based palliative care but there is considerable variability in how such services are delivered. As part of a quality improvement initiative to enhance community-based palliative care, we aimed to characterize publicly accessible services for persons suffering from serious illness in a diverse, large North American city in Canada. We assessed the degree to which structures and processes followed best-practice recommendations of high-quality community-based palliative care.MethodologyWe conducted a cross-sectional survey with healthcare workers to assess structures and processes related to community-based palliative care team composition, care access and provision, care continuity, and care transitions.ResultsCommunity-based palliative care teams in our sample adhered to many best-practice recommendations, such as working in multi-disciplinary teams, providing 24/7 access, and fostering care transitions to and from inpatient palliative care settings. However, access to community-based palliative care was not uniform, and considerable variability existed in prognostic admission criteria. We also identified gaps in psycho-spiritual and personal care support capacity. Specialized, dedicated psycho-spiritual, and personal care support services were missing from more than 75% of community-based palliative care teams.ConclusionsA survey of structures and processes in community-based palliative care teams revealed variability in service organization and care processes. Many services lacked psycho-spiritual and personal care support. Our findings may be representative of similar structural issues elsewhere and suggest the need for broader efforts to understand the system-level factors that shape community-based palliative care service structures and processes.