Access to palliative care by home care clients with severe and persistent mental illness: a retrospective study of health administrative data

Though it is recommended that a palliative approach be considered early during a serious or life-limiting illness, in most cases it is provided very late in the course of illness, if at all. Persons with severe and persistent mental illnesses (SPMI) have been identified as an underserved group with respect to palliative care despite higher rates of morbidity and mortality. This study examined access to palliative care (PC) by home care clients with SPMI and factors associated with access. This study employed a retrospective study design using population-level health administrative data based on the interRAI Home Care assessment in Ontario (Canada) Prevalence of access to PC was determined and compared among those with and without SPMI. Univariate and multivariable logistic regression models were fitted to assess the association between PC access and several social-demographic and clinical factors. Of the 616,296 clients, 25.3% had SPMI and 2.5% accessed PC; 23.5% of those who accessed PC had SPMI. Of note, the association between SPMI and access was modified by gender (p = 0.02) and age (p = 0.04), where females with SPMI under 65 years had 15% lower odds (OR = 0.85, CI = 0.76, 0.95) of access compared to males without SPMI under 65 years. Also, females with SPMI aged 65-74 had 16% lower odds (OR = 0.84, CI = 0.76, 0.93) of access compared to males without SPMI in that age group. Together, these results indicate that women with SPMI under 75 years had lower odds of PC access than women without SPMI; this was not seen for males. Overall, persons with SPMI had lower access to palliative care compared to those without SPMI, and this association was modified by gender and age. Given that persons with SPMI represent approximately one quarter of home care clients, further research is needed to examine timing of provision of palliative care to persons with SPMI, as well as its outcomes in terms of symptom management and quality of life.