A recent study describes that the community members are served by our health-care system as they face death. This study of the palliative care showing similarities between these cities and providing important context for health-care system planning.

In both cities, the most common place of death is a hospital, despite statements by patients, families and health-care providers that alternate locations, such as home or hospice, might be preferred. Gaps between primary care, community care, and specialized hospital care were recognized in providing seamless and co-ordinated services. Metrics provided by HQO for the province, Hamilton's LHIN and Ottawa's LHIN show that the percentages of patients who received home care in their last 30 days of life were 76%, 76%, and 74%, respectively.

The percentages of patients who received one home visit from a family doctor in their last 30 days of life were 34%, 33% and 42%. The percentages of patients who had at least one emergency department visit in their last 30 days of life an undesirable occurrence were 63%, 59, and 61%. The percentages of patients who died in hospital were 65%, 62%, and 58%.

These data demonstrate how understanding home-care delivery, emergency department use, and place of death can assist in improving our palliative-care systems. The metrics imply that as communities engage in discussions of palliative care, themes related to patient-centered care and service integration will emerge as priorities. Four themes are of particular importance.

1. A first theme is to create expectations among patients, families and health-care providers that soon after a diagnosis of a life-limiting disease, patients will be able to discuss their thoughts, wishes, and goals as they live and acknowledge the possibility of death. 

2. A second theme is to ensure patients' families, and caregivers are included. While inclusion is important for many reasons, it is exemplified by the metric related to death in one's home.  There is a need to recognize the unique roles of family caregivers and to identify supports they require so that fatigue and distress do not compromise their care of loved ones.

3. The third theme is to recognize that supporting patients and families requires co-ordinated teamwork by health-care providers across all settings. Consistency among core team members, and access to specialized care when appropriate, is fundamental to supporting patients and families. 

4. A fourth theme prioritizes the role of the community in effectively implementing palliative approaches to care. Recognizing death as part of our natural life cycle has been described though the lens of the "compassionate community."

The provision of compassionate and holistic palliative care to meet the needs of our community members and their families presents an extraordinary calling to our society and our health-care systems. As dying and death are more than a health-care issue, we should recognize the important roles for local communities and our broader society in placing perspective around our philosophies and approaches to care.