• Hsien Seow, Anish Arora, Lisa Barbera, Kim McGrail, Beverley Lawson, Fred Burge, and Rinku Sutradhar.
• McMaster University, Hamilton, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. Electronic address: seowh@mcmaster.ca.
• Health Policy. 2018 Feb 1; 122 (2): 134-139.

BackgroundStudies have demonstrated the strong association between increased end-of-life homecare nursing use and reduced acute care utilization. However, little research has described the utilization patterns of end-of-life homecare nursing and how this differs by region and community size.MethodsA retrospective population-based cohort study of cancer decedents from Ontario, British Columbia, and Nova Scotia was conducted between 2004 and 2009. Provinces linked administrative databases which provide data about homecare nursing use for the last 6 months of life for each cancer decedent. Among weekly users of homecare nursing in their last six months of life, we describe the proportion of patients receiving end-of-life homecare nursing by province and community size.ResultsOur cohort included 83,746 cancer decedents across 3 provinces. Patients receiving end-of-life nursing among homecare nursing users increased from weeks -26 to -1 before death by: 78% to 93% in British Columbia, 40% to 81% in Ontario, and 52% to 91% in Nova Scotia. In all 3 provinces, the smallest community size had the lowest proportion of patients using end-of-life nursing compared to the second largest community size, which had the highest proportion.ConclusionsDifferences in end-of-life homecare nursing use are much larger between provinces than between community sizes.Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

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