Evolution of Palliative Care in Ontario: The Impact of Geography, Funding, and Advocacy

Despite the growing interest in and awareness of palliative care in Ontario, its evolution has not yet been described or explained. The purpose of this study was to examine the evolution of palliative care in the province of Ontario, with a large rural representation, in both area and impending need for palliative care. Academic and grey literatures were reviewed to synthesize a provincial timeline of key developmental milestones. Interviews (n=7) were conducted with stakeholders to confirm the validity of the timeline produced. Three temporal periods comprising the past 30 years of palliative care evolution in Ontario were determined: (1) the 1980s: the foundational years; (2) the 1990s: increased government involvement, and; (3) 2000+: stakeholders working together. Thematic analysis of interview transcripts revealed three emergent themes consistent throughout the three temporal periods: the impact of geography, funding, and advocacy on the development of palliative care in Ontario. These results can be useful in illustrating what facilitates and constrains the development of quality palliative care service delivery in other geographies, whether provincial, regional or national. Keywords: palliative care, developmental milestones, geography, funding, advocacy