Building system capacity for home visits for patients near the end of life: A mixed-methods study in Canada

Despite known benefits, many Canadians do not receive adequate physician and nurse practitioner (NP) home visits in their last year of life, in part due to the declining providers who deliver this care. Factors influencing providers' decisions to deliver home visits in end-of-life contexts remain poorly understood.

To examine the influence of various enablers and barriers on physician and NP provision of home visits near the end of life and identify policy actions to enable delivery.

Explanatory sequential mixed-methods study, including a pan-Canadian survey of physicians and NPs who do and do not provide home visits, followed by qualitative interviews with a subset of participants to explore findings and identify policy solutions.

78 participants completed the survey with 16 participating in interviews. Both home visit providers (i.e., those providing home visits at the time of the study) and non-providers (i.e., those not providing home visits at the time of the study) identified improving access for patients unable to attend clinic-based care as an enabler. Both groups identified heavy workloads and staff shortages as barriers, but differed with providers emphasizing travel distance and non-providers highlighting demands that compete with other responsibilities. Participants' policy recommendations included enhanced training and mentorship, team-based models with support staff, improved remuneration and flexibility, expanded NP autonomy, integration of virtual care, and investment in dedicated home visiting teams.

Expanding home visits will require system-level interventions that reduce heavy workloads and create conditions to enable uptake among non-providers and sustainability among providers.