Publications by authors named "Shirley Bush"
Article Synopsis
- The study examined how the disease trajectory and care setting affect burdensome transitions to hospitals at the end of life for older adults in Ontario, focusing on individuals aged 65 and above who died between 2015 and 2018.
- It found that over 40% of participants had organ failure, and the majority received long-term care (LTC), with significant interactions noted between disease types and care options influencing hospital transitions.
- Specifically, patients with organ failure had a higher likelihood of being hospitalized early and late, compared to those with terminal illness, while frailty increased the odds of early hospital transitions only in those receiving non-end-of-life home care.
Objectives: Long-term care (LTC) homes provide personal and medical care 24/7 to individuals unable to live at home due to illness or disability and are often the final place of care and death for their residents. Therefore, LTC homes are tasked with providing quality end-of-life care, often requiring injectable symptom management medications to relieve distressing symptoms (eg, pain). In this study, we aimed to understand the enablers and barriers to prescribing and administering end-of-life symptom management medications in LTC homes.
View Article and Find Full Text PDFBackground: The practice of continuous palliative sedation until death is the subject of much medical and ethical debate, which is reflected in the inconsistency that persists in the literature regarding the definition and indications of palliative sedation.
Aim: This study aims to gain a better understanding of palliative care clinicians' experiences with continuous palliative sedation.
Design: We conducted a qualitative study based on focus group discussions.
Background: Palliative care (PC) benefits patients with amyotrophic lateral sclerosis (ALS), however the needs of patients and caregivers and the optimal timing of PC discussions remains unclear. This study reports the analysis of PC consult notes from a larger feasibility trial. The specific aims of this analysis were to i) identify the PC needs of patients with ALS via qualitative analysis and ii) identify characteristics of patients and caregivers that could predict specific PC needs.
View Article and Find Full Text PDFBackground: Returning home from the hospital for palliative-focused care is a common transition, but the process can be emotionally distressing and logistically challenging for patients and caregivers. While interventions exist to aid in the transition, none have been developed in partnership with patients and caregivers.
Objective: To undergo the initial stages of codesign to create an intervention (Advancing the Care Experience for patients receiving Palliative care as they Transition from hospital to Home [ACEPATH]) to improve the experience of hospital-to-home transitions for adult patients receiving palliative care and their caregiver(s).
Article Synopsis
- The study aimed to assess how the prescribing of medications for end-of-life symptom management in long-term care homes changed during the COVID-19 pandemic in Ontario, Canada.
- Researchers examined data from residents who died between 2017 and 2021, comparing periods before and during the pandemic.
- The findings revealed significant differences in medication prescribing rates across various long-term care homes, with lower prescribing rates correlating with higher rates of COVID-19 outbreaks and negative outcomes for residents.
Background: At the end of life, individuals may experience physical symptoms such as pain, and guidelines recommend medications to manage these symptoms. Yet, little is known about the symptom management long-term care (LTC) residents receive at the end of life. Our research team developed a metric-whether residents receive one or more prescriptions for an end-of-life symptom management medication in their last two weeks-to explore end-of-life care for LTC residents.
View Article and Find Full Text PDFBackground: The teaching of palliative care competencies is an essential component of undergraduate medical education. There is significant variance in the palliative care content delivered in undergraduate medical curricula, revealing the utility of reference standards to guide curricular development and assessment. To evaluate our university's undergraduate palliative care teaching, we undertook a curriculum mapping exercise, comparing official learning objectives to the national Educating Future Physicians in Palliative and End-of-Life Care (EFPPEC) and the international Palliative Education Assessment Tool (PEAT) reference objectives.
View Article and Find Full Text PDFBackground: Medications are often needed to manage distressing end-of-life symptoms (eg, pain, agitation).
Objectives: In this study, we describe the variation in prescribing rates of symptom relief medications at the end of life among long-term care (LTC) decedents. We evaluate the extent these medications are prescribed in LTC homes and whether prescribing rates of end-of-life symptom management can be used as an indicator of quality end-of-life care.
Background: Severe grief is highly distressing and prevalent up to 1 year post-death among people bereaved during the first wave of COVID-19, but no study has assessed changes in grief severity beyond this timeframe.
Aim: Understand the trajectory of grief during the pandemic by reassessing grief symptoms in our original cohort 12-18 months post-death.
Design: Prospective matched cohort study.
Background: The impact of delirium on cognition has not been well-studied in long-term care (LTC) residents. This study examined changes in cognition 1 year after a probable delirium episode among LTC residents, compared to LTC residents without probable delirium. We also evaluated whether the relationship between probable delirium and cognitive change differed according to a diagnosis of dementia.
View Article and Find Full Text PDFBackground: The Richmond Agitation-Sedation Scale - Palliative version (RASS-PAL) tool is a brief observational tool to quantify a patient's level of agitation or sedation. The objective of this study was to implement the RASS-PAL tool on an inpatient palliative care unit and evaluate the implementation process.
Methods: Quality improvement implementation project using a short online RASS-PAL self-learning module and point-of-care tool.
Objectives: This study examined potentially inappropriate prescribing (PIP) of medication and its association with probable delirium among long-term care (LTC) residents in Ontario, Canada.
Design: Population-based cross-sectional study using provincial health administrative data, including LTC assessment data via the Resident Assessment Instrument-Minimum Dataset version 2.0 (RAI-MDS 2.
Article Synopsis
- The study aimed to compare the comorbidities and end-of-life (EoL) medication usage among patients who died before and during the COVID-19 pandemic.
- It involved analyzing records of decedents from three Ottawa hospitals, categorizing them into prepandemic and two intrapandemic groups, one with COVID-19 and one without, totaling 425 decedents.
- Results indicated that COVID-19 positive patients had higher rates of symptoms like dementia, breathlessness, cough, and fever, and they received higher doses of opioids, particularly morphine, compared to pre-COVID and COVID-negative groups.
Background: Delirium is a distressing condition often experienced by hospice in-patients. Increased understanding of current multidisciplinary care of delirium is needed to develop interventions in this setting.
Aim(s): To explore hospice staff and volunteers' practice, its influences and what may need to change to improve hospice delirium care.
Background: Physicians in acute care require tools to assist them in transitioning patients from a "life prolonging" approach to "end-of-life care," and standardized order sets can be a useful strategy. The end-of-life order set (EOLOS) was developed and implemented in the medical wards of a community academic hospital.
Objective: To compare adherence with best practices in end-of-life care after implementing the EOLOS.
Background: Palliative medicine physicians may be at higher risk of burnout due to increased stressors and compromised resilience during the COVID-19 pandemic. Burnout prevalence and factors influencing this among UK and Irish palliative medicine physicians is unknown.
Aim: To determine the prevalence of burnout and the degree of resilience among UK and Irish palliative medicine physicians during the COVID-19 pandemic, and associated factors.
Article Synopsis
- A study examined treatment preferences and end-of-life outcomes in 250 advanced heart failure patients receiving collaborative home-based palliative care in Ontario, Canada, over a median of 1.9 months from 2013 to 2019.
- Among patients prioritizing quantity of life, nearly half (48.8%) changed their preferences to focus on comfort at home rather than hospitalization, with 82.8% dying outside of a hospital.
- Those prioritizing quantity of life had lower odds of an out-of-hospital death and experienced more frequent hospitalizations, highlighting the need for early and flexible advanced care planning.
Article Synopsis
- The study looked at how different people, like patients and nurses, felt about a special treatment to prevent delirium (a confused state) in cancer patients at the end of their lives in Australia.
- Researchers talked to 39 people involved in a pilot trial to understand what worked well and what didn't, using ideas from psychology to analyze their answers.
- The findings showed that the treatment fit well with the caring nature of palliative care, but also highlighted some challenges in how the treatment was carried out and understood by everyone involved.
Background: Using delirium clinical guidelines may align interprofessional clinical practice and improve the care of delirious patients and their families. The aim of this project was to adapt, implement and evaluate an interprofessional modular delirium clinical practice guideline for an inpatient palliative care unit.
Methods: The setting was a 31-bed adult inpatient palliative care unit within a university-affiliated teaching hospital.
Background: The COVID-19 pandemic has caused millions of deaths worldwide, leading to symptoms of grief among the bereaved. Neither the burden of severe grief nor its predictors are fully known within the context of the pandemic.
Aim: To determine the prevalence and predictors of severe grief in family members who were bereaved early in the COVID-19 pandemic.
Objective: To compare end-of-life in-person family presence, patient-family communication and healthcare team-family communication encounters in hospitalised decedents before and during the COVID-19 pandemic.
Design: In a regional multicentre retrospective cohort study, electronic health record data were abstracted for a prepandemic group (pre-COVID) and two intrapandemic (March-August 2020, wave 1) groups, one COVID-19 free (COVID-ve) and one with COVID-19 infection (COVID+ve). Pre-COVID and COVID-ve groups were matched 2:1 (age, sex and care service) with the COVID+ve group.
Background The HeartFull Collaborative is a regionally organized model of care which involves specialist palliative care and cardiology health care providers (HCPs) in a collaborative, home-based palliative care approach for patients with advanced heart failure (AHF). We evaluated HCP perspectives of barriers and facilitators to providing coordinated palliative care for patients with AHF at home. Methods and Results We conducted a qualitative study with 17 HCPs (11 palliative care and 6 cardiology) who were involved in the HeartFull Collaborative from April 2013 to March 2020.
View Article and Find Full Text PDFThe use of intravenous inotropic medications in advanced heart failure (HF) has been shown to improve symptoms and decrease hospitalizations, prompting support for their use as a palliative measure for symptom management. Recommendations regarding inotrope management and method of discontinuation at the end of life are not specifically detailed in the literature and current guidelines. This case report describes the use of milrinone in a patient with advanced HF during the terminal phase of illness in a non-monitored palliative care unit setting, including dose reduction and discontinuation of milrinone.
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