Measuring the Use of End-of-Life Symptom Relief Medications in Long-Term Care Homes-a Qualitative Study

Rhiannon L Roberts; Christina Milani; Colleen Webber; Shirley H Bush; Kaitlyn Boese; Jessica E Simon; James Downar; Amit Arya; Peter Tanuseputro; Sarina R Isenberg

doi:10.5770/cgj.27.712

Measuring the Use of End-of-Life Symptom Relief Medications in Long-Term Care Homes-a Qualitative Study

Can Geriatr J. 2024 Mar 1;27(1):29-46. doi: 10.5770/cgj.27.712. eCollection 2024 Mar.

Authors

Rhiannon L Roberts¹, Christina Milani², Colleen Webber^{1

2}, Shirley H Bush^{1

2

3}, Kaitlyn Boese^{1

3}, Jessica E Simon⁴, James Downar^{1

2

3}, Amit Arya^{5

6}, Peter Tanuseputro^{1

2

3}, Sarina R Isenberg^{3

2

5

7}

Affiliations

¹ Ottawa Hospital Research Institute, Ottawa, ON.
² Bruyère Research Institute, Ottawa, ON.
³ Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, ON.
⁴ Department of Oncology, Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB.
⁵ Department of Family and Community Medicine, University of Toronto, Toronto, ON.
⁶ Kensington Research Institute, Toronto, ON.
⁷ School of Epidemiology and Public Health, Faculty of Medicine, Ottawa, ON.

Abstract

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. This qualitative study aimed to inform the refinement of the end-of-life prescribing metric, including the acceptability and applicability to assess the quality of a resident's symptom management at end-of-life.

Methods: We conducted 14 semi-structured interviews with Ontario health-care providers (physicians and nurses) who work in LTC homes and family caregivers of residents who died in LTC. Interviews were conducted virtually between February 2021 and December 2022, and were analyzed using thematic analysis.

Results: We identified three major themes relating to perceptions of the metric: 1) appropriateness, 2) health-care provider applicability, and 3) caregiver applicability. Participants noted that the metric may be appropriate to assess end-of-life care, but noted important nuances. Regarding applicability, health-care providers found value in the metric and that it could inform their practice. Conversely, caregivers found limited value in the metric.

Conclusion: The proposed metric captures a very specific aspect of end-of-life care-whether end-of-life medications were prescribed or not. Participants deemed that the metric may reflect whether LTC homes have processes to manage a resident's end-of-life symptoms with medication. However, participants thought the metric could not provide a complete picture of end-of-life care and its quality.

Keywords: end-of-life; long-term care; medications; metric; qualitative; thematic analyses.

Grants and funding

This study received funding from the College of Family Physicians of Canada COVID-19 Pandemic Response and Impact Grant Program. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. PT is supported by PSI Graham Farquharson Knowledge Translation Fellowship. SHB receives an Academic Protected Time Award from the Department of Medicine, University of Ottawa, Ottawa, Canada. The funders had no influence in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication