Developing a Frailty Care Pathway for Older Adults in Long-Term Care: A Modified Delphi Process.

Objective: We developed a clinical care pathway for the detection and management of frailty for older adults living in long-term care (LTC) homes.

Methods: We utilized a modified Delphi with residents of LTC homes experiencing frailty, their caregivers, and care providers. The pathway was created using existing literature and input from key LTC experts.

Associations Between Symptom Complexity and Acute Care Utilization Among Adult Advanced Cancer Patients Followed by a Palliative Care Service.

Among adult advanced cancer patients already accessing palliative care, symptoms can contribute to unplanned acute care utilizations, which can disrupt care and worsen patient outcomes. We examined how a novel symptom complexity algorithm, using patients' ratings of the nine Edmonton Symptom Assessment System-Revised (ESAS-r) symptoms to assign "low", "medium", or "high" complexity, predicts acute care utilizations. This retrospective observational cohort study used electronic medical record data from the Durham Regional Cancer Centre in Ontario, Canada, comprising adult advanced cancer patients who completed at least one ESAS-r report between 1 January 2022 and 31 December 2023.

The Development of an Online Palliative Care Toolkit for Cirrhosis.

Background: Liver cirrhosis carries high symptom burden and health care utilization. Palliative care (PC) has demonstrated improvements in symptom burden and overall quality of life. Despite this, PC remains underutilized in patients with chronic liver disease.

Physician Billing in Long-Term Care Homes and the Association With the Prescribing of End-of-Life Symptom Management Medications: A Population-Based Retrospective Cohort Study.

Objectives: Medications are often needed to manage distressing end-of-life symptoms (eg, pain, agitation, dyspnea). We evaluated whether physician billing in long-term care (LTC) was associated with LTC residents' receipt of an end-of-life symptom management medication prescription.

Design: Retrospective cohort study using administrative health data.

Perceptions of Frailty in Long-Term Care.

Background: An early palliative approach to care may best suit the care needs of older persons with frailty living in long-term care (LTC). The study objective was to evaluate the barriers and facilitators to care for frailty in the LTC setting.

Methods: Semi-structured interviews were completed with physicians, nurse practitioners, registered nurses, allied health-care providers, care partners, and residents with care experience in LTC.

Association of physician-delivered virtual care near the end of life with healthcare use outcomes: A national population-based study of Canadians.

Background: The last 90 days of life are marked by high healthcare utilization in acute care settings, often conflicting with the preference to remain at home. The COVID-19 pandemic accelerated the adoption of virtual care, but its impact on healthcare utilization near the end-of-life remains unclear. This study assessed the association between physician-delivered virtual care use near the end-of-life and acute healthcare utilization, before and during the COVID-19 pandemic across four Canadian provinces.

Financial burden in advanced cancer: colorectal cancer data analysis.

Objectives: To characterise patient-reported financial burden of living with advanced colorectal cancer in Alberta, Canada, as part of a larger prospective cohort study characterising the experiences of people living with advanced colorectal cancer.

Methods: Patients were recruited from Alberta's tertiary cancer centres between January 2018 and July 2020. Enrolled participants were invited to complete the Patient Self-Administered Financial Effects (P-SAFE) questionnaire at 1 month post-enrolment and every 6 months thereafter, until death or end of study (December 2020).

Improving equity and wellness in cancer care with people of Latin American and African Descent: a study protocol.

Background: Cancer inequities such as late access to cancer screening and diagnosis affect people of African and Latin American descent in Canada. These inequities in addition to experiences of racism and discrimination and unequal living and working conditions are detrimental to their wellness. We aim to delineate together with people of African and Latin American descent a patient-oriented pathway to improve their equity and wellness in cancer care.

Variations in Prescribing Rates of End-of-Life Medications Among Long-Term Care Residents in Alberta Compared with Ontario-a Retrospective Cohort Study.

Background: Prescribing rates for subcutaneous medications may be an indicator of quality of end-of-life care in long-term care (LTC). It is not known if this system level measure is valid across jurisdictions. We compared prescribing rates of medications used for end-of-life symptom relief among LTC residents in Alberta and Ontario.

Symptoms, Symptom Profiles, and Healthcare Utilization in Patients with Hematologic Malignancies: A Retrospective Observational Cohort Study and Latent Class Analysis.

Symptom burden is known to be high in patients with hematologic malignancies and can adversely impact patients' quality of life. The aims of this retrospective observational cohort study were to explore symptoms in patients with hematologic malignancies, including during the last year of life, to explore symptom profiles in patients with hematologic malignancies, and to explore associations among symptoms/symptom profiles and demographic, clinical, and treatment-related variables. Symptom prevalence and severity and symptom profiles were explored in patients with hematologic malignancies who completed patient-reported outcome measures (n = 6136) between October 2019 and April 2020.

Effect of emergency department opioid prescribing on health outcomes.

Background: The relation between emergency department opioid prescribing and subsequent harm is complex and poorly studied. We sought to quantify adverse outcomes, incremental risk, and rates of prolonged opioid use among emergency department patients receiving an opioid prescription and propensity-matched controls.

Methods: We used administrative data to sample all Alberta emergency department visits over 10 years, excluding patients with cancer, palliative care, or concurrent opioid use.

Patient-Rated Acceptability of Automatic Palliative Care Referral: A Prospective Cohort Study.

Context: Timely palliative care can alleviate distress after diagnosis of an incurable cancer. However, late referrals to palliative care continue, reflecting various provider and patient barriers.

Objectives: To determine patient/caregiver-reported acceptability of a phone call offering a supportive and palliative care (SPC) consultation without requiring oncologist referral.

Correction: A multi-stage process to develop quality indicators for community-based palliative care using interRAI data.

[This corrects the article DOI: 10.1371/journal.pone.

Point-of-care ultrasound in palliative medicine residency programs: report of a national survey and local workshop.

Purpose: Point-of-care ultrasound (POCUS) is used in various clinical specialties to improve diagnostic and procedural accuracy and has many potential applications in palliative care. However, it is unclear what is the current state of training and use of POCUS in palliative care in Canada. Our objectives were to understand the current state of training and use of POCUS in Canadian Palliative Medicine subspecialty residency programs and to develop and implement a local training workshop for POCUS in palliative care.

Describing the characteristics and symptom profile of a group of urban patients experiencing socioeconomic inequity and receiving palliative care: a descriptive exploratory analysis.

Background: Individuals experiencing socioeconomic inequity have worse health outcomes and face barriers to palliative and end-of-life care. There is a need to develop palliative care programs tailored to this underserved population.

Objectives: To understand the characteristics and symptom profiles of a group of urban patients experiencing socioeconomic inequity and receiving palliative care.

Acceptability of automatic referrals to supportive and palliative care by patients living with advanced lung cancer: qualitative interviews and a co-design process.

Purpose: Timely access to supportive and palliative care (PC) remains a challenge. A proposed solution is to trigger an automatic referral process to PC by pre-determined clinical criteria. This study sought to co-design with patients and providers an automatic PC referral process for patients newly diagnosed with stage IV lung cancer.

Colorectal Cancer Patients' Reported Frequency, Content, and Satisfaction with Advance Care Planning Discussions.

(1) Background: This observational cohort study describes the frequency, content, and satisfaction with advance care planning (ACP) conversations with healthcare providers (HCPs), as reported by patients with advanced colorectal cancer. (2) Methods: The patients were recruited from two tertiary cancer centers in Alberta, Canada. Using the survey with previously validated questions, the patients were asked about specific ACP elements discussed, with which HCPs these elements were discussed, their satisfaction with these conversations, and whether they had a goals of care designation (GCD) order.

Sex-Based Analysis of Quality Indicators of End-of-Life Care in Gastrointestinal Malignancies.

Indices of aggressive or supportive end-of-life (EOL) care are used to evaluate health services quality. Disparities according to sex were previously described, with studies showing that male sex is associated with aggressive EOL care. This is a secondary analysis of 69,983 patients who died of a GI malignancy in Ontario between 2006 and 2018.

Care Coordination Between Family Physicians and Palliative Care Physicians for Patients With Cancer: Results of a Quality Improvement Initiative.

Purpose: At our institution's cancer palliative care (PC) clinic, new referrals from oncologists were scheduled for consultation and ongoing follow-up by PC physicians without input from the patients' family physicians (FPs). FPs reported that they felt out of the loop. We implemented a quality improvement (QI) initiative aimed at systematically facilitating care coordination between FPs and PC physicians.

Palliative End-of-Life Medication Prescribing Rates in Long-Term Care: A Retrospective Cohort Study.

Background: 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.

Increasing access to palliative care for patients with advanced cancer of African and Latin American descent: a patient-oriented community-based study protocol.

Background: Cancer disparities are a major public health concern in Canada, affecting racialized communities of Latin American and African descent, among others. This is evident in lower screening rates, lower access to curative, and palliative-intent treatments, higher rates of late cancer diagnoses and lower survival rates than the general Canadian population. We will develop an Access to Palliative Care Strategy informed by health equity and patient-oriented research principles to accelerate care improvements for patients with advanced cancer of African and Latin American descent.

Tertiary Inpatient Palliative Care within Region-Wide Services: A Retrospective Examination of Psychosocial and Medical Demographics at Admissions.

Unlabelled: Palliative care offers symptom relief and improved quality of life. Tertiary palliative care units (TPCUs) focus on complex suffering under the care of specialist palliative physicians and interdisciplinary teams. The Intensive Palliative Care Unit (IPCU) is a TPCU integrated in well-developed region-wide palliative services in Calgary, Canada.

Nurse practitioner and physician end-of-life home visits and end-of-life outcomes.

Objectives: Physicians and nurse practitioners (NPs) play critical roles in supporting palliative and end-of-life care in the community. We examined healthcare outcomes among patients who received home visits from physicians and NPs in the 90 days before death.

Methods: We conducted a retrospective cohort study using linked data of adult home care users in Ontario, Canada, who died between 1 January 2018 and 31 December 2019.

Safe Prescribing Practices: Clinicians' Views on Prescribing Opioids to Patients With Early-Stage Cancer.

Purpose: Opioids are often necessary for patients experiencing high-intensity pain. However, side effects exist and some patients may misuse opioids. To better understand how opioids are prescribed to patients with early-stage cancer and how to enhance opioid safety, clinicians' views of opioid prescribing were explored.