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Article ; Online: Mapping an undergraduate medical education curriculum against national and international palliative care reference learning objectives.

Murphy, Rebekah / Barnes, Christopher J / Enright, Paula D / Gratton, Valerie / Bush, Shirley H

2024 Volume 24, Issue 1, Page(s) 105

Abstract: Background: 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 ... ...

Abstract	Background: 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. Methods: Multiple assessors independently compared our university's UGME learning objectives with EFPPEC and PEAT reference objectives to determine the degree-of-coverage. Visual curriculum maps were created to depict in which part of the curriculum each objective is delivered and by which medical specialty. Results: Of 122 EFPPEC objectives, 55 (45.1%) were covered fully, 42 (34.4%) were covered partially, and 25 (20.5%) were not covered by university objectives. Of 89 PEAT objectives, 40 (44.9%) were covered fully, 35 (39.3%) were covered partially, and 14 (15.7%) were not covered by university objectives. Conclusions: The majority of EFPPEC and PEAT reference objectives are fully or partially covered in our university's undergraduate medical curriculum. Our approach could serve as a guide for others who endeavour to review their universities' specialty-specific medical education against reference objectives. Future curriculum development should target the elimination of identified gaps and evaluate the attainment of palliative care competencies by medical learners.
MeSH term(s)	Humans ; Education, Medical, Undergraduate ; Palliative Care ; Education, Nursing ; Curriculum ; Soil
Chemical Substances	Soil
Language	English
Publishing date	2024-02-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2044473-4
ISSN	1472-6920 ; 1472-6920
ISSN (online)	1472-6920
ISSN	1472-6920
DOI	10.1186/s12909-024-05082-1
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: I Don't Want to Die an Old Person.

Bush, Shirley H

Journal of palliative medicine

2016 Volume 20, Issue 4, Page(s) 432

Language	English
Publishing date	2016-11-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	1427361-5
ISSN	1557-7740 ; 1096-6218
ISSN (online)	1557-7740
ISSN	1096-6218
DOI	10.1089/jpm.2016.0474
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Zs.A 5440: Show issues

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Article ; Online: Delirium at the End of Life.

Agar, Meera / Bush, Shirley H

The Medical clinics of North America

2020 Volume 104, Issue 3, Page(s) 491–501

Abstract: Delirium is a prevalent acute neurocognitive condition in patients with progressive life-limiting illness. Delirium remains underdetected; a systematic approach to screening is essential. Delirium at the end of life requires a comprehensive assessment. ... ...

Abstract	Delirium is a prevalent acute neurocognitive condition in patients with progressive life-limiting illness. Delirium remains underdetected; a systematic approach to screening is essential. Delirium at the end of life requires a comprehensive assessment. Consider the potential for reversibility, illness trajectory, patient preference, and goals of care before proceeding with investigations and interventions. Management should be interdisciplinary, and nonpharmacologic therapy is fundamental. For patients with refractory and severe agitation or perceptual disturbance, judicious use of medication may also be required. Carers and family should be seen as partners in care and be involved in shared decision making about care.
MeSH term(s)	Antipsychotic Agents/adverse effects ; Antipsychotic Agents/therapeutic use ; Delirium/drug therapy ; Delirium/epidemiology ; Delirium/physiopathology ; Delirium/prevention & control ; Emergence Delirium/drug therapy ; Emergence Delirium/epidemiology ; Humans ; Mass Screening/methods ; Palliative Care/methods ; Patient Care Planning/standards ; Perceptual Disorders/drug therapy ; Perceptual Disorders/epidemiology ; Prevalence ; Terminal Care/methods
Chemical Substances	Antipsychotic Agents
Language	English
Publishing date	2020-03-09
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Review
ZDB-ID	215710-x
ISSN	1557-9859 ; 0025-7125
ISSN (online)	1557-9859
ISSN	0025-7125
DOI	10.1016/j.mcna.2020.01.006
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Article ; Online: Comparing Adherence with Best Practices in End-of-Life Care After Implementing the End-of-Life Order Set: A Quality Improvement Project in an Ottawa Academic Hospital.

Warmels, Grace / Roberts, Anne / Haddad, John / Chomienne, Marie-Hélène / Bush, Shirley H / Gratton, Valerie

Palliative medicine reports

2023 Volume 4, Issue 1, Page(s) 100–107

Abstract: 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 ... ...

Abstract	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. Methods: We conducted a retrospective chart review of admitted patients with expected deaths in the year preceding EOLOS implementation ("before EOLOS" group), and in the 12 to 24 months following EOLOS implementation ("after EOLOS" group). Results: A total of 295 charts were included: 139 (47%) in the "before EOLOS" group and 156 (53%) in the "after EOLOS" group, of which 117/156 charts (75%) had a completed EOLOS. The "after EOLOS" group demonstrated more "do not resuscitate" orders and more written communication to team members about comfort goals of care. There was a decrease in nonbeneficial interventions in the last 24 hours of life in the "after EOLOS" group: high-flow oxygen, intravenous antibiotics, and deep vein thrombosis/venous thromboembolism prophylaxis. The "after EOLOS" group demonstrated increased prescription of all common end-of-life medications, except for opioids, which had a high preexisting rate of prescription. Patients in the "after EOLOS" group showed a higher rate of spiritual care and palliative care consult team consultation. Conclusion: Findings support standardized order sets as a good framework allowing generalist hospital staff to improve adherence to established palliative care principles and improve end-of-life care of hospital inpatients.
Language	English
Publishing date	2023-04-14
Publishing country	United States
Document type	Journal Article
ISSN	2689-2820
ISSN (online)	2689-2820
DOI	10.1089/pmr.2022.0070
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Article ; Online: Implementation of the Richmond Agitation-Sedation Scale (palliative version) on an inpatient palliative care unit.

Bush, Shirley H / Bronicki, Katarzyna / Dionne, Michel / Lelievre, Natasha / Lawlor, Peter G / Kabir, Monisha

BMC palliative care

2023 Volume 22, Issue 1, Page(s) 171

Abstract: Background: 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 ... ...

Abstract	Background: 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. Participants were staff working on a 31-bed inpatient palliative care unit who completed the RASS-PAL self-learning module and online evaluation survey. Results: The self-learning module was completed by 49/50 (98%) of regular palliative care unit staff (nurses, physicians, allied health, and other palliative care unit staff). The completion rate of the self-learning module by both regular and casual palliative care unit staff was 63/77 (82%). The follow-up online evaluation survey was completed by 23/50 (46%) of respondents who regularly worked on the palliative care unit. Respondents agreed (14/26; 54%) or strongly agreed (10/26; 38%) that the self-learning module was implemented successfully, with 100% agreement that it was effective for their educational needs. Conclusion: Using an online self-learning module is an effective method to engage and educate interprofessional staff on the RASS-PAL tool as part of an implementation strategy.
MeSH term(s)	Humans ; Palliative Care/methods ; Inpatients ; Hospice and Palliative Care Nursing ; Intensive Care Units ; Hypnotics and Sedatives/therapeutic use
Chemical Substances	Hypnotics and Sedatives
Language	English
Publishing date	2023-11-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2091556-1
ISSN	1472-684X ; 1472-684X
ISSN (online)	1472-684X
ISSN	1472-684X
DOI	10.1186/s12904-023-01298-y
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Article ; Online: Use and Discontinuation of Milrinone for Advanced Heart Failure in an Academic Palliative Care Unit: A Case Report and Discussion of Recommendations.

Wolfe, Amanda / Watt, Christine L / Downar, James / Bush, Shirley H

Journal of pain & palliative care pharmacotherapy

2022 Volume 36, Issue 1, Page(s) 24–33

Abstract: The 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 ... ...

Abstract	The 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. Increased patient anxiety during the weaning process was managed with midazolam. The provision of individualized milrinone therapy in non-monitored palliative care settings is feasible and well-tolerated using the presented detailed recommendations for its use and administration, monitoring, dose reduction and discontinuation and proactive symptom management at the end of life. Further research is needed for the optimal management of terminally ill patients with advanced HF.Supplemental data for this article is available online at here. show.
MeSH term(s)	Death ; Heart Failure/diagnosis ; Heart Failure/drug therapy ; Humans ; Milrinone/therapeutic use ; Palliative Care/methods
Chemical Substances	Milrinone (JU9YAX04C7)
Language	English
Publishing date	2022-03-02
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2078852-6
ISSN	1536-0539 ; 1536-0288
ISSN (online)	1536-0539
ISSN	1536-0288
DOI	10.1080/15360288.2022.2027058
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Article ; Online: Delirium: non-pharmacological and pharmacological management.

Boland, Jason W / Lawlor, Peter G / Bush, Shirley H

BMJ supportive & palliative care

2019 Volume 9, Issue 4, Page(s) 482–484

Language	English
Publishing date	2019-07-30
Publishing country	England
Document type	Journal Article
ISSN	2045-4368
ISSN (online)	2045-4368
DOI	10.1136/bmjspcare-2019-001966
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Article: Measuring the Use of End-of-Life Symptom Relief Medications in Long-Term Care Homes-a Qualitative Study.

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

Canadian geriatrics journal : CGJ

2024 Volume 27, Issue 1, Page(s) 29–46

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 ...

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.
Language	English
Publishing date	2024-03-01
Publishing country	Canada
Document type	Journal Article
ISSN	1925-8348
ISSN	1925-8348
DOI	10.5770/cgj.27.712
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Article ; Online: Continuous palliative sedation until death: a qualitative study of palliative care clinicians' experiences.

Guité-Verret, Alexandra / Boivin, Jessica / Hanna, Andrew M R / Downar, James / Bush, Shirley H / Marcoux, Isabelle / Guay, Diane / Tapp, Diane / Lapenskie, Julie / Gagnon, Bruno

BMC palliative care

2024 Volume 23, Issue 1, Page(s) 104

Abstract: Background: 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 ... ...

Abstract	Background: 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. Setting/participants: We conducted six focus groups with a total of 28 palliative care clinicians (i.e., 15 nurses, 12 physicians, and 1 end-of-life doula) from diverse care settings across Canada, where assisted dying has recently been legalized. Results: An interpretative phenomenological analysis was used to consolidate the data into six key themes: responding to suffering; grappling with uncertainty; adapting care to ensure ongoing quality; grounding clinical practice in ethics; combining medical expertise, relational tact, and reflexivity; and offering an alternative to assisted death. Conclusions: Interaction with the patient's family, uncertainty about the patient's prognosis, the concurrent practice of assisted dying, and the treatment of existential suffering influence the quality of sedation and indicate a lack of clear palliative care guidelines. Nevertheless, clinicians exhibit a reflective and adaptive capacity that can facilitate good practice.
MeSH term(s)	Humans ; Palliative Care ; Terminal Care ; Qualitative Research ; Euthanasia ; Focus Groups ; Deep Sedation
Language	English
Publishing date	2024-04-18
Publishing country	England
Document type	Journal Article
ZDB-ID	2091556-1
ISSN	1472-684X ; 1472-684X
ISSN (online)	1472-684X
ISSN	1472-684X
DOI	10.1186/s12904-024-01426-2
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Article ; Online: Over a third of palliative medicine physicians meet burnout criteria: Results from a survey study during the COVID-19 pandemic.

Boland, Jason W / Kabir, Monisha / Spilg, Edward G / Webber, Colleen / Bush, Shirley H / Murtagh, Fliss / Lawlor, Peter G

Palliative medicine

2023 Volume 37, Issue 3, Page(s) 343–354

Abstract: ... among physicians who worked ⩽20 h/week (vs 31-40 h/week, adjusted odds ratio (aOR) 0.03, 95% confidence interval ...

Abstract	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. Design: Online survey using validated assessment scales assessed burnout and resilience: The Maslach Burnout Inventory Human Services Survey for Medical Personnel [MBI-HSS (MP)] and the Connor-Davidson Resilience Scale (CD-RISC). Additional tools assessed depressive symptoms, alcohol use, and quality of life. Setting/participants: Association of Palliative Medicine of UK and Ireland members actively practising in hospital, hospice or community settings. Results: There were 544 respondents from the 815 eligible participants (66.8%), 462 provided complete MBI-HSS (MP) data and were analysed. Of those 181/462 (39.2%) met burnout criteria, based on high emotional exhaustion or depersonalisation subscales of the MBI-HSS (MP). A reduced odds of burnout was observed among physicians who worked ⩽20 h/week (vs 31-40 h/week, adjusted odds ratio (aOR) 0.03, 95% confidence interval (CI) 0.002-0.56) and who had a greater perceived level of clinical support (aOR 0.70, 95% CI 0.62-0.80). Physicians with higher levels of depressive symptoms had higher odds of burnout (aOR 18.32, 95% CI 6.75-49.73). Resilience, mean (SD) CD-RISC score, was lower in physicians who met burnout criteria compared to those who did not (62.6 (11.1) vs 70.0 (11.3); Conclusions: Over one-third of palliative medicine physicians meet burnout criteria. The provision of enhanced organisational and colleague support is paramount in both the current and future pandemics.
MeSH term(s)	Humans ; Pandemics ; Palliative Medicine ; Quality of Life ; COVID-19/epidemiology ; Physicians/psychology ; Surveys and Questionnaires ; Burnout, Professional/epidemiology ; Burnout, Professional/psychology
Language	English
Publishing date	2023-02-15
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639247-7
ISSN	1477-030X ; 0269-2163
ISSN (online)	1477-030X
ISSN	0269-2163
DOI	10.1177/02692163231153067
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