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The management of end-of-life care can be complex. It is composed of multiple aspects including the management of medication. A recent study completed by Tanuseputro (2024) and colleagues attempted to research how often people in long-term care homes in Ontario receive medications for managing difficult symptoms at the end of their lives. Medications in palliative care are used to manage difficult and uncomfortable symptoms such as pain and agitation. Their main goal was to examine if the rate at which these medications are prescribed, it could demonstration the quality of care given during end-of-life care.
To accomplish this a total of 626 long term care homes in Ontario were studied between January 1st, 2017, and March 17th, 2020. The data demonstrates that a good majority of people in long-term care homes, around two-thirds of people receive at least one medication to help control symptoms in their last two weeks of life. The most popular type of medication distributed was opioids, which are mostly used to relieve pain.
The long-term care homes were then divided into groups depending on the frequency at which these end-of-life medications are being prescribed. The researchers discovered that there are some big differences between the homes and the groups they were classified into. The groups with the lowest rates of prescription, around 37% of patients received medications whereas the long-term care homes prescribing the highest number of medications, 83% of the patients receive them. Another interesting difference between the groups was the number of patients who were moved out of the long-term homes in their last two weeks of life. For the homes with the lowest prescription rates, around 30% of patients were moved home. However, the group with the highest prescription rates only had about 13% of their patients moved out in their last weeks of life.
This study highlights that there are some significant differences in how medication is offered during end-of-life care depending on the place of treatment. This study suggests that the use data administration, including information about the offered end-of-life care, can be beneficial in order to understand how well end-of-life-care is being given to patients.
In summary, the research discovered that there are some significant differences between the medications prescribed to patients in different long-term care homes. It highlights that the system could benefit from additional monitoring of prescriptions. Further research could also be helpful to explore the different factors leading to these major differences and variations and to establish some targeted interventions and continue to improve end-of-life care.
Source: Tanuseputro, P., Roberts, R. L., Milani, C., Clarke, A. E., Webber, C., Isenberg, S. R., … & Downar, J. (2024). Palliative end-of-life medication prescribing rates in long-term care: a retrospective cohort study. Journal of the American Medical Directors Association.
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