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Background: People with opioid use disorder (OUD) are at risk of premature death and can benefit from palliative care. We sought to compare palliative care provision for decedents with and without OUD. Methods: We conducted a cohort study using health administrative databases in Ontario, Canada, to identify people who died between July 1, 2015, and Dec. 31, 2021. The exposure was OUD, defined as having emergency department visits, hospital admissions, or pharmacologic treatments suggestive of OUD within 3 years of death. Our primary outcome was receipt of 1 or more palliative care services during the last 90 days before death. Secondary outcomes included setting, initiation, and intensity of palliative care. We conducted a secondary analysis excluding sudden deaths (e.g., opioid toxicity, injury). Results: Of 679 840 decedents, 11 200 (1.6%) had OUD. Compared with people without OUD, those with OUD died at a younger age and were more likely to live in neighbourhoods with high marginalization indices. We found people with OUD were less likely to receive palliative care at the end of their lives (adjusted relative risk [RR] 0.84, 95% confidence interval [CI] 0.82–0.86), but this difference did not exist after excluding people who died suddenly (adjusted RR 0.99, 95% CI 0.96–1.01). People with OUD were less likely to receive palliative care in clinics and their homes regardless of cause of death. Interpretation: Opioid use disorder can be a chronic, life-limiting illness, and people with OUD are less likely to receive palliative care in communities during the 90 days before death. Health care providers should receive training in palliative care and addiction medicine to support people with OUD. [ABSTRACT FROM AUTHOR]

Introduction: In addition to shifting and expanding clinical responsibilities, rapidly evolving information and guidelines during the COVID-19 pandemic has made it difficult for health care workers (HCW) to synthesise and translate COVID-19 information into practice. This study evaluated whether a COVID-19-specific telemedicine education program (ECHO COVID) would impact health care workers' self-efficacy and satisfaction in the management of patients with COVID-19. Methods: A prospective mixed methods parallel-design study was conducted among ECHO COVID participants using pre-post questionnaires and a focus group discussion. Questionnaire results were examined for changes in health care workers' self-efficacy and satisfaction. Focus group discussion data were analysed to explore health care workers' experience in ECHO COVID and the context of their practice during the COVID-19 pandemic. Results: 239 health care workers registered in ECHO COVID and 114 (47.7%) completed questionnaires and attended at least one ECHO COVID session. Median self-efficacy scores increased from 5 (IQR 4–6) to 6 (IQR 6–6) (p < 0.0001), independent of profession, years in practice, age group, or practice environment. Participants were highly satisfied with ECHO COVID sessions with a median score of 4 (IQR 4–5). Focus group discussion data indicated that health care workers gained knowledge through ECHO COVID and revealed facilitators for ECHO COVID program success, including the transition to virtual care, the practicability of knowledge provided, and a 'perspective from the trenches.' Discussion: This study demonstrated that a telemedicine education program aimed to support health care workers in managing patients with COVID-19 had a positive impact on health care workers' self-efficacy and satisfaction. This impact was specifically mediated by the ECHO COVID program. [ABSTRACT FROM AUTHOR]

Purpose: Telehealth allows patients to maintain contact with healthcare providers without necessitating travel, and is becoming increasingly utilized. The purpose of this study is to describe the components of telehealth palliative care interventions for patients with advanced cancer before the COVID-19 pandemic; identify any intervention components associated with improvements in outcomes; and evaluate reporting of interventions. Methods: This scoping review was registered on the Open Science Framework. We searched 5 medical databases from inception to June 19, 2020. Inclusion criteria were: age ≥ 18, advanced cancer, asynchronous or synchronous telehealth intervention, and specialized palliative care interventions in any setting. We assessed the quality of intervention reporting using the Template for Intervention Description and Replication (TIDieR) checklist. Results: Twenty-three studies met the inclusion criteria: 15 (65%) quantitative (7 randomized controlled trials, 5 feasibility trials, 3 retrospective chart reviews); 4 (17%) mixed methods, and 4 (17%) qualitative. Most quantitative and mixed methods studies were conducted in North America (12/19, 63%), reported on hybrid (in-person and telehealth) interventions (9/19, 47%), and were delivered by nurses (12/19, 63%) in the home setting (14/19, 74%). In most studies that reported improvements in patient- or caregiver-reported outcomes, the content was psychoeducational and resulted in improvements for psychological symptoms. No study provided complete reporting on all 12 TIDieR checklist items. Conclusion: Telehealth studies are needed that reflect palliative care's mission to provide multidisciplinary team-based care that improves quality of life in diverse settings, and that provide detailed reporting of interventions. [ABSTRACT FROM AUTHOR]

Background: Health care professional students can develop knowledge and skills to care for elderly patients during placements in residential aged care facilities (RACF). Enabling student contribution during clinical placements can enhance student learning and quality of care. Our medical student RACF placement includes a learning task where students recommend improvements to resident care. This study aimed to identify these recommendations and measure how many were adopted. Methods: Students completed a medical assessment of a resident during their RACF placement, summarising their recommendations in a letter to the resident's general practitioner (GP). Recommendations were categorised for quantification and audit. Three months after the time of recommendation residents' files were audited. Definitions and descriptive statistics of the types of recommendations, and whether they had been implemented, are reported. Results: Forty residents and 43 students participated in the study. In total, 391 recommendations were made. Medication recommendations were most common (47%), followed by allied health referrals (12%), lifestyle changes (10%) and GP review (10%). Smaller numbers of recommendations for nursing care, investigations, specialist review and patient education were made. Seventy‐seven recommendations were adopted. Discussion: Student learning is enhanced when contributing to resident care, and educators can structure clinical placements to support this. Using an existing student learning task to feed into genuine quality improvements for care is one example of how this might be implemented. This study gives insight into types of recommendations students make, suggesting further research to explore barriers and enablers to maximise the benefits of student contributions. [ABSTRACT FROM AUTHOR]

1. Participants in this session will benefit from an understanding of how people with opioid-related health harms experience palliative care, including barriers related to the social determinants of health and structural vulnerability. 2. Participants will also learn about the structural, social and self-stigma experiences of people with a history of opioid use with respect to receiving palliative care and opioids. Providing high-quality palliative care and prescribing opioids for patients with opioid use disorder with advanced illness is complicated by many barriers, including stigma, social determinants of health, and structural vulnerability. Specialized approaches to address these challenges and gaps would contribute to meeting the end-of-life needs of such patients. Given rising prevalence of opioid use disorder (OUD), there is an urgent need to understand the end-of-life needs and to improve palliative care for people with a history of opioid-related health harms (OHH), suggestive of OUD. Due to stigma, people with OHH likely face difficulty accessing palliative care and opioids, which are essential medicines to relieve pain and shortness of breath. We aim to understand the end-of-life experiences of people with OHH, including those living in poverty and experiencing homelessness. Particularly, we explore perceptions of access to healthcare and palliative care, opioid prescribing, and stigma associated with access and prescribing at end of life. This study is a multi-phased, mixed-methods project. Phase 1 involved population level studies using administrative data to compare people with and without OHH. Phase 1 informed Phase 2, a qualitative examination in which we are interviewing patients with OHH and/or their caregivers, as well as conducting focus groups with healthcare providers. Patients include people who have received formal palliative care or informal supports for advanced illness, as well as people receiving care across diverse settings (e.g., hospital, hospice, home, shelter) in Ottawa and Toronto, Canada. Phase 1 found differences in the receipt of palliative care for people with OHH compared to the general population with respect to location, timing, and intensity of palliative care. Phase 2 takes a deeper dive into these findings and explores the perspectives of patients/caregivers and healthcare providers regarding these differences. Themes highlight the intersection of palliative care with social factors (e.g., gender, income), including how stigma influences access to palliative care and receipt of opioid prescriptions. The study findings demonstrate key challenges in the provision of high-quality palliative care for people with OHH, bringing awareness to this group's end-of-life needs and highlighting areas for further research. Diversity, Equity, Inclusion, Belonging, Justice [ABSTRACT FROM AUTHOR]

In response to Canada's opioid crisis, national strategies and guidelines have been developed but primarily focus on opioid use for chronic noncancer pain. Despite the well-established utility of opioids in cancer care, and the growing emphasis on early palliative care, little attention has been paid to opioid risk in this population, where evidence increasingly shows a higher risk of opioid-related harms than was previously thought. The primary objective of this study was to assess oncology clinicians' attitudes, confidence, and practices in managing opioids in outpatients with cancer. This was explored using pilot-tested, profession-specific surveys for physicians/nurse practitioners, nurses and pharmacists. Descriptive analyses were conducted in aggregate and separately based on discipline. Univariate and multiple linear regression analyses were performed to explore relationships between confidence and practices within and across disciplines. The survey was distributed to approximately 400 clinicians in January 2019. Sixty-five responses (27 physicians/nurse practitioners, 31 nurses, 7 pharmacists) were received. Participants endorsed low confidence, differing attitudes, and limited and varied practice in managing and mitigating opioid risks in the cancer population. This study provides valuable insights into knowledge gaps and clinical practices of oncology healthcare professionals in managing opioids and mitigating associated risks for patients with cancer. [ABSTRACT FROM AUTHOR]