Here is the standardised PICO analysis for the sixth uploaded article:
Full Title
Enablers and Barriers for End-of-Life Symptom Management Medications in Long-Term Care Homes: A Qualitative Study
Authors: Rhiannon L. Roberts, Christina Milani, Colleen Webber, et al.
Journal: Journal of the American Medical Directors Association (JAMDA), 2024; 25:105076
DOI: 10.1016/j.jamda.2024.105076
Type of Study
Qualitative study using semi-structured interviews and thematic analysis
PICO Summary
Population (P)
- Health care providers (physicians, nurse practitioners, registered nurses) and family caregivers
- Participants were from long-term care (LTC) homes in Ontario, Canada
- LTC residents referenced were mostly older adults, many with advanced dementia or frailty
- Interviews covered both pre-COVID and during-COVID experiences
Intervention (I)
- Prescribing and administering of end-of-life symptom management medications, especially injectable and subcutaneous medications (e.g., opioids, benzodiazepines, antipsychotics)
- Use of tools such as standardised end-of-life order sets, education sessions, and mentorship/coaching for staff
Comparison (C)
- Not applicable (no direct control or comparator group)
- However, variation was examined between homes with high vs low prescribing rates, and pre- vs during-COVID periods
Outcomes (O)
Person-centred outcomes (from the family caregiver perspective):
- Resident comfort at end-of-life
- Family distress when medications were delayed or withheld
- Importance of timely medication to manage symptoms like pain, breathlessness, and agitation
Process outcomes:
- Identification of four major themes as barriers and enablers:
- Recognition of end-of-life period and symptoms
- Communication among staff and with families
- Health care provider comfort and competence
- Availability of support resources (e.g., order sets, training, palliative consults)
Health system outcomes:
- Variation in prescribing practices across homes (30%–80% of residents received EOL medications in last 2 weeks)
- Some LTC homes implemented standardised order sets, improving consistency in care
- COVID-19 pandemic had limited effect on medication provision, though staffing and communication were strained
Findings Summary
- Barriers include: difficulty identifying dying phase in dementia, staff turnover, fear of opioids, reluctance to use PRNs, communication gaps, and inconsistent policies
- Enablers include: confident staff, standardised order sets, family advocacy, and supportive leadership
- The study supports developing interventions focused on staff education, structured communication, and policy-level standardisation
Life In The Slower Lane 
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