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Lo YT, Wang JJ, Yang YC, Yu CY, Chang CM, Yang YP. Effects of Advance Care Planning on End-of-Life Indicators for Nursing Home Residents-An Experimental Study with a Retrospective Chart Review. Geriatrics (Basel) 2024; 9:42. [PMID: 38667509 PMCID: PMC11050193 DOI: 10.3390/geriatrics9020042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Advance care planning (ACP) has the potential to improve the outcomes of end-of-life care for residents in nursing homes. The aim of this study was to determine whether an ACP program was beneficial for nursing home residents by assessing end-of-life indicators. An experimental study with a retrospective chart review was conducted. In total, 37 residents in the intervention group participated in an institutional advance care planning program for 1 year, and their chart data over 1 year were collected following the completion of the program; 33 residents in the control group had died within 1 year before the start date of program, and their chart data were reviewed retrospectively. Chi-square and t tests were used to examine four indicators of the quality of end-of-life care. Compared with the control group, the intervention group had a higher proportion of do-not-resuscitate directives, hospice care before death, and deaths in the nursing home, and fewer hospitalizations and deaths in an emergency department. ACP programs may improve the quality of end-of-life care for nursing home residents in Taiwan. Further research across different long-term care facilities is warranted.
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Affiliation(s)
- Yu-Tai Lo
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; (Y.-T.L.); (Y.-C.Y.); (C.-M.C.)
| | - Jin-Jy Wang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
| | - Yi-Ching Yang
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; (Y.-T.L.); (Y.-C.Y.); (C.-M.C.)
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Chiu-Yen Yu
- Department of Gerontological and Long-Term Care Business, Fooyin University, Kaohsiung 831, Taiwan;
| | - Chia-Ming Chang
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; (Y.-T.L.); (Y.-C.Y.); (C.-M.C.)
- Department of Medicine & Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Ya-Ping Yang
- Department of Nursing, National Tainan Junior College of Nursing, Tainan 700, Taiwan
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Clements H, El Boghdady M, Alijani A. Acute surgical admissions at the end of life-an analysis of non-operative hospital deaths. Surgeon 2021; 20:351-355. [PMID: 34840066 DOI: 10.1016/j.surge.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients with advanced illnesses are often admitted with acute surgical emergencies. There is currently no evidence characterising such admissions. We aimed to evaluate emergency patients, managed non-operatively, who died during the same admission. METHODS This single-centre retrospective, observational study collected data points for a 12 month period including age, prior documented do not resuscitate order (DNAR), existing cancer, Charlson Comorbidity Index, frailty, surgical diagnosis, interval from admission to death and care given. Patients who underwent surgical intervention were excluded. Non-parametric tests were used for statistical analysis. RESULTS A total of 72 patients were included in this study, of which 68.1% died within 6 days of admission (median 4.0 days). Patients with visceral perforation, obstruction, bowel ischaemia or known malignancy were more likely to die within 6 days than those with pancreatitis, sepsis or new malignancy (median 2 vs 7 days, p < 0.001). Patients with frailty (2 vs 4 days, p = 0.017) and existing DNAR (3 vs 4 days, p = 0.048) died more rapidly than those without. Age and comorbidity index did not impact time to death. CONCLUSION Frailty, surgical diagnosis and existing DNAR were predictors of shorter admission to death interval, while age and comorbidity index were not. This has implications on inpatient palliative care service planning.
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Affiliation(s)
- Hollie Clements
- Department of General Surgery, Royal Liverpool University Hospital, Liverpool, UK
| | - Michael El Boghdady
- Department of General Surgery, Kingston Hospital NHS Foundation Trust, London, UK; St George's University, London, UK.
| | - Afshin Alijani
- Department of General Surgery, Ninewells Hospital and Medical School, Dundee, UK
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3
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Buck D, Tucker S, Roe B, Hughes J, Challis D. Hospital admissions and place of death of residents of care homes receiving specialist healthcare services: A systematic review without meta-analysis. J Adv Nurs 2021; 78:666-697. [PMID: 34532884 DOI: 10.1111/jan.15043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 08/09/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
AIM To synthesize evidence on the ability of specialist care home support services to prevent hospital admission of older care home residents, including at end of life. DESIGN Systematic review, without meta-analysis, with vote counting based on direction of effect. DATA SOURCES Fourteen electronic databases were searched from January 2010 to January 2019. Reference lists of identified reviews, study protocols and included documents were scrutinized for further studies. REVIEW METHODS Papers on the provision of specialist care home support that addressed older, long-term care home residents' physical health needs and provided comparative data on hospital admissions were included. Two reviewers undertook study selection and quality appraisal independently. Vote counting by direction of effect and binomial tests determined service effectiveness. RESULTS Electronic searches identified 79 relevant references. Combined with 19 citations from an earlier review, this gave 98 individual references relating to 92 studies. Most were from the UK (22), USA (22) and Australia (19). Twenty studies were randomized controlled trials and six clinical controlled trials. The review suggested interventions addressing residents' general health needs (p < .001), assessment and management services (p < .0001) and non-training initiatives involving medical staff (p < .0001) can reduce hospital admissions, while there was also promising evidence for services targeting residents at imminent risk of hospital entry or post-hospital discharge and training-only initiatives. End-of-life care services may enable residents to remain in the home at end of life (p < .001), but the high number of weak-rated studies undermined confidence in this result. CONCLUSION This review suggests specialist care home support services can reduce hospital admissions. More robust studies of services for residents at end of life are urgently needed. IMPACT The review addressed the policy imperative to reduce the avoidable hospital admission of older care home residents and provides important evidence to inform service design. The findings are of relevance to commissioners, providers and residents.
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Affiliation(s)
- Deborah Buck
- Social Care and Society, University of Manchester, Manchester, UK
| | - Sue Tucker
- Social Care and Society, University of Manchester, Manchester, UK
| | - Brenda Roe
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Jane Hughes
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - David Challis
- Institute of Mental Health, University of Nottingham, Nottingham, UK
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Sanders GJ, Griffiths C, Flint S, Christensen A, Gately P. Implementation fidelity of an Integrated Healthy Lifestyle Service: a process evaluation. Perspect Public Health 2021; 142:278-286. [PMID: 33779407 PMCID: PMC9483679 DOI: 10.1177/1757913920986205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Aims: The current study aimed to evaluate implementation fidelity of an
Integrated Healthy Lifestyle Service (IHLS). Methods: A pragmatic sample of 28 individual interviews and 11 focus groups
were conducted. This resulted in a total of 81 (22 male)
individuals comprising key stakeholders (n = 18), as well as
intervention staff across senior management (n = 4), team lead
(n = 14) and practitioner (n = 11) roles, and intervention
clients (n = 34). Results: A mixed degree of implementation fidelity was demonstrated
throughout the five a priori fidelity domains of study design,
provider training, intervention delivery, intervention receipt,
and enactment. Stakeholders, staff and clients alike noted a
high degree of intervention receipt across all services offered.
Contrastingly, practitioners noted that they received minimal
formal operational, data systems, clinical, and curriculum
training as well as a lack of personal development
opportunities. Consequently, practitioners reported low
confidence in delivering sessions and collecting and analysing
any data. A top-down approach to information dissemination
within the service was also noted among practitioners which
affected motivation and overall team morale. Conclusion: Results can be used to conceptualise best practices as a process to
further strengthen the design, delivery and recruitment
strategies of the IHLS.
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Affiliation(s)
- G J Sanders
- Carnegie School of Sport, Leeds Beckett University, Fairfax Hall Rm 230, Headingley Campus, Leeds LS6 3QS, UK
| | - C Griffiths
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - S Flint
- School of Psychology, University of Leeds, Leeds, UK.,Scaled Insights, Nexus, University of Leeds, Leeds, UK
| | - A Christensen
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - P Gately
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
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Spacey A, Scammell J, Board M, Porter S. A critical realist evaluation of advance care planning in care homes. J Adv Nurs 2021; 77:2774-2784. [PMID: 33751625 DOI: 10.1111/jan.14822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate care planning in advance of end-of-life care in care homes. DESIGN A qualitative study. METHODS Qualitative data were collected from January 2018-July 2019 (using focus groups and semi-structured interviews) from three care homes in the South West of England. The data were analysed using thematic analysis followed by Critical Realist Evaluation. RESULTS Participants comprised of registered nurses (N = 4), care assistants (N = 8), bereaved relatives (N = 7), and domiciliary staff (N = 3). Although the importance of advance care planning was well recognized, the emotional labour of frequently engaging in discussions about death and dying was highlighted as a problem by some care home staff. It was evident that in some cases care home staff's unmet emotional needs led them to rushing and avoiding discussions about death and dying with residents and relatives. A sparsity of mechanisms to support care home staff's emotional needs was noted across all three care homes. Furthermore, a lack of training and knowledge appeared to inhibit care home staff's ability to engage in meaningful care planning conversations with specific groups of residents such as those living with dementia. The lack of training was principally evident amongst non-registered care home staff and those with non-formal caring roles such as housekeeping. CONCLUSION There is a need for more focused education to support registered and non-registered care home staff to effectively engage in sensitive discussions about death and dying with residents. Furthermore, greater emotional support is necessary to help build workforce resilience and sustain change. IMPACT Knowledge generated from this study can be used to inform the design and development of future advance care planning interventions capable of supporting the delivery of high-quality end-of-life care in care homes.
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Affiliation(s)
- Adam Spacey
- School of Health and Society, University of Salford, Salford, UK
| | - Janet Scammell
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Michele Board
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, Bournemouth, UK
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6
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Iida K, Ryan A, Hasson F, Payne S, McIlfatrick S. Palliative and end-of-life educational interventions for staff working in long-term care facilities: An integrative review of the literature. Int J Older People Nurs 2020; 16:e12347. [PMID: 32918793 DOI: 10.1111/opn.12347] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/01/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Given the increase in the number of deaths within long-term care facilities (LTCFs), the need for palliative and end-of-life (EOL) care education among such facilities has been increasing. As such, a systematic synthesis of global palliative and EOL care educational approaches and evaluation can aid further educational development. OBJECTIVE To synthesise the current literature on palliative and EOL care educational interventions for staff working in LTCFs and identify barriers to, and facilitators of, intervention implementation. METHODS The study used an integrative review framework wherein indexed databases, namely, CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, Cochrane Library and Japan Medical Abstract Society, were systematically searched for studies published in English and Japanese between 2007 and 2019. Search terms that are related to palliative care, LTCF, and education were combined to increase search sensitivity. The quality of the papers was assessed using Joanna Briggs Institute Critical Appraisal Tools and the Mixed-Methods Appraisal Tool. RESULTS A total of 52 studies were included in the review. Our results suggested that although studies in this area and setting have been evolving, suboptimal developmental research and educational practices, global variability and unstandardised approaches to education and lacking viewpoints from service users have remained. Barriers to intervention implementation were also reported due to the specific characteristics of LTCFs, which include high staff turnover and considerable variation in professional skills and experience. CONCLUSIONS Given the different LTCF types, systems and policies across each country or region, further research on standardised educational interventions with contextual considerations using large-scale studies with robust methodology is needed to meet the increasing demand for palliative and EOL care among the global ageing population. IMPLICATIONS FOR PRACTICE Palliative and EOL care educational intervention for LTCF staff need to include more consideration of context, organisational culture and the user involvement throughout the process of education and research to enhance the quality of care in this complex setting.
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Affiliation(s)
- Kieko Iida
- Institute of Nursing and Health Research and School of Nursing, Ulster University, Newtownabbey, UK
| | - Assumpta Ryan
- Institute of Nursing and Health Research and School of Nursing, Ulster University, Londonderry, UK
| | - Felicity Hasson
- Institute of Nursing and Health Research and School of Nursing, Ulster University, Newtownabbey, UK
| | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Sonja McIlfatrick
- Institute of Nursing and Health Research and School of Nursing, Ulster University, Newtownabbey, UK
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Siewert JS, Alvarez AM, Santos SMAD, Brito FA, Hammerschmidt KSDA. Institutionalized elderly people with dementia: an integrative review on nursing care. Rev Bras Enferm 2020; 73 Suppl 3:e20180419. [PMID: 32756799 DOI: 10.1590/0034-7167-2018-0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 05/11/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To ascertain the characteristics of the nursing care provided to institutionalized elderly people with dementia. METHODS Integrative review of studies published between 2013 and 2017, in English, Spanish, and Portuguese, from the databases BDENF, LILACS, CINAHL, PubMed, SciELO, TRIP, and National Guideline Clearing House. Thematic data analysis was used. RESULTS From the data collected in the 41 included studies, three themes emerged: Care with a focus on the needs of elderly people in LTCIEs; Care based on the work process of the nursing team; and Shared care. Final considerations: Elderly care can take place from different perspectives: that of the elderly; the nursing team; and it can be shared among the different parties involved. The importance of communication must be stressed, as do the development of skills and attitudes of the team, as well as proper training and support, good environment in the care process, and an approach centered on the institutionalized elderly.
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8
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Alcorn G, Murray SA, Hockley J. Care home residents who die in hospital: exploring factors, processes and experiences. Age Ageing 2020; 49:468-480. [PMID: 32091569 DOI: 10.1093/ageing/afz174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/11/2019] [Accepted: 12/04/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Care home residents are increasingly frail with complex health and social care needs. Their transfer to hospital at the end-of-life can be associated with unwanted interventions and distress. However, hospitals do enable provision of care that some residents wish to receive. We aimed to explore the factors that influence hospital admission of care home residents who then died in hospital. METHODS This study combined in-depth case note review of care home residents dying in two Scottish teaching hospitals during a 6-month period and semi-structured interviews with a purposive sample of 26 care home staff and two relatives. RESULTS During the 6-month period, 109 care home residents died in hospital. Most admissions occurred out-of-hours (69%) and most were due to a sudden event or acute change in clinical condition (72%). Length of stay in hospital before death was short, with 42% of deaths occurring within 3 days. Anticipatory Care Planning (ACP) regarding hospital admission was documented in 44%.Care home staff wanted to care for residents who were dying; however, uncertain trajectories of decline, acute events, challenges of ACP, relationship with family and lack of external support impeded this. CONCLUSIONS Managing acute changes on the background of uncertain trajectories is challenging in care homes. Enhanced support is required to improve and embed ACP in care homes and to provide rapid, 24 hours-a-day support to manage difficult symptoms and acute changes.
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Affiliation(s)
- Gemma Alcorn
- Primary Palliative Care Research Group, Usher Institute of Population Health Sciences, University of Edinburgh, Edinburgh
| | - Scott A Murray
- Primary Palliative Care Research Group, Usher Institute of Population Health Sciences, University of Edinburgh, Edinburgh
| | - Jo Hockley
- Primary Palliative Care Research Group, Usher Institute of Population Health Sciences, University of Edinburgh, Edinburgh
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9
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Collingridge Moore D, Payne S, Keegan T, Deliens L, Smets T, Gambassi G, Kylänen M, Kijowska V, Onwuteaka-Philipsen B, Van den Block L. Associations between Length of Stay in Long Term Care Facilities and End of Life Care. Analysis of the PACE Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082742. [PMID: 32316148 PMCID: PMC7215712 DOI: 10.3390/ijerph17082742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 01/01/2023]
Abstract
Long term care facilities (LTCFs) are increasingly a place of care at end of life in Europe. Longer residence in an LTCF prior to death has been associated with higher indicators of end of life care; however, the relationship has not been fully explored. The purpose of this analysis is to explore associations between length of stay and end of life care. The analysis used data collected in the Palliative Care for Older People in care and nursing homes in Europe (PACE) study, a cross-sectional mortality follow-back survey of LTCF residents who died within a retrospective 3-month period, conducted in Belgium, England, Finland, Italy, the Netherlands and Poland. Primary outcomes were quality of care in the last month of life, comfort in the last week of life, contact with health services in the last month of life, presence of advance directives and consensus in care. Longer lengths of stay were associated with higher scores of quality of care in the last month of life and comfort in the last week of life. Longer stay residents were more likely to have advance directives in place and have a lasting power of attorney for personal welfare. Further research is needed to explore the underlying reasons for this trend, and how good quality end of life care can be provided to all LTCF residents.
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Affiliation(s)
- Danni Collingridge Moore
- International Observatory on End of Life Care, Lancaster University, Lancaster LA1 4YW, UK;
- Correspondence: ; Tel.: +44-(0)15-2459-4457
| | - Sheila Payne
- International Observatory on End of Life Care, Lancaster University, Lancaster LA1 4YW, UK;
| | - Thomas Keegan
- Lancaster Medical School, Lancaster University, Lancaster LA1 4YG, UK;
| | - Luc Deliens
- VUB-UGhent End of Life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium; (L.D.); (T.S.); (L.V.d.B.)
| | - Tinne Smets
- VUB-UGhent End of Life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium; (L.D.); (T.S.); (L.V.d.B.)
| | - Giovanni Gambassi
- Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Marika Kylänen
- National Institute for Health and Welfare, (00)271 Helsinki, Finland;
| | - Violetta Kijowska
- Unit for Research on Aging Society, Department of Sociology, Faculty of Medicine, Jagiellonian University Medical College, 31-034 Krakow, Poland;
| | - Bregje Onwuteaka-Philipsen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, 1081 HV Amsterdam, The Netherlands;
| | - Lieve Van den Block
- VUB-UGhent End of Life Care Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium; (L.D.); (T.S.); (L.V.d.B.)
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10
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Duberstein PR, Chen M, Hoerger M, Epstein RM, Perry LM, Yilmaz S, Saeed F, Mohile SG, Norton SA. Conceptualizing and Counting Discretionary Utilization in the Final 100 Days of Life: A Scoping Review. J Pain Symptom Manage 2020; 59:894-915.e14. [PMID: 31639495 PMCID: PMC8928482 DOI: 10.1016/j.jpainsymman.2019.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT There has been surprisingly little attention to conceptual and methodological issues that influence the measurement of discretionary utilization at the end of life (DIAL), an indicator of quality care. OBJECTIVE The objectives of this study were to examine how DIALs have been operationally defined and identify areas where evidence is biased or inadequate to inform practice. METHODS We conducted a scoping review of the English language literature published from 1/1/04 to 6/30/17. Articles were eligible if they reported data on ≥2 DIALs within 100 days of the deaths of adults aged ≥18 years. We explored the influence of research design on how researchers measure DIALs and whether they examine demographic correlates of DIALs. Other potential biases and influences were explored. RESULTS We extracted data from 254 articles published in 79 journals covering research conducted in 29 countries, mostly focused on cancer care (69.1%). More than 100 DIALs have been examined. Relatively crude, simple variables (e.g., intensive care unit admissions [56.9% of studies], chemotherapy [50.8%], palliative care [40.0%]) have been studied more frequently than complex variables (e.g., burdensome transitions; 7.3%). We found considerable variation in the assessment of DIALs, illustrating the role of research design, professional norms and disciplinary habit. Variables are typically chosen with little input from the public (including patients or caregivers) and clinicians. Fewer than half of the studies examined age (44.6%), gender (37.3%), race (26.5%), or socioeconomic (18.5%) correlates of DIALs. CONCLUSION Unwarranted variation in DIAL assessments raises difficult questions concerning how DIALs are defined, by whom, and why. We recommend several strategies for improving DIAL assessments. Improved metrics could be used by the public, patients, caregivers, clinicians, researchers, hospitals, health systems, payers, governments, and others to evaluate and improve end-of-life care.
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Affiliation(s)
- Paul R Duberstein
- Department of Health Behavior, Society and Policy, Rutgers University School of Public Health, Piscataway, New Jersey, USA.
| | - Michael Chen
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Michael Hoerger
- Departments of Psychology, Psychiatry, and Medicine, Tulane University, New Orleans, Louisiana, USA; Tulane Cancer Center, Tulane University, New Orleans, Louisiana, USA
| | - Ronald M Epstein
- James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Laura M Perry
- Departments of Psychology, Psychiatry, and Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Sule Yilmaz
- Margaret Warner School of Human Development, Rochester, New York, USA
| | - Fahad Saeed
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Supriya G Mohile
- James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Sally A Norton
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA; School of Nursing, University of Rochester, Rochester, New York, USA
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11
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Spacey A, Scammell J, Board M, Porter S. Systematic critical realist review of interventions designed to improve end-of-life care in care homes. Nurs Health Sci 2019; 22:343-354. [PMID: 31797527 DOI: 10.1111/nhs.12665] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/28/2019] [Accepted: 10/23/2019] [Indexed: 11/28/2022]
Abstract
The demand for high-quality end-of-life care is rising. Frequently evidenced concerns about the provision of end-of-life in care homes relate to inter-disciplinary communication and engagement in advance care planning. A number of interventions employing different mechanisms have been designed to address these issues. Therefore, the aim of this systematic critical realist review was to describe and explain the effectiveness of interventions designed to improve end-of-life care in care homes. Electronic searches were conducted in ScienceDirect, MEDLINE, PubMed, PsychINFO, and CINAHL from January 2000 to August 2018. Forty one studies were included in the review. While most of the evidence identified in this review was not strong, there was evidence to suggest that education and inter-professional collaboration can be effective intervention mechanisms for improving end-of-life care in care homes. High staff turnover was a significant contextual mechanism impacting on the sustainability of interventions. In terms of human agency, it is important to note a consistent finding related to the dedication and enthusiasm of care home staff who deliver end-of-life care.
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Affiliation(s)
- Adam Spacey
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - Janet Scammell
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - Michele Board
- Department of Adult Nursing, Bournemouth University, Poole, UK
| | - Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
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12
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Olsson C, Kling E, Grundel Persson K, Larsson M. Impact of the Liverpool Care Pathway on quality end-of- care in residential care homes and home care-Nurses' perceptions. Nurs Open 2019; 6:1589-1599. [PMID: 31660187 PMCID: PMC6805710 DOI: 10.1002/nop2.364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/28/2019] [Accepted: 08/05/2019] [Indexed: 12/02/2022] Open
Abstract
AIM Aim was to describe how Registered Nurses (RNs) and assistant nurses (ANs) working in residential care homes and home care perceived quality end-of-life care after implementation of the Liverpool Care Pathway (LCP) in terms of subjective importance of care aspects and actual care given. DESIGN Descriptive cross-sectional. METHODS Registered Nurses (N = 22; 100% response rate) and ANs (N = 120; 59% response rate) working in a Swedish municipality. Data collection with a study-specific questionnaire (50 items) about perceived reality (PR) and subjective importance (SI). Non-parametric statistics. RESULTS Implementation of the LCP ensured systematic assessment and alleviation of patients' symptoms and needs. The ANs, more than the RNs, perceived that the patients received the best possible nursing and medical care (p = .01). Both groups considered that communication with patients and families as well as the information exchange between the team members was facilitated. Areas for improvement were identified about psychological and existential support and patients and families' participation in care.
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Affiliation(s)
- Cecilia Olsson
- Department of Health SciencesKarlstad UniversityKarlstadSweden
| | - Elisabeth Kling
- Department of Health SciencesKarlstad UniversityKarlstadSweden
| | | | - Maria Larsson
- Department of Health SciencesKarlstad UniversityKarlstadSweden
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Abstract
ABSTRACTThe purpose of this study was to analyse the consistency and extent of palliative content across high-level guiding documents related to the care of persons residing in Canadian long-term care homes. A systematic search was conducted examining documents at the national level and across five provinces (Alberta, Ontario, Saskatchewan, Manitoba, and Quebec). Twenty-five documents were selected based on inclusion criteria from 273 documents identified in the systematic search. The majority of these documents were created nationally (48%) or in Ontario (28%). Documents varied in palliative topics discussed, and long-term care was discussed minimally. A minimal number of palliative care guiding documents were found. Long-term care specific documents were absent, and all documents lacked consistency on palliative topics. It is imperative that palliative principles are present and consistent in high-level documents in order to improve the quality of life and care for long-term care residents across Canada.
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Di Giulio P, Finetti S, Giunco F, Basso I, Rosa D, Pettenati F, Bussotti A, Villani D, Gentile S, Boncinelli L, Monti M, Spinsanti S, Piazza M, Charrier L, Toscani F. The Impact of Nursing Homes Staff Education on End-of-Life Care in Residents With Advanced Dementia: A Quality Improvement Study. J Pain Symptom Manage 2019; 57:93-99. [PMID: 30315916 DOI: 10.1016/j.jpainsymman.2018.10.268] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Abstract
CONTEXT End-of-life care in nursing homes (NHs) needs improvement. We carried out a study in 29 NHs in the Lombardy Region (Italy). OBJECTIVES The objective of this study was to compare end-of-life care in NH residents with advanced dementia before and after an educational intervention aimed to improving palliative care. METHODS The intervention consisted of a seven-hour lecture, followed by two 3-hour meetings consisting of case discussions. The intervention was held in each NH and well attended by NH staff. This multicenter, comparative, observational study included up to 20 residents with advanced dementia from each NH: the last 10 who died before the intervention (preintervention group, 245 residents) and the first 10 who died at least three months after the intervention (postintervention group, 237 residents). Data for these residents were collected from records for 60 days and seven days before death. RESULTS The use of "comfort hydration" (<1000 mL/day subcutaneously) tended to increase from 16.9% to 26.8% in the postintervention group. The number of residents receiving a palliative approach for nutrition and hydration increased, though not significantly, from 24% preintervention to 31.5% postintervention. On the other hand, the proportion of tube-fed residents and residents receiving intravenous hydration decreased from 15.5% to 10.5%, and from 52% to 42%, respectively. Cardiopulmonary resuscitations decreased also from 52/245 (21%) to 18/237 (7.6%) cases (P = 0.002). CONCLUSION The short educational intervention modified some practices relevant to the quality of end-of-life care of advanced dementia patients in NHs, possibly raising and reinforcing beliefs and attitudes already largely present.
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Affiliation(s)
- Paola Di Giulio
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy; SUPSI, Manno, Switzerland
| | - Silvia Finetti
- Lino Maestroni Foundation, Palliative Medicine Research Institute, Cremona, Italy
| | - Fabrizio Giunco
- Department of Health and Social Services Polo Lombardia 2, Don Carlo Gnocchi Foundation ONLUS, Milano, Italy
| | - Ines Basso
- Intensive Care Unit, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Debora Rosa
- Nursing Degree Course, Section of Don Carlo Gnocchi Foundation, University of Milan, Milan, Italy
| | - Francesca Pettenati
- Lino Maestroni Foundation, Palliative Medicine Research Institute, Cremona, Italy
| | - Alessandro Bussotti
- Agenzia Continuità Ospedale Territorio, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Daniele Villani
- Neuro-Rehabilitation and Alzheimer Disease Evaluation Unit, "Figlie di San Camillo" Hospital, Cremona, Italy
| | - Simona Gentile
- Rehabilitation and Alzheimer Disease Evaluation Unit, Ancelle della Carità Hospital, Cremona, Italy
| | | | - Massimo Monti
- Geriatric Institute "Pio Albergo Trivulzio", Milano, Italy
| | | | - Massimo Piazza
- Italian Foundation of Leniterapia (FILE), Firenze, Italy
| | - Lorena Charrier
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
| | - Franco Toscani
- Lino Maestroni Foundation, Palliative Medicine Research Institute, Cremona, Italy
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15
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Robinson A, Eccleston C, Annear M, Elliott KE, Andrews S, Stirling C, Ashby M, Donohue C, Banks S, Toye C, McInerney F. Who Knows, who Cares? Dementia Knowledge among Nurses, Care Workers, and Family members of People Living with Dementia. J Palliat Care 2018. [DOI: 10.1177/082585971403000305] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The number of people with dementia is increasing rapidly worldwide. Commensurate with population ageing, the use of nursing homes in Australia (known as residential aged care facilities) for individuals with dementia is growing. As a terminal condition, dementia is best managed by instituting a palliative approach to care. A good knowledge of dementia, including its progression and management, among staff and families of people living with dementia is essential for clear decision making and the provision of appropriate care. Yet there is limited information regarding relative levels of dementia knowledge. This paper reports the results of a study that assessed dementia knowledge among these two cohorts using the Dementia Knowledge Assessment Tool; the study surveyed 279 staff members and 164 family members of residents with dementia. Dementia knowledge deficits were evident in both cohorts across a range of areas. It is critical that dementia knowledge deficits are identified and addressed in order to support evidence-based dementia care. Le nombre de personnes atteintes de démence augmente rapidement à travers le monde. Ainsi on remarque en Australie une augmentation du nombre de ces malades admis dans les institutions de soins de longue durée. La démence étant une maladie terminale il appert que l'approche palliative est la meilleure forme de soins. Cependant, il est essentiel que le personnel soignant autant que les familles aient une bonne connaissance de la maladie, de ses symptomes, de la façon de traiter les maladies, et des décisions à prendre. Or, on en sait très peu quant au niveau de connaissances de ces deux groupes de personnes sur le sujet. Cet article porte sur les résultats d'une étude qui tentait d'évaluer le niveau de connaissances de 279 membres du personnel et de 164 membres des familles à l'aide de l'Έchelle d'évaluation des connaissances sur la démence. Le peu de connaissances était évident chez les deux cohortes et ce, sur un bon nombre de points. Il est donc de la plus haute importance que l'on identifie spécifiquement ces points et qu'on améliore la qualité des soins chez les personnes démentes en se basant sur des données probantes.
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Affiliation(s)
- Andrew Robinson
- School of Health Sciences and Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Private Bag 143, Hobart TAS 7001, Australia
| | - Claire Eccleston
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Michael Annear
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Kate-Ellen Elliott
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Sharon Andrews
- Wicking Dementia Research and Education Centre, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Christine Stirling
- School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Michael Ashby
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia; and Royal Hobart Hospital (THO-South), Hobart, Tasmania, Australia
| | - Catherine Donohue
- Australian Catholic University/Mercy Health, Melbourne, Fitzroy, Victoria, Australia
| | - Susan Banks
- Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Christine Toye
- Australian Catholic University/Mercy Health, Melbourne, Victoria, Australia
| | - Fran McInerney
- Australian Catholic University/Mercy Health, Melbourne, Victoria, Australia
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16
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Udo C, Neljesjö M, Strömkvist I, Elf M. A qualitative study of assistant nurses' experiences of palliative care in residential care. Nurs Open 2018; 5:527-535. [PMID: 30338098 PMCID: PMC6177554 DOI: 10.1002/nop2.159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/16/2018] [Indexed: 01/20/2023] Open
Abstract
AIM To explore assistant nurses' experiences and perceptions of both positive and negative aspects of providing palliative care for older people in residential care facilities. DESIGN A qualitative explorative study. METHODS Critical incidents were collected through semi-structured face-to-face interviews and analysed by performing a qualitative content analysis. RESULTS A total of 40 critical incidents from daily work was described by assistant nurses. The results showed that close cooperation between unlicensed and licensed professionals was crucial to provide good care but was sometimes negatively affected by the organizational structure. The availability of professionals was identified as a critical factor in providing good care at the end of life in a consultative organization. The most prominent findings were those that indicated that, especially in a consultative organization, there seems to be a need for clear roles, comprehensive and clear care plans and a solid support structure to ensure continuity of care.
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Affiliation(s)
- Camilla Udo
- School of Education, Health and Social StudiesDalarna UniversityFalunSweden
- Center for Clinical Research DalarnaFalunSweden
| | - Maria Neljesjö
- School of Education, Health and Social StudiesDalarna UniversityFalunSweden
| | | | - Marie Elf
- School of Education, Health and Social StudiesDalarna UniversityFalunSweden
- Karolinska InstitutetDepartment of Neurobiology, Care Sciences and SocietyStockholmSweden
- Chalmers University of TechnologySchool of ArchitectureGothenburgSweden
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17
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Resnick B, Kolanowski A, Van Haitsma K, Galik E, Boltz M, Ellis J, Behrens L, Flanagan NM, Eshraghi KJ, Zhu S. Testing the evidence integration triangle for implementation of interventions to manage behavioral and psychological symptoms associated with dementia: Protocol for a pragmatic trial. Res Nurs Health 2018; 41:228-242. [PMID: 29485197 DOI: 10.1002/nur.21866] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/27/2017] [Indexed: 01/30/2023]
Abstract
Behavioral and psychological symptoms of dementia (BPSD) include aggression, agitation, resistiveness to care, depression, anxiety, apathy, and hallucinations. BPSD are common in nursing home residents and can be ameliorated using person-centered approaches. Despite regulatory requirements, less than 2% of nursing homes consistently implement person-centered behavioral approaches. In a National Institute of Nursing Research-funded research protocol, we are implementing a pragmatic cluster randomized clinical trial designed to enable staff in nursing homes to reduce BPSD using behavioral approaches while optimizing function, preventing adverse events, and improving quality of life of residents. The implementation is based on use of the Evidence Integration Triangle (EIT), a parsimonious, community-engaged participatory framework that is well suited to the complexity and variability in the nursing home environment. A total of 50 nursing home communities will be randomized to EIT-4-BPSD or education only. Primary Aim 1 is to determine if communities exposed to EIT-4-BPSD demonstrate evidence of implementation evaluated by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) criteria. Primary Aim 2 is to evaluate the feasibility, utility, and cost of the EIT approach in EIT-4-BPSD communities.
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Ann Kolanowski
- Pennsylvania State University, University Park, Pennsylvania
| | | | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Marie Boltz
- Pennsylvania State University, University Park, Pennsylvania
| | - Jeanette Ellis
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Liza Behrens
- Pennsylvania State University, University Park, Pennsylvania
| | - Nina M Flanagan
- Decker School of Nursing, Binghamton University, Binghamton, New York
| | | | - Shijun Zhu
- School of Nursing, University of Maryland, Baltimore, Maryland
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18
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Finucane AM, Stevenson B, Murray SA. Gradual physical decline characterises the illness trajectories of care home residents. Int J Palliat Nurs 2017; 23:457-461. [DOI: 10.12968/ijpn.2017.23.9.457] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Barbara Stevenson
- Community Palliative Care Clinical Nurse Specialist Marie Curie Hospice Edinburgh
| | - Scott A Murray
- St Columba's Hospice Chair of Primary Palliative Care, Primary Palliative Care Research Group, Centre for Population Health Sciences, The Usher Institute Of Population Health Sciences And Informatics, The University of Edinburgh
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19
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Forbat L, Chapman M, Lovell C, Liu WM, Johnston N. Improving specialist palliative care in residential care for older people: a checklist to guide practice. BMJ Support Palliat Care 2017; 8:347-353. [PMID: 28768680 DOI: 10.1136/bmjspcare-2017-001332] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/15/2017] [Accepted: 05/24/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Palliative care needs rounds are triage meetings that have been introduced in residential care for older adults to help identify and prioritise care for people most at risk for unplanned dying with inadequately controlled symptoms. This study sought to generate an evidence-based checklist in order to support specialist palliative care clinicians integrate care in residential nursing homes for older people. METHODS A grounded theory ethnographic study, involving non-participant observation and qualitative interviews. The study was conducted at four residential facilities for older people in one city. Observations and recordings of 15 meetings were made, and complimented by 13 interviews with staff attending the needs rounds. RESULTS The palliative care needs round checklist is presented, alongside rich description of how needs rounds are conducted. Extracts from interviews with needs rounds participants illustrate the choice of items within the checklist and their importance in supporting the evolution towards efficient and effective high-quality specialist palliative care input to the care of older people living in residential care. CONCLUSIONS The checklist can be used to support the integration of specialist palliative care into residential care to drive up quality care, provide staff with focused case-based education, maximise planning and reduce symptom burden for people at end of life.
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Affiliation(s)
- Liz Forbat
- Calvary Public Hospital, Canberra, Australia.,Australian Catholic University, Canberra, Australia
| | | | | | - Wai-Man Liu
- Australian National University, Canberra, Australia
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20
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Thomas T, Kuhn I, Barclay S. Inpatient transfer to a care home for end-of-life care: What are the views and experiences of patients and their relatives? A systematic review and narrative synthesis of the UK literature. Palliat Med 2017; 31:102-108. [PMID: 27468912 DOI: 10.1177/0269216316648068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transfers from hospital or 'hospice palliative care units' to care homes for end-of-life care are an increasingly common part of clinical practice but are a source of anxiety and distress for patients, relatives and healthcare professionals. AIM To understand the experiences of patients discharged to care homes for end-of-life care. DESIGN Systematic review and narrative synthesis of the UK literature concerning inpatient transfer from a hospital or hospice palliative care unit to a care home for end-of-life care. RESULTS The published literature is very limited: only three papers and one conference abstract were identified, all of low quality using Gough's weight of evidence assessment. No papers examined transfer from hospital: all were of transfers from hospices and were retrospective case note reviews. Many patients were reported to have been negative or ambivalent about moving and experienced feelings of anxiety or abandonment when transferred. Relatives were often either vehemently opposed or ambivalent. Although some came to accept transfer, others reported the transfer to have seriously affected their loved one's quality of life and that the process of finding a care home had been traumatic. No studies investigated patients' views prospectively, the views of staff or the processes of decision-making. CONCLUSION The UK literature is very limited, despite such transfers being an increasingly common part of clinical practice and a source of concern to patients, relatives and staff alike. Further research is urgently needed in this area, especially studies of patients themselves, in order to understand their experiences and views.
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Affiliation(s)
| | - Isla Kuhn
- 2 Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- 3 Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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21
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Lester PE, Kawai F, Rodrigues L, Lolis J, Martins-Welch D, Shalshin A, Fazzari MJ, Pan CX. Palliative Care in New York State Nursing Homes: A Descriptive Study. Am J Hosp Palliat Care 2017; 35:203-210. [DOI: 10.1177/1049909117691229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To describe the current landscape of palliative care (PC) in nursing homes (NHs) in New York State (NYS). Measurements: A statewide survey was completed by 149 respondents who named 61 different NHs as their workplace. Questions were related to presence, type, and composition of PC programs; perceptions of PC; barriers to implementing PC; and qualifying medical conditions. Results: Hospice is less available than palliative or comfort care programs, with three-fourths of NYS NH responded providing a PC program. In general, medical directors and physicians were more similar in perspective about the role/impact of PC compared to nursing and others. There was general agreement about the positive impact and role of PC in the NH. Funding and staffing were recognized as barriers to implementing PC. Conclusion: There is growing penetration of PC programs in NH facilities in NYS, with good perception of the appropriate utilization of PC programs. Financial reimbursement and staffing are barriers to providing PC in the NH and need to be addressed by the health-care system.
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Affiliation(s)
- Paula E. Lester
- Division of Geriatric Medicine, Winthrop University Hospital, Mineola, NY, USA
| | - Fernando Kawai
- Division of Geriatrics and Palliative Care Medicine, Weill Cornell Medical College, New York–Presbyterian Queens, Flushing, NY, USA
| | - Lucan Rodrigues
- Division of Palliative Care, Flushing Hospital Medical Center, Flushing, NY, USA
| | - James Lolis
- Division of Geriatric and Palliative Medicine, Hofstra Northwell School of Medicine, Great Neck, NY, USA
- Department of Medicine, Highfield Gardens Care Center, Great Neck, NY, USA
| | - Diana Martins-Welch
- Division of Geriatric and Palliative Medicine, Hofstra Northwell School of Medicine, Great Neck, NY, USA
- Department of Medicine, Highfield Gardens Care Center, Great Neck, NY, USA
| | - Alexander Shalshin
- Division of Palliative Medicine, Plainview–Syosset Hospitals, Northwell Health, Great Neck, NY, USA
| | - Melissa J. Fazzari
- Department of Biostatistics, Stony Brook University School of Medicine, Winthrop University Hospital, Mineola, NY, USA
| | - Cynthia X. Pan
- Division of Geriatrics and Palliative Care Medicine, Weill Cornell Medical College, New York–Presbyterian Queens, Flushing, NY, USA
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22
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Bükki J, Neuhaus PM, Paal P. End of life care in nursing homes: Translating focus group findings into action. Geriatr Nurs 2016; 37:440-445. [DOI: 10.1016/j.gerinurse.2016.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/06/2016] [Accepted: 06/13/2016] [Indexed: 11/30/2022]
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23
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Resnick B, Kolanowski A, Van Haitsma K, Boltz M, Galik E, Bonner A, Vigne E, Holtzman L, Mulhall PM. Pilot Testing of the EIT-4-BPSD Intervention. Am J Alzheimers Dis Other Demen 2016; 31:570-579. [PMID: 27609932 PMCID: PMC10852713 DOI: 10.1177/1533317516662337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behavioral and psychological symptoms of dementia are common in nursing home residents, and the Centers for Medicare and Medicaid Services now require that nonpharmacological interventions be used as a first-line treatment. Few staff know how to implement these interventions. The purpose of this study was to pilot test an implementation strategy, Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD), which was developed to help staff integrate behavioral interventions into routine care. The EIT-4-BPSD was implemented in 2 nursing homes, and 21 residents were recruited. A research nurse facilitator worked with facility champions and a stakeholder team to implement the 4 steps of EIT-4-BPSD. There was evidence of reach to all staff; effectiveness with improvement in residents' quality of life and a decrease in agitation; adoption based on the environment, policy, and care plan changes; and implementation and plans for maintenance beyond the 6-month intervention period.
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | | | | | - Marie Boltz
- William F. Connell School of Nursing, Boston College, Boston, MA, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Alice Bonner
- School of Nursing, Northeastern University, Boston, MA, USA
| | - Erin Vigne
- School of Nursing, University of Maryland, Baltimore, MD, USA
| | - Lauren Holtzman
- School of Nursing, University of Maryland, Baltimore, MD, USA
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Fryer S, Bellamy G, Morgan T, Gott M. "Sometimes I've gone home feeling that my voice hasn't been heard": a focus group study exploring the views and experiences of health care assistants when caring for dying residents. BMC Palliat Care 2016; 15:78. [PMID: 27543042 PMCID: PMC4992208 DOI: 10.1186/s12904-016-0150-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/14/2016] [Indexed: 11/12/2022] Open
Abstract
Background In most developed countries, Health Care Assistants comprise a significant, and growing, proportion of the residential aged care workforce. Despite the fact that they provide the majority of direct care for residents, little is known about a key care aspect of their work, namely their experience of caring for dying residents. Methods Twenty-six Health Care Assistants working in aged residential care facilities in Auckland, New Zealand participated in six focus group discussions. Focus groups were designed to explore the experiences of Health Care Assistants caring for imminently dying residents in aged care facilities and to identify barriers and facilitators to their work in this area. The focus groups were digitally recorded, transcribed verbatim and analysed using a general inductive approach. Results Participants confirmed that Health Care Assistants provide the majority of hands on care to dying residents and believed they had a valuable role to play at this time due to their unique ‘familial’ relationship with residents and families. However, it was apparent that a number of barriers existed to them maximising their contribution to supporting dying residents, most notably the lack of value placed on their knowledge and experience by other members of the multidisciplinary team. Whilst a need for additional palliative and end of life care education was identified, a preference was identified for hands on education delivered by peers, rather than the didactic education they currently receive. Conclusion Given ageing populations internationally coupled with a constrained health budget, the role of Health Care Assistants in most developed countries is likely to become even more significant in the short to medium term. This study makes a unique contribution to the international literature by identifying the barriers to caring for dying residents experienced by this valuable sector of the aged care workforce. These data have the potential to inform new, innovative, interventions to address the urgent need identified to improve palliative and end of life care management in aged care internationally.
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Affiliation(s)
- Susan Fryer
- Manukau Locality, Counties Manukau Health, Manukau, New Zealand
| | - Gary Bellamy
- North West London Clinical Research Network, London, England
| | - Tessa Morgan
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand.
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25
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Chapman M, Johnston N, Lovell C, Forbat L, Liu WM. Avoiding costly hospitalisation at end of life: findings from a specialist palliative care pilot in residential care for older adults. BMJ Support Palliat Care 2016; 8:102-109. [PMID: 27496356 DOI: 10.1136/bmjspcare-2015-001071] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/12/2016] [Accepted: 07/14/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Specialist palliative care is not a standardised component of service delivery in nursing home care in Australia. Specialist palliative care services can increase rates of advance care planning, decrease hospital admissions and improve symptom management in such facilities. New approaches are required to support nursing home residents in avoiding unnecessary hospitalisation and improving rates of dying in documented preferred place of death. This study examined whether the addition of a proactive model of specialist palliative care reduced resident transfer to the acute care setting, and achieved a reduction in hospital deaths. METHODS A quasi-experimental design was adopted, with participants at 4 residential care facilities. The intervention involved a palliative care nurse practitioner leading 'Palliative Care Needs Rounds' to support clinical decision-making, education and training. Participants were matched with historical decedents using propensity scores based on age, sex, primary diagnosis, comorbidities and the Aged Care Funding Instrument rating. Outcome measures included participants' hospitalisation in the past 3 months of life and the location of death. RESULTS The data demonstrate that the intervention is associated with a substantial reduction in the length of hospital stays and a lower incidence of death in the acute care setting. While rates of hospitalisation were unchanged on average, length of admission was reduced by an average of 3.22 days (p<0.01 and 95% CI -5.05 to -1.41), a 67% decrease in admitted days. CONCLUSIONS The findings have significant implications for promoting quality outcomes through models of palliative care service delivery in residential facilities.
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Affiliation(s)
- Michael Chapman
- Department of Palliative Care, Canberra Regional Cancer Centre, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Nikki Johnston
- Clare Holland House, Calvary Health Care ACT, Canberra, Australian Capital Territory, Australia
| | - Clare Lovell
- Clare Holland House, Calvary Health Care ACT, Canberra, Australian Capital Territory, Australia
| | - Liz Forbat
- Director for the Calvary Centre for Palliative Care Research, Calvary Health Care Bruce and the Australian Catholic University, Canberra, Australian Capital Territory, Australia
| | - Wai-Man Liu
- Research School of Finance, Actuarial Studies & Statistics, Australian National University, Canberra, Australian Capital Territory, Australia
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26
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Johnston N, Lovell C, Liu WM, Chapman M, Forbat L. Normalising and planning for death in residential care: findings from a qualitative focus group study of a specialist palliative care intervention. BMJ Support Palliat Care 2016; 9:e12. [PMID: 27489222 DOI: 10.1136/bmjspcare-2016-001127] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/12/2016] [Accepted: 07/14/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Improving access to palliative care for older adults living in residential care is recognised internationally as a pressing clinical need. The integration of specialist palliative care in residential care for older adults is not yet standard practice. OBJECTIVE This study aimed to understand the experience and impact of integrating a specialist palliative care model on residents, relatives and staff. METHODS Focus groups were held with staff (n=40) and relatives (n=17). Thematic analysis was applied to the data. RESULTS Three major themes were identified. The intervention led to (1) normalising death and dying in these settings, (2) timely access to a palliative care specialist who was able to prescribe anticipatory medications aiding symptom management and unnecessary hospitalisations and (3) better decision-making and planned care for residents, which meant that staff and relatives were better informed about, and prepared for, the resident's likely trajectory. CONCLUSIONS The intervention normalised death and dying and also underlined the important role that specialists play in providing staff education, timely access to medicines and advance care planning. The findings from our study, and the growing wealth of evidence integrating specialist palliative care in residential care for older adults, indicate a number of priorities for care providers, academics and policymakers. Further work on determining the role of primary and specialist palliative care services in residential care settings is needed to inform service delivery models.
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Affiliation(s)
- Nikki Johnston
- Clare Holland House, Calvary Health Care ACT, Canberra, Australian Capital Territory, Australia
| | - Clare Lovell
- Clare Holland House, Calvary Health Care ACT, Canberra, Australian Capital Territory, Australia
| | - Wai-Man Liu
- Research School of Finance, Actuarial Studies & Statistics, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michael Chapman
- Clare Holland House, Calvary Health Care ACT, Canberra, Australian Capital Territory, Australia
| | - Liz Forbat
- Calvary Centre for Palliative Care Research, Calvary Health Care Bruce and the Australian Catholic University, Canberra, Australian Capital Territory, Australia
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Davies N, Mathew R, Wilcock J, Manthorpe J, Sampson EL, Lamahewa K, Iliffe S. A co-design process developing heuristics for practitioners providing end of life care for people with dementia. BMC Palliat Care 2016; 15:68. [PMID: 27484683 PMCID: PMC4969644 DOI: 10.1186/s12904-016-0146-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The end of life for someone with dementia can present many challenges for practitioners; such as, providing care if there are swallowing difficulties. This study aimed to develop a toolkit of heuristics (rules-of-thumb) to aid practitioners making end-of-life care decisions for people with dementia. METHODS An iterative co-design approach was adopted using a literature review and qualitative methods, including; 1) qualitative interviews and focus groups with family carers and 2) focus groups with health and care professionals. Family carers were recruited from a national charity, purposively sampling those with experience of end-of-life care for a person with dementia. Health and care professionals were purposively sampled to include a broad range of expertise including; general practitioners, palliative care specialists, and geriatricians. A co-design group was established consisting of health and social care experts and family carers, to synthesise the findings from the qualitative work and produce a toolkit of heuristics to be tested in practice. RESULTS Four broad areas were identified as requiring complex decisions at the end of life; 1) eating/swallowing difficulties, 2) agitation/restlessness, 3) ending life-sustaining treatment, and 4) providing "routine care" at the end of life. Each topic became a heuristic consisting of rules arranged into flowcharts. Eating/swallowing difficulties have three rules; ensuring eating/swallowing difficulties do not come as a surprise, considering if the situation is an emergency, and considering 'comfort feeding' only versus time-trialled artificial feeding. Agitation/restlessness encourages a holistic approach, considering the environment, physical causes, and the carer's wellbeing. Ending life-sustaining treatment supports practitioners through a process of considering the benefits of treatment versus quality-of-life and comfort. Finally, a heuristic on providing routine care such as bathing, prompts practitioners to consider adapting the delivery of care, in order to promote comfort and dignity at the end of life. CONCLUSIONS The heuristics are easy to use and remember, offering a novel approach to decision making for dementia end-of-life care. They have the potential to be used alongside existing end-of-life care recommendations, adding more readily available practical assistance. This is the first study to synthesise experience and existing evidence into easy-to-use heuristics for dementia end-of-life care.
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Affiliation(s)
- Nathan Davies
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Rammya Mathew
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Jane Wilcock
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, WC2B 6NR, UK
| | - Elizabeth L Sampson
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,Barnet Enfield and Haringey Mental Health Trust Liaison Team, North Middlesex University Hospital, Sterling Way, London, N18 1QX, UK
| | - Kethakie Lamahewa
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
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Colón-Emeric C, Toles M, Cary MP, Batchelor-Murphy M, Yap T, Song Y, Hall R, Anderson A, Burd A, Anderson RA. Sustaining complex interventions in long-term care: a qualitative study of direct care staff and managers. Implement Sci 2016; 11:94. [PMID: 27422011 PMCID: PMC4947307 DOI: 10.1186/s13012-016-0454-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/16/2016] [Indexed: 12/02/2022] Open
Abstract
Background Little is known about the sustainability of behavioral change interventions in long-term care (LTC). Following a cluster randomized trial of an intervention to improve staff communication (CONNECT), we conducted focus groups of direct care staff and managers to elicit their perceptions of factors that enhance or reduce sustainability in the LTC setting. The overall aim was to generate hypotheses about how to sustain complex interventions in LTC. Methods In eight facilities, we conducted 15 focus groups with 83 staff who had participated in at least one intervention session. Where possible, separate groups were conducted with direct care staff and managers. An interview guide probed for staff perceptions of intervention salience and sustainability. Framework analysis of coded transcripts was used to distill insights about sustainability related to intervention features, organizational context, and external supports. Results Staff described important factors for intervention sustainability that are particularly challenging in LTC. Because of the tremendous diversity in staff roles and education level, interventions should balance complexity and simplicity, use a variety of delivery methods and venues (e.g., group and individual sessions, role-play/storytelling), and be inclusive of many work positions. Intervention customizability and flexibility was particularly prized in this unpredictable and resource-strapped environment. Contextual features noted to be important include addressing the frequent lack of trust between direct care staff and managers and ensuring that direct care staff directly observe manager participation and support for the program. External supports suggested to be useful for sustainability include formalization of changes into facility routines, using “train the trainer” approaches and refresher sessions. High staff turnover is common in LTC, and providing materials for new staff orientation was reported to be important for sustainability. Conclusions When designing or implementing complex behavior change interventions in LTC, consideration of these particularly salient intervention features, contextual factors, and external supports identified by staff may enhance sustainability. Trial registration ClinicalTrial.gov, NCT00636675
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Affiliation(s)
- Cathleen Colón-Emeric
- Duke University School of Medicine, Box 3003 DUMC, Durham, NC, 27710, USA. .,Durham VA Geriatric Research Education and Clinical Center, 508 Fulton St., Durham, NC, 27705, USA.
| | - Mark Toles
- University of North Carolina School of Nursing, Carrington Hall CB #7460, Chapel Hill, NC, 27599, USA
| | - Michael P Cary
- Duke University School of Nursing, 307 Trent Dr, Durham, NC, 27710, USA
| | | | - Tracey Yap
- Duke University School of Nursing, 307 Trent Dr, Durham, NC, 27710, USA
| | - Yuting Song
- Duke University School of Nursing, 307 Trent Dr, Durham, NC, 27710, USA
| | - Rasheeda Hall
- Duke University School of Medicine, Box 3003 DUMC, Durham, NC, 27710, USA.,Durham VA Geriatric Research Education and Clinical Center, 508 Fulton St., Durham, NC, 27705, USA
| | - Amber Anderson
- Duke University School of Nursing, 307 Trent Dr, Durham, NC, 27710, USA
| | - Andrew Burd
- Duke University School of Nursing, 307 Trent Dr, Durham, NC, 27710, USA
| | - Ruth A Anderson
- University of North Carolina School of Nursing, Carrington Hall CB #7460, Chapel Hill, NC, 27599, USA
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Anstey S, Powell T, Coles B, Hale R, Gould D. Education and training to enhance end-of-life care for nursing home staff: a systematic literature review. BMJ Support Palliat Care 2016; 6:353-61. [PMID: 27329513 PMCID: PMC5013161 DOI: 10.1136/bmjspcare-2015-000956] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 05/05/2016] [Indexed: 11/09/2022]
Abstract
Background The delivery of end-of-life care in nursing homes is challenging. This situation is of concern as 20% of the population die in this setting. Commonly reported reasons include limited access to medical care, inadequate clinical leadership and poor communication between nursing home and medical staff. Education for nursing home staff is suggested as the most important way of overcoming these obstacles. Objectives To identify educational interventions to enhance end-of-life care for nursing home staff and to identify types of study designs and outcomes to indicate success and benchmark interventions against recent international guidelines for education for palliative and end-of-life care. Design Thirteen databases and reference lists of key journals were searched from the inception of each up to September 2014. Included studies were appraised for quality and data were synthesised thematically. Results Twenty-one studies were reviewed. Methodological quality was poor. Education was not of a standard that could be expected to alter clinical behaviour and was evaluated mainly from the perspectives of staff: self-reported increase in knowledge, skills and confidence delivering care rather than direct evidence of impact on clinical practice and patient outcomes. Follow-up was often short term, and despite sound economic arguments for delivering effective end-of-life care to reduce burden on the health service, no economic analyses were reported. Conclusions There is a clear and urgent need to design educational interventions that have the potential to improve end-of-life care in nursing homes. Robust evaluation of these interventions should include impact on residents, families and staff and include economic analysis.
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Affiliation(s)
- Sally Anstey
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Tom Powell
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Bernadette Coles
- Cancer Research Wales (CRW) Library, Velindre National Health Trust, Cardiff, UK
| | - Rachel Hale
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Dinah Gould
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Amador S, Goodman C, Mathie E, Nicholson C. Evaluation of an Organisational Intervention to Promote Integrated Working between Health Services and Care Homes in the Delivery of End-of-Life Care for People with Dementia: Understanding the Change Process Using a Social Identity Approach. Int J Integr Care 2016; 16:14. [PMID: 27616969 PMCID: PMC5015557 DOI: 10.5334/ijic.2426] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 05/18/2016] [Indexed: 11/20/2022] Open
Abstract
In the United Kingdom, approximately a third of people with dementia live in long-term care facilities for adults, the majority of whom are in the last years of life. Working arrangements between health services and care homes in England are largely ad hoc and often inequitable, yet quality end-of-life care for people with dementia in these settings requires a partnership approach to care that builds on existing practice. This paper reports on the qualitative component of a mixed method study aimed at evaluating an organisational intervention shaped by Appreciative Inquiry to promote integrated working between visiting health care practitioners (i.e. General Practitioners and District Nurses) and care home staff. The evaluation uses a social identity approach to elucidate the mechanisms of action that underlie the intervention, and understand how organisational change can be achieved. We uncovered evidence of both (i) identity mobilisation and (ii) context change, defined in theory as mechanisms to overcome divisions in healthcare. Specifically, the intervention supported integrated working across health and social care settings by (i) the development of a common group identity built on shared views and goals, but also recognition of knowledge and expertise specific to each service group which served common goals in the delivery of end-of-life care, and (ii) development of context specific practice innovations and the introduction of existing end-of-life care tools and frameworks, which could consequently be implemented as part of a meaningful bottom-up rather than top-down process. Interventions structured around a Social Identity Approach can be used to gauge the congruence of values and goals between service groups without which efforts to achieve greater integration between different health services may prove ineffectual. The strength of the approach is its ability to accommodate the diversity of service groups involved in a given area of care, by valuing their respective contributions and building on existing ways of working within which practice changes can be meaningfully integrated.
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Affiliation(s)
- Sarah Amador
- Research Associate, Marie Curie Palliative Care Research Department, University College London, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, W1T 7NF, UK
| | - Claire Goodman
- Professor of Health Care Research, Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield AL10 9AB, UK
| | - Elspeth Mathie
- Research Fellow, Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield AL10 9AB, UK
| | - Caroline Nicholson
- NIHR Postdoctoral Research Fellow, National Nursing Research Unit, King’s College London, 4th Floor Room 2.49b James Clerk Maxwell Building, Waterloo, Waterloo, London SE1 8WA, UK
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Palliative care and dementia—A time and place? Maturitas 2016; 84:5-10. [DOI: 10.1016/j.maturitas.2015.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 11/24/2022]
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The feasibility of a train-the-trainer approach to end of life care training in care homes: an evaluation. BMC Palliat Care 2016; 15:11. [PMID: 26801232 PMCID: PMC4724146 DOI: 10.1186/s12904-016-0081-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 01/12/2016] [Indexed: 11/12/2022] Open
Abstract
Background The ABC End of Life Education Programme trained approximately 3000 care home staff in End of Life (EoL) care. An evaluation that compared this programme with the Gold Standards Framework found that it achieved equivalent outcomes at a lower cost with higher levels of staff satisfaction. To consolidate this learning, a facilitated peer education model that used the ABC materials was piloted. The goal was to create a critical mass of trained staff, mitigate the impact of staff turnover and embed EoL care training within the organisations. The aim of the study was to evaluate the feasibility of using a train the trainer (TTT) model to support EoL care in care homes. Methods A mixed method design involved 18 care homes with and without on-site nursing across the East of England. Data collection included a review of care home residents’ characteristics and service use (n = 274), decedents’ notes n = 150), staff interviews (n = 49), focus groups (n = 3), audio diaries (n = 28) and observations of workshops (n = 3). Results Seventeen care homes participated. At the end of the TTT programme 28 trainers and 114 learners (56 % of the targeted number of learners) had been trained (median per home 6, range 0–13). Three care homes achieved or exceeded the set target of training 12 learners. Trainers ranged from senior care staff to support workers and administrative staff. Results showed a positive association between care home stability, in terms of leadership and staff turnover, and uptake of the programme. Care home ownership, type of care home, size of care home, previous training in EoL care and resident characteristics were not associated with programme completion. Working with facilitators was important to trainers, but insufficient to compensate for organisational turbulence. Variability of uptake was also linked to management support, programme fit with the trainers’ roles and responsibilities and their opportunities to work with staff on a daily basis. Conclusion When there is organisational stability, peer to peer approaches to skills training in end of life care can, with expert facilitation, cascade and sustain learning in care homes.
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Nash A, Fitzpatrick JM. Views and experiences of nurses and health-care assistants in nursing care homes about the Gold Standards Framework. Int J Palliat Nurs 2015; 21:35-41. [PMID: 25615833 DOI: 10.12968/ijpn.2015.21.1.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To explore the views and experiences of nurses and health-care support staff about the use of the Gold Standards Framework (GSF) for end-of-life care (EoLC) for older people in nursing care homes (NCHs) with GSF accreditation. METHODS A qualitative descriptive study was conducted with three purposively selected NCHs in London. Individual interviews were conducted with NCH managers (n=3) and in each NCH, a focus group was conducted with registered nurses (RNs) and health-care assistants (HCAs): focus group 1, n=2 RN, n=2 HCA; focus group 2, n=2 RN, n=3 HCA; focus group 3, n=3 RN, n=3 HCA. Interviews were audio-recorded, transcribed and analysed using framework analysis. FINDINGS Three core themes were identified: (i) a positive regard for the GSF for care homes (GSFCH); (ii) challenges around EoLC for older people; and (iii) difficulties in using the GSFCH. CONCLUSIONS RNs, HCAs and managers regarded the training and support afforded by the GSFCH programme to inform EoLC for older residents positively. The framework has the potential to promote a coordinated approach to EoLC for older people. In the post accreditation period, there is a need for ongoing support and development to help embed the key tenets of the GSFCH in the culture of caring.
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Affiliation(s)
- Anne Nash
- Matron, St Christopher's Hospice, London
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Ali M, Capel M, Jones G, Gazi T. The importance of identifying preferred place of death. BMJ Support Palliat Care 2015; 9:84-91. [DOI: 10.1136/bmjspcare-2015-000878] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/03/2015] [Accepted: 09/06/2015] [Indexed: 11/03/2022]
Abstract
ObjectivesThe majority of people would prefer to die at home and the stated intentions of both statutory and voluntary healthcare providers aim to support this. This service evaluation compared the preferred and actual place of death of patients known to a specialist community palliative care service.DesignAll deaths of patients (n=2176) known to the specialist palliative care service over a 5-year period were examined through service evaluation to compare the actual place of death with the preferred place of death previously identified by the patient. Triggers for admission were established when the patients did not achieve this preference.ResultsBetween 2009 and 2013, 73% of patients who expressed a choice about their preferred place of death and 69.3% who wanted to die at home were able to achieve their preferences. During the course of their illness, 9.5% of patients changed their preference for place of death. 30% of patients either refused to discuss or no preference was elicited for place of death.ConclusionsDirect enquiry and identification of preferences for end-of-life care is associated with patients achieving their preference for place of death. Patients whose preferred place of death was unknown were more likely to be admitted to hospital for end-of-life care.
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35
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Lester PE, Stefanacci RG, Feuerman M. Prevalence and Description of Palliative Care in US Nursing Homes. Am J Hosp Palliat Care 2014; 33:171-7. [DOI: 10.1177/1049909114558585] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To describe rates and policies in U.S. Nursing Homes (NH) related to palliative care, comfort care, and hospice care based on a nationwide survey of directors of nursing. Measurements: A national survey was distributed online and was completed by 316 directors of nursing of NHs (11% response rate). The directors of nursing were asked about availability and policies in their facilities. Specifically, questions were related to policies, referral patterns, discussion about such care, and types of medical conditions qualifying for such services. Results: Hospice is significantly more available than palliative or comfort care programs; also, for-profit facilities, compared to non-profits, are significantly more likely to have palliative care programs and medical directors for palliative care. Social workers and nurses were most likely to suggest palliative type programs. Only 42% of facilities with palliative program provide consultation by a palliative certified physician. Residents with non-healing pressure ulcers, frequent hospitalizations, or severe/uncontrolled pain or non-pain symptoms were less likely to be referred. Conclusions: There is limited availability of palliative type programs in NH facilities and underutilization in those NH with programs.
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Affiliation(s)
- Paula E. Lester
- Winthrop University Hospital, Mineola, NY, USA
- SUNY Stony Brook, Stony Brook, NY, USA
| | | | - Martin Feuerman
- Office of Academic Affairs, Winthrop University Hospital, Mineola, NY, USA
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Raijmakers N, Dekkers A, Galesloot C, van Zuylen L, van der Heide A. Barriers and facilitators to implementation of the Liverpool Care Pathway in the Netherlands: a qualitative study. BMJ Support Palliat Care 2014; 5:259-65. [PMID: 25200707 DOI: 10.1136/bmjspcare-2014-000684] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 08/24/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The Liverpool Care Pathway (LCP) is a quality instrument for the dying patient. This study evaluates barriers and facilitators to its implementation in the Netherlands from the perspective of key stakeholders, to inform future implementation processes. METHODS An interview study was conducted among 28 stakeholders involved in implementation of the LCP in the Netherlands, followed by a consecutive focus group with 8 interviewees to discuss and validate the findings of the interview study. Interviews were conducted by telephone and the notes taken during the interviews and focus group were transcribed into non-verbatim transcripts. Data collected during the interviews and focus group were evaluated using thematic analysis. RESULTS According to the stakeholders, a context analysis prior to implementation was useful to find the appropriate orientation to adequately motivate healthcare professionals as well as management. The main contributing factors were the quality of the LCP (including its evidence-based character and completeness), and that it fitted the needs of healthcare professionals. During the implementation phase, a multidisciplinary project team, competent support and continuous monitoring were identified as important facilitators. Furthermore, for successful implementation, a facilitator working in liaison with others was helpful. To guarantee sustainability of the use of the LCP, it was important to disentangle tasks from the project leader and formally integrate these into the quality systems of the organisation. CONCLUSIONS The Dutch experience with large-scale implementation of the LCP has identified important barriers and facilitators to the implementation of a quality instrument within palliative care. To successfully implement such a promising instrument, liaison with others is important. The sense of being part of a process of improvement is valuable, while consolidation of this idea contributes to successful implementation.
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Affiliation(s)
- Natasja Raijmakers
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands Department of Medical Oncology, Erasmus MC, Rotterdam, The Netherlands
| | - Anneke Dekkers
- Palliative Care, Comprehensive Cancer Centre, The Netherlands
| | - Cilia Galesloot
- Palliative Care, Comprehensive Cancer Centre, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Erasmus MC, Rotterdam, The Netherlands
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