Enhancing Care for Long-Term Care Residents Approaching End-of-Life: A Mixed-Methods Study Assessing a Palliative Care Transfer Form

Continuity of care during long-term care transitions: a scoping review of the Canadian literature

BACKGROUND

Patients who maintain longitudinal provider-patient relationships experience better overall health outcomes. However, most older adults in Canada lose contact with their family physician when they enter long-term care (LTC) as new providers assume responsibility for their care. There is relatively little known about the contextual factors, processes, knowledge, and health professions education antecedents that promote the benefits of relational, management, and informational care continuity during LTC transitions.

METHODS

Using a rigorous scoping review method, we searched multiple databases systematically to identify and scrutinize peer-reviewed articles pertaining to continuity of care during LTC transitions in Canada. Guided by Transitions Theory, two independent reviewers screened citations and extracted data. A descriptive analytical method was employed to categorize content into themes.

RESULTS

Eight articles met the inclusion criteria. Our findings confirm that instances of relational continuity are very few during LTC transitions, suggesting barriers associated with practice models and the influence of physician characteristics. Notably, the review also highlights that the involvement of interprofessional team members, patients, and their partners-in-care in transition planning could improve informational and management care continuity for patients as they move into LTC.

CONCLUSION

Patient and family involvement, provider training, and practice and funding arrangements are all critical to improving relational, management, and informational care continuity during LTC transition. We recommend more studies to understand processes and policies to optimize informational continuity as a panacea for the often-disrupted relational continuity.

Quality of information transferred to palliative care

AIMS AND OBJECTIVES

To describe the quality of information coming from previous care units to palliative care.

BACKGROUND

Information quality is an interconnected concept that includes different dimensions and can be viewed from different perspectives. More knowledge is needed from a multi-professional perspective on the information quality coming to palliative care.

DESIGN

Descriptive qualitative study.

METHODS

Altogether 33 registered nurses, practical nurses, social workers and physicians working in palliative care were purposively selected to participate in thematic interviews. The research was carried out in six palliative care units in three hospital districts. The data were analysed by using deductive and inductive content analysis. The COREQ checklist was used.

RESULTS

Three main categories with thirteen categories were identified in connection with the deductive analysis based on the Clinical Information Quality framework: (1). Informativeness of information coming from previous care units to palliative care included accuracy, completeness, interpretability, plausibility, provenance and relevance. (2). Availability of information coming from previous care units to palliative care included accessibility, portability, security and timeliness. (3). Usability of information coming from previous care units to palliative care included conformance, consistency and maintainability. Each category is divided into sub-categories followed by narratives of their content.

CONCLUSIONS

This study provides new knowledge on the quality of information coming to palliative care from a multi-professional perspective. Professionals working in palliative care units highlight issues describing good information quality, but also point out quality issues and areas for improvement.

RELEVANCE TO CLINICAL PRACTICE

The results can guide the development of documentation practices and Health Information System development as well as be used in the generation of a new audit instrument of information quality.

Gift of time: learning together to embed a palliative approach to care in long-term care

BACKGROUND

Embedding a Palliative Approach to Care (EPAC) is a model that helps shift the culture in long-term care (LTC) so that residents who could benefit from palliative care are identified early. Healthcare Excellence Canada supported the implementation of EPAC in seven teams from across Canada between August 2018 and September 2019.

OBJECTIVE

To identify effective strategies for supporting the early identification of palliative care needs to improve the quality of life of residents in LTC.

INTERVENTION

Training methods on the EPAC model included a combination of face-to-face education (national and regional workshops), online learning (webinars and access to an online platform) and expert coaching. Each team adapted EPAC based on their organisational context and jurisdictional requirements for advance care planning.

MEASURES

Teams tracked their progress by collecting monthly data on the number of residents who died, date of their most recent goals of care (GOCs) conversation, location of death and number of emergency department (ED) transfers in the last 3 months of life. Teams also shared their implementation strategies including successes, barriers and lessons.

RESULTS

Implementation of EPAC required leadership support and dedicated time for changing how palliative care is perceived in LTC. Based on 409 resident deaths, 89% (365) had documented GOC conversations; 78% (318) had no transfers to the ED within the last 3 months of life; and 81% (333) died at home. A monthly review of the results showed that teams were having earlier GOC conversations with residents. Teams also reported improvements in the quality of care provided to residents and their families.

CONCLUSION

EPAC was successfully adapted and adopted to the organisational contexts of homes participating in the collaborative.