1
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Rogan C, Rock B, Begley E, Boland B, Brazil K, Diaz-Orueta U, Donnelly S, Foley M, Foley T, Hannigan C, Hopper L, Keogh F, Lawlor B, Leroi I, O'Neill C, O'Philbin L, Pertl M, Trépel D, Kennelly S. Dementia research in Ireland: What should we prioritise? HRB Open Res 2023; 6:12. [PMID: 37954094 PMCID: PMC10638481 DOI: 10.12688/hrbopenres.13563.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
Background Dementia research prioritisation allows for the systematic allocation of investment in dementia research by governments, funding agencies and the private sector. There is currently a lack of information available in Ireland regarding priority areas for dementia research. To address this gap, a dementia research prioritisation exercise was undertaken, consisting of an online survey of professionals in the dementia field and workshops for people living with dementia and family carers. Methods (1) An anonymous online survey of professionals, based on an existing WHO global survey: the global survey was adapted to an Irish context and participants were asked to score 65 thematic research avenues under five criteria; (2) A mixed-methods exercise for people living with dementia and family carers: this involved two facilitated workshops where participants voted on the research themes they felt were important to them and should be addressed through research. Results Eight of the top ten research priorities in the survey of professionals ( n=108) were focused on the delivery and quality of care and services for people with dementia and carers. Other research avenues ranked in the top ten focused on themes of timely and accurate diagnosis of dementia in primary health-care practices and diversifying therapeutic approaches in clinical trials. Participants in the workshops ( n=13) ranked 'better drugs and treatment for people with dementia', 'dementia prevention/ risk reduction' and 'care for people with dementia and carers' as their top priority areas. Conclusions Findings from this prioritisation exercise will inform and motivate policymakers, funders and researchers to support and conduct dementia-focused research and ensure that the limited resources made available are spent on research that has the most impact for those who will benefit from and use the results of research.
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Affiliation(s)
- Carol Rogan
- School of Medicine, Trinity College Dublin, Dublin, D.2, Ireland
| | - Bernadette Rock
- The Irish Medical Council, Dublin, D.2, Ireland
- The Alzheimer Society of Ireland, Blackrock, Co. Dublin, A94 N8Y0, Ireland
| | - Emer Begley
- The National Dementia Office (HSE), Tullamore, Co. Offaly, R35 F6F8, Ireland
| | - Barry Boland
- Department of Pharmacology & Therapeutics, University College Cork, Cork, T12 XF62, Ireland
| | - Kevin Brazil
- School of Nursing & Midwifery, Queen's University, Belfast, BT9 7BL, UK
| | - Unai Diaz-Orueta
- Department of Psychology, Maynooth University, Maynooth, W23 F2H6, Ireland
| | - Sarah Donnelly
- School of Social Policy, Social Work and Social Justice, University College Dublin, Dublin, Ireland
| | - Michael Foley
- PPI Ignite Office, Trinity College Dublin, Dublin, D.2, Ireland
| | - Tony Foley
- Department of General Practice, University College Cork, Cork, T12 XF62, Ireland
| | - Caoimhe Hannigan
- Department of Psychology, School of Business, National College of Ireland, Dublin, Dublin 1, Ireland
| | - Louise Hopper
- School of Psychology, Dublin City University, Dublin, D.9, Ireland
| | - Fiona Keogh
- Mental Health Ireland, Dunlaoghaire, Co. Dublin, A96 E289, Ireland
| | - Brian Lawlor
- School of Medicine, Trinity College Dublin, Dublin, D.2, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, D.2, Ireland
| | - Iracema Leroi
- School of Medicine, Trinity College Dublin, Dublin, D.2, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, D.2, Ireland
- St James's Hospital, Dublin, D.8, Ireland
| | - Cora O'Neill
- Cork Neuroscience Centre, University College Cork, Cork, T12 XF62, Ireland
| | - Laura O'Philbin
- The Alzheimer Society of Ireland, Blackrock, Co. Dublin, A94 N8Y0, Ireland
| | - Maria Pertl
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, D.2, Ireland
| | - Dominic Trépel
- School of Medicine, Trinity College Dublin, Dublin, D.2, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, D.2, Ireland
| | - Seán Kennelly
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, D.24, Ireland
- Department of Medical Gerontology, Trinity College Dublin, Dublin, D.2, Ireland
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2
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Bavelaar L, Visser M, Walshe C, Preston N, Kaasalainen S, Sussman T, Cornally N, Hartigan I, Loucka M, di Giulio P, Brazil K, Achterberg WP, van der Steen JT. The impact of the mySupport advance care planning intervention on family caregivers' perceptions of decision-making and care for nursing home residents with dementia: pretest-posttest study in six countries. Age Ageing 2023; 52:7066941. [PMID: 36861181 PMCID: PMC9978311 DOI: 10.1093/ageing/afad027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND the mySupport advance care planning intervention was originally developed and evaluated in Northern Ireland (UK). Family caregivers of nursing home residents with dementia received an educational booklet and a family care conference with a trained facilitator to discuss their relative's future care. OBJECTIVES to investigate whether upscaling the intervention adapted to local context and complemented by a question prompt list impacts family caregivers' uncertainty in decision-making and their satisfaction with care across six countries. Second, to investigate whether mySupport affects residents' hospitalisations and documented advance decisions. DESIGN a pretest-posttest design. SETTING in Canada, the Czech Republic, Ireland, Italy, the Netherlands and the UK, two nursing homes participated. PARTICIPANTS in total, 88 family caregivers completed baseline, intervention and follow-up assessments. METHODS family caregivers' scores on the Decisional Conflict Scale and Family Perceptions of Care Scale before and after the intervention were compared with linear mixed models. The number of documented advance decisions and residents' hospitalisations was obtained via chart review or reported by nursing home staff and compared between baseline and follow-up with McNemar tests. RESULTS family caregivers reported less decision-making uncertainty (-9.6, 95% confidence interval: -13.3, -6.0, P < 0.001) and more positive perceptions of care (+11.4, 95% confidence interval: 7.8, 15.0; P < 0.001) after the intervention. The number of advance decisions to refuse treatment was significantly higher after the intervention (21 vs 16); the number of other advance decisions or hospitalisations was unchanged. CONCLUSIONS the mySupport intervention may be impactful in countries beyond the original setting.
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Affiliation(s)
- Laura Bavelaar
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Mandy Visser
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Catherine Walshe
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | | | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Canada
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Irene Hartigan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Paola di Giulio
- Department of Public Health and Pediatrics, University of Torino, Turin, Italy
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Jenny T van der Steen
- Address correspondence to: Jenny T. van der Steen, Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbox 9600, 2300 Leiden, the Netherlands.
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3
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Rogan C, Rock B, Begley E, Boland B, Brazil K, Diaz-Orueta U, Donnelly S, Foley M, Foley T, Hannigan C, Hopper L, Keogh F, Lawlor B, Leroi I, O'Neill C, O'Philbin L, Pertl M, Trépel D, Kennelly S. Dementia research in Ireland: What should we prioritise? HRB Open Res 2023. [DOI: 10.12688/hrbopenres.13563.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Background: Dementia research prioritisation allows for the systematic allocation of investment in dementia research by governments, funding agencies and the private sector. There is currently a lack of information available in Ireland regarding priority areas for dementia research. To address this gap, a dementia research prioritisation exercise was undertaken, consisting of an online survey of professionals in the dementia field and workshops for people living with dementia and family carers. Methods: (1) An anonymous online survey of professionals, based on an existing WHO global survey: The global survey was adapted to an Irish context and participants were asked to score 65 thematic research avenues under 5 criteria; (2) A mixed-methods exercise for people living with dementia and family carers: This involved two facilitated workshops where participants voted on the research themes they felt were important to them and should be addressed through research. Results: Eight of the top ten research priorities in the survey of professionals (n=108) were focused on the delivery and quality of care and services for people with dementia and carers. Other research avenues ranked in the top ten focused on themes of timely and accurate diagnosis of dementia in primary health-care practices and diversifying therapeutic approaches in clinical trials. Participants in the workshops (n=13) ranked ‘better drugs and treatment for people with dementia’, ‘dementia prevention/ risk reduction’ and ‘care for people with dementia and carers’ as their top priority areas. Conclusions: Findings from this prioritisation exercise will inform and motivate policymakers, funders, and researchers to support and conduct research to address the burden of dementia and ensure that the limited resources made available are spent on research that has the most impact for those who will benefit from and use the results of research.
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van der Steen JT, van Leussen CA, Ballentine J, Gribben L, Reid J, Hasson F, Brazil K, The BAM, McLaughlin D. Implementing Palliative Care Teams Specialized in Dementia in Two Countries: Experiences of Failure and Success. J Alzheimers Dis 2023; 91:551-557. [PMID: 36463448 PMCID: PMC9912720 DOI: 10.3233/jad-220772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Much is known about palliative care needs of persons with dementia and their family. Less is known about how to successfully implement models that address those needs. We present specialist models in the Netherlands (2017-2018) and Northern Ireland (2016-2017) contrasting its evaluations. From implementation failure in the Netherlands compared with successful implementation in Northern Ireland, we learn that recognizing roles and competencies among all involved is essential in developing effective partnership relationships. All of this is facilitated by referral before the end of life and offering various training programs and in-patient and out-patient services and therapies to show benefits early.
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Affiliation(s)
- Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands,Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands,Correspondence to: Jenny T. van der Steen, PhD, MSc, FGSA, Leiden University Medical Center, Department of Public Health and Primary Care, Hippocratespad 21, Gebouw 3, P.O. Box 9600, 2300 RC Leiden, The Netherlands. Tel.: +31 6 11758240; E-mail: . ORCID: 0000-0002-9063-7501
| | | | - Joanne Ballentine
- Project Lead of Hospice Enabled Dementia Partnership, Northern Ireland Hospice, Belfast, Northern Ireland
| | - Loretta Gribben
- Policy and Practice Royal College of Nursing NI, Belfast, Northern Ireland
| | - Joanne Reid
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland
| | - Felicity Hasson
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Newtownabbey, Northern Ireland
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland
| | | | - Dorry McLaughlin
- Formerly Lecturer in Palliative Care and Chronic Illness, School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen’s University, Belfast, Northern Ireland
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McMahon J, Thompson DR, Brazil K, Ski CF. Co-Design of an eHealth Intervention to Reduce Cardiovascular Disease Risk in Male Taxi Drivers: ManGuard. Int J Environ Res Public Health 2022; 19:15278. [PMID: 36429995 PMCID: PMC9690601 DOI: 10.3390/ijerph192215278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
Taxi driving, a male-dominated occupation, is associated with an increased risk of cardiovascular disease (CVD). The increased risk is linked to a high prevalence of modifiable CVD risk factors including overweight/obesity, poor nutrition, smoking, excessive alcohol consumption and physical inactivity. Behaviour change interventions may prove advantageous, yet little research has been conducted to reduce CVD risk in this population. The purpose of this study was to co-design an eHealth intervention, 'ManGuard', to reduce CVD risk in male taxi drivers. The IDEAS framework was utilised to guide the development of the eHealth intervention, with the Behaviour Change Wheel (BCW) incorporated throughout to ensure the intervention was underpinned by behaviour change theory. Development and refinement of ManGuard was guided by current literature, input from a multidisciplinary team, an online survey, a systematic review and meta-analysis, and focus groups (n = 3) with male taxi drivers. Physical inactivity was identified as the prime behavior to change in order to reduce CVD risk in male taxi drivers. Male taxi drivers indicated a preference for an eHealth intervention to be delivered using smartphone technology, with a simple design, providing concise, straightforward, and relatable content, and with the ability to track and monitor progress.
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Affiliation(s)
- James McMahon
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK
| | - David R. Thompson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK
| | - Chantal F. Ski
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK
- Integrated Care Academy, University of Suffolk, Ipswich IP4 1QJ, UK
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Harding AJE, Doherty J, Bavelaar L, Walshe C, Preston N, Kaasalainen S, Sussman T, van der Steen JT, Cornally N, Hartigan I, Loucka M, Vlckova K, Di Giulio P, Gonella S, Brazil K. A family carer decision support intervention for people with advanced dementia residing in a nursing home: a study protocol for an international advance care planning intervention (mySupport study). BMC Geriatr 2022; 22:822. [PMID: 36289458 PMCID: PMC9607827 DOI: 10.1186/s12877-022-03533-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background Where it has been determined that a resident in a nursing home living with dementia loses decisional capacity, nursing home staff must deliver care that is in the person's best interests. Ideally, decisions should be made involving those close to the person, typically a family carer and health and social care providers. The aim of the Family Carer Decisional Support intervention is to inform family carers on end-of-life care options for a person living with advanced dementia and enable them to contribute to advance care planning. This implementation study proposes to; 1) adopt and apply the intervention internationally; and, 2) train nursing home staff to deliver the family carer decision support intervention. Methods This study will employ a multiple case study design to allow an understanding of the implementation process and to identify the factors which determine how well the intervention will work as intended. We will enrol nursing homes from each country (Canada n = 2 Republic of Ireland = 2, three regions in the UK n = 2 each, The Netherlands n = 2, Italy n = 2 and the Czech Republic n = 2) to reflect the range of characteristics in each national and local context. The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework will guide the evaluation of implementation of the training and information resources. Our mixed methods study design has three phases to (1) establish knowledge about the context of implementation, (2) participant baseline information and measures and (3) follow up evaluation. Discussion The use of a multiple case study design will enable evaluation of the intervention in different national, regional, cultural, clinical, social and organisational contexts, and we anticipate collecting rich and in-depth data. While it is hoped that the intervention resources will impact on policy and practice in the nursing homes that are recruited to the study, the development of implementation guidelines will ensure impact on wider national policy and practice. It is our aim that the resources will be sustainable beyond the duration of the study and this will enable the resources to have a longstanding relevance for future advance care planning practice for staff, family carers and residents with advanced dementia.
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Affiliation(s)
- Andrew J E Harding
- grid.9835.70000 0000 8190 6402Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Julie Doherty
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - Laura Bavelaar
- grid.5132.50000 0001 2312 1970Leiden University Medical Centre, Leiden University, Leiden, The Netherlands
| | - Catherine Walshe
- grid.9835.70000 0000 8190 6402Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- grid.9835.70000 0000 8190 6402Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sharon Kaasalainen
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, Hamilton, Canada
| | - Tamara Sussman
- grid.14709.3b0000 0004 1936 8649School of Social Work, McGill University, Hamilton, Canada
| | - Jenny T van der Steen
- grid.5132.50000 0001 2312 1970Leiden University Medical Centre, Leiden University, Leiden, The Netherlands
| | - Nicola Cornally
- grid.7872.a0000000123318773School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | - Irene Hartigan
- grid.7872.a0000000123318773School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | | | | | - Paola Di Giulio
- grid.7605.40000 0001 2336 6580Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Silvia Gonella
- grid.7605.40000 0001 2336 6580Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Kevin Brazil
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
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7
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McLaughlin D, Hasson F, Reid J, Brazil K, Rutherford L, Stone C, van der Steen JT, Ballentine J. Evaluating a partnership model of hospice enabled dementia care: A three-phased monitoring, focus group and interview study. Palliat Med 2022; 36:1351-1363. [PMID: 36065098 PMCID: PMC9606481 DOI: 10.1177/02692163221116763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND People with dementia and their caregivers often lack equitable access to hospice care which is a concern internationally. Domains of best practice in palliative care for this population exist and hospices are urged to become dementia friendly. AIM This study aimed to evaluate the model of 'Hospice Enabled Dementia Partnership' mapped to international domains of best practice. DESIGN Three-phased monitoring, group interview and individual interview study using a formative evaluation framework. SETTINGPARTICIPANTS The partnership model was a collaboration between a large specialist palliative care hospice, a dementia charity and a Health Care Trust in the United Kingdom. Service documents were subjected to documentary review of monitoring activity and key indicators of service success. Group interviews and individual interviews took place with family carers (n = 12), health care professionals involved in delivering the service (n = 32) and senior professionals (n = 5) responsible for service commissioning in palliative or dementia care. RESULTS One hundred people with dementia were referred to the service between May 2016 and December 2017. Thirty-eight of the 42 people who died, achieved their preferred place of care and died at home. Four themes were derived from the data 'Impact of Dementia', 'Value of the Service', 'Information and Learning Needs' and 'Working in Partnership'. CONCLUSIONS Positive outcomes resulted from this best practice model; achievement of preferred place of care and death at home, dual benefits of therapies for patients and families and partnership in cross working and learning between services. Replication of this model should be considered internationally.
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Affiliation(s)
- Dorry McLaughlin
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen's University, Belfast, Northern Ireland
| | - Felicity Hasson
- Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, Northern Ireland
| | - Joanne Reid
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen's University, Belfast, Northern Ireland
| | - Kevin Brazil
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen's University, Belfast, Northern Ireland
| | - Lesley Rutherford
- School of Nursing and Midwifery & Centre for Evidence and Social Innovation, Queen's University, Belfast, Northern Ireland.,Belfast Health and Social Care Trust, Marie Curie Hospice, Belfast, Northern Ireland
| | - Carol Stone
- Belfast Health and Social Care Trust, Marie Curie Hospice, Belfast, Northern Ireland
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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McMahon J, Thompson DR, Brazil K, Ski CF. An eHealth intervention (ManGuard) to reduce cardiovascular disease risk in male taxi drivers: protocol for a feasibility randomised controlled trial. Pilot Feasibility Stud 2022; 8:209. [PMID: 36104740 PMCID: PMC9472349 DOI: 10.1186/s40814-022-01163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 08/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background Men are at higher risk then women of developing cardiovascular disease (CVD), and male taxi drivers are a particularly high-risk group because of their typically unhealthy behaviours, such as poor eating habits, smoking and sedentary lifestyle. However, only two studies of behavioural interventions targeting taxi drivers have been identified, one of which reported a high attrition rate. Therefore, an eHealth intervention co-designed by taxi drivers may prove more acceptable and effective. The aim of this study is to assess the feasibility an eHealth intervention (ManGuard) to reduce CVD risk in male taxi drivers. Methods A randomised wait-list controlled trial will be conducted with a sample of 30 male taxi drivers to establish feasibility, including recruitment, engagement, and retention rates. Program usability and participant satisfaction will be assessed by a survey completed by all participants at 3 months after allocation. Additionally, an in-depth qualitative process evaluation to explore acceptability of the intervention will be conducted with a subset of participants by semi-structured telephone interviews. Preliminary efficacy of ManGuard for improving key CVD-related outcomes will be assessed, including biomarkers (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, and total/HDL cholesterol ratio), blood pressure, anthropometry (body mass index, body fat percentage, and waist circumference), physical activity (accelerometery, and self-report) and psychosocial status (health-related quality of life, self-efficacy, and social support). Outcomes will be assessed at baseline, 7 weeks, and 3 months after group allocation. The wait-list control group will be offered access to the intervention at the completion of data collection. Discussion eHealth interventions show potential for promoting behaviour change and reducing CVD risk in men, yet there remains a paucity of robust evidence pertaining to male taxi drivers, classified as a high-risk group. This study uses a randomised controlled trial to assess the feasibility of ManGuard for reducing CVD risk in male taxi drivers. It is envisaged that this study will inform a fully powered trial that will determine the effectiveness of eHealth interventions for this high risk and underserved population. Trial registration This trial has been registered prospectively on the ISRCTN registry on 5 January 2022, registration number ISRCTN29693943 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01163-4.
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9
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Gonella S, Di Giulio P, Angaramo M, Dimonte V, Campagna S, Brazil K, MySupport Study Group. Implementing a nurse-led quality improvement project in nursing home during COVID 19 pandemic: A qualitative study. Int Health Trends & Persp 2022. [DOI: 10.32920/ihtp.v2i2.1631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: There is broad consensus that the quality of nursing home (NH) care is a research priority to advance NH practice. However, NHs often fail to implement quality improvement (QI) research projects and complex circumstances such as Coronavirus disease 19 (COVID-19) pandemic may further hinder compliance. This study aims to describe the challenges associated with implementing a nurse-led QI project in NH during COVID-19 pandemic and potential strategies for their overcoming. Methods: A descriptive qualitative study was performed, and three data collection strategies employed, including: 1. semi-structured, open-ended interviews with follow-up questions (one NH manager, three members of the NH staff, and two family caregivers of people with advanced dementia); 2. research diary; and 3. in-the-field-notes. A combined deductive and inductive content analysis was adopted to analyze data. Results: Challenges may be anticipated or unanticipated. QI projects should include preliminary assessments to identify the willingness to change and establish partnerships at multiple levels with all stakeholders, adjust the implementation plan to the organizational context, and be open to ongoing changes. Conclusions: Early and regular engagement of stakeholders strengthen relationships. Moreover, an ongoing reflective practice throughout the entire implementation process promotes openness to change, and finally learning and improvement.
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Ski CF, Mcmahon J, Mcmahon J, Brazil K, Brazil K, Thompson DR, Thompson DR. ManGuard an eHealth intervention to reduce cardiovascular risk in male taxi drivers: a pilot randomised controlled trial protocol. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Department for the Economy, Northern Ireland
Background
Men are at higher risk then women of developing cardiovascular disease (CVD) and male taxi drivers are a particularly high risk group because of their typically unhealthy behaviours, such as poor eating habits, smoking and a sedentary lifestyle. However, only two studies of behavioural interventions targeting taxi drivers have been identified, one of which had a high attrition rate. Therefore, an eHealth intervention co-designed by taxi drivers may prove more user-friendly and effective.
Purpose
The aim of this study is to assess the feasibility of a randomised controlled trial (RCT) of an eHealth intervention – ManGuard – to reduce CVD risk in male taxi drivers.
Methods
A wait-list controlled trial of 30 male taxi drivers in Belfast, Northern Ireland, will be assigned randomly to an intervention or usual care group. The ManGuard Application comprises seven modules: i) introduction and goal setting, ii) being active iii) eating well, iv) managing stress, v) smoking, vi) alcohol and vii) keep accelerating, the latter to be used as a re-cap module. This trial will establish feasibility, including recruitment, engagement and retention rates, program usability and participant satisfaction, as well as preliminary efficacy of ManGuard in improving key outcomes. Primary outcome is to determine the feasibility of an eHealth intervention for reducing CVD risk in male taxi drivers by assessing the following outcome measures:
o Acceptability, recruitment, retention and engagement rates
o Usability and participant satisfaction, process evaluation and survey
The secondary outcome is to evaluate the preliminary efficacy of ManGuard compared to usual care in improving the following outcomes:
o Clinical indices: CVD biomarkers (cholesterol, glucose), blood pressure, anthropometry (BMI, waist circumference, body fat percentage)
o Physical activity
o Psychosocial status: health related quality of life, self-efficacy, social support
An in-depth qualitative process evaluation to explore acceptability of the intervention will also be conducted.
Trial registration: This trial has been registered prospectively on the ISRCTN registry on 5 January 2022
Conclusion
eHealth interventions have been shown to promote behaviour change and reduce CVD risk in men, but there is a lack of robust evidence for this in male taxi drivers, a high-risk group. This study aims to assess the feasibility of a future RCT assessing the impact of ManGuard on CVD risk in male taxi drivers. This study will inform a fully-powered trial that will provide robust evidence for eHealth interventions for this underserved population.
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Affiliation(s)
- C F Ski
- University of Suffolk , Ipswich , United Kingdom of Great Britain & Northern Ireland
| | - J Mcmahon
- Queen's University of Belfast , Belfast , United Kingdom of Great Britain & Northern Ireland
| | - J Mcmahon
- Queen's University of Belfast , Belfast , United Kingdom of Great Britain & Northern Ireland
| | - K Brazil
- Queen's University of Belfast , Belfast , United Kingdom of Great Britain & Northern Ireland
| | - K Brazil
- Queen's University of Belfast , Belfast , United Kingdom of Great Britain & Northern Ireland
| | - D R Thompson
- Queen's University of Belfast , Belfast , United Kingdom of Great Britain & Northern Ireland
| | - D R Thompson
- Queen's University of Belfast , Belfast , United Kingdom of Great Britain & Northern Ireland
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11
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Brazil K, Cardwell C, Carter G, Clarke M, Corry DAS, Fahey T, Gillespie P, Hobbins A, McGlade K, O'Halloran P, O'Neill N, Wallace E, Doyle F. Anticipatory care planning for community-dwelling older adults at risk of functional decline: a feasibility cluster randomized controlled trial. BMC Geriatr 2022; 22:452. [PMID: 35610581 PMCID: PMC9131621 DOI: 10.1186/s12877-022-03128-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 05/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To determine the feasibility, implementation and outcomes of an Anticipatory Care Planning (ACP) intervention in primary care to assist older adults at risk of functional decline by developing a personalized support plan. Design Feasibility cluster randomized control trial. Setting and participants Eight primary care practices (four in Northern Ireland, United Kingdom and four in the Republic of Ireland) were randomly assigned to either intervention or control arm. Eligible patients were those identified in each practice as 70 years of age or older and assessed as at risk of functional decline. Study participants (intervention n = 34, control n = 31) and research staff were not blinded to group assignment. Anticipatory care intervention The intervention delivered by a registered nurse including: a) a home-based patient assessment; b) care planning on the basis of a holistic patient assessment, and c) documentation of a support plan. Outcome measures A conceptual framework (RE-AIM) guided the assessment on the potential impact of the ACP intervention on patient quality of life, mental health, healthcare utilisation, costs, perception of person-centred care, and reduction of potentially inappropriate prescribing. Data were collected at baseline and at 10 weeks and six months following delivery of the intervention. Results All pre-specified feasibility indicators were met. Patients were unanimous in the acceptance of the ACP intervention. Health care providers viewed the ACP intervention as feasible to implement in routine clinical practice with attending community supports. While there were no significant differences on the primary outcomes (EQ-5D-5L: -0.07 (-0.17, 0.04) p = .180; CES-D: 1.2 (-2.5, 4.8) p = .468) and most secondary measures, ancillary analysis on social support showed responsiveness to the intervention. Incremental cost analysis revealed a mean reduction in costs of €320 per patient (95% CI -31 to 25; p = 0.82) for intervention relative to the control. Conclusions We successfully tested the ACP intervention in primary care settings and have shown that it is feasible to implement. The ACP intervention deserves further testing in a definitive trial to determine whether its implementation would lead to better outcomes or reduced costs. Trial registration Clinicaltrials.gov, ID: NCT03902743. Registered on 4 April 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03128-x.
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Affiliation(s)
- Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Christopher Cardwell
- Centre for Public Health, ICSB, Royal Victoria Hospital, Queen's University, Belfast, UK
| | - Gillian Carter
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Mike Clarke
- Centre for Public Health, ICSB, Royal Victoria Hospital, Queen's University, Belfast, UK
| | - Dagmar Anna S Corry
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Tom Fahey
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Patrick Gillespie
- Health Economics and Policy Analysis Centre, Institute for Lifecourse and Society, National University of Ireland, Galway (NUI Galway), Republic of Ireland
| | - Anna Hobbins
- Health Economics and Policy Analysis Centre, Institute for Lifecourse and Society, National University of Ireland, Galway (NUI Galway), Republic of Ireland
| | - Kieran McGlade
- School of Medicine, Dentistry, and Biomedical Sciences, Dunluce Health Centre, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Peter O'Halloran
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Nina O'Neill
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland.,Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Frank Doyle
- Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
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12
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Bavelaar L, McCann A, Cornally N, Hartigan I, Kaasalainen S, Vankova H, Di Giulio P, Volicer L, Arcand M, van der Steen JT, Brazil K. Guidance for family about comfort care in dementia: a comparison of an educational booklet adopted in six jurisdictions over a 15 year timespan. Palliat Care 2022; 21:76. [PMID: 35578219 PMCID: PMC9112535 DOI: 10.1186/s12904-022-00962-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 04/28/2022] [Indexed: 11/07/2022] Open
Abstract
Background To support family caregivers of people with dementia in end-of-life decision making, a family booklet on comfort care has been adapted and adopted by several European jurisdictions since the original publication in Canada in 2005. Methods We analyzed and compared the adaptations to the family booklets used in Canada, the Czech Republic, Italy, the Netherlands, the UK and Ireland that were made up to 2021. Qualitative content analysis was used to create a typology of changes to the original booklet. Interviews with the teams that adapted the booklets contributed to methodological triangulation. Further, using an established framework, we assessed whether the contents of the booklets addressed all domains relevant to optimal palliative dementia care. Results The booklets differed in the types of treatment addressed, in particular tube feeding, euthanasia, and spiritual care. There was also variability in the extent to which medical details were provided, an emphasis on previously expressed wishes in medical decision making, addressing of treatment dilemmas at the end of life, the tone of the messages (indirect or explicit) and the discussion of prognosis (as more or less positive), and the involvement of various healthcare professionals and family caregivers in care. All booklets addressed all domains of palliative dementia care. Conclusions We identified core elements in providing information on end-of-life care to family caregivers of people with dementia as related to optimal palliative care in dementia. Additionally, local adaptations and updates are required to account for socio-cultural, clinical, and legal differences which may also change over time. These results may inform development of educational and advance care planning materials for different contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00962-z.
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Cousins E, Preston N, Doherty J, Varey S, Harding A, McCann A, Harrison Dening K, Finucane A, Carter G, Mitchell G, Brazil K. Implementing and evaluating online advance care planning training in UK nursing homes during COVID-19: findings from the Necessary Discussions multi-site case study project. BMC Geriatr 2022; 22:419. [PMID: 35562712 PMCID: PMC9098790 DOI: 10.1186/s12877-022-03099-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advance care planning in nursing homes is important to ensure the wishes and preferences of residents are recorded, especially during the COVID-19 pandemic. However, care staff and family members frequently report feeling unprepared for these conversations. More resources are needed to support them with these necessary discussions. This research aimed to develop, implement and evaluate a website intervention for care staff and family members to provide training and information about advance care planning during COVID-19. METHODS The research was a primarily qualitative case study design, comprising multiple UK nursing home cases. Data collection included semi-structured interviews with care staff and family members which were coded and analysed thematically. A narrative synthesis was produced for each case, culminating in a thematic cross-case analysis of the total findings. Theoretical propositions were refined throughout the research. RESULTS Eight nursing homes took part in the study, involving 35 care staff and 19 family members. Findings were reported according to the RE-AIM framework which identified the reach, effectiveness, adoption, implementation and maintenance of the intervention. Themes included: website content that was well received; suggestions for improvement; implementation barriers and facilitators; examples of organisational and personal impact. CONCLUSIONS Four theoretical propositions relating to advance care planning in nursing homes are presented, relating to: training and information needs, accessibility, context, and encouraging conversations. Implications for practice and training include an awareness of diverse learning styles, re-enforcing the right to be involved in advance care planning and encouraging opportunities for facilitated discussion. TRIAL REGISTRATION ISRCTN registry (ID 18003630 ) on 19.05.21.
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Affiliation(s)
- Emily Cousins
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Julie Doherty
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Sandra Varey
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Andrew Harding
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Adrienne McCann
- Innovation Value Institute, Maynooth University, Maynooth & Age Friendly Ireland, Ireland
| | - Karen Harrison Dening
- School of Nursing and Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester & Dementia UK, London, UK
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh & Marie Curie Hospice Edinburgh, Edinburgh, UK
| | - Gillian Carter
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
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14
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Bavelaar L, Nicula M, Morris S, Kaasalainen S, Achterberg WP, Loucka M, Vlckova K, Thompson G, Cornally N, Hartigan I, Harding A, Preston N, Walshe C, Cousins E, Dening KH, De Vries K, Brazil K, van der Steen JT. Developing country-specific questions about end-of-life care for nursing home residents with advanced dementia using the nominal group technique with family caregivers. Patient Educ Couns 2022; 105:965-973. [PMID: 34376304 DOI: 10.1016/j.pec.2021.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We aimed to develop question prompt lists (QPLs) for family caregivers of nursing home residents with advanced dementia in the context of a study involving Canada, the Czech Republic, Italy, the Netherlands, the United Kingdom and Ireland, and to explore cross-national differences. QPLs can encourage family caregivers to ask questions about their relative's end-of-life care. METHODS We used nominal group methods to create country-specific QPLs. Family caregivers read an information booklet about end-of-life care for people with dementia, and generated questions to ask healthcare professionals. They also selected questions from a shortlist. We analyzed and compared the QPLs using content analysis. RESULTS Four to 20 family caregivers per country were involved. QPLs ranged from 15 to 24 questions. A quarter (24%) of the questions appeared in more than one country's QPL. One question was included in all QPLs: "Can you tell me more about palliative care in dementia?". CONCLUSION Family caregivers have many questions about dementia palliative care, but the local context may influence which questions specifically. Local end-user input is thus important to customize QPLs. PRACTICE IMPLICATIONS Prompts for family caregivers should attend to the unique information preferences among different countries. Further research is needed to evaluate the QPLs' use.
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Affiliation(s)
- Laura Bavelaar
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Nicula
- School of Nursing, McMaster University, Ontario, Canada
| | - Sophie Morris
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Irene Hartigan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Andrew Harding
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Catherine Walshe
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Emily Cousins
- School of Nursing and Midwifery, De Montfort University, Leicester, UK
| | - Karen Harrison Dening
- School of Nursing and Midwifery, De Montfort University, Leicester, UK; Dementia UK , London, UK
| | - Kay De Vries
- School of Nursing and Midwifery, De Montfort University, Leicester, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands; Department of Primary and Community Care, Radboud uNiversity Medical Center, Nijmegen, The Netherlands.
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15
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Corry DAS, Carter G, Doyle F, McGlade K, O'Halloran P, Wallace E, Brazil K. Lessons from a feasibility study testing an anticipatory care planning intervention for older adults at risk of functional decline: feedback from implementing stakeholders. Pilot Feasibility Stud 2022; 8:10. [PMID: 35045877 PMCID: PMC8767659 DOI: 10.1186/s40814-022-00973-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background Anticipatory care is becoming increasingly important in effectively managing complex multimorbidity in aging populations, preventing further functional decline, and avoiding hospital admissions. This study aimed to elicit the feedback of participating general practitioners, practice managers, nurses and an adjunct pharmacist on the implementation strengths and limitations of a nurse-led, person-centered anticipatory care planning (ACP) intervention for older people at risk of functional decline in a primary care setting. The findings have implications for a full trial and intervention design. Methods As part of a feasibility cluster randomized controlled trial (cRCT) testing the ACP intervention, we sought feedback from implementing stakeholders: general practitioners (N = 3), practice staff (N = 3), research nurses (N = 5), and adjunct pharmacist (N = 1) in both the Republic of Ireland (ROI) and Northern Ireland (NI), UK. Following written, informed consent, they were interviewed to investigate their experience of participating in the implementation of the ACP intervention as part of the feasibility trial, and elicit any recommendations for a full trial. Using the Consolidated Framework for Implementation Research, thematic analysis was employed to analyze data. The intervention consisted of home visits by specially trained nurses who assessed participants’ health, discussed with them their health goals and plans, and devised an anticipatory care plan following consultation with participants’ General Practitioners and the adjunct clinical pharmacist. Results Participating stakeholders indicated that the strengths of the implementation process included the training provided to the nurses, constructive collaboration of the research team, and structure of implementation process. Perceived limitations included the selection process and screening tool, communication between the research team and the nurses, the assessment questionnaire, and the final document left with the patient, as well as lack of access to medical records for the adjunct pharmacist. Recommendations include better communication and team-wide consensus on alterations to procedure and documents, and standardized protocols for patient selection, data collection, and reporting for research nurses. Conclusions The findings have identified strengths of the implementation process on which to build, and recognized limitations which can now be addressed to ensure improved efficiency and effectiveness in future trials. Trial registration Clinicaltrials.gov, ID: NCT03902743. Registered on 4 April 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-00973-w.
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Affiliation(s)
- Dagmar Anna S Corry
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK. .,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Gillian Carter
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Frank Doyle
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Kieran McGlade
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Dunluce Health Centre, Belfast, Northern Ireland, UK
| | - Peter O'Halloran
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Emma Wallace
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland.,Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Kevin Brazil
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK. .,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
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16
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Matthys O, De Vleminck A, Dierickx S, Deliens L, Van Goethem V, Lapeire L, Groenvold M, Lund L, Arnfeldt CM, Sengeloev L, Pappot H, Johnsen AT, Guerin S, Larkin PJ, Jordan C, Connolly M, D'Alton P, Costantini M, Di Leo S, Guberti M, Turola E, van der Heide A, Witkamp E, Rietjens J, van der Wel M, Brazil K, Prue G, Reid J, Scott D, Bristowe K, Harding R, Normand C, May P, Cronin C, Northouse L, Hudson P, Cohen J. Effectiveness of a nurse-delivered (FOCUS+) and a web-based (iFOCUS) psychoeducational intervention for people with advanced cancer and their family caregivers (DIAdIC): study protocol for an international randomized controlled trial. BMC Palliat Care 2021; 20:193. [PMID: 34963453 PMCID: PMC8713043 DOI: 10.1186/s12904-021-00895-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/10/2021] [Indexed: 11/21/2022] Open
Abstract
Background Worldwide, millions of people with advanced cancer and their family caregivers are experiencing physical and psychological distress. Psychosocial support and education can reduce distress and prevent avoidable healthcare resource use. To date, we lack knowledge from large-scale studies on which interventions generate positive outcomes for people with cancer and their informal caregivers’ quality of life. This protocol describes the DIAdIC study that will evaluate the effectiveness of two psychosocial and educational interventions aimed at improving patient-family caregiver dyads’ emotional functioning and self-efficacy. Methods We will conduct an international multicenter three-arm randomized controlled trial in Belgium, Denmark, Ireland, Italy, The Netherlands, and the United Kingdom. In each country, 156 dyads (936 in total) of people with advanced cancer and their family caregiver will be randomized to one of the study arms: 1) a nurse-led face-to-face intervention (FOCUS+), 2) a web-based intervention (iFOCUS) or 3) a control group (care as usual). The two interventions offer tailored psychoeducational support for patient-family caregiver dyads. The nurse-led face-to-face intervention consists of two home visits and one online video session and the web-based intervention is completed independently by the patient-family caregiver dyad in four online sessions. The interventions are based on the FOCUS intervention, developed in the USA, that addresses five core components: family involvement, optimistic outlook, coping effectiveness, uncertainty reduction, and symptom management. The FOCUS intervention will be adapted to the European context. The primary outcomes are emotional functioning and self-efficacy of the patient and the family caregiver, respectively. The secondary outcomes are quality of life, benefits of illness, coping, dyadic communication, and ways of giving support of the patient and family caregiver. Discussion DIAdIC aims to develop cost-effective interventions that integrate principles of early palliative care into standard care. The cross-country setup in six European countries allows for comparison of effectiveness of the interventions in different healthcare systems across Europe. By focusing on empowerment of the person with cancer and their family caregiver, the results of this RCT can contribute to the search for cost-effective novel interventions that can relieve constraints on professional healthcare. Trial registration Registration on ClinicalTrials.gov on 12/11/2020, identifier NCT04626349. Date and version identifier 20211209_DIAdIC_Protocol_Article. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00895-z.
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Affiliation(s)
- Orphé Matthys
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Aline De Vleminck
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Sigrid Dierickx
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Vincent Van Goethem
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Lore Lapeire
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen and Palliative Care Research Unit, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Line Lund
- Department of Public Health, University of Copenhagen and Palliative Care Research Unit, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Caroline Moeller Arnfeldt
- Department of Public Health, University of Copenhagen and Palliative Care Research Unit, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lisa Sengeloev
- Department of Oncology, Herlev Gentofte University Hospital, Herlev, Denmark
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Suzanne Guerin
- UCD School of Psychology, University College Dublin, Belfield, Ireland
| | - Philip J Larkin
- Palliative and Supportive Care Service, Chair of Palliative Care Nursing, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Catherine Jordan
- UCD School of Psychology, University College Dublin, Belfield, Ireland
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Paul D'Alton
- UCD School of Psychology, University College Dublin, Belfield, Ireland
| | - Massimo Costantini
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Di Leo
- Psycho-oncology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Monica Guberti
- Nursing & Health Care Professions Directorate, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Elena Turola
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Agnes van der Heide
- Deparmtent of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Erika Witkamp
- Deparmtent of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Judith Rietjens
- Deparmtent of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maaike van der Wel
- Deparmtent of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - Gillian Prue
- School of Nursing and Midwifery, Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - David Scott
- School of Nursing and Midwifery, Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - Katherine Bristowe
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Richard Harding
- King's College London, Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, London, UK
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.,Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Peter May
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.,The Irish Longitudinal Study on Ageing, Dublin, Ireland
| | - Catherine Cronin
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | | | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital, Melbourne, Australia.,Vrije University Brussels (VUB), Brussels, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
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Tinkler M, Reid J, Brazil K. Co-Design of an Evidenced Informed Service Model of Integrated Palliative Care for Persons Living with Severe Mental Illness: A Qualitative Exploratory Study. Healthcare (Basel) 2021; 9:1710. [PMID: 34946437 PMCID: PMC8701131 DOI: 10.3390/healthcare9121710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Globally, close to one billion people are living with a mental health disorder, and it is one of the most neglected areas in Public Health. People with severe mental illness have greater mortality risk than the general population, experience health care inequalities throughout life and represent a vulnerable, under-served and under-treated population, who have been overlooked in health inequality research to date. There is currently a dearth of evidence in relation to understanding the palliative care needs of people with severe mental illness and how future care delivery can be designed to both recognise and respond to those needs. This study aims to co-design an evidenced informed service model of integrated palliative care for persons living with a severe mental illness. METHODS This qualitative sequential study underpinned by interpretivism will have six phases. An expert reference group will be established in Phase 1, to inform all stages of this study. Phase 2 will include a systematic literature review to synthesise current evidence in relation to palliative care service provision for people with severe mental illness. In Phase 3, qualitative interviews will be undertaken with both, patients who have a severe mental illness and in receipt of palliative care (n = 13), and bereaved caregivers of people who have died 6-18 months previously with a diagnosis of severe mental illness (n = 13), across two recruitment sties in the United Kingdom. Focus groups (n = 4) with both mental health and palliative care multidisciplinary staff will be undertaken across the two recruitment sites in Phase 4. Phase 5 will involve the co-design of a service model of integrated palliative care for persons living with severe mental illness. Phase 6 will develop practice recommendations for this client cohort. DISCUSSION Palliative care needs to be available at all levels of care systems; it is estimated that, globally, only 14% of patients who need palliative care receive it. Reducing inequalities experienced by people with severe mental illness is embedded in the National Health Service Long Term Plan. Internationally, the gap between those with a mental illness needing care and those with access to care remains considerable. Future policy and practice will benefit from a better understanding of the needs of this client cohort and the development of a co-designed integrated care pathway to facilitate timely access to palliative care for people with a severe mental illness.
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Affiliation(s)
- Marianne Tinkler
- Northern Health and Social Care Trust, Antrim BT41 2RL, UK;
- Medical Biology Centre, School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK;
| | - Joanne Reid
- Medical Biology Centre, School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK;
| | - Kevin Brazil
- Medical Biology Centre, School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK;
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18
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De Panfilis L, Peruselli C, Artioli G, Perin M, Bruera E, Brazil K, Tanzi S. A Qualitative Study on Nudging and Palliative Care: "An Attractive but Misleading Concept". Int J Environ Res Public Health 2021; 18:ijerph18189575. [PMID: 34574501 PMCID: PMC8468152 DOI: 10.3390/ijerph18189575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/04/2022]
Abstract
The debate about the ethical decision-making process in the healthcare context has been enriched with a theory called “nudging”, which has been defined as the framing of information that can significantly influence behaviour without restricting choice. The literature shows very limited data on the opinion and experience of palliative care healthcare professionals on the use of nudging techniques in their care setting. The aim of this study is to explore the beliefs of experienced palliative care professionals towards nudging. We performed a qualitative study using textual data collected through a focus group. It was audio-recorded, and the transcripts were subjected to a thematic analysis. It was performed within an oncological research hospital with a small and multidisciplinary group of healthcare professionals specialised in PC. Participants reported two overarching positions grounded in two main themes: (1) translating nudging in the PC setting and (2) towards a neutral space. The participants found few justifications for the use of nudging in the PC field, even if it can be very attractive and reassuring. Participants also expressed concerns about the excessive risk of developing pure paternalism.
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Affiliation(s)
- Ludovica De Panfilis
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
- Correspondence: ; Tel.: +39-0522-269212
| | - Carlo Peruselli
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (C.P.); (G.A.); (S.T.)
| | - Giovanna Artioli
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (C.P.); (G.A.); (S.T.)
| | - Marta Perin
- Bioethics Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, & Integrative Medicine, UT MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK;
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (C.P.); (G.A.); (S.T.)
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19
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Corry DAS, Carter G, Doyle F, Fahey T, Gillespie P, McGlade K, O'Halloran P, O'Neill N, Wallace E, Brazil K. Successful implementation of a trans-jurisdictional, primary care, anticipatory care planning intervention for older adults at risk of functional decline: interviews with key health professionals. BMC Health Serv Res 2021; 21:871. [PMID: 34433441 PMCID: PMC8387014 DOI: 10.1186/s12913-021-06896-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023] Open
Abstract
Background Aging populations present a challenge to health systems internationally, due to the increasing complexity of care for older adults living with functional decline. This study aimed to elicit expert views of key health professionals on effective and sustainable implementation of a nurse-led, person-centred anticipatory care planning (ACP) intervention for older adults at risk of functional decline in a primary care setting. Methods We examined the feasibility of an ACP intervention in a trans-jurisdictional feasibility cluster randomized controlled trial consisting of home visits by research nurses who assessed participants’ health, discussed their health goals and devised an anticipatory care plan following consultation with participants’ GPs and adjunct clinical pharmacist. As part of the project, we elicited the views and recommendations of experienced key health professionals working with the target population who were recruited using a ‘snowballing technique’ in cooperation with older people health networks in the Republic of Ireland (ROI) and Northern Ireland (NI), United Kingdom [n = 16: 7 ROI, 9 NI]. Following receipt of written information about the intervention and the provision of informed consent, the health professionals were interviewed to determine their expert views on the feasibility of the ACP intervention and recommendations for successful implementation. Data were analyzed using thematic analysis. Results The ACP intervention was perceived to be beneficial for most older patients with multimorbidity. Effective and sustainable implementation was said to be facilitated by accurate and timely patient selection, GP buy-in, use of existing structures within health systems, multidisciplinary and integrated working, ACP nurse training, as well as patient health literacy. Barriers emerged as significant work already undertaken, increasing workload, lack of time, funding and resources, fragmented services, and geographical inequalities. Conclusions The key health professionals perceived the ACP intervention to be highly beneficial to patients, with significant potential to prevent or avoid functional decline and hospital admissions. They suggested that successful implementation of this primary care based, whole-person approach would involve integrated and multi-disciplinary working, GP buy in, patient health education, and ACP nurse training. The findings have potential implications for a full trial, and patient care and health policy. Trial registration Clinicaltrials.gov, ID: NCT03902743. Registered on 4 April 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06896-1.
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Affiliation(s)
- Dagmar Anna S Corry
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK. .,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Gillian Carter
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Frank Doyle
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Tom Fahey
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Patrick Gillespie
- Health Economics and Policy Analysis Centre, National University of Ireland, Galway (NUI Galway), Galway, Republic of Ireland
| | - Kieran McGlade
- School of Medicine, Dentistry, and Biomedical Sciences, Dunluce Health Centre, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Peter O'Halloran
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Nina O'Neill
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland.,Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Kevin Brazil
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK. .,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
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20
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Harding A, Preston N, Doherty J, Cousins E, Varey S, McCann A, Dening KH, Finucane A, Carter G, Mitchell G, Brazil K. Developing and evaluating online COVID-centric advance care planning training and information resources for nursing staff and family members in nursing homes: the necessary discussions study protocol. BMC Geriatr 2021; 21:456. [PMID: 34372794 PMCID: PMC8350283 DOI: 10.1186/s12877-021-02398-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Nursing home residents are typically older adults with high levels of chronic illness and impairment. As such, they are particularly susceptible to severe complications and mortality from COVID-19. Since all nursing home residents are at increased risk, nursing home care staff need to know what residents would want to happen should they become infected with COVID-19. This study aims to develop and evaluate advance care planning (ACP) COVID-centric online training and information resources for nursing home staff and family members of residents, to improve care at the end of life during a COVID-19 outbreak. Based on the findings we will develop implementation guidelines for nursing homes to ensure wider impact and application during the pandemic and beyond. Methods The content of the training and information resources will be based on a rapid review of literature and guidance on ACP in the context of COVID-19 and consultation with the study expert reference group. An integrated communications company will then work alongside the research team to design the online training and information resources. To evaluate the resources, we will employ a multiple case study design where a nursing home (defined as an institutional setting in which nursing care is provided to older adults on-site 24 h a day) will be the unit of analysis or ‘case’. The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework will guide the evaluation of implementation of the training and information resources. We will recruit and interview staff and family members from between 6 and 9 nursing homes across Northern Ireland, England and Scotland and gather quantitative data from a feedback survey included in the training and information resources. Discussion The Necessary Discussions study is very timely given the challenging experiences of nursing homes, their staff, residents and their family members during the COVID-19 pandemic. It meets a key need and addresses an important gap in research and practice. The training and information resources will be ‘COVID-centric’, but they will also have a longstanding relevance for future ACP practice in UK care homes. Trial registration ISRCTN registry (ID 18003630) on 19.05.21
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Affiliation(s)
- Andrew Harding
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Julie Doherty
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Emily Cousins
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sandra Varey
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Adrienne McCann
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Karen Harrison Dening
- School of Nursing and Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester & Dementia UK, London, UK
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh & Marie Curie Hospice Edinburgh, Edinburgh, UK
| | - Gillian Carter
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Gary Mitchell
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK.
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21
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Mcmahon J, Thompson DR, Pascoe MC, Brazil K, Ski CF. eHealth interventions for reducing cardiovascular disease risk in men: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Department for the Economy (DfE) studentships
Background. Men remain at a higher risk of developing cardiovascular disease (CVD) than women and behavioral risk factor modification is an important preventive measure. However, engaging men in behavior change interventions is challenging. eHealth interventions have the potential to address this gap, though their effectiveness for reducing CVD risk in men is unclear.
Purpose. To conduct a systematic review and meta-analysis to evaluate the effectiveness of eHealth interventions for reducing CVD risk in men.
Methods. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and principles laid out by the Cochrane Handbook for Systematic Reviews of Interventions. A search of published randomised controlled trials (RCTs) with no date restrictions up to July 2020 was conducted across five electronic databases: Cochrane Central register of Controlled Trials (CENTRAL), Medline, CINAHL Plus, PsycINFO and SCOPUS. Reference lists of relevant systematic reviews and meta-analyses were manually searched for additional trials not identified during the database search. Eligible studies were RCTs that focused on the use of eHealth to improve a minimum of two major CVD related risk factors in males aged 18 years or older.
Results. A total of 3168 records were retrieved from the online database search, with nine trials meeting the inclusion criteria following screening and full-text assessment. Study quality ranged from low to unclear, with one trial at a high risk of bias. Compared to those in a control group or receiving printed materials, participants randomised to an eHealth intervention had statistically significant improvements in BMI (Z=-2.75, p = 0.01), body weight (Z=-3.25, p = 0.01), waist circumference (Z=-2.30, p = 0.02) and systolic (Z=-3.57, p = 0.01) and diastolic (Z=-3.56, p = 0.01) blood pressure. Though less evident, there were also improvements in physical activity and diet in favour of the intervention group.
Conclusion. This was the first systematic review and meta-analysis conducted on the effectiveness of eHealth interventions for reducing CVD risk in men. This review suggests that eHealth interventions can reduce CVD risk in adult men through behavior change. However, we were unable to determine the association between intervention characteristics and outcomes. Also, overall, participant adherence to the intervention was poor. Both of these issues should be considered in future studies.
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Affiliation(s)
- J Mcmahon
- Queen"s University of Belfast, Belfast, United Kingdom of Great Britain & Northern Ireland
| | - DR Thompson
- Queen"s University of Belfast, Belfast, United Kingdom of Great Britain & Northern Ireland
| | - MC Pascoe
- Victoria University, Melbourne, Australia
| | - K Brazil
- Queen"s University of Belfast, Belfast, United Kingdom of Great Britain & Northern Ireland
| | - CF Ski
- University of Suffolk, Ipswich, United Kingdom of Great Britain & Northern Ireland
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22
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Corry DAS, Doherty J, Carter G, Doyle F, Fahey T, O’Halloran P, McGlade K, Wallace E, Brazil K. Acceptability of a nurse-led, person-centred, anticipatory care planning intervention for older people at risk of functional decline: A qualitative study. PLoS One 2021; 16:e0251978. [PMID: 34015046 PMCID: PMC8136649 DOI: 10.1371/journal.pone.0251978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 05/06/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND As the population of older adults increases, the complexity of care required to support those who choose to remain in the community amplifies. Anticipatory Care Planning (ACP), through earlier identification of healthcare needs, is evidenced to improve quality of life, decrease aggressive interventions, and prolong life. With patient acceptability of growing importance in the design, implementation, and evaluation of healthcare interventions, this study reports on the acceptability of a primary care based ACP intervention on the island of Ireland. METHODS As part of the evaluation of a feasibility cluster randomized controlled trial (cRCT) testing an ACP intervention for older people at risk of functional decline, intervention participants [n = 34] were interviewed in their homes at 10-week follow-up to determine acceptability. The intervention consisted of home visits by specifically trained registered nurses who assessed participants' health, discussed their health goals and plans, and devised an anticipatory care plan in collaboration with participants' GPs and adjunct clinical pharmacist. Thematic analysis was employed to analyze interview data. The feasibility cRCT involved eight general practitioner (GP) practices as cluster sites, stratified by jurisdiction, four in Northern Ireland (NI) (two intervention, two control), and four in the Republic of Ireland (ROI) (two intervention, two control). Participants were assessed for risk of functional decline. A total of 34 patients received the intervention and 31 received usual care. FINDINGS Thematic analysis resulted in five main themes: timing of intervention, understanding of ACP, personality & individual differences, loneliness & social isolation, and views on healthcare provision. These map across the Four Factor Model of Acceptability ('4FMA'), a newly developed conceptual framework comprising four components: intervention factors, personal factors, social support factors, and healthcare provision factors. CONCLUSION Acceptability of this primary care based ACP intervention was high, with nurses' home visits, GP anchorage, multidisciplinary working, personalized approach, and active listening regarded as beneficial. Appropriate timing, and patient health education emerged as vital.
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Affiliation(s)
- Dagmar A. S. Corry
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Julie Doherty
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Gillian Carter
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Frank Doyle
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Tom Fahey
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Peter O’Halloran
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Kieran McGlade
- School of Medicine, Dentistry, and Biomedical Sciences, Queen’s University Belfast, Dunluce Health Centre, Belfast, Northern Ireland, United Kingdom
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Kevin Brazil
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
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23
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McMahon J, Thompson DR, Pascoe MC, Brazil K, Ski CF. eHealth interventions for reducing cardiovascular disease risk in men: A systematic review and meta-analysis. Prev Med 2021; 145:106402. [PMID: 33388336 DOI: 10.1016/j.ypmed.2020.106402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/02/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
Men remain at a higher risk of developing cardiovascular disease (CVD) than women and behavioral risk factor modification is an important preventive measure. However, engaging men in behavior change interventions is challenging. Although men often indicate a preference for gender-specific information and support, this rarely occurs. eHealth interventions have the potential to address this gap, though their effectiveness for reducing CVD risk in men is unclear. Therefore, the aim of this systematic review and meta-analysis was to evaluate the effectiveness of eHealth interventions for reducing CVD risk in men. A search of published randomised controlled trials with no date restrictions up to July 2020 was conducted to identify those targeting at least two major CVD risk factors. Nine trials were identified and reviewed. Study quality ranged from low to unclear, with one trial at a high risk of bias. Compared to those in a control group or receiving printed materials, participants randomised to an eHealth intervention had statistically significant improvements in BMI (Z=-2.75, p=0.01), body weight (Z=-3.25, p=0.01), waist circumference (Z=-2.30, p=0.02) and systolic (Z=-3.57, p=0.01) and diastolic (Z=-3.56, p=0.01) blood pressure. Though less evident, there were also improvements in physical activity and diet in favour of the intervention group. This review suggests that eHealth interventions can reduce CVD risk in adult men through behavior change. However, we were unable to determine the association between intervention characteristics and outcomes. Also, overall, participant adherence to the intervention was poor. Both of these issues should be considered in future studies.
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Affiliation(s)
- James McMahon
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Michaela C Pascoe
- Institute for Health & Sport, Victoria University, Melbourne, Australia
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Chantal F Ski
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK; Integrated Care Academy, University of Suffolk, Ipswich, UK.
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24
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van der Steen JT, Galway K, Carter G, Brazil K. Corrigendum to 'Initiating advance care planning on end-of-life issues in dementia: Ambiguity among UK and Dutch physicians' [Archives of Gerontology and Geriatrics 65 (2016) 225-230/AGG 3314]. Arch Gerontol Geriatr 2021; 95:104382. [PMID: 33657490 DOI: 10.1016/j.archger.2021.104382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Jenny T van der Steen
- Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands; Radboud university medical center, Department of Primary and Community Care, Nijmegen, The Netherlands.
| | - Karen Galway
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, United Kingdom
| | - Gillian Carter
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, United Kingdom
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, United Kingdom
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25
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Chan AJ, O'Donnell D, Kaasa B, Mathers A, Papaioannou A, Brazil K, Paraschiv N, Goldstein M, Sadowski CA, Dolovich L. Barriers and facilitators of implementing an antimicrobial stewardship intervention for urinary tract infection in a long-term care facility. Can Pharm J (Ott) 2021; 154:100-109. [PMID: 33868521 DOI: 10.1177/1715163521989756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Fifty percent of antibiotic courses in long-term care facilities (LTCFs) are unnecessary, leading to increased risk of harm. Most studies to improve antibiotic prescribing in LTCFs showed modest and unsustained results. We aimed to identify facilitators, barriers and strategies in implementing a urinary tract infection (UTI)-focused antimicrobial stewardship (AS) intervention at a LTCF, with the secondary objective of exploring the pharmacist's potential roles. Methods The study used a qualitative descriptive design. Participants attended either a focus group or one-on-one interview. Data were analyzed inductively using a codebook modified in an iterative analytic process. Barrier and facilitator themes were mapped using the capability, opportunity, motivation and behaviour (COM-B) model. Similarly, themes were identified from the transcripts regarding the pharmacist's roles. Results Sixteen participants were interviewed. Most barriers and facilitators mapped to the opportunities domain of the COM-B model. The main barrier themes were lack of access, lack of knowledge, ineffective communication, lack of resources and external factors, while the main facilitator themes were education, effective collaboration, good communication, sufficient resources and access. For the pharmacist's role, the barrier themes were ineffective collaboration and communication. Conclusion This study supports the importance of tailoring interventions to target factors underlying barriers to behaviour change. At this LTCF, an effective antimicrobial stewardship intervention should incorporate strategies to improve access, knowledge, communication and collaboration in its design, having sufficient resources and addressing external factors to optimize its success and long-term sustainability. Can Pharm J (Ott) 2021;154:xx-xx.
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26
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Hasson F, Jordan J, McKibben L, Graham-Wisener L, Finucane A, Armour K, Zafar S, Hewison A, Brazil K, Kernohan WG. Challenges for palliative care day services: a focus group study. BMC Palliat Care 2021; 20:11. [PMID: 33435954 PMCID: PMC7802306 DOI: 10.1186/s12904-020-00699-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Palliative care day services provide a safe environment for people with palliative care needs, enabling them to access a range of services while acting as a respite services for family caregivers. Viewed as marginal services, they are often under resourced and under researched. The aim of this study was to understand how palliative day care services contribute to client care from the perspective of management and hospice multidisciplinary teams. METHODS A descriptive qualitative study, using six focus groups conducted with staff at three United Kingdom hospices in England, Scotland and Northern Ireland. Thirty-five participants were recruited, including management and staff. Discussions were transcribed and analysed thematically. RESULTS Four key themes emerged: (1) variations of care, beyond heterogeneity of patients; (2) unclear referrals and inconsistent patient population; (3) recognising strengths and challenges and (4) an uncertain future. A major focus of group discussions was the model of care and the benefits of the service, however the importance of demonstrating services' effectiveness and value for money was highlighted. CONCLUSIONS Management and hospice staff believed day-services to be a helpful introduction to palliative care, providing both social and medical support. Economic pressures and patient demand were influencing them to move from a social model to a hybrid model. Further research is needed to understand the effectiveness of the service.
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Affiliation(s)
- Felicity Hasson
- Ulster University, Institute of Nursing and Health Research, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland.
| | - Joanne Jordan
- Ulster University, Institute of Nursing and Health Research, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland
| | - Laurie McKibben
- Ulster University, Institute of Nursing and Health Research, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland
| | - Lisa Graham-Wisener
- School of Psychology, Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland
| | - Anne Finucane
- Marie Curie Hospice, Frogston Road West, Edinburgh, EH10 7DR, Scotland
| | - Kathy Armour
- Marie Curie Hospice, Marsh Lane Solihull, West Midlands, B91 2PQ, England
| | - Shazia Zafar
- University of Birmingham, Institute of Clinical Sciences, School of Nursing, College of Medical & Dental Services, Birmingham, BT15 2TT, England
| | - Alistair Hewison
- University of Birmingham, Institute of Clinical Sciences, School of Nursing, College of Medical & Dental Services, Birmingham, BT15 2TT, England
| | - Kevin Brazil
- School of Nursing and Midwifery Centre for Evidence and Social Innovation, Queens University, Belfast, BT7 1NN, Northern Ireland
| | - W George Kernohan
- Ulster University, Institute of Nursing and Health Research, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland
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27
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Bavelaar L, van der Steen HT, de Jong H, Carter G, Brazil K, Achterberg WP, van der Steen JT. Physicians' perceived barriers and proposed solutions for high-quality palliative care in dementia in the Netherlands: Qualitative analysis of survey data. J Nurs Home Res Sci 2021; 7:23-31. [PMID: 36506875 PMCID: PMC7613902 DOI: 10.14283/jnhrs.2021.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The literature indicates that palliative care for people with dementia needs to be enhanced. Objectives To assess barriers to providing high-quality palliative dementia care and potential solutions to overcome these barriers, as perceived by physicians responsible for end-of-life care with dementia. Design Cross-sectional study. Setting The Netherlands. Participants A representative sample of 311 elderly care physicians of whom 67% (n=207) responded. Measurements A postal survey in 2013 containing open-ended items probing for barriers in the elderly care physicians' practices and possible solutions. Answers were coded and grouped using qualitative content analysis and presented to expert physicians in 2021. Results Barriers to palliative care in dementia were (1) beliefs held by family, healthcare professionals or the public that are not in line with a palliative care approach, (2) obstacles in recognizing and addressing care needs, (3) poor interdisciplinary team approach and consensus, (4) limited use or availability of resources, and (5) poor family support and involvement. Suggested solutions were improving communication and information transfer, and educating healthcare staff, families and the public about palliative care in dementia. Timely and frequent communication with the family, including advance care planning, and more highly skilled nursing staff were also proposed as solutions. Conclusions The results suggest a strong need for ongoing education for healthcare professionals about palliative dementia care. Strengthening interprofessional collaboration and shared responsibility for advance care planning is also key. Increasing public awareness of the dementia trajectory and the need for a proactive approach call for a broader societal agenda setting.
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Affiliation(s)
- Laura Bavelaar
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Hilde T.A. van der Steen
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands,Faculty of Science, University of Amsterdam, Amsterdam, the Netherlands
| | - Hilde de Jong
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Gillian Carter
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Wilco P. Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands,Department of Primary and Community Care, Radboud university medical center, Nijmegen, the Netherlands,Corresponding author: Jenny T. van der Steen, Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbox 9600, 2300 RC, Leiden, the Netherlands, , telephone: 0031 715268497
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Bavelaar L, van der Steen J, Nicula M, Morris S, Kaasalainen S, Achterberg W, Brazil K. Developing Country-Specific Question Prompt Lists About Dementia Palliative Care for Family Caregivers. Innov Aging 2020. [PMCID: PMC7743734 DOI: 10.1093/geroni/igaa057.2846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
We aimed to develop question prompt lists for family caregivers of nursing home residents with advanced dementia to augment advance care planning conversations. In the context of a joint European-Canadian study, we used standardized nominal group methods to create country-specific lists of questions. (Bereaved) family caregivers of persons with dementia read an information booklet about end-of-life care for people with dementia, and generated questions to ask healthcare professionals. They also marked the most important questions from pre-selected questions from other lists. In the Netherlands, 20 participants contributed to a question prompt list of 24 questions that gravitated towards questions about terminating life and the responsibilities of physicians and family involved in decision making. In Canada, 4 participants came up with a question prompt list of 15 questions, related mostly to staff-family communication, with some the same as selected in the Netherlands. Data from the other countries will be presented too.
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Affiliation(s)
- Laura Bavelaar
- Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | | | - Maria Nicula
- McMaster University, School of Nursing, Hamilton, Ontario, Canada
| | - Sophie Morris
- Queen’s University Belfast, School of Nursing and Midwifery, Belfast, Northern Ireland, United Kingdom
| | | | - Wilco Achterberg
- Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Kevin Brazil
- Queen’s University Belfast, School of Nursing and Midwifery, Belfast, Northern Ireland, United Kingdom
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O'Halloran P, Noble H, Norwood K, Maxwell P, Murtagh F, Shields J, Mullan R, Matthews M, Cardwell C, Clarke M, Morton R, Shah K, Forbes T, Brazil K. Nurse-led advance care planning with older people who have end-stage kidney disease: feasibility of a deferred entry randomised controlled trial incorporating an economic evaluation and mixed methods process evaluation (ACReDiT). BMC Nephrol 2020; 21:478. [PMID: 33187506 PMCID: PMC7663906 DOI: 10.1186/s12882-020-02129-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Advance Care Planning is recommended for people with end-stage kidney disease but evidence is limited. Robust clinical trials are needed to investigate the impact of advance care planning in this population. There is little available data on cost-effectiveness to guide decision makers in allocating resources for advance care planning. Therefore we sought to determine the feasibility of a randomised controlled trial and to test methods for assessing cost-effectiveness. METHODS A deferred entry, randomised controlled feasibility trial, incorporating economic and process evaluations, with people with end-stage kidney disease, aged 65 years or older, receiving haemodialysis, in two renal haemodialysis units in Northern Ireland, UK. A nurse facilitator helped the patient make an advance care plan identifying: a surrogate decision-maker; what the participant would like to happen in the future; any advance decision to refuse treatment; preferred place of care at end-of-life. RESULTS Recruitment lasted 189 days; intervention and data collection 443 days. Of the 67 patients invited to participate 30 (45%) declined and 36 were randomised to immediate or deferred advance care plan groups. Twenty-two (61%) made an advance care plan and completed data collection at 12 weeks; 17 (47.2%) were able to identify a surrogate willing to be named in the advance care plan document. The intervention was well-received and encouraged end-of-life conversations, but did not succeed in helping patients to fully clarify their values or consider specific treatment choices. There was no significant difference in health system costs between the immediate and deferred groups. CONCLUSIONS A trial of advance care planning with participants receiving haemodialysis is feasible and acceptable to patients, but challenging. A full trial would require a pool of potential participants five times larger than the number required to complete data collection at 3 months. Widening eligibility criteria to include younger (under 65 years of age) and less frail patients, together with special efforts to engage and retain surrogates may improve recruitment and retention. Traditional advance care planning outcomes may need to be supplemented with those that are defined by patients, helping them to participate with clinicians in making medical decisions. TRIAL REGISTRATION Registered December 16, 2015. ClinicalTrials.gov Identifier: NCT02631200 .
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Affiliation(s)
- Peter O'Halloran
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Kelly Norwood
- School of Psychology, Ulster University, Cromore Road, Coleraine, Co. Londonderry, BT52 1SA, UK
| | - Peter Maxwell
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, BT9 7BL, UK
- Regional Nephrology Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, UK
| | - Fliss Murtagh
- Hull York Medical School, University of Hull, Allam Medical Building, Hull, HU6 7RX, UK
| | - Joanne Shields
- Regional Nephrology Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, UK
| | - Robert Mullan
- Renal Unit, Antrim Area Hospital, Bush Road, Antrim, BT41 2RL, UK
| | - Michael Matthews
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
- Renal Unit, Antrim Area Hospital, Bush Road, Antrim, BT41 2RL, UK
| | - Christopher Cardwell
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Rachael Morton
- NHMRC Clinical Trials Centre, University of Sydney, Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, NSW, 2050, Australia
| | - Karan Shah
- NHMRC Clinical Trials Centre, University of Sydney, Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, NSW, 2050, Australia
| | - Trisha Forbes
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
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Mitchell PM, Coast J, Myring G, Ricciardi F, Vickerstaff V, Jones L, Zafar S, Cudmore S, Jordan J, McKibben L, Graham-Wisener L, Finucane AM, Hewison A, Haraldsdottir E, Brazil K, Kernohan WG. Exploring the costs, consequences and efficiency of three types of palliative care day services in the UK: a pragmatic before-and-after descriptive cohort study. BMC Palliat Care 2020; 19:119. [PMID: 32767979 PMCID: PMC7412842 DOI: 10.1186/s12904-020-00624-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/27/2020] [Indexed: 12/21/2022] Open
Abstract
Background Palliative Care Day Services (PCDS) offer supportive care to people with advanced, progressive illness who may be approaching the end of life. Despite the growth of PCDS in recent years, evidence of their costs and effects is scarce. It is important to establish the value of such services so that health and care decision-makers can make evidence-based resource allocation decisions. This study examines and estimates the costs and effects of PCDS with different service configurations in three centres across the UK in England, Scotland and Northern Ireland. Methods People who had been referred to PCDS were recruited between June 2017 and September 2018. A pragmatic before-and-after descriptive cohort study design analysed data on costs and outcomes. Data on costs were collected on health and care use in the 4 weeks preceding PCDS attendance using adapted versions of the Client Service Receipt Inventory (CSRI). Outcomes, cost per attendee/day and volunteer contribution to PCDS were also estimated. Outcomes included quality of life (MQOL-E), health status (EQ-5D-5L) and capability wellbeing (ICECAP-SCM). Results Thirty-eight attendees were recruited and provided data at baseline and 4 weeks (centre 1: n = 8; centre 2: n = 8, centre 3: n = 22). The cost per attendee/day ranged from £121–£190 (excluding volunteer contribution) to £172–£264 (including volunteer contribution) across the three sites. Volunteering constituted between 28 and 38% of the total cost of PCDS provision. There was no significant mean change at 4 week follow-up from baseline for health and care costs (centre 1: £570, centre 2: -£1127, centre 3: £65), or outcomes: MQOL-E (centre 1: − 0.48, centre 2: 0.01, centre 3: 0.24); EQ-5D-5L (centre 1: 0.05, centre 2: 0.03, centre 3: − 0.03) and ICECAP-SCM (centre 1:0.00, centre 2: − 0.01, centre 3: 0.03). Centre costs variation is almost double per attendee when attendance rates are held constant in scenario analysis. Conclusions This study highlights the contribution made by volunteers to PCDS provision. There is insufficient evidence on whether outcomes improved, or costs were reduced, in the three different service configurations for PCDS. We suggest how future research may overcome some of the challenges we encountered, to better address questions of cost-effectiveness in PCDS.
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Affiliation(s)
- Paul Mark Mitchell
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, UK.
| | - Joanna Coast
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, UK
| | - Gareth Myring
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, UK
| | - Federico Ricciardi
- Department of Statistical Science, University College London, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Shazia Zafar
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Sarah Cudmore
- Division of Nursing, Queen Margaret University, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanne Jordan
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
| | - Laurie McKibben
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Lisa Graham-Wisener
- Marie Curie Hospice, Belfast and School of Psychology, Queen's University Belfast, Belfast, UK
| | - Anne M Finucane
- Marie Curie Hospice, Edinburgh and Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Alistair Hewison
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Erna Haraldsdottir
- Division of Nursing, Queen Margaret University, Edinburgh, UK.,St Columba's Hospice, Edinburgh, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - W George Kernohan
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
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Brazil K, Scott D, Wallace E, Clarke M, Fahey T, Gillespie P, O'Halloran P, Cardwell C, Carter G, McGlade K, Doyle F. Anticipatory care planning intervention for older adults at risk of functional decline: study protocol for a primary care cluster feasibility randomised trial. Trials 2020; 21:168. [PMID: 32046767 PMCID: PMC7014651 DOI: 10.1186/s13063-020-4100-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The treatment and management of long-term health conditions is the greatest challenge facing health systems around the world today. Innovative approaches to patient care in the community such as Anticipatory Care Planning (ACP), which seek to help with the provision of high-quality comprehensive care to older adults at risk of functional decline, require evaluation. This study will evaluate one approach that will include primary care as the setting for ACP. METHODS/DESIGN This study will help to determine the feasibility for a definitive randomised trial to evaluate the implementation and outcomes of an ACP intervention. The intervention will be delivered by specially trained registered nurses in a primary care setting with older adults identified as at risk of functional decline. The intervention will comprise: (a) information collection via patient assessment; (b) facilitated informed dialogue between the patient, family carer, general practitioner and other healthcare practitioners; and, (c) documentation of the agreed support plan and follow-up review dates. Through a structured consultation with patients and their family carers, the nurses will complete a mutually agreed personalised support plan. DISCUSSION This study will determine the feasibility for a full trial protocol to evaluate the implementation and outcomes of an (ACP) intervention in primary care to assist older adults aged 70 years of age or older and assessed as being at risk of functional decline. The study will be implemented in two jurisdictions on the island of Ireland which employ different health systems but which face similar health challenges. This study will allow us to examine important issues, such as the impact of two different healthcare systems on the health of older people and the influence of different legislative interpretations on undertaking cross jurisdictional research in Ireland. PROTOCOL VERSION Version 1, 17 September 2019. TRIAL REGISTRATION Clinicaltrials.gov, ID: NCT03902743. Registered on 4 April 2019.
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Affiliation(s)
- Kevin Brazil
- School of Nursing and Midwifery, Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - David Scott
- School of Nursing and Midwifery, Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - Emma Wallace
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, D02 YN77, Ireland
| | - Mike Clarke
- Centre for Public Health, ICSB, Royal Victoria Hospital, Queen's University Belfast, Belfast, Northern Ireland, BT12 6BA, UK
| | - Tom Fahey
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, D02 YN77, Ireland
| | - Patrick Gillespie
- Health Economics and Policy Analysis Centre, National University of Ireland, Galway, H91 TK33, Ireland
| | - Peter O'Halloran
- School of Nursing and Midwifery, Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - Christopher Cardwell
- Centre for Public Health, ICSB, Royal Victoria Hospital, Queen's University Belfast, Belfast, Northern Ireland, BT12 6BA, UK
| | - Gillian Carter
- School of Nursing and Midwifery, Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - Kieran McGlade
- Centre for Medical Education, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Frank Doyle
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, D02 YN77, Ireland. .,School of Psychology, Queen's University Belfast, University Road, Belfast, Northern Ireland, BT71NN, UK.
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McKibben L, Brazil K, Hudson P, McLaughlin D. Informational needs of family caregivers of people with intellectual disability who require palliative care: a two-phase integrative review of the literature. Int J Palliat Nurs 2019; 25:4-18. [PMID: 30676158 DOI: 10.12968/ijpn.2019.25.1.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: People with intellectual disabilities are living longer, with increasingly complex needs and their family caregivers may have a broad scope of unmet needs. AIMS: To identify the most common needs of family caregivers, to identify gaps in the literature, and distinguish the information needs of family caregivers of people with intellectual disabilities who require palliative care. METHODS: This two phase literature review used five electronic databases (CINAHL, PsycINFO, Medline, Cochrane and Pubmed). Phase 1 involved a review of systematic reviews of the needs of family caregivers across healthcare settings. Phase 2 explored the commonly reported information needs from phase 1, in relation to family caregivers of people with intellectual disability who require palliative care. There was no research explicit to the information needs of these family caregivers. FINDINGS: This review reveals potential information needs which may exist, guided by the palliative caregiving literature; alluding to information needs surrounding the disease, finances, and psychological or practical support. CONCLUSION: It is surmised that a greater scope of informational need exists for this population and further research is pertinent for international healthcare settings.
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Affiliation(s)
- Laurie McKibben
- PhD graduate, School of Nursing and Midwifery, Queen's University Belfast, UK
| | - Kevin Brazil
- Professor, School of Nursing and Midwifery, Queen's University Belfast, UK
| | - Peter Hudson
- Professor, Centre for Palliative Care, Centre for Palliative Care, St Vincent's Hospital and The University of Melbourne, Fitzroy, Victoria, Australia
| | - Dorry McLaughlin
- Lecturer, School of Nursing and Midwifery, Queen's University Belfast, UK
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Chan A, O’Donnell D, Kaasa B, Mathers A, Paraschiv N, Goldstein ML, Brazil K, Papaioannou A, Dolovich L. 2046. A Qualitative Study on Perceived Barriers and Facilitators of Implementing an Antimicrobial Stewardship Intervention in the Management of Urinary Tract Infections in a Long-Term Care Setting. Open Forum Infect Dis 2019. [PMCID: PMC6809289 DOI: 10.1093/ofid/ofz360.1726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background 50% of antibiotic courses in long-term care facilities (LTCFs) are unnecessary, leading to increased risk of harm such as Clostridiodes difficile infection and antibiotic-resistant organisms. Antimicrobial stewardship (AS) interventions play an important role in optimizing antibiotic use. Most studies addressing strategies to improve antibiotic prescribing in LTCFs showed modest and unsustained results. We aimed to identify facilitators, barriers and strategies in implementing a urinary tract infection (UTI)-focused AS intervention at an LTCF in Toronto. Methods A qualitative approach using conventional content analysis was used. Through purposeful sampling, we recruited different LTCF healthcare providers and administrators at Kensington Gardens. Interviewees attended focus groups or one-on-one interviews. Data were collected using a semi-structured interview guide. Data were analyzed inductively using a codebook modified in an iterative analytic process. Barriers and facilitators with potential strategies were summarized and mapped using the COM-B (capability, opportunity, motivation and behavior) model (Mitchie et al.) and emerging themes identified. Results Sixteen participants were interviewed. The most common barriers were family pressure, lack of access and test result delay while the barrier themes were lack of access, inadequate communication, lack of time and lack of knowledge of both HCPs and resident’s families. These can be addressed by the most common facilitators and facilitator themes, which included good communication between healthcare professionals (HCPs), education for HCPs and families and collaboration between HCPs. Most barriers and facilitators were mapped to the opportunities domain of the COM-B model. Conclusion Strategies for improved UTI-focused antimicrobial stewardship intervention in LTC setting should focus on increasing opportunities and innovative formats for education, communication and collaboration among HCPs and with families although barriers and facilitators in all aspects of the COM-B model were identified. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
- April Chan
- Unity Health Toronto- St. Joseph’s Health Centre, Toronto, Ontario, Toronto, ON, Canada
| | | | | | | | | | | | - Kevin Brazil
- Queen’s University Belfast, Belfast, Northern Ireland, UK
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Hartigan I, Brazil K, Kaasalainen S, Sussman T, Van Der Steen J, Loucka M, Di Giulio P, Cornally N. 333 A Transnational Effectiveness-Implementation Study of the Family Carer Decision Support Intervention to Improve End of Life Care in Long-Term Care. Age Ageing 2019. [DOI: 10.1093/ageing/afz103.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The Family Carer Decision Support (FCDS) intervention has been designed to inform family carers about end of life care options available to a person living with advanced dementia. The FCDS intervention demonstrated a statistically significant impact in reducing family carer decision uncertainty on establishing goals of care at the end of life and, improved family carer satisfaction on quality of care in a study conducted in the United Kingdom.
Methods
The aim of this research is to adapt the application of the FCDS for use in different countries. Funding supported through the EU Joint Programme – Neurodegenerative Disease Research (JPND) project has supported the scaling up of the FCDS transnationally in the United Kingdom; Republic of Ireland; Netherlands; Canada; Czech Republic ; and, Italy. Launched in April 2019, this presentation will report on present activities including: a) description of the FCDS intervention; b) strategy for implementing the FCDS in care homes; c) study design employed for the evaluation of the FCDS; and d) work packages and that will be deployed to achieve intended outcomes
Results
Expected project outcomes of this work will include a) develop guidelines to facilitate transnational use of the FCDS within care homes; (b) staff education material including web learning resources; (c) family carer informational material including web learning resources; (d) measures and tools to evaluate the uptake and outcome of the FCDS intervention; (e) establish a transnational FCDS community of practice across study care homes; (f) estimated costs of providing the FCDS intervention; (g) evidence of enhancing decision making among family members regarding resident care and satisfaction with care.
Conclusion
Recent research revealed that care home structures and staff play an important role in the successful implementation and adoption of innovations such as the FCDS intervention, this is further examined in this transnational study.
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Affiliation(s)
| | - Kevin Brazil
- Queen's University Belfast, Belfast, United Kingdom
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Abstract
Providing palliative care for residents with dementia in long-term care (LTC) settings is problematic due to their declining verbal abilities and related challenges. The goal of this study was to explore nurses’ perceptions around providing palliative care for such residents. Using a qualitative descriptive design, data were gathered from focus groups at three LTC facilities. Participants represented all levels of nursing staff. Concepts that emerged from the data were labelled, categorized, and coded in an iterative manner. Nurses appraise residents’ general deterioration as a main factor in deciding that a resident is palliative. Nurses often employ creative strategies using limited resources to facilitate care, but are challenged by environmental restrictions and insufficient educational preparation. However, nurses said they do not wish for residents to be transferred to a hospice setting, as they wish to grieve with residents and their family members. Nurses aim to facilitate a “good death” for residents with dementia, while trying to manage multiple demands and deal with environmental issues. Supportive and educational initiatives are needed for nursing staff and families of dying residents.
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Affiliation(s)
| | - Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University & St. Joseph's Health System Research Network
| | - Jenny Ploeg
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton
| | - Lori Schindel Martin
- School of Nursing, Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada
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Brazil K, Krueger P, Bedard M, Kelley ML, Mcainey C, Justice C, Taniguchi A. Quality of Care for Residents Dying in Ontario Long-Term Care Facilities: Findings from a Survey of Directors of Care. J Palliat Care 2019. [DOI: 10.1177/082585970602200104] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to collect information on the practice of end-of-life (EOL) care in long-term care (LTC) facilities in the Province of Ontario, Canada. A cross-sectional survey of directors of care in all licensed LTC facilities in the province was conducted between September 2003 and April 2004. Directors of care from 426 (76% response rate) facilities completed the postal survey questionnaire. The survey results identified communication problems between service providers and families, inadequate staffing levels to provide quality care to dying residents, and the need for training to improve staff skills in providing EOL care. Directors of care endorsed the use of a number of strategies that would improve the care of dying residents. Logistic regression analysis identified the eight most important items predictive of facility staff having the ability to provide quality EOL care. The findings contribute to the current discussion on policies for meeting the care needs of residents in LTC facilities until life's end.
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Affiliation(s)
- Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics, McMaster University, and St. Joseph's Health System Research Network, Hamilton
| | - Paul Krueger
- Department of Clinical Epidemiology and Biostatistics, McMaster University, and St. Joseph's Health System Research Network, Hamilton
| | - Michel Bedard
- Public Health Program, Lakehead University & Division of Human Sciences, Northern Ontario School of Medicine, Thunder Bay
| | | | - Carrie Mcainey
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton
| | | | - Alan Taniguchi
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Affiliation(s)
| | - Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics, McMaster University and St. Joseph's Health System Research Network
| | - Steven Hanna
- Department of Clinical Epidemiology and Biostatistics, McMaster University
| | - Julia Abelson
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Affiliation(s)
- Kevin Brazil
- St. Mary's of the Lake Hospital, Kingston, Ontario, Canada
| | - Doris Thomas
- St. Mary's of the Lake Hospital, Kingston, Ontario, Canada
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Allard P, Brajtman S, Brazil K, Guirguis-Younger M, Kaasalainen S, Kelley ML, Legault F, Mckee M, Mcpherson C, Wilson KG. End-of-Life Care for Seniors: Contributions from a New Emerging Team. J Palliat Care 2019. [DOI: 10.1177/082585970702300302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Pierre Allard
- Élisabeth Bruyère Research Institute, SCO Health Service and University of Ottawa, Ottawa, Ontario
| | - Susan Brajtman
- School of Nursing, University of Ottawa, Ottawa, Ontario
| | - Kevin Brazil
- St. Joseph's Health System Research Network, Hamilton, Ontario
| | | | | | | | - Frances Legault
- School of Social Work, Lakehead University, Thunder Bay, Ontario
| | - Marg Mckee
- School of Nursing, University of Ottawa, Ottawa, Ontario
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Abstract
A postal survey was used to collect data from family members of deceased residents of six long-term care (LTC) facilities in order to explore end-of-life (EOL) care using the Family Perception of Care Scale. This article reports on the results of thematic analysis of family member comments provided while completing the survey. Family comments fell into two themes: 1) appreciation for care and 2) concerns with care. The appreciation for care theme included the following subthemes: psychosocial support, family care, and spiritual care. The concerns with care theme included the subthemes: physical care, staffing levels, staff knowledge, physician availability, communication, and physical environment. This study identified the need for improvement in EOL care skills among LTC staff and attending physicians. As such, there is a need to implement continuing education to address these issues.
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Affiliation(s)
- Julie Uma Vohra
- St. Joseph's Health System Research Network, McMaster University and St. Joseph's Health System Research Network
| | - Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics, McMaster University and St. Joseph's Health System Research Network
| | - Karen Szala-Meneok
- School for Rehabilitation Sciences, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Abstract
Improvement in the quality of end-of-life (EOL) care is a priority health care issue since serious deficiencies in quality of care have been reported across care settings. Increasing pressure is now focused on Canadian health care organizations to be accountable for the quality of palliative and EOL care delivered. Numerous domains of quality EOL care upon which to create accountability frameworks are now published, with some derived from the patient/family perspective. There is a need to reach common ground on the domains of quality EOL care valued by patients and families in order to develop consistent performance measures and set priorities for health care improvement. This paper describes a meta-synthesis study to develop a common conceptual framework of quality EOL care integrating attributes of quality valued by patients and their families.
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Affiliation(s)
- Doris Howell
- Oncology Department, University Health Network, and Faculty of Nursing, University of Toronto, Toronto, Ontario
| | - Kevin Brazil
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Abstract
We conducted a qualitative case study as part of a needs assessment for a day hospice in a small Ontario city. Data were gathered from semi-structured interviews with 28 stakeholders: nine health care administrators, 11 health care providers, and eight lay people (terminally ill adults and informal caregivers). Respondents described support, counselling, social activities, and respite as key day hospice services. They also described several barriers to accessing services, including location, transportation, admission criteria, referrals, and fees. For most respondents, the ideal staff mix includes both volunteers and paid professionals in either a free-standing organization or institutionally linked hospice. Although the vast majority of participants were reluctant to impose admission criteria or other limitations on hospice clientele, they expressed the need to ensure equitable access to this scarce resource. Opinions varied greatly across stakeholder groups, highlighting the need to collect information from all relevant stakeholder groups when planning hospices.
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Affiliation(s)
- Lynne H. Lohfeld
- Department of Clinical Epidemiology & Biostatistics, McMaster University; St. Joseph's Health Care System Research Network, Father Sean O'Sullivan Research Centre, Hamilton, and St. Joseph's Hospital and Home, Guelph
| | - Annie Sandberg Tschopp
- St. Joseph's Health Care System Research Network, Father Sean O'Sullivan Research Centre, Hamilton
| | | | - Kevin Brazil
- Department of Clinical Epidemiology & Biostatistics, McMaster University; St. Joseph's Health Care System Research Network, Father Sean O'Sullivan Research Centre, and St. Joseph's Hospital Community Health Centre, Hamilton
| | - Paul Krueger
- Department of Clinical Epidemiology & Biostatistics, McMaster University; St. Joseph's Health Care System Research Network, Father Sean O'Sullivan Research Centre, Hamilton, and St. Joseph's Hospital, Brantford, Ontario, Canada
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Lohfeld L, Brazil K, Willison K. Continuity of Care for Advanced Cancer Patients: Comparing the Views of Spousal Caregivers in Ontario, Canada, to Dumont et al.'s Theoretical Model. J Palliat Care 2019. [DOI: 10.1177/082585970702300207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lynne Lohfeld
- Department of Clinical Epidemiology and Biostatistics, Department of Family Medicine, and Program for Educational Research and Development, McMaster University
| | - Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics, and Division of Palliative Care, Department of Family Medicine, McMaster University, St. Joseph's Health System Research Network, Hamilton
| | - Kathleen Willison
- Division of Palliative Care, Department of Family Medicine, and School of Nursing, Faculty of Health Sciences, McMaster University, St. Joseph's Healthcare, Hamilton, and Niagara West Palliative Care Team, Grimsby, Ontario, Canada
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Brazil K, Howell D, Marshall D, Critchley P, Van Den Elzen P, Thomson C. Building Primary Care Capacity in Palliative Care: Proceedings of an Interprofessional Workshop. J Palliat Care 2019. [DOI: 10.1177/082585970702300206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kevin Brazil
- St. Joseph's Health System Research Network, and Department of Clinical Epidemiology and Biostatistics, McMaster University, and Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton
| | - Doris Howell
- Oncology and Blood Disorders Program, University Health Network, and Faculty of Nursing, University of Toronto, Toronto
| | - Denise Marshall
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton
| | | | | | - Caroline Thomson
- St. Joseph's Health System Research Network, Hamilton, Ontario, Canada
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Sussman T, Kaasalainen S, Lee E, Akhtar-Danesh N, Strachan PH, Brazil K, Bonifas R, Bourgeois-Guérin V, Durivage P, Papaioannou A, Young L. Condition-Specific Pamphlets to Improve End-of-life Communication in Long-term Care: Staff Perceptions on Usability and Use. J Am Med Dir Assoc 2018; 20:262-267. [PMID: 30583908 DOI: 10.1016/j.jamda.2018.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/31/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This article reports findings on the usability and staff use of 5 condition- specific pamphlets of high prevalence in long-term care (LTC): dementia, heart failure, chronic obstructive pulmonary disease, renal failure, and frailty. The pamphlets were created in response to residents', families', and staff's recommendations for activating early reflections and communication about end-of-life care. DESIGN A mixed-method (qualitative and quantitative) survey design was used. Step 1 collected survey data on the usability of the pamphlets. Step 2 collected survey data on pamphlet use. SETTINGS AND PARTICIPANTS Two nurses with specialized palliative care training, 2 resident/family representatives, 10 condition-specific specialists, and 33 LTC palliative leads reviewed the pamphlets for usability prior to distribution. A total of 178 LTC home staff in 4 participating LTC homes reported on pamphlet use. MEASURES Specialists and resident/family representatives were asked to provide open comments and LTC home palliative leads were asked to complete a survey on the accuracy, readability, and relevance of the pamphlets. After 6 months of distribution, all staff in participating LTC homes were asked to complete a survey on pamphlet use, usefulness, and comfort with distribution. RESULTS The pamphlets were reportedly accurate, relevant, and easy to understand. Following 6 months of availability, most staff in LTC had read the pamphlets, found the information useful, and planned to share them. However, half of the staff questioned their role in pamphlet distribution and most had not distributed them. Regulated staff (ie, staff affiliated with a regulated profession) expressed more comfort sharing the pamphlets than care aides and support staff. CONCLUSIONS/IMPLICATIONS Condition-specific pamphlets appear to hold promise in providing residents and families with relevant information that may activate early reflections and conversations about end-of-life care. However, structured implementation strategies, training, and discussions are required to improve staff comfort with distribution and explore roles in distribution and follow-up.
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Affiliation(s)
| | | | - Eunyoung Lee
- School of Social Work, McGill University, Canada
| | | | | | - Kevin Brazil
- School of Nursing and Midwifery, Queens University Belfast, United Kingdom
| | | | | | - Patrick Durivage
- Montreal Central West University Affiliated Health and Social Service Network, Canada
| | | | - Laurel Young
- Creative Arts Therapies Department, Concordia University, Canada
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Bainbridge D, Brazil K, Krueger P, Ploeg J, Taniguchi A, Darnay J. Evaluating Program Integration and the Rise in Collaboration: Case study of A Palliative Care Network. J Palliat Care 2018. [DOI: 10.1177/082585971102700403] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: There is increasing global interest in using regional palliative care networks (PCNs) to integrate care and create systems that are more cost-effective and responsive. We examined a PCN that used a community development approach to build capacity for palliative care in each distinct community in a region of southern Ontario, Canada, with the goal of achieving a competent integrated system. Methods: Using a case study methodology, we examined a PCN at the structural level through a document review, a survey of 20 organizational administrators, and an interview with the network director. Results: The PCN identified 14 distinct communities at different stages of development within the region. Despite the lack of some key features that would facilitate efficient palliative care delivery across these communities, administrators largely viewed the network partnership as beneficial and collaborative. Conclusion: The PCN has attempted to recognize specific needs in each local area. Change is gradual but participatory. There remain structural issues that may negatively affect the functioning of the PCN.
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Affiliation(s)
- Daryl Bainbridge
- D Bainbridge (corresponding author) Department of Clinical Epidemiology and Biostatistics, and Department of Oncology, McMaster University, Juravinski Cancer Centre, 699 Concession Street, Room 4-203, Hamilton, Ontario, Canada L8V 5C2
| | - Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics, and Division of Palliative Care, Department of Family Medicine, McMaster University, and St. Joseph's Health System Research Network, Hamilton, Ontario, Canada
| | - Paul Krueger
- Department of Family and Community Medicine, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, and Department of Health, Aging and Society, McMaster University, and Health Sciences Centre, Hamilton, Ontario, Canada
| | - Alan Taniguchi
- Division of Palliative Care, Department of Family Medicine, McMaster University, and Health Sciences Centre, Hamilton, Ontario, Canada
| | - Julie Darnay
- Hamilton, Niagara, Haldimand, Brant Hospice Palliative Care Network, St. Catharines, Ontario, Canada
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Muldrew DHL, Kaasalainen S, McLaughlin D, Brazil K. Ethical issues in nursing home palliative care: a cross-national survey. BMJ Support Palliat Care 2018; 10:e29. [DOI: 10.1136/bmjspcare-2018-001643] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/19/2018] [Accepted: 11/28/2018] [Indexed: 11/03/2022]
Abstract
ObjectivesWith an increased dependency on nursing homes to provide care to the ageing population, it is likely that ethical issues will also increase. This study aimed to identify the type of ethical issues and level of associated distress experienced by nurses providing palliative care in nursing homes in the UK and Canada, and pilot the Ethical issues in Palliative Care for Nursing Homes (EPiCNH) instrument in Canada.MethodsA cross-sectional survey design was used. One hundred and twenty-three nurses located in 21 nursing homes across the UK and Canada completed the EPiCNH instrument.ResultsFrequent ethical issues include upholding resident autonomy, managing family distress, lack of staff communication and lack of time in both countries. Higher levels of distress resulted from poor communication, insufficient training, lack of time and family disagreements. Nurses in Canada experienced a greater frequency of ethical issues (p=0.022); however, there was no statistical difference in reported distress levels (p=0.53). The survey was positively rated for ease of completion, relevance and comprehensiveness.ConclusionsNurses’ reported comparable experiences of providing palliative care in UK and Canadian nursing homes. These findings have implications on the practice of care in nursing homes, including how care is organised as well as capacity of staff to care for residents at the end of life. Training staff to take account of patient and family values during decision-making may address many ethical issues, in line with global policy recommendations. The EPiCNH instrument has demonstrated international relevance and applicability.
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McAiney CA, Ploeg J, Wickson-Griffiths A, Kaasalainen S, Martin-Misener R, Akhtar-Danesh N, Donald F, Carter N, Sangster-Gormley E, Brazil K, Taniguchi A, Martin LS. Perspectives of Nurse Practitioner-Physician Collaboration among Nurse Practitioners in Canadian Long-Term Care Homes: A National Survey. ACTA ACUST UNITED AC 2018; 30:10-25. [PMID: 29676987 DOI: 10.12927/cjnl.2017.25452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Nurse practitioners (NPs) can play an important role in providing primary care to residents in long-term care (LTC) homes. However, relatively little is known about the day-to-day collaboration between NPs and physicians (MDs) in LTC, or factors that may influence this collaboration. Survey data from NPs in Canadian LTC homes were used to explore these issues. Thirty-seven of the 45 (82%) identified LTC NPs across Canada completed the survey. NPs worked with an average of 3.4 MDs, ranging from 1-26 MDs. The most common reasons for collaborating included managing acute and chronic conditions, and updating MDs on resident status changes. Satisfaction with NP-MD collaboration was high, and did not significantly differ among NPs working full versus part time, NPs working in a single versus multiple homes, or NPs with more versus less experience. By understanding the nature of NP-MD collaboration, we can identify ways of supporting and enhancing collaboration between these professionals.
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Affiliation(s)
- Carrie A McAiney
- Associate Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON
| | - Jenny Ploeg
- Professor, School of Nursing, McMaster University, Hamilton, ON
| | | | - Sharon Kaasalainen
- Associate Professor, School of Nursing, McMaster University, Hamilton, ON
| | | | | | - Faith Donald
- Associate Professor, Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
| | - Nancy Carter
- Assistant Professor, School of Nursing, McMaster University, Hamilton, ON
| | | | - Kevin Brazil
- Professor, School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Alan Taniguchi
- Palliative Care Physician, Hamilton Health Sciences, Hamilton, ON
| | - Lori Schindel Martin
- Associate Professor, Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON
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O'Halloran P, Noble H, Norwood K, Maxwell P, Shields J, Fogarty D, Murtagh F, Morton R, Brazil K. Advance Care Planning With Patients Who Have End-Stage Kidney Disease: A Systematic Realist Review. J Pain Symptom Manage 2018; 56:795-807.e18. [PMID: 30025939 PMCID: PMC6203056 DOI: 10.1016/j.jpainsymman.2018.07.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 01/02/2023]
Abstract
CONTEXT Patients with end-stage kidney disease have a high mortality rate and disease burden. Despite this, many do not speak with health care professionals about end-of-life issues. Advance care planning is recommended in this context but is complex and challenging. We carried out a realist review to identify factors affecting its implementation. OBJECTIVES The objectives of this study are 1) to identify implementation theories; 2) to identify factors that help or hinder implementation; and 3) to develop theory on how the intervention may work. METHODS We carried out a systematic realist review, searching seven electronic databases: Medline, Embase, CINAHL, PsycINFO, Cochrane Library, Google Scholar, and ScienceDirect. RESULTS Sixty-two papers were included in the review. CONCLUSION We identified two intervention stages-1) training for health care professionals that addresses concerns, optimizes skills, and clarifies processes and 2) use of documentation and processes that are simple, individually tailored, culturally appropriate, and involve surrogates. These processes work as patients develop trust in professionals, participate in discussions, and clarify values and beliefs about their condition. This leads to greater congruence between patients and surrogates; increased quality of communication between patients and professionals; and increased completion of advance directives. Advance care planning is hindered by lack of training; administrative complexities; pressures of routine care; patients overestimating life expectancy; and when patients, family, and/or clinical staff are reluctant to initiate discussions. It is more likely to succeed where organizations treat it as core business; when the process is culturally appropriate and takes account of patient perceptions; and when patients are willing to consider death and dying with suitably trained staff.
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Affiliation(s)
- Peter O'Halloran
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, United Kingdom.
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, United Kingdom
| | - Kelly Norwood
- School of Psychology, Ulster University, Coleraine Campus, Coleraine, United Kingdom
| | - Peter Maxwell
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Health Sciences Building, Belfast, United Kingdom; Regional Nephrology Unit, Belfast City Hospital, Belfast, United Kingdom
| | - Joanne Shields
- Regional Nephrology Unit, Belfast City Hospital, Belfast, United Kingdom
| | - Damian Fogarty
- Regional Nephrology Unit, Belfast City Hospital, Belfast, United Kingdom
| | - Fliss Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull, United Kingdom
| | - Rachael Morton
- Sydney Medical School, University of Sydney, NSW, Australia
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, Belfast, United Kingdom
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Duggleby W, Jovel Ruiz K, Ploeg J, McAiney C, Peacock S, Nekolaichuk C, Holroyd-Leduc J, Ghosh S, Brazil K, Swindle J, Forbes D, Woodhead Lyons S, Parmar J, Kaasalainen S, Cottrell L, Paragg J. Mixed-methods single-arm repeated measures study evaluating the feasibility of a web-based intervention to support family carers of persons with dementia in long-term care facilities. Pilot Feasibility Stud 2018; 4:165. [PMID: 30410783 PMCID: PMC6208108 DOI: 10.1186/s40814-018-0356-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/15/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Following institutionalization of a relative with Alzheimer disease and related dementias (ADRD), family carers continue to provide care. They must learn to negotiate with staff and navigate the system all of which can affect their mental health. A web-based intervention, My Tools 4 Care-In Care (MT4C-In Care) was developed by the research team to aid carers through the transitions experienced when their relative/friend with ADRD resides in a long-term care (LTC) facility. The purpose of this study was to evaluate MT4C-In Care for feasibility, acceptability, ease of use, and satisfaction, along with its potential to help decrease carer's feelings of grief and improve their hope, general self-efficacy, and health-related quality of life. METHODS The study was a mixed-methods single-arm repeated measures feasibility study. Participants accessed MT4C-In Care over a 2-month period. Data were collected at baseline and 1 and 2 months. Using a checklist, participants evaluated MT4C-In Care for ease of use, feasibility, acceptability, and satisfaction. Measures were also used to assess the effectiveness of the MT4C-In Care in improving hope (Herth Hope Index), general self-efficacy (GSES), loss and grief (NDRGEI), and health-related quality of life (SF12v2) of participants. Qualitative data were collected at 2 months and informed quantitative findings. RESULTS The majority of the 37 participants were female (65%; 24/37), married (73%; 27/37), and had a mean age of 63.24 years (SD = 11.68). Participants reported that MT4C-In Care was easy to use, feasible, and acceptable. Repeated measures ANOVA identified a statistically significant increase over time in participants hope scores (p = 0.03) and a significant decrease in grief (< 0.001). Although significant differences in mental health were not detected, hope (r = 0.43, p = 0.03) and grief (r = - 0.66, p < 0.001) were significantly related to mental health quality of life. CONCLUSION MT4C-In Care is feasible, acceptable, and easy to use and shows promise to help carers of family members with ADRD residing in LTC increase their hope and decrease their grief. This study provides the foundation for a future pragmatic trial to determine the efficacy of MT4C-In Care. TRIAL REGISTRATION ClinicalTrials.gov NCT03571165. June 30, 2018 (retrospectively registered).
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Affiliation(s)
- Wendy Duggleby
- Nursing Research Chair Aging and Quality of Life, Innovations in Seniors Care Research Unit, Faculty of Nursing Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Kathya Jovel Ruiz
- Faculty of Nursing Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Carrie McAiney
- School of Public Health and Health Systems, Schlegel Research Chair in Dementia, Schlegel-UW Research Institute for Aging, University of Waterloo, 200 University Avenue West, Waterloo, ON N2l 3G1 Canada
| | - Shelley Peacock
- College of Nursing, University of Saskatchewan, 4340 E-wing Health Sciences104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Cheryl Nekolaichuk
- Division of Palliative Care Medicine, University of Alberta, c/o Palliative Institute, 404, Health Services Centre, 1090 Youville Drive West, Edmonton, AB T6L 0A3 Canada
| | - Jayna Holroyd-Leduc
- Section of Geriatric Medicine, Cumming School of Medicine, Brenda Strafford Foundation Chair of Geriatric Medicine, University of Calgary, 1403 29th Street NW, Calgary, AB T2N 2T9 Canada
| | - Sunita Ghosh
- Department of Medical Oncology/Department of Mathematical and Statistical Sciences, University of Alberta, 11560 University Avenue, Edmonton, AB T6G 1Z2 Canada
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL UK
| | - Jennifer Swindle
- Faculty of Nursing Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Dorothy Forbes
- Arthur Labatt Family School of Nursing, Western University, London, ON N6A 5B9 Canada
| | - Sandra Woodhead Lyons
- Institute for Continuing Care Education and Research (ICCER), 4-023 Edmonton Clinic Health Academy, University of Alberta, 11405 - 87 Avenue NW, Edmonton, AB T6G 1C9 Canada
| | - Jasneet Parmar
- Department of Family Medicine University of Alberta, CH Network of Excellence in Seniors’ Health and Wellness, Home Living and Transitions, AHS EZ Continuing Care, c/o Grey Nuns Community Hospital, 416 St. Marguerite Health Services Centre, 1090 Youville Drive West, Edmonton, AB T6L 0A3 Canada
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Laura Cottrell
- Faculty of Nursing Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Jillian Paragg
- Faculty of Nursing Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
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