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Punia H, Kaasalainen S, Ploeg J, Strachan P, Sussman T. Exploring the Role of Nurses in Advance Care Planning Within Long-Term Care Homes: A Qualitative Study. SAGE Open Nurs 2024; 10:23779608241249335. [PMID: 38690399 PMCID: PMC11060033 DOI: 10.1177/23779608241249335] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024] Open
Abstract
Background Residents in long-term care homes (LTCHs) are often diagnosed with chronic, life-limiting illnesses, and it is now a common site to provide high levels of care and eventual death. There is an urgent need to address communication gaps and uncertainties surrounding resident's end of life preferences. Nurses are well situated to be key facilitators of necessary advance care planning (ACP), ensuring residents have discussions with family, substitute decision-makers and healthcare providers regarding future health and personal care preferences. However, LTCHs present unique challenges for nurses due to not only complex comorbidities but also staffing dynamics. Purpose This study explored the experiences and perceptions of Registered Nurses (RNs) and Registered Practical Nurse (RPNs) in LTCHs regarding their role in engaging residents and families in ACP discussions. Methods Qualitative interpretive descriptive methodology was used. Data were collected from two LTCHs in Southern Ontario with a sample of 15 nurses (7 RNs and 8 RPNs). Analysis involved review of semistructured interviews, field notes, and utilizing constant comparison within an inductive approach. Results Power and authority dynamics in LTCH's was an overarching theme in the data, with four subthemes: (1) Nurses lacking clarity about ACP, (2) nurses' uncertainty regarding their role in ACP, (3) nurses feeling uncomfortable engaging in ACP discussions, and (4) nurses struggling to support families in ACP discussions. Conclusion Recommendations for nurses, healthcare providers, LTCH administrators, and policy makers include: (1) development of policies which support, from a systemic level, nurses to feel safe while engaging in ACP; (2) reassessing LTCH's hierarchical structure, and clarifying RN, RPN, and interdisciplinary team members roles in ACP; (3) developing culture change that allows a team and person-centered approach to ACP; and (4) providing ongoing education and mentorship for nurses to manage family dynamics and expand their understanding of ACP beyond a biomedical lens.
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Affiliation(s)
- Harveer Punia
- School of Nursing, McMaster University, Hamilton, Canada
| | | | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Canada
| | | | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Canada
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Vlckova K, Gonella S, Bavelaar L, Mitchell G, Sussman T. Methodological and ethical challenges in designing and conducting research at the end of life: A systematic review of qualitative and textual evidence. Int J Nurs Pract 2023:e13224. [PMID: 38113927 DOI: 10.1111/ijn.13224] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/16/2023] [Accepted: 11/26/2023] [Indexed: 12/21/2023]
Abstract
AIM This systematic review aims to identify methodological and ethical challenges in designing and conducting research at the end of life from the perspective of researchers and provide a set of recommendations. BACKGROUND Conducting research with patients and family carers facing end-of-life issues is ethically and methodologically complex. DESIGN A systematic review was conducted. DATA SOURCES Four databases (MEDLINE, EMBASE, CINAHL, PsycInfo) were searched from inception until the end of 2021 in February 2022. REVIEW METHODS The Preferred Reporting Items for Systematic Reviews was followed, and the JBI Approach to qualitative synthesis was used for analysis. RESULTS Seventeen of 1983 studies met inclusion criteria. Data were distilled to six main themes. These included (1) the need for flexibility at all stages of the research process; (2) careful attention to timing; (3) sensitivity in approach; (4) the importance of stakeholder collaboration; (5) the need for unique researcher skills; and (6) the need to deal with the issue of missing data. CONCLUSION The findings illuminate several considerations that can inform training programmes, ethical review processes and research designs when embarking on research in this field.
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Affiliation(s)
- Karolina Vlckova
- Center for Palliative Care, Prague, The Czech Republic
- Third Faculty of Medicine, Prague, The Czech Republic
| | - Silvia Gonella
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza of Torino, Torino, Italy
| | - Laura Bavelaar
- Leiden University Medical Center, Leiden, The Netherlands
| | - Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Canada
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Kaasalainen S, Wickson-Griffiths A, Hunter P, Thompson G, Kruizinga J, McCleary L, Sussman T, Venturato L, Shaw S, Boamah SA, Bourgeois-Guérin V, Hadjistavropoulos T, Macdonald M, Martin-Misener R, McClement S, Parker D, Penner J, Ploeg J, Sinclair S, Fisher K. Evaluation of the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) programme: a protocol of a cluster randomised control trial. BMJ Open 2023; 13:e073585. [PMID: 37880170 PMCID: PMC10603462 DOI: 10.1136/bmjopen-2023-073585] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Despite the high mortality rates in long-term care (LTC) homes, most do not have a formalised palliative programme. Hence, our research team has developed the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) programme. The goal of the proposed study is to examine the implementation and effectiveness of the SPA-LTC programme. METHODS AND ANALYSIS A cross-jurisdictional, effectiveness-implementation type II hybrid cluster randomised control trial design will be used to assess the SPA-LTC programme for 18 LTC homes (six homes within each of three provinces). Randomisation will occur at the level of the LTC home within each province, using a 1:1 ratio (three homes in the intervention and control groups). Baseline staff surveys will take place over a 3-month period at the beginning for both the intervention and control groups. The intervention group will then receive facilitated training and education for staff, and residents and their family members will participate in the SPA-LTC programme. Postintervention data collection will be conducted in a similar manner as in the baseline period for both groups. The overall target sample size will be 594 (297 per arm, 33 resident/family member participants per home, 18 homes). Data collection and analysis will involve organisational, staff, resident and family measures. The primary outcome will be a binary measure capturing any emergency department use in the last 6 months of life (resident); with secondary outcomes including location of death (resident), satisfaction and decisional conflict (family), knowledge and confidence implementing a palliative approach (staff), along with implementation outcomes (ie, feasibility, reach, fidelity and perceived sustainability of the SPA-LTC programme). The primary outcome will be analysed via multivariable logistic regression using generalised estimating equations. Intention-to-treat principles will be used in the analysis. ETHICS AND DISSEMINATION The study has received ethical approval. Results will be disseminated at various presentations and feedback sessions; at provincial, national and international conferences, and in a series of manuscripts that will be submitted to peer-reviewed, open access journals. TRIAL REGISTRATION NUMBER NCT039359.
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Affiliation(s)
- Sharon Kaasalainen
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Gladys Sharpe Chair in Nursing, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Julia Kruizinga
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Lynn McCleary
- Department of Nursing, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Québec, Canada
| | | | - Sally Shaw
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Sheila A Boamah
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Susan McClement
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Deborah Parker
- Aged Care, University of Technology Sydney Faculty of Health, Sydney, New South Wales, Australia
| | - Jamie Penner
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn Fisher
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
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Gonçalves PD, Duarte CS, Corbeil T, Ramos-Olazagasti MA, Sussman T, Talati A, Alegria M, Canino G, Bird H, Martins SS. Adverse Childhood Experiences and Risk Patterns of Alcohol and Cannabis Co-Use: A Longitudinal Study of Puerto Rican Youth. J Adolesc Health 2023; 73:421-427. [PMID: 37294259 PMCID: PMC10959424 DOI: 10.1016/j.jadohealth.2023.04.010] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Adverse childhood experiences (ACEs) are common in Puerto Rican youths. Few large longitudinal studies of Latine youth examined what predicts co-use of alcohol and cannabis in late adolescence and young adulthood. We investigated the prospective association between ACEs with alcohol/cannabis co-use in Puerto Rican youth. METHODS Participants from a longitudinal study of Puerto Rican youth (n = 2,004) were included. Using multinomial logistic regressions to test associations between prospectively reported ACEs (11 types, reported by parents and/or children, categorized as 0-1, 2-3, and 4+ ACEs) with young adult alcohol/cannabis use patterns in the past month (i.e., no lifetime use, low-risk [no binge drinking and cannabis use < 10], binge-drinking only, regular cannabis use only, and alcohol/cannabis co-use). Models were adjusted for sociodemographic variables. RESULTS In this sample, 27.8% reported 4+ ACEs, 28.6% endorsed binge drinking, 4.9% regular cannabis use, and 5.5% alcohol/cannabis co-use. Compared to individuals with no lifetime use, those reporting 4+ (vs. 0-1) ACEs had greater odds of low-risk use (adjusted odds ratio [aOR] 1.60, 95% confidence interval [CI] = 1.04-2.45), regular cannabis use (aOR 3.13 95% CI = 1.44-6.77), and alcohol/cannabis co-use (aOR 3.57, 95% CI = 1.89-6.75). In relation to low-risk use, reporting 4+ ACEs (vs. 0-1) was associated with 1.96 odds (95% CI = 1.01-3.78) of regular cannabis use and 2.24 odds (95% CI = 1.29-3.89) of alcohol/cannabis co-use. DISCUSSION Exposure to 4+ ACEs was associated with the occurrence of adolescent/young adulthood regular cannabis use and alcohol/cannabis co-use. Importantly, ACEs exposure differentiated young adults who were co-using compared to those engaged in low-risk use. Preventing ACE or interventions for Puerto Rican youth experiencing 4+ ACEs may mitigate negative consequences associated with alcohol/cannabis co-use.
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Affiliation(s)
- Priscila Dib Gonçalves
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York; Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York
| | - Cristiane S Duarte
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York; Center for Intergenerational Psychiatry, Division of Child Psychiatry, New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, New York
| | - Thomas Corbeil
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York; Area Mental Health Data Science, New York State Psychiatric Institute, New York, New York
| | | | - Tamara Sussman
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York; Center for Intergenerational Psychiatry, Division of Child Psychiatry, New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, New York
| | - Ardesheer Talati
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York; Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York
| | - Margarita Alegria
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Hector Bird
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
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Au C, L. Drolet J, Kaushik V, Charles G, Franco M, Henton J, Hirning M, McConnell S, Nicholas D, Nickerson A, Ossais J, Shenton H, Sussman T, Verdicchio G, Walsh CA, Wickman J. Impact of COVID-19 on social work field education: Perspectives of Canadian social work students. J Soc Work (Lond) 2023; 23:522-547. [PMID: 38602934 PMCID: PMC10020857 DOI: 10.1177/14680173231162499] [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] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Summary Social work field education has experienced major disruptions due to the COVID-19 pandemic, while also embracing new opportunities to grow. The Transforming the Field Education Landscape research partnership developed a cross-sectional web-based survey with closed- and open-ended questions to understand student perceptions of COVID-19's impacts on social work field education. The survey opened during the first wave of the pandemic from July 8 to 29, 2020 and was completed by 367 Bachelor of Social Work (BSW) and Master of Social Work (MSW) students across Canada. Quantitative and qualitative data were analyzed using descriptive statistics and thematic analysis. Findings Respondents experienced reduced practicum hours and placements terminating early or moving online. Students were concerned about gaining adequate experience for future job prospects. They were generally positive about academic institutional responses to COVID-19 but described financial challenges with tuition costs and a lack of paid practica. Respondents were mostly satisfied with practicum supervision. They experienced negative impacts of COVID-19 on mental health with isolation and remote learning and described a lack of institutional mental health support. Students were concerned with missing direct practice skills, while some students reported more flexible hours, access to online events beyond their region, and increased research experience. They expressed a need for practicum flexibility and accommodation. Applications Recommendations include an increase in flexibility and accommodations for practicum students, exchanges of promising and wise field education practices, and accessible postsecondary mental health supports. Professional development opportunities should support graduates who missed learning opportunities in their practicum.
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Affiliation(s)
- Cara Au
- Faculty of Social Work, University of
Calgary, Calgary, Alberta, Canada
| | - Julie L. Drolet
- Faculty of Social Work, University of
Calgary, Edmonton, Alberta, Canada
| | - Vibha Kaushik
- Faculty of Social Work, University of
Calgary, Calgary, Alberta, Canada
| | - Grant Charles
- School of Social Work, The University of
British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Marina Hirning
- Faculty of Social Work, University of
Calgary, Calgary, Alberta, Canada
| | - Sheri McConnell
- School of Social Work, Memorial University of
Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - David Nicholas
- Faculty of Social Work, University of
Calgary, Edmonton, Alberta, Canada
| | | | | | - Heather Shenton
- Faculty of Social Work, University of
Calgary, Calgary, Alberta, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | | | | | - Jayden Wickman
- Faculty of Social Work, University of
Calgary, Calgary, Alberta, Canada
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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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Wallach I, Keyser-Verreault A, Beauchamp J, Brisson-Guérin M, Sussman T, Durivage P. Palliative Care Professionals' Perceptions and Communication About Sexual Expression of Older Adults at End of Life: How Biases Compromise Holistic Care. Gerontologist 2023; 63:318-327. [PMID: 36197993 DOI: 10.1093/geront/gnac150] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The sexuality of older people, which has historically been invisible, is increasingly represented and promoted in the media. However, the sexuality of the oldest older adults showing signs of frailty remains obscure and subject to ageist and ableist biases. Studies on sexual expression at the end of life have shown that sexuality and the need for support related to it remain important for many people. RESEARCH DESIGN AND METHODS This article examines the perceptions and attitudes of professionals regarding the sexuality of older adults in palliative care, based on an exploratory qualitative study. Participants were recruited from several palliative care teams working either in hospital or in home settings in Canada. RESULTS Professionals (n = 16) held two main views of sexuality: broad and holistic or narrow and genital-focused. Perceptions of sexuality in later life were either described as a continuation of or distinct from middle adulthood. No matter what views were held, most professionals did not discuss sexuality with their patients at the end of life. DISCUSSION AND IMPLICATIONS The lack of communication about sexuality may be largely due to professional's ageist, ableist, and heterosexist views regarding the sexuality of this population group. Results confirm the relevance of providing palliative care training about diverse sexual experiences and the importance of supporting older adults at the end of life with respect to their intimate and sexual needs. Such an approach is in line with the holistic vocation of palliative care.
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Affiliation(s)
- Isabelle Wallach
- Department of Sexology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | | | - Julie Beauchamp
- Department of Psychiatry and Neurosciences, Université Laval, Quebec City, Quebec, Canada
| | - Maude Brisson-Guérin
- Department of Sexology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Patrick Durivage
- Center for Research and Expertise in Social Gerontology, CIUSSS West Central Montreal, Montreal, Quebec, Canada
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Vellani S, Maradiaga Rivas V, Nicula M, Lucchese S, Kruizinga J, Sussman T, Kaasalainen S. Palliative Approach to Care Education for Multidisciplinary Staff of Long-Term Care Homes: A Pretest Post-Test Study. Gerontol Geriatr Med 2023; 9:23337214231158470. [PMID: 36845318 PMCID: PMC9947670 DOI: 10.1177/23337214231158470] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/20/2023] [Accepted: 02/02/2023] [Indexed: 02/24/2023] Open
Abstract
This study used a single-group pre-test and post-test design to evaluate an educational workshop for multidisciplinary staff working in long-term care homes on implementing a palliative approach to care and perceptions about advanced care planning conversations. Two outcomes were measured to assess the preliminary efficacy of the educational workshop at baseline and 1-month post-intervention. Knowledge regarding implementing a palliative approach to care was assessed using the End-of-Life Professional Caregivers Survey and changes in staff perception toward ACP conversations were assessed using the Staff Perceptions Survey. Findings suggest that staff experienced an improvement in self-reported knowledge regarding a palliative approach to care (p ≤ .001); and perceptions of knowledge, attitude, and comfort related to advance care planning discussions (p ≤ .027). The results indicate that educational workshops can assist in improving multidisciplinary staff's knowledge about a palliative approach to care and comfort in carrying out advance care planning discussions with residents, family care partners, and among long-term care staff.
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Affiliation(s)
- Shirin Vellani
- Faculty of Health Sciences, School of
Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Maria Nicula
- Faculty of Health Sciences, School of
Nursing, McMaster University, Hamilton, ON, Canada
| | - Stephanie Lucchese
- Faculty of Health Sciences, School of
Nursing, McMaster University, Hamilton, ON, Canada
| | - Julia Kruizinga
- Faculty of Health Sciences, School of
Nursing, McMaster University, Hamilton, ON, Canada
| | - Tamara Sussman
- Faculty of Arts, School of Social Work,
McGill University, Montreal, QC, Canada
| | - Sharon Kaasalainen
- Faculty of Health Sciences, School of
Nursing, McMaster University, Hamilton, ON, Canada,Sharon Kaasalainen, Faculty of Health
Sciences, School of Nursing, McMaster University, 1280 Main Street West,
Hamilton, ON L8S 4L8, Canada.
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Saunders D, Sussman T, Corbeil T, Canino G, Bird H, Alegria M, Duarte CS. Development, religious affiliation, and social context: Substance use disorders in Puerto Rican transitional age youth. Front Psychiatry 2023; 14:1076869. [PMID: 36873209 PMCID: PMC9978336 DOI: 10.3389/fpsyt.2023.1076869] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction Transitional age youth (i. e., ages 16-24; TAY) use higher levels of substances than any age group in the United States. Understanding what factors increase substance use during TAY could suggest novel targets for prevention/intervention. Studies suggest that religious affiliation is inversely associated with substance use disorders (SUDs). However, the association of religious affiliation and SUD, including the role of gender and social context, has not been studied in TAY of Puerto Rican ethnicity. Methods Using data from N = 2,004 TAY of Puerto Rican ethnicity across two social contexts-Puerto Rico (PR) and the South Bronx, NY (SBx)-we tested the association of religious identity (Catholic, Non-Catholic Christian, Other/Mixed, and no religious affiliation, or "None"), and four SUD outcomes (alcohol use disorder, tobacco use disorder, illicit SUD, and any SUD). Logistic regression models were used to examine the association between religious identity and SUDs, then we tested for interaction by social context and gender. Result Half the sample identified as female; 30, 44, and 25% were 15-20, 21-24, and 25-29 years of age, respectively; 28% of the sample received public assistance. There was a statistically significant difference between sites for public assistance (22 and 33% in SBx/PR, respectively; p < 0.001); 29% of the sample endorsed None (38 and 21% in SBx/PR, respectively.) Compared to None, identifying as Catholic was associated with reduced risk of illicit SUD (OR = 0.51, p = 0.02), and identifying as Non-Catholic Christian with reduced risk for any SUD (OR = 0.68, p = 0.04). Additionally, in PR but not SBx, being Catholic or Non-Catholic Christian was protective for illicit SUD when compared to None (OR = 0.13 and 0.34, respectively). We found no evidence of an interaction between religious affiliation and gender. Discussion The percentage of PR TAY who endorse no affiliation is higher than the general PR population, reflective of increasing religious non-affiliation among TAY across cultures. Critically, TAY with no religious affiliation are twice as likely as Catholics to have illicit SUD, and 1.5 times as likely as Non-Catholic Christians to have any SUD. Endorsing no affiliation is more adverse for illicit SUD in PR than the SBx, underscoring the importance of social context.
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Affiliation(s)
- David Saunders
- Center for Intergenerational Psychiatry, Division of Child Psychiatry, New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, NY, United States
| | - Tamara Sussman
- Center for Intergenerational Psychiatry, Division of Child Psychiatry, New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, NY, United States
| | - Thomas Corbeil
- Center for Intergenerational Psychiatry, Division of Child Psychiatry, New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, NY, United States
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico School of Medicine, San Juan, PR, United States
| | - Hector Bird
- Center for Intergenerational Psychiatry, Division of Child Psychiatry, New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, NY, United States
| | - Margarita Alegria
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Cristiane S. Duarte
- Center for Intergenerational Psychiatry, Division of Child Psychiatry, New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, NY, United States
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Mohanty A, Jin F, Sussman T. What Do We Know About Threat-Related Perceptual Decision Making? Curr Dir Psychol Sci 2023; 32:18-25. [PMID: 37780954 PMCID: PMC10540672 DOI: 10.1177/09637214221129795] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
The ability to make rapid and precise decisions regarding the presence or absence of threats in our environment is critical for our survival. While threatening stimuli may be detected more accurately and faster due to the "bottom-up" salience of their features, in the real-world, these stimuli are often encountered in familiar environments in which "top-down" cues signal their arrival. There has been significant progress in our understanding of the mechanisms by which we make perceptual decisions regarding relatively routine stimuli; however, the mechanisms of threat-related perceptual decision-making remain unclear. In this paper, we discuss the psychological, computational, and neural mechanisms by which information from threatening stimuli is integrated with our prior knowledge from cues and surrounding contexts to guide perceptual decision-making.
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Affiliation(s)
- Aprajita Mohanty
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Frances Jin
- Department of Psychology, The University of Hong Kong & The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Tamara Sussman
- Department of Psychiatry, Columbia University, Irving Medical Center, New York, NY, USA
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11
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Weldrick R, Canham SL, Sussman T, Walsh CA, Cormier É, Mahmood A. Delivering Services to Older Persons Experiencing Homelessness: Providers' Perspectives of What Does and Does Not Work. J Gerontol Soc Work 2023; 66:29-42. [PMID: 35678024 DOI: 10.1080/01634372.2022.2087128] [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] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
Older people with experiences of homelessness (OPEH) tend to experience more complex health, social, and psychological issues than people experiencing homelessness at younger ages. Simultaneously, many housing resources (e.g., shelters, temporary housing) are often ill equipped to meet the needs of OPEH. As such, OPEH are often unable to age in the right place (AIRP) - that is, in a place that supports unique needs and vulnerabilities. However, several promising practices exist that deliver housing and services tailored to OPEH. To investigate the aspects of housing and shelter that both promote and impede AIRP for OPEH, this study examines the delivery of services in three such promising practices from the perspective of service providers. Findings from fifteen qualitative interviews revealed three overarching themes: 1) barriers to providing individualized support (e.g., staff turnover); 2) shifting contexts and structures (e.g., housing market changes); and 3) mechanisms of success (e.g., facilitating smooth transitions into permanent housing). These findings provide evidence to support the refinement of service delivery to promote AIRP for OPEH. In doing so, these insights can help to elevate promising practices to the level of best practice.
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Affiliation(s)
- Rachel Weldrick
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Sarah L Canham
- College of Social Work, University of Utah, Salt Lake City, UT, USA
- College of Architecture and Planning, University of Utah, Salt Lake City, UT, USA
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, QC, Canada
| | | | | | - Atiya Mahmood
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
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12
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Yous ML, Boamah SA, Hunter PV, Coker E, Hadjistavropoulos T, Sussman T, Kaasalainen S. Exploring the factors influencing meaningful engagement of persons living with advanced dementia through the Namaste Care Program: a qualitative descriptive study. Palliat Care Soc Pract 2023; 17:26323524231165319. [PMID: 37025503 PMCID: PMC10071147 DOI: 10.1177/26323524231165319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/07/2023] [Indexed: 04/04/2023] Open
Abstract
Background: Meaningful engagement has been described as active participation based on a person’s interests, preferences, personhood, or perceived value. It has many benefits for persons living with dementia in long-term care (LTC) homes, including improvement in physical and cognitive function, and mental health. People with advanced dementia continue to need and benefit from inclusion and social contact in LTC, yet there is not a well-developed understanding of how to support this. A tailored intervention called Namaste Care has been shown to be an effective approach to meaningfully engage residents in LTC, decrease behavioral symptoms, and improve their comfort and quality of life. There is a need to consider how best to deliver this intervention. Objective: The aim of this study was to describe environmental, social, and sensory factors influencing meaningful engagement of persons with advanced dementia during Namaste Care implementation in LTC. Methods: In this qualitative descriptive study, focus groups and interviews were conducted with families, volunteers, staff, and managers at two LTC homes. Directed content analysis was conducted. The Comprehensive Process Model of Engagement was used as a coding framework. Results: With respect to environmental attributes, participants emphasized that a designated quiet space and a small group format were helpful for engagement. In terms of social attributes, participants emphasized Namaste Care staff capacity to deliver individualized care. Regarding sensorial factors, familiarity with the activities delivered in the program was emphasized. Conclusion: Findings reveal the need to offer small group programs that include adapted recreational and stimulating activities, such as Namaste Care, for residents at the end of life in LTC. Such programs facilitate meaningful engagement for persons with dementia as they focus on individual preferences, comfort, and inclusion while recognizing changing needs and abilities of residents.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Sheila A. Boamah
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Paulette V. Hunter
- Department of Psychology, St. Thomas More College, University of Saskatchewan, Saskatoon, SK, Canada
| | - Esther Coker
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- St. Peter’s Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina, SK, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, QC, Canada
| | - Sharon Kaasalainen
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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13
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Weldrick R, Canham SL, Sussman T, Walsh CA, Mahmood A, Nixon L, Burns VF. "A right place for everybody": Supporting aging in the right place for older people experiencing homelessness. Health Soc Care Community 2022; 30:e4652-e4661. [PMID: 35674005 DOI: 10.1111/hsc.13871] [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] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/13/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
While policies and practices that promote aging in place have risen in prominence over the last two decades, marginalised older adults have largely been overlooked. 'Aging in the right place' is a concept that recognises the importance of adequate and appropriate age-related health and psychosocial supports in shelter/housing settings and their impact on the ability of older people to age optimally. To understand the unique shelter/housing challenges and solutions that affect aging in the right place for older people experiencing homelessness (OPEH), we conducted three World Café workshops in three Canadian cities-Montreal, Calgary, and Vancouver. In total, 89 service providers and OPEH engaged in the workshops, which involved guided, small-table discussions with the goal of stimulating creative ideas and fostering a productive atmosphere. Findings revealed two overarching themes 1) Discrepancies, between the need and availability of housing options and community supports for OPEH, such as affordable transportation, case management, access to healthcare, and system navigation; and 2) Desires, for more peer support, participatory planning, service-enriched housing, social programming, and policies that promote agency, independence, and choice for OPEH. These findings provide evidence to inform the development or modification of housing and supports for OPEH that promote aging in the right place.
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Affiliation(s)
- Rachel Weldrick
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Sarah L Canham
- College of Social Work, University of Utah, Salt Lake City, Utah, USA
- College of Architecture and Planning, University of Utah, Salt Lake City, Utah, USA
| | - Tamara Sussman
- School of Social Work, McGill University, Montréal, Quebec, Canada
| | - Christine A Walsh
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Atiya Mahmood
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Lara Nixon
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Victoria F Burns
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
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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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15
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Sussman T, Lawrence J, Earn A, Wilkie M, Hunter P, Kaasalainen S. Chart based data as a resource for tracking and improving a person-centred palliative approach in long-term care. J Clin Nurs 2022. [PMID: 36225135 DOI: 10.1111/jocn.16558] [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] [Received: 06/20/2022] [Revised: 08/29/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To enhance the practice of a person-centred palliative approach in long-term care. BACKGROUND Implementing a person-centred palliative approach in long-term care entails placing residents at the centre of care planning that attends to the 'whole' person, rather than prioritising biomedical needs. DESIGN We conducted a four-stage directed content analysis of long-term care progress notes to meet our study aims and applied the EQUATOR guidelines for qualitative research publication (COREQ). METHODS We qualitatively analysed 78 resident charts across three long-term care homes in southern Ontario to capture the extent to which person-centred care was absent, initiated or implemented in different types of documented care interactions. RESULTS Most residents had interactions related to daily care activities (65/78, 83%), social concerns (65/78, 83%) and treatment decisions (53/78, 68%). By contrast, interactions around pain and discomfort (34/78, 44%) and spirituality (27/78, 35%) were documented for less than half of the residents. Almost all (92%) residents had at least one progress note where staff initiated person-centred care by documenting their preference for a certain type of care, but only a third had at least one progress note that suggested their preference was implemented (35%). CONCLUSIONS While person-centred care is often initiated by nurses and other allied health professionals, changes to care plans to address resident preferences are implemented less often. Nurses and other allied health professionals should be encouraged to elicit care preferences crucial for holistic care planning and equipped with the skills and support to enact collaborative care planning. RELEVANCE TO CLINICAL PRACTICE Collaborative care planning appears relatively absent in charted progress notes, constraining the full implementation of a person-centred palliative approach to care. PATIENT OR PUBLIC CONTRIBUTION An advisory group consisting of long-term care resident and staff representatives informed the overall study design and dissemination of the results.
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Affiliation(s)
- Tamara Sussman
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Jack Lawrence
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Arielle Earn
- Faculty of Arts & Science, University of Toronto, Toronto, Ontario, Canada
| | - Matt Wilkie
- Faculty of Arts & Science, University of Toronto, Toronto, Ontario, Canada
| | - Paulette Hunter
- Psychology, St Thomas More College, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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16
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Sussman T, Lawrence J, Pimienta R. "This is how I want it": Exploring the use of a workbook with persons with dementia to support advance care planning engagement. Dementia (London) 2022; 21:2601-2618. [PMID: 36151606 PMCID: PMC9583280 DOI: 10.1177/14713012221127358] [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] [Indexed: 11/16/2022]
Abstract
This mixed method sequential study reports focus group and pilot intervention
findings that (1) explore the views of persons with dementia and their
caregivers on using a self-directed advance care planning engagement workbook
(Your Conversation Starter Kit) and (2) uncover the
conditions that encouraged and hindered workbook use. In Phase 1, we conducted
five focus groups consisting of 10 persons with dementia and eight family
members/caregivers from two urban Canadian cities to explore overall impressions
of the workbook and factors that might affect its use. In Phase 2, we
empirically explored the factors identified in Phase 1 by distributing the
workbook to 24 persons with dementia. The combined findings suggest that the
workbook offers promise in supporting advance care planning engagement for
persons with dementia in the early stages of their condition. Involving
family/caregivers and clarifying some of the ranked questions might improve the
workbook’s use. Persons with dementia without familial support or those who have
never contemplated advance care planning may require additional guidance prior
to workbook distribution.
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Affiliation(s)
- Tamara Sussman
- School of Social Work, 5620McGill University, Montreal, Canada
| | - Jack Lawrence
- School of Social Work, 5620McGill University, Montreal, Canada
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17
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Vellani S, Green E, Kulasegaram P, Sussman T, Wickson-Griffiths A, Kaasalainen S. Interdisciplinary staff perceptions of advance care planning in long-term care homes: a qualitative study. BMC Palliat Care 2022; 21:127. [PMID: 35836164 PMCID: PMC9284816 DOI: 10.1186/s12904-022-01014-2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Residents living in long-term care homes (LTCH) have complex care needs, multiple chronic conditions, increasing frailty and cognitive impairment. A palliative approach that incorporates advance care planning (ACP) should be integrated with chronic disease management, yet it is not a norm in most LTCHs. Despite its growing need, there remains a lack of staff engagement in the ACP process. Objectives The aim of this study was to explore the perceptions and experiences of interdisciplinary staff related to the practice of ACP in LTCHs. Methods This study is part of a larger Canadian project, iCAN ACP, that aims to increase uptake, and access to ACP for older Canadians living with frailty. An exploratory qualitative design using an interpretive descriptive approach was employed utilizing focus groups and semi-structured interviews with staff from four LTCHs in Ontario, Canada. Findings There were 98 participants, including nurses (n = 36), physicians (n = 4), personal support workers (n = 34), support staff (n = 23), and a public guardian (n = 1). Three common themes and nine subthemes were derived: a) ongoing nature of ACP; b) complexities around ACP conversations; and c) aspirations for ACP becoming a standard of care in LTCHs. Discussion The findings of this study provide important contributions to our understanding of the complexities surrounding ACP implementation as a standard of practice in LTCHs. One of the critical findings relates to a lack of ACP conversations prior to admission in the LTCHs, by which time many residents may have already lost cognitive abilities to engage in these discussions. The hierarchical nature of LTCH staffing also serves as a barrier to the interdisciplinary collaboration required for a successful implementation of ACP initiatives. Participants within our study expressed support for ACP communication and the need for open lines of formal and informal interdisciplinary communication. There is a need for revitalizing care in LTCHs through interdisciplinary care practices, clarification of role descriptions, optimized staffing, capacity building of each category of staff and commitment from the LTCH leadership for such care. Conclusion The findings build on a growing body of research illustrating the need to improve staff engagement in ACP communication in LTCHs. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01014-2.
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Affiliation(s)
- Shirin Vellani
- Faculty of Health Sciences, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 3Z1, Canada
| | - Elizabeth Green
- Faculty of Health Sciences, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 3Z1, Canada
| | - Pereya Kulasegaram
- Faculty of Health Sciences, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 3Z1, Canada
| | - Tamara Sussman
- Faculty of Arts, School of Social Work, McGill University, 3506 University St, Montreal, QC, H3A 2A7, Canada
| | - Abby Wickson-Griffiths
- Faculty of Nursing, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S0A2, Canada
| | - Sharon Kaasalainen
- Faculty of Health Sciences, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 3Z1, Canada.
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18
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Dube D, Sussman T, Brotman S, de Vries B, Gutman G. Advance Care Planning among Older Gay Men Living with HIV in Montreal, Canada: Challenges to Thinking and Talking about Future Care. J Homosex 2022; 69:756-772. [PMID: 33433307 DOI: 10.1080/00918369.2020.1855029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This qualitative study employed a cross sectional focus group design to explore how older gay men living with HIV, experience, perceive, and engage with advance care planning (ACP). Seven gay men 50+, residing in Montreal, Canada, participated in a focus group that was audio-recorded, transcribed, and thematically analyzed. Findings suggested that social isolation, preoccupations with day-to-day living, and managing disclosures related to sexual orientation and HIV status created barriers to these men's capacities to think about let alone talk about future care. These findings challenge current conceptualizations of ACP, which position reflection as an individual process that precedes allocating a decision-maker and communicating care preferences. Analyses further revealed that relational connections helped create a space where ACP could occur for participants. Hence, improving the uptake of ACP amongst older gay men with HIV may require interventions that embed such discussions into broader programs aimed at building support and community.
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Affiliation(s)
- Denis Dube
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Shari Brotman
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Brian de Vries
- Department of Gerontology, San Francisco State University, San Francisco, California, USA
| | - Gloria Gutman
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
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19
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Kaasalainen S, Sussman T. Evaluating the Conversation Starter Kit in Long Term Care: A Canadian Perspective. Innov Aging 2021. [PMCID: PMC8682152 DOI: 10.1093/geroni/igab046.3388] [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: 11/24/2022] Open
Abstract
This study evaluated an advance care planning intervention, the Conversation Starter Kit (CSK) booklet, for use in long term care (LTC) homes. This study used a quasi-experimental, one group pre/post design. Quantitative surveys were administered before and after a 3-month advance care planning intervention (CSK booklet). Data were collected at three LTC homes in southern Ontario. We collected data from 55 resident who were able to make decisions on their own paired with 11 family members of these residents. We also collected data from 24 family members of residents who were not able to make decisions on their own. Quantitative surveys were administered before and after the intervention. An additional structured interview was completed at the end of the intervention period, which included both closed and open-ended questions to assess perceptions about the CSK booklet’s use or non-use. Residents reported higher engagement in advance care planning after having completed the CSK booklet than before, particularly related to asking questions to health care providers about health care decisions. Family members reported feeling very certain that they would be able to make decisions on behalf of the resident but they felt less certain after completing the CSK booklet, implying that the CSK booklet raised their awareness of the types of decisions that they might need to make, hopefully triggering them to become more prepared for these decisions in the future. The CSK appears acceptable, easy to use for residents and family members/friends in LTC, and can improve resident engagement in ACP.
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20
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Brais H, Cormier É, Serrano D, Mahmood A, Sussman T, Bourgeois-Guerin V. Evaluating Spaces for Older Adults Experiencing Homelessness: Findings From an Environmental Audit. Innov Aging 2021. [PMCID: PMC8679541 DOI: 10.1093/geroni/igab046.1130] [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: 11/14/2022] Open
Abstract
Homeless populations require spaces and services that take into account their life trajectories. The Aging in the Right Place - Environmental Checklist (AIRP-ENV) is an environmental audit tool developed by our team to evaluate the accessibility and overall design features of housing targeted for aging individuals experiencing homelessness. Researchers in Vancouver, Calgary and Montreal employed this tool in 2021 to evaluate environmental features in selected promising practices to identify built environment factors that promote aging in the right place. Preliminary findings reveal the following themes across sites: access to communal and recreational spaces encourage social inclusion and meaningful recreation opportunities; barrier-free built environment features foster independence and safety; and access to services and amenities encourage community mobility. Findings demonstrate a need to employ a broader evaluative lens that incorporates psycho-social factors to gain a nuanced understanding of aging in the right place for older adults who have experienced homelessness.
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Affiliation(s)
- Hannah Brais
- Old Brewery Mission, Old Brewery Mission, Quebec, Canada
| | - Émilie Cormier
- Université du Québec à Montréal, Montreal, Quebec, Canada
| | | | - Atiya Mahmood
- Simon Fraser University, Vancouver, British Columbia, Canada
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21
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Weldrick R, Canham S, Mahmood A, Sussman T, Walsh C. Aging in the Right Place: A Conceptual Framework for Housing Insecure Older People. Innov Aging 2021. [PMCID: PMC8679485 DOI: 10.1093/geroni/igab046.1128] [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: 11/26/2022] Open
Abstract
Emerging research has highlighted the significance of aging in the right place (AIRP) by recognizing that secure and optimal housing should support an individual’s unique vulnerabilities and lifestyles. Existing literature, however, has yet to consider what it means for older people experiencing homelessness and/or housing insecurity to age-in-the-right-place. In order to address this knowledge gap, a review of person-environment fit models for older people and other relevant literature was conducted to determine critical identifiers of AIRP for housing insecure older people. Findings from this literature review were then refined in collaboration with interdisciplinary scholars and community partners to establish a conceptual framework. This paper presents the resulting conceptual framework and outlines the key indicators of AIRP relevant to housing insecure older people. The proposed framework provides a practical and meaningful contribution to the literature which can be used to promote housing security among individuals often excluded from existing aging-in-place models.
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Affiliation(s)
- Rachel Weldrick
- Simon Fraser University, Vancouver, British Columbia, Canada
| | - Sarah Canham
- University of Utah, Salt Lake City, Utah, United States
| | - Atiya Mahmood
- Simon Fraser University, Vancouver, British Columbia, Canada
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Kaasalainen S, Sussman T, Nicula M, Lawrence J, Thompson G, McCleary L, Wickson-Griffiths A, You JJ. Evaluating the Implementation of the Conversation Starter Kit in Long Term Care. SAGE Open Nurs 2021; 7:23779608211051824. [PMID: 34746381 PMCID: PMC8564126 DOI: 10.1177/23779608211051824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/10/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Advance care planning can improve the quality of life for residents in
long-term care homes and reduce stress for families. However, care home
staff and families often lack knowledge about advance care planning, making
it especially difficult for residents with dementia to communicate their
care plan wishes. A Conversation Starter Kit may increase advance care
planning awareness among staff and families. Objectives This study evaluated an advance care planning intervention, the Conversation
Starter Kit booklet, for use in long term care homes. Methods Data were collected at three long-term care homes in southern Ontario. We
collected data from 55 residents who were able to make decisions on their
own paired with 11 family members of these residents. We also collected data
from 24 family members of residents who were unable to make decisions on
their own. This study used a quasi-experimental, one group pre/post design.
Quantitative surveys were administered before and after a three-month
advance care planning intervention. An additional structured interview was
completed at the end of the intervention period, which included both closed
and open-ended questions to assess perceptions about the booklet's use or
non-use. Results Residents reported more engagement in advance care planning after completing
the Conversation Starter Kit booklet, particularly related to asking
questions to health care providers about health care decisions. Family
members reported feeling very certain that they would be able to make
decisions on behalf of the resident but felt less certain after completing
the booklet, implying the booklet raised their awareness of the types of
decisions they might need to make, hopefully prompting them to be more
prepared for decisions in the future. Conclusions An advance care planning intervention – The Conversation Starter Kit booklet
- appears acceptable and easy to use for residents and family
members/friends in long-term care and can improve resident engagement in
advance care planning. Although using the booklet may decrease efficacy for
decision making among family members of long-term care residents, it may
highlight the importance of more actionable engagement in advance care
planning among residents, their families/friends, and staff.
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Affiliation(s)
| | - Tamara Sussman
- Faculty of Arts, School of Social Work, McGill University, Montreal, QC, Canada
| | - Maria Nicula
- Health Research Methodology, McMaster University, Hamilton, ON, Canada
| | - Jack Lawrence
- Faculty of Arts, School of Social Work, McGill University, Montreal, QC, Canada
| | - Genevieve Thompson
- College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba,Winnipeg, MB, Canada
| | - Lynn McCleary
- Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | | | - John J You
- Division of General Internal and Hospitalist Medicine, Credit Valley Hospital, Mississauga, Ontario, Canada
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Nebhan C, Cortellini A, Ma W, Ganta T, Song H, Ye F, Irlmeier R, Debnath N, Saeed A, Radford M, Alahmadi A, Diamond A, Hoimes C, Ramaiya N, Presley C, Owen D, Alaiwi SA, Nassar A, Ricciuti B, Lamberti G, Bersanelli M, Casartelli C, Buti S, Marchetti P, Giusti R, Filetti M, Vanella V, Mallardo D, Macherla S, Sussman T, Botticelli A, Galetta D, Catino A, Pizzutilo P, Genova C, Bello MGD, Kalofonou F, Daniels E, Ascierto P, Pinato D, Choueiri T, Johnson D, Marron T, Wang Y, Naqash AR. 239 Efficacy and toxicity of single agent immune checkpoint inhibitors among adults with cancer aged ≥80 years: a multicenter international cohort study. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.239] [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: 11/03/2022] Open
Abstract
BackgroundImmune checkpoint inhibitors (ICIs) are approved by the U.S. Food&Drug Administration in over 17 tumor types. Older adult patients make up about a quarter of all cancer patients but are historically understudied in cancer clinical trials. ICIs are associated with immune-related adverse events (irAEs), which may be particularly morbid for older adult patients with underlying comorbidities and impaired functional status. In this study, we provide insight into the real-world safety and efficacy of ICIs among older adult patients (≥80 years) with cancer.MethodsThis is a multicenter, international retrospective study of tumor-agnostic older adult patients with cancer treated with single-agent ICIs between 2010–2019 from 18 academic centers in the U.S. and Europe. A cohort of 928 patients aged ≥80 years during treatment with ICI was assembled and analyzed to evaluate clinical outcomes and irAE patterns in older adult patients treated with single-agent ICIs.ResultsMedian age at ICI initiation was 83.0 years (range 75.8–97.0). Most patients (86.9%) were treated with anti-PD-1 therapy. Among the full cohort, the three most common tumors were non-small cell lung cancer (NSCLC, 37.2%,n=345), melanoma (35.5%,n=329), and genitourinary (GU) tumors (16.5%,n=153). Objective response rates for patients with NSCLC, melanoma, and GU tumors were 32.2%, 39.3%, and 26.2%, respectively. Median progression-free survival (PFS) was 6.7 months (95%CI, 5.2–8.6) for patients with NSCLC, 11.1 months (95%CI, 8.9–16.0) for patients with melanoma, and 6.0 months (95% CI, 5.0–10.7) for patients with GU malignancy. Median overall survival (OS) was 10.9 months (95%CI, 8.6–13.1) for patients with NSCLC, 30.0 months (95%CI, 23.6–46.4) for patients with melanoma, and 15.0 months (95%CI 9.1–25.4) for GU patients (Figure 1A-C). Within histology-specific cohorts (NSCLC, melanoma and GU), clinical outcomes were similar across age subgroups (<85,85–89,>90). Among all patients (N=928), 41.3% experienced ≥1 irAE(s), including 12.2% reported to be grade (G)3–4. No irAE-related deaths occurred. The median time to irAE onset was 9.8 weeks; 57% occurred within the first 3 months after ICI initiation. ICI was discontinued due to irAEs in 16.1% patients. There was no significant difference in the rate of irAEs among patients age <85, 85–89, and ≥90 years (p=0.15). Despite similar rates of G3+ irAEs, ICIs were discontinued due to irAE more than twice as often among patients ≥90 years compared to patients <90 years (30.9% vs. 15.1%, p=0.008) (table 1).ConclusionsICIs are effective and generally well-tolerated among older patients with cancer. However, ICI discontinuation due to irAE is more frequent with increasing age.
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24
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Margolis AE, Pagliaccio D, Ramphal B, Banker S, Thomas L, Robinson M, Honda M, Sussman T, Posner J, Kannan K, Herbstman J, Rauh V, Marsh R. Prenatal environmental tobacco smoke exposure alters children's cognitive control circuitry: A preliminary study. Environ Int 2021; 155:106516. [PMID: 33964643 PMCID: PMC8292185 DOI: 10.1016/j.envint.2021.106516] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 10/31/2020] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Prenatal exposure to environmental tobacco smoke (ETS) is associated with increased attention problems in children, however, the effects of such exposure on children's brain structure and function have not been studied. Herein, we probed effects of prenatal ETS on children's cognitive control circuitry and behavior. METHODS Forty-one children (7-9 years) recruited from a prospective longitudinal birth cohort of non-smoking mothers completed structural and task-functional magnetic resonance imaging to evaluate effects of maternal ETS exposure, measured by maternal prenatal urinary cotinine. Attention problems and externalizing behaviors were measured by parent report on the Child Behavior Checklist. RESULTS Compared to non-exposed children, exposed children had smaller left and right thalamic and inferior frontal gyrus (IFG) volumes, with large effect sizes (p-FDR < .05, Cohen's D range from 0.79 to 1.07), and increased activation in IFG during the resolution of cognitive conflict measured with the Simon Spatial Incompatibility Task (38 voxels; peak t(25) = 5.25, p-FWE = .005). Reduced thalamic volume was associated with increased IFG activation and attention problems, reflecting poor cognitive control. Mediation analyses showed a trend toward left thalamic volume mediating the association between exposure and attention problems (p = .05). CONCLUSIONS Our findings suggest that maternal ETS exposure during pregnancy has deleterious effects on the structure and function of cognitive control circuitry which in turn affects attentional capacity in school-age children. These findings are consistent with prior findings documenting the effects of active maternal smoking on chidlren's neurodevleoment, pointing to the neurotixicity of nicotine regardless of exposure pathway.
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Affiliation(s)
- Amy E Margolis
- The Division of Child and Adolescent Psychiatry in the Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA.
| | - David Pagliaccio
- The Division of Child and Adolescent Psychiatry in the Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Bruce Ramphal
- The Division of Child and Adolescent Psychiatry in the Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Sarah Banker
- The Division of Child and Adolescent Psychiatry in the Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Lauren Thomas
- The Division of Child and Adolescent Psychiatry in the Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Morgan Robinson
- Department of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Masato Honda
- Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA
| | - Tamara Sussman
- The Division of Child and Adolescent Psychiatry in the Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Jonathan Posner
- The Division of Child and Adolescent Psychiatry in the Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Kurunthachalam Kannan
- Department of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Julie Herbstman
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Virginia Rauh
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Rachel Marsh
- The Division of Child and Adolescent Psychiatry in the Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
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25
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Sussman T, Kaasalainen S, Lawrence J, Hunter PV, Bourgeois-Guerin V, Howard M. Using a self-directed workbook to support advance care planning with long term care home residents. BMC Palliat Care 2021; 20:121. [PMID: 34325675 PMCID: PMC8323265 DOI: 10.1186/s12904-021-00815-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND While advance care planning (ACP) has been shown to improve the quality of end-of-life (EOL) communication and palliative care, it is rarely practiced in long term care (LTC) homes, where staff time to support the process is limited. This study examines the potential of a publicly available self-directed ACP workbook distributed to LTC residents to encourage ACP reflection and communication. METHODS Recruitment took place across three LTC homes, between June 2018 and July 2019. To be eligible, residents had to have medical stability, cognitive capacity, and English literacy. The study employed a mixed methods concurrent design using the combination of ranked (quantitative) and open (qualitative) workbook responses to examine documented care preferences and ACP reflections and communications. RESULTS 58 residents initially agreed to participate in the study of which 44 completed self-directed ACP workbooks. Our combined quantitative and qualitative results suggested that the workbooks supported the elicitation of a range of resident care preferences of relevance for EOL care planning and decision making. For example, ranked data highlighted that most residents want to remain involved in decisions pertaining to their care (70%), even though less than half expect their wishes to be applied without discretion (48%). Ranked data further revealed many residents value quality of life over quantity of life (55%) but a sizable minority are concerned they will not receive enough care at EOL (20%). Open comments affirmed and expanded on ranked data by capturing care preferences not explored in the ranked data such as preferences around spiritual care and post mortem planning. Analysis of all open comments also suggested that while the workbook elicited many reflections that could be readily communicated to family/friends or staff, evidence that conversations had occurred was less evident in recorded workbook responses. CONCLUSIONS ACP workbooks may be useful for supporting the elicitation of resident care preferences and concerns in LTC. Developing follow up protocols wherein residents are supported in communicating their workbook responses to families/friends and staff may be a critical next step in improving ACP engagement in LTC. Such protocols would require staff training and an organizational culture that empowers staff at all levels to engage in follow up conversations with residents.
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Affiliation(s)
- Tamara Sussman
- McGill University School of Social Work, 3506 University St. #300, Montreal, QC, H3A 2A7, Canada.
| | - Sharon Kaasalainen
- Faculty of Health Sciences, School of Nursing, Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, 2J20L8S 4K1, Canada
| | - Jack Lawrence
- McGill University School of Social Work, 3506 University St. #300, Montreal, QC, H3A 2A7, Canada
| | - Paulette V Hunter
- University of Saskatchewan, St Thomas More College, Psychology, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada
| | - Valerie Bourgeois-Guerin
- Department of Psychology, University of Quebec in Montreal, 100 Sherbrook St West, Montreal, QC, H3C 3P8, Canada
| | - Michelle Howard
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th floor, Hamilton, On, L8P 1H6, Canada
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26
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Canham SL, Walsh CA, Sussman T, Humphries J, Nixon L, Burns VF. Identifying Shelter and Housing Models for Older People Experiencing Homelessness. Journal of Aging and Environment 2021. [DOI: 10.1080/26892618.2021.1955806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sarah L. Canham
- College of Social Work, University of Utah, Salt Lake City, UT, USA
- College of Architecture and Planning, University of Utah, Salt Lake City, UT, USA
| | | | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Canada
| | - Joe Humphries
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | - Lara Nixon
- Department of Family Medicine, University of Calgary, Calgary, Canada
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27
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Durepos P, Akhtar-Danesh N, Sussman T, Ploeg J, Boerner K, Kaasalainen S. Evaluation of the Caring Ahead: Preparing for End-of-Life With Dementia Questionnaire. J Am Med Dir Assoc 2021; 22:2108-2114.e4. [PMID: 34302752 DOI: 10.1016/j.jamda.2021.06.032] [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] [Received: 03/23/2021] [Revised: 06/03/2021] [Accepted: 06/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Family caregivers of persons with dementia rarely feel prepared for end of life although preparedness predicts outcomes in bereavement. The Caring Ahead: Preparing for End-of-Life With Dementia questionnaire was developed to measure family caregiver death preparedness. The aim of this study was to evaluate questionnaire psychometrics and refine the Caring Ahead questionnaire. DESIGN A quantitative cross-sectional reliability study design was used to evaluate the questionnaire. SETTING/PARTICIPANTS Data were collected by mail from 134 English-speaking family caregivers of persons with dementia recruited from more than 50 congregate living facilities in Canada. Thirty-two participants completed a test-retest. METHODS Analysis of psychometrics included exploratory factor analysis, calculation of correlation with a single-global preparedness item, Cronbach alpha, intraclass correlation coefficient (ICC) over time. RESULTS A 4-factor model with 20 items emerged through exploratory factor analysis with principal factors extraction and promax rotation. The revised questionnaire includes 4 factor subscales: Actions (7 items), Dementia Knowledge (5 items), Communication (4 items), and Emotions and Support Needs (4 items). Evidence was demonstrated for concurrent validity (0.44-0.55, P < .001), internal consistency (alpha > 0.7), and reliability (ICCs > 0.7). Lower levels of preparedness were reported for "knowing what the dying process with dementia may be like" and "discussing end-of-life care and preferences with health care providers." CONCLUSIONS AND IMPLICATIONS Preliminary evidence for validity and reliability of the refined 20-item Caring Ahead questionnaire suggests the questionnaire may be useful to clinicians and researchers seeking to assess caregivers' feelings of preparedness, identify specific areas for intervention, and evaluate the effectiveness of caregiver interventions. Additional testing is needed to evaluate predictive validity.
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Affiliation(s)
- Pamela Durepos
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada.
| | - Noori Akhtar-Danesh
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Jenny Ploeg
- Director of Aging and Community Health Research Unit [ACHRU], Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Kathrin Boerner
- Department of Gerontology, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Sharon Kaasalainen
- Gladys Sharpe Chair in Nursing, Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
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28
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Brotman S, Sussman T, Pacheco L, Dickson D, Lach L, Raymond É, Deshaies MH, Freitas Z, Milot É. The Crisis Facing Older People Living with Neurodiversity and Their Aging Family Carers: A Social Work Perspective. J Gerontol Soc Work 2021; 64:547-556. [PMID: 33900151 DOI: 10.1080/01634372.2021.1920537] [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] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
This commentary addresses barriers to care among older adults living with neurodiversity (ND), and their aging family carers in the context of the COVID-19 pandemic in Canada. Factors contributing to inequities are described and the significant negative consequences of current policy decisions on the social and mental health of older adults with ND and their aging family carers are highlighted. The commentary calls for a collective social work response that highlights the critical role of support and advocacy necessary to redress social exclusion.
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Affiliation(s)
- Shari Brotman
- McGill School of Social Work, Research Member of the Centre for Research and Expertise in Social Gerontology (CREGÉS), Montréal, Québec, Canada
| | - Tamara Sussman
- McGill School of Social Work, and Research Member of CREGÉS, Montréal, Québec, Canada
| | - Laura Pacheco
- McGill School of Social Work, Parenting Services, Direction DI-TSA-DP CIUSSS Du Ouest-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | - Daniel Dickson
- Political Science, Concordia University and Student Member of CREGÉS, Montréal, Québec, Canada
| | - Lucyna Lach
- McGill School of Social Work, Montréal, Québec, Canada
| | - Émilie Raymond
- École De Travail Social Et De Criminologie, Université Laval and Research Member of CREGÉS, Québec City, Québec, Canada
| | - Marie-Hélène Deshaies
- École De Travail Social Et De Criminologie, Université Laval, Québec City, Québec, Canada
| | - Zelda Freitas
- McGill School of Social Work, Coordinator of Caregiving, CREGÉS/CIUSSS Centre-Ouest-de-l'Île-de-Montréal, Montréal, Québec, Canada
| | - Élise Milot
- École De Travail Social Et De Criminologie, Université Laval, Québec City, Québec, Canada
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29
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Harasym PM, Afzaal M, Brisbin S, Sinnarajah A, Venturato L, Quail P, Kaasalainen S, Straus S, Sussman T, Virk N, Holroyd-Leduc JM. Multi-disciplinary supportive end of life care in long-term care: an integrative approach to improving end of life. BMC Geriatr 2021; 21:326. [PMID: 34022818 PMCID: PMC8140573 DOI: 10.1186/s12877-021-02271-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/06/2020] [Accepted: 05/04/2021] [Indexed: 08/23/2023] Open
Abstract
Background Optimal supportive end of life care for frail, older adults in long term care (LTC) homes involves symptom management, family participation, advance care plans, and organizational support. This 2-phase study aimed to combine multi-disciplinary opinions, build group consensus, and identify the top interventions needed to develop a supportive end of life care strategy for LTC. Methods A consensus-building approach was undertaken in 2 Phases. The first phase deployed modified Delphi questionnaires to address and transform diverse opinions into group consensus. The second phase explored and prioritized the interventions needed to develop a supportive end of life care strategy for LTC. Development of the Delphi questionnaire was based on findings from published results of physician perspectives of barriers and facilitators to optimal supportive end of life care in LTC, a literature search of palliative care models in LTC, and published results of patient, family and nursing perspectives of supportive end of life care in long term care. The second phase involved World Café Style workshop discussions. A multi-disciplinary purposive sample of individuals inclusive of physicians; staff, administrators, residents, family members, and content experts in palliative care, and researchers in geriatrics and gerontology participated in round one of the modified Delphi questionnaire. A second purposive sample derived from round one participants completed the second round of the modified Delphi questionnaire. A third purposive sample (including participants from the Delphi panel) then convened to identify the top priorities needed to develop a supportive end-of-life care strategy for LTC. Results 19 participants rated 75 statements on a 9-point Likert scale during the first round of the modified Delphi questionnaire. 11 participants (participation rate 58 %) completed the second round of the modified Delphi questionnaire and reached consensus on the inclusion of 71candidate statements. 35 multidisciplinary participants discussed the 71 statements remaining and prioritized the top clinical practice, communication, and policy interventions needed to develop a supportive end of life strategy for LTC. Conclusions Multi-disciplinary stakeholders identified and prioritized the top interventions needed to develop a 5-point supportive end of life care strategy for LTC. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02271-1.
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Affiliation(s)
| | - Misha Afzaal
- Faculty of Science, University of British Columbia, Vancouver, Canada
| | - Sarah Brisbin
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Aynharan Sinnarajah
- Cumming School of Medicine, University of Calgary, Calgary, Canada.,Alberta Health Services, Calgary, Canada
| | | | - Patrick Quail
- Cumming School of Medicine, University of Calgary, Calgary, Canada.,Alberta Health Services, Calgary, Canada
| | | | - Sharon Straus
- Faculty of Medicine, University of Toronto, Toronto, Canada.,St Michael's Hospital, Toronto, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Canada
| | - Navjot Virk
- Brenda Strafford Foundation, Calgary, Canada
| | - Jayna M Holroyd-Leduc
- Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Alberta Health Services, Calgary, Canada. .,Foothills Medical Centre, 1403-29th Street NW, T2N 2T9, Calgary, Alberta, Canada.
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30
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Howard M, Elston D, Vries BD, Kaassalainen S, Gutman G, Swinton M, Carter RZ, Sussman T, Barwich D, Urquhart R, Jayaraman D, Munene P, You JJ. Implementing Advance Care Planning Tools in Practice: A Modified World Café to Elicit Barriers and Recommendations from Potential Adopters. Healthc Q 2021; 24:60-68. [PMID: 33864443 DOI: 10.12927/hcq.2021.26463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This paper reports findings from a modified World Café conducted at a palliative care professional conference in 2019, where input on tools to support advance care planning (ACP) was solicited from healthcare practitioners, managers and family members of patients. Barriers to ACP tool use included insufficient structures and resources in healthcare, death-avoidance culture and inadequate patient and family member engagement. Recommendations for tool use included clarification of roles and processes, training, mandates and monitoring, leadership support, greater reflection of diversity in tools and methods for public engagement. This paper illuminates factors to consider when implementing ACP tools in healthcare.
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Affiliation(s)
- Michelle Howard
- An associate professor at the Department of Family Medicine, McMaster University in Hamilton, ON, with a research focus in health services. She can be reached by e-mail at
| | - Dawn Elston
- A research coordinator in the Department of Family Medicine, McMaster University in Hamilton, ON
| | - Brian De Vries
- Professor emeritus of Gerontology at the San Francisco State University in San Francisco, California
| | - Sharon Kaassalainen
- A professor and Gladys Sharpe Chair in Nursing in the School of Nursing at McMaster University in Hamilton, ON. She is a researcher focusing on improving quality of living and dying in long-term care homes
| | - Gloria Gutman
- Professor emerita of the Gerontology Department at Simon Fraser University in Vancouver, BC
| | - Marilyn Swinton
- A research coordinator in the School of Nursing at McMaster University in Hamilton, ON
| | - Rachel Z Carter
- A post-doctoral fellow at the Division of Palliative Care, Department of Medicine, Faculty of Medicine at the University of British Columbia in Vancouver, BC
| | - Tamara Sussman
- An associate professor in the School of Social Work at McGill University and an associate professor at the McGill School of Social Work in Montreal, QC, with a research focus on long-term care and end-of-life communication
| | - Doris Barwich
- An associate professor in the Department of Medicine at the University of British Columbia in Vancouver, BC, and the medical director of the BC Centre for Palliative Care - a hub for innovation and research in advance care planning and the palliative approach to care
| | - Robin Urquhart
- An associate professor in the Department of Community Health and Epidemiology at the Dalhousie University in Halifax, NS, with a research focus on health services
| | - Dev Jayaraman
- An associate professor in the Department of Medicine at McGill University in Montreal, QC, and a hospital-based general internist and critical care physician
| | - Peter Munene
- An assistant professor in the Department of Medicine at the University of Ottawa and a hospital-based general internist in Ottawa, ON
| | - John J You
- A hospital-based general internist at the Division of General Internal and Hospitalist Medicine, Credit Valley Hospital, Trillium Health Partners in Mississauga, ON
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Abstract
BACKGROUND Family caregivers of persons with dementia often feel unprepared for end-of-life and preparedness predicts caregiver outcomes in bereavement. Existing questionnaires assessing preparedness have limitations. A multi-dimensional questionnaire assessing family caregiver preparedness for the end-of-life of persons with dementia is needed to identify caregivers at risk for negative outcomes in bereavement and evaluate the quality of strategies within a palliative approach. AIM To develop a multi-dimensional questionnaire titled 'Caring Ahead' to assess feelings of preparedness for end-of-life in family caregivers of persons with dementia. DESIGN A mixed methods, sequential design employed semi-structured interviews, a Delphi-survey and pilot-testing of the questionnaire, June 2018 to July 2019. SETTING/POPULATION Participants included five current and 16 bereaved family caregivers of persons with symptoms advanced dementia from long-term care homes in Ontario, Canada; and 12 professional experts from clinical and academic settings in Canada, Europe, United States. RESULTS Interviews generated three core concepts and 114 indicators of preparedness sampling cognitive, affective and behavioural traits in four domains (i.e., medical, psychosocial, spiritual, practical). Indicators were translated and reduced to a pool of 73 potential questionnaire items. 30-items were selected to create the 'Caring Ahead' preparedness questionnaire through a Delphi-survey. Items were revised through a pilot-test with cognitive interviewing. CONCLUSIONS Family caregivers' feelings of preparedness for end-of-life need to be assessed and the quality of strategies within a palliative approach evaluated. Future psychometric testing of the Caring Ahead questionnaire will evaluate evidence for validity and reliability.
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Affiliation(s)
- Pamela Durepos
- Faculty of Nursing, University of New Brunswick, Fredericton, NB, Canada
| | - Noori Akhtar-Danesh
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Jenny Ploeg
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada
- Aging, Community and Health Research Unit, Hamilton, ON, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, QB, Canada
| | - Sharon Kaasalainen
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada
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de Vries B, Gutman G, Sussman T, Brotman S, Dube D. Looking Ahead: Intersecting Influences on Older Gay Men Living With HIV. Innov Aging 2020. [PMCID: PMC7742429 DOI: 10.1093/geroni/igaa057.2561] [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: 11/14/2022] Open
Abstract
Abstract
Older HIV-positive gay men live at the intersection of multiple inequalities—with cascading effects on their present and future lives. This qualitative study explored how they plan for their future, with a focus on Advance Care Planning—the process of reflecting/communicating preferences and values for future health and end-of-life care. Seven French-speaking gay men aged 55+ in Montreal, Canada participated in a focus group that was audio-recorded, transcribed and thematically analyzed in four steps. Findings suggest the intersection of sexual orientation and HIV-positive status exacerbated self-disclosure issues; the further addition of age led to preoccupation with day-to-day living and rendered these men vulnerable to social isolation. These tensions not only interfered with their capacities to talk about future care, but also created barriers to thinking about future care. These findings describe the multiple layers and compounding consequences of inequality among older gay men living with HIV.
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Affiliation(s)
- Brian de Vries
- San Francisco State University, San Francisco, California, United States
| | - Gloria Gutman
- Simon Fraser University, Vancouver, British Columbia, Canada
| | | | | | - Denis Dube
- McGill University, Montreal, Quebec, Canada
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Canham S, Humphries J, Burns V, Sussman T, Walsh C. Uncovering Promising Practices for Supporting Older People Experiencing Homelessness. Innov Aging 2020. [PMCID: PMC7743831 DOI: 10.1093/geroni/igaa057.2489] [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: 11/12/2022] Open
Abstract
Abstract
Montréal, Calgary, and Vancouver have seen a dramatic increase in homelessness among adults aged 50+. In order to identify ‘promising practices’ that promote aging-in-the-right-place for older people experiencing homelessness (OPEH) in Montréal, Calgary, and Vancouver, we conducted an environmental scan and three World Café workshops with 99 service providers and OPEH. We identified 53 promising practices managed or operated by 42 providers which we categorized across a shelter/housing continuum: 1) Emergency/transitional/temporary shelter/housing; 2) Independent housing with offsite supports; 3) Supported independent housing with onsite, non-medical supports; 4) Permanent supportive housing with onsite medical support and/or specialized services; 5) Long-term care; and 6) Palliative care/hospice. Study findings provide a template for existing solutions to the diverse shelter/housing needs of OPEH and insight into the gaps in shelter/housing and services that would support OPEH to age-in-the-right place. Policy and practice implications for scaling promising practices will be discussed. Part of a symposium sponsored by the Environmental Gerontology Interest Group.
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Affiliation(s)
- Sarah Canham
- University of Utah, Salt Lake City, Utah, United States
| | - Joe Humphries
- Simon Fraser University, Vancouver, British Columbia, Canada
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Kaasalainen S, Sussman T. Using the Conversation Starter Kit in Canada to Promote Resident Care Planning Discussions in Long-Term Care. Innov Aging 2020. [PMCID: PMC7742106 DOI: 10.1093/geroni/igaa057.796] [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: 11/24/2022] Open
Abstract
Advance care planning (ACP) is still rare in Canadian long-term care (LTC) homes. Residents and their families view ACP as uncomfortable and difficult to implement, leading them to avoid these discussions. The purpose of this study was to explore the perceptions of LTC residents and their families about using an ACP tool called The Conversation Starter Kit. This study utilized a mixed methods approach. Data was collected in four LTC homes in Ontario, Canada from 78 residents and family members. Data was analyzed using thematic analysis and descriptive statistics. All participants read all sections but only 73% completed all sections of the toolkit. Participants spent an average of 52.3 minutes completing the toolkit and 36.4 minutes discussing it with their family members and/or LTC staff. Participants reported: a better understanding of ACP after using the tool (80%), that the tool helped clarify the available resources and/or choices (53%), and that they felt less apprehensive about ACP after using the tool (60%). Qualitative findings revealed many strengths (e.g., usefulness, ability to start difficult conversations, content and clarification), and weaknesses of the tool (e.g., redundant information, difficulty understanding the content and lack of information regarding medically assisted dying). Family members noted that the toolkit would have been helpful to receive earlier on in their family members’ disease trajectory, perhaps before being admitted into LTC. These study findings support the feasibility and acceptability of the tool to engage residents and family members in/; ACP discussions in LTC.
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Durepos P, Kaasalainen S, Ploeg J, Sussman T, Akhtar-Danesh N. Development and Evaluation of the Caring Ahead: Preparing for End of Life in a Dementia Questionnaire. Innov Aging 2020. [PMCID: PMC7740940 DOI: 10.1093/geroni/igaa057.055] [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: 12/03/2022] Open
Abstract
A palliative approach is recommended in long-term care to support persons with dementia and help families prepare for end-of-life. Despite this, 50% of family caregivers of persons with dementia report feeling unprepared for death. A questionnaire is needed to assess caregiver death preparedness as an outcome measure for strategies within palliative care. A mixed methods design with qualitative and quantitative phases was used to develop and evaluate the ‘Caring Ahead: Preparing for End-of-Life in Dementia’ questionnaire. The questionnaire has 30 items organized into Medical, Relationship/Personal, Spiritual and Practical subscales with a 7-pt Likert response scale. To date, the questionnaire has been tested with 117 participants who are 61 years old on average, female (86%), adult children (77%) caring for a person with dementia in long-term care. The mean item score is 5.61 (SD 0.71). Participants report limitations in preparedness related to: 1) communication with healthcare providers about traditions and preferences for end-of-life care; 2) knowledge of the dying process and; 3) life purpose after death. A test-retest with 32 participants demonstrates a high degree of reliability; Intraclass Correlation Coefficient 0.91 (CI95%: 0.31-0.97). A moderate positive correlation between participant total scores and a single global preparedness item suggests concurrent validity, r=.66 (CI95%: 0.51-0.80). These findings will be used to refine the questionnaire and contribute a valuable measurement tool for clinicians, researchers and policy-makers working in palliative care.
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Affiliation(s)
| | | | - Jenny Ploeg
- McMaster University, Hamilton, Ontario, Canada
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Abstract
This study reports findings from a series of focus groups with persons with dementia and family caregivers intended to explore: (1) perceptions of and experiences with advance care planning (ACP); (2) concerns related to future care including, but not limited to, end-of-life care; and (3) practices that may support positive engagement with ACP. A total of 18 participants including 10 persons with dementia and eight family caregivers participated in five focus groups held in two urban cities in Canada. All focus group deliberations were audio recorded, transcribed verbatim, and analyzed in five stages using a semantic thematic approach. All participants expressed some form of engagement in ACP, but understandings were limited and divergence was expressed regarding the timing of more expansive conversations about future care. Although some persons with dementia were ready to engage in future care discussions, most preferred focusing on the present and suggested their families did not require direction. This placed families in the complex dilemma of protecting their loved ones while compromising their own needs for dialogue. Although individually focused models of ACP engagement hold promise for those persons with dementia ready to engage in future planning, our findings suggest that early engagement of families in the reflective process may go a long way in supporting ACP activation. Our findings further suggest that persons with dementia who do not have close family/friends may require extensive ACP encouragement and support from service providers.
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Affiliation(s)
- Tamara Sussman
- School of Social Work, 5620McGill University, Montreal, Quebec, Canada
| | - Rebecca Pimienta
- School of Social Work, 5620McGill University, Montreal, Quebec, Canada
| | - April Hayward
- Special Care Counselling, 91424Vanier College, Montreal, Quebec, Canada
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Sussman T, Kaasalainen S, Bimman R, Punia H, Edsell N, Sussman J. Exploration of the acceptability and usability of advance care planning tools in long term care homes. BMC Palliat Care 2020; 19:179. [PMID: 33243203 PMCID: PMC7756921 DOI: 10.1186/s12904-020-00689-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/10/2020] [Accepted: 11/22/2020] [Indexed: 11/10/2022] Open
Abstract
Objectives Despite known benefits, advance care planning (ACP) is rarely a component of usual practice in long-term care (LTC). A series of tools and workbooks have been developed to support ACP uptake amongst the generable population. Yet, their potential for improving ACP uptake in LTC has yet to be examined. This study explored if available ACP tools are acceptable for use in LTC by (a) eliciting staff views on the content and format that would support ACP tool usability in LTC (b) examining if publicly available ACP tools include content identified as relevant by LTC home staff. Ultimately this study aimed to identify the potential for existing ACP tools to improve ACP engagement in LTC. Methods A combination of focus group deliberations with LTC home staff (N = 32) and content analysis of publicly available ACP tools (N = 32) were used to meet the study aims. Results Focus group deliberations suggested that publicly available ACP tools may be acceptable for use in LTC if the tools include psychosocial elements and paper-based versions exist. Content analysis of available paper-based tools revealed that only a handful of ACP tools (32/611, 5%) include psychosocial content, with most encouraging psychosocially-oriented reflections (30/32, 84%), and far fewer providing direction around other elements of ACP such as communicating psychosocial preferences (14/32, 44%) or transforming preferences into a documented plan (7/32, 22%). Conclusions ACP tools that include psychosocial content may improve ACP uptake in LTC because they elicit future care issues considered pertinent and can be supported by a range of clinical and non-clinical staff. To increase usability and engagement ACP tools may require infusion of scenarios pertinent to frail older persons, and a better balance between psychosocial content that elicits reflections and psychosocial content that supports communication.
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Affiliation(s)
- Tamara Sussman
- McGill University School of Social Work, 3506 Rue University #300, Montréal, QC, H3A 2A7, Canada.
| | - Sharon Kaasalainen
- Health Sciences Centre, McMaster University School of Nursing, 2J20, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Rennie Bimman
- McGill University School of Social Work, 3506 Rue University #300, Montréal, QC, H3A 2A7, Canada
| | - Harveer Punia
- Health Sciences Centre, McMaster University School of Nursing, 2J20, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Nathaniel Edsell
- McGill University School of Social Work, 3506 Rue University #300, Montréal, QC, H3A 2A7, Canada
| | - Jess Sussman
- University of Toronto Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
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Abstract
Objectives: Death preparedness amongst family caregivers (CG) is a valuable and measurable concept. Preparedness predicts CG outcomes in bereavement and is modifiable through a palliative approach which includes advance care planning (ACP) interventions. Improving death preparedness is important for CGs of persons with dementia (PwD) whom are more likely to develop negative outcomes in bereavement, and experience less than adequate palliative care. However, the adequacy of existing tools to measure death preparedness in CGs of PwD is unknown, which limits intervention design and prospective evaluation of ACP effectiveness.Methods: We conducted a review and evaluation of existing tools measuring the attribute domains and traits of CG death preparedness. Literature was searched for articles describing caregiving at end of life (EOL). Measurement tools were extracted, screened for inclusion criteria, and data extracted regarding: conceptual basis, population of development, and psychometrics. Tool content was compared to preparedness domains/traits to assess congruency and evaluate the adequacy of tools as measures of death preparedness for CGs of PwD.Results: Authors extracted 569 tools from articles, retaining seven tools for evaluation. The majority of tools, n = 5 (70%) did not sample all preparedness domains/traits. Few tools had items specific to EOL; only one tool had a specific item questioning CG preparedness for death, and only one tool had items specific to dementia.Conclusion: Limitations in existing tools suggest they are not adequate measures of death preparedness for CGs of PwD. Consequently, the authors are currently developing a questionnaire to be titled, 'Caring Ahead' for this purpose.
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Affiliation(s)
- Pamela Durepos
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada.,Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada.,Aging, Community and Health Research Unit, Hamilton, Ontario, Canada
| | - Noori Akhtar-Danesh
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada
| | - Tamara Sussman
- Department of Social Work, McGill University, Montreal, Quebec, Canada
| | - Elizabeth Orr
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada
| | - Sharon Kaasalainen
- McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada
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Durepos P, Ploeg J, Sussman T, Akhtar-Danesh N, Kaasalainen S. "A Crazy Roller Coaster at the End": A Qualitative Study of Death Preparedness With Caregivers of Persons With Dementia. SAGE Open Nurs 2020; 6:2377960820949111. [PMID: 33415300 PMCID: PMC7774442 DOI: 10.1177/2377960820949111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/30/2020] [Accepted: 07/19/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction Caregivers of persons with dementia experience challenges that can make
preparing for end-of-life particularly difficult. Feeling prepared for death
is associated with caregiver well-being in bereavement and is promoted by
strategies supporting a palliative approach. Further conceptualization of
caregiver preparedness for death of persons with dementia is needed to guide
the practice of healthcare providers and to inform development of a
preparedness questionnaire. Objectives We aimed to: 1) explore the end-of-life experiences of caregivers of persons
with dementia to understand factors perceived as influencing preparedness;
and 2) identify the core concepts (i.e., components), barriers and
facilitators of preparedness for death. Methods This study used an interpretive descriptive design. Semi-structured
interviews were conducted with sixteen bereaved caregivers of persons with
dementia, recruited from long-term care homes in Ontario. Data was analyzed
through reflexive thematic analysis. Findings Four themes were interpreted including: ‘A crazy rollercoaster at the end’
which described the journey of caregivers at end-of-life. The journey
provided context for the development of core concepts (i.e., components) of
preparedness represented by three themes: ‘A sense of control, ‘Doing right’
and ‘Coming to terms’. Conclusion The study findings serve to expand the conceptualization of preparedness and
can guide improvements to practice in long-term care. Core concepts,
facilitators and influential factors of preparedness will provide the
conceptual basis and content to develop the Caring Ahead: Preparing for
End-of-Life with Dementia questionnaire.
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Affiliation(s)
- Pamela Durepos
- School of Nursing, Faculty of Health Sciences, McMaster University.,Canadian Frailty Network, Kingston, Ontario, Canada.,Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, Faculty of Health Sciences, McMaster University.,Aging, Community and Health Research Unit, Hamilton, Ontario, Canada
| | | | - Noori Akhtar-Danesh
- School of Nursing, Faculty of Health Sciences, McMaster University.,Aging, Community and Health Research Unit, Hamilton, Ontario, Canada
| | - Sharon Kaasalainen
- School of Nursing, Faculty of Health Sciences, McMaster University.,Aging, Community and Health Research Unit, Hamilton, Ontario, Canada
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Sussman T, Barken R, Grenier A. Supporting Older Homeless Persons' Positive Relocations to Long-Term Care: Service Provider Views. Gerontologist 2020; 60:1149-1158. [PMID: 31895408 DOI: 10.1093/geront/gnz171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study sought to explore the challenges and opportunities associated with supporting older homeless persons' relocations to long-term care (LTC) from the perspective of service providers. It aims to inform how to improve relocation processes for this vulnerable and growing subpopulation of older persons. RESEARCH DESIGN AND METHODS This cross-sectional qualitative study employed semistructured face-to-face interviews with service providers from two Health and Social Service Centres in Montreal, Quebec. All interviews were audio-recorded, transcribed verbatim, and thematically analyzed in five stages. RESULTS A total of eight service providers reported on their experiences supporting over 40 relocations of older homeless persons (50+) in the last year. According to participants, older homeless persons' trajectories into LTC typically included a series of neglected medical issues followed by hospitalization and eventual relocation to LTC. Systemic barriers such as limited-time for proper planning, insufficient housing options for persons with minor functional limitations, disregard for preferred geographic location, multiple moves, and staff prejudices worked together to expedite premature relocation and challenge relocation processes. DISCUSSION AND IMPLICATIONS Older homeless persons appear to be at heightened risk of premature and challenging relocation processes. Expanding housing stock for persons with functional limitations, strengthening intersectoral collaborations, providing education and training to staff, and ensuring flexibility around rules and regulations in receiving LTC homes would both improve access to aging in place for this marginalized group of older persons and ensure conditions are in place to support positive relocations to LTC for those who require it.
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Affiliation(s)
- Tamara Sussman
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Rachel Barken
- Department of Sociology, York University, Toronto, Ontario, Canada
| | - Amanda Grenier
- Factor-Inwentash Faculty of Social Work, University of Toronto and Baycrest Hospital, Ontario, Canada
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Harasym P, Brisbin S, Afzaal M, Sinnarajah A, Venturato L, Quail P, Kaasalainen S, Straus SE, Sussman T, Virk N, Holroyd-Leduc J. Barriers and facilitators to optimal supportive end-of-life palliative care in long-term care facilities: a qualitative descriptive study of community-based and specialist palliative care physicians' experiences, perceptions and perspectives. BMJ Open 2020; 10:e037466. [PMID: 32759247 PMCID: PMC7409966 DOI: 10.1136/bmjopen-2020-037466] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has highlighted ongoing challenges to optimal supportive end-of-life care for adults living in long-term care (LTC) facilities. A supportive end-of-life care approach emphasises family involvement, optimal symptom control, multidisciplinary team collaboration and death and bereavement support services for residents and families. Community-based and palliative care specialist physicians who visit residents in LTC facilities play an important role in supportive end-of-life care. Yet, perspectives, experiences and perceptions of these physicians remain unknown. The objective of this study was to explore barriers and facilitators to optimal supportive end-of-life palliative care in LTC through the experiences and perceptions of community-based and palliative specialist physicians who visit LTC facilities. DESIGN Qualitative study using semi-structured interviews, basic qualitative description and directed content analysis using the COM-B (capability, opportunity, motivation - behaviour) theoretical framework. SETTING Residential long-term care. PARTICIPANTS 23 physicians who visit LTC facilities from across Alberta, Canada, including both in urban and rural settings of whom 18 were community-based physicians and 5 were specialist palliative care physicians. RESULTS Motivation barriers include families' lack of frailty knowledge, unrealistic expectations and emotional reactions to grief and uncertainty. Capability barriers include lack of symptom assessment tools, as well as palliative care knowledge, training and mentorship. Physical and social design barriers include lack of dedicated spaces for death and bereavement, inadequate staff, and mental health and spiritual services of insufficient scope for the population. CONCLUSION Findings reveal that validating families' concerns, having appropriate symptom assessment tools, providing mentorship in palliative care and adapting the physical and social environment to support dying and grieving with dignity facilitates supportive, end-of-life care within LTC.
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Affiliation(s)
- Patricia Harasym
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Brisbin
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Misha Afzaal
- Faculty of Science (Undergraduate), University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Patrick Quail
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Sharon E Straus
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Navjot Virk
- Brenda Strafford Foundation, Calgary, Alberta, Canada
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Kaasalainen S, Sussman T, Thompson G, McCleary L, Hunter PV, Venturato L, Wickson-Griffiths A, Ploeg J, Parker D, Sinclair S, Dal Bello-Haas V, Earl M, You JJ. A pilot evaluation of the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) program. BMC Palliat Care 2020; 19:107. [PMID: 32660621 PMCID: PMC7358198 DOI: 10.1186/s12904-020-00599-w] [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: 06/10/2019] [Accepted: 06/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background Despite increased annual mortality in long-term care (LTC) homes, research has shown that care of dying residents and their families is currently suboptimal in these settings. The purpose of this study was to evaluate resident and family outcomes associated with the Strengthening a Palliative Approach in LTC (SPA-LTC) program, developed to help encourage meaningful end of life discussions and planning. Methods The study employs a mixed method design in four LTC homes across Southern Ontario. Data were collected from residents and families of the LTC homes through chart reviews, interviews, and focus groups. Interviews with family who attended a Palliative Care Conference included both closed-ended and open-ended questions. Results In total, 39 residents/families agreed to participate in the study. Positive intervention outcomes included a reduction in the proportion of emergency department use at end of life and hospital deaths for those participating in SPA-LTC, improved support for families, and increased family involvement in the care of residents. For families who attended a Palliative Care Conference, both quantitative and qualitative findings revealed that families benefited from attending them. Residents stated that they appreciated learning about a palliative approach to care and being informed about their current status. Conclusions The benefits of SPA-LTC for residents and families justify its continued use within LTC. Study results also suggest that certain enhancements of the program could further promote future integration of best practices within a palliative approach to care within the LTC context. However, the generalizability of these results across LTC homes in different regions and countries is limited given the small sample size.
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Affiliation(s)
- Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, HSC 3N25F, Hamilton, ON, L8S 4K1, Canada.
| | - Tamara Sussman
- School of Social Work, McGill University, 3506 University St., Montreal, QC, Canada
| | - Genevieve Thompson
- College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, Canada
| | - Lynn McCleary
- Faculty of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2N 3A1, Canada
| | - Paulette V Hunter
- St. Thomas More College, University of Saskatchewan, 1437 College Drive, Saskatoon, SK, Canada
| | - Lorraine Venturato
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada
| | | | - Jenny Ploeg
- School of Nursing, McMaster University, 1280 Main Street West, HSC 3N25F, Hamilton, ON, L8S 4K1, Canada
| | - Deborah Parker
- Faculty of Health, University of Technology Sydney, 235 Jones St, Ultimo, Australia
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, IAHS 403E, Hamilton, ON, Canada
| | - Marie Earl
- School of Physiotherapy, Dalhousie University, 5869 University Avenue, Halifax, NS, Canada
| | - John J You
- Division of General Internal and Hospitalist Medicine, Credit Valley Hospital, Trillium Health Partners, 2200 Eglinton Ave W, Mississauga, ON, Canada
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Kaasalainen S, Sussman T, McCleary L, Thompson G, Hunter PV, Wickson-Griffiths A, Cook R, Bello-Haas VD, Venturato L, Papaioannou A, You J, Parker D. Palliative Care Models in Long-Term Care: A Scoping Review. ACTA ACUST UNITED AC 2020; 32:8-26. [PMID: 31714204 DOI: 10.12927/cjnl.2019.25975] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The goal of this scoping review was to identify existing palliative models in long-term care (LTC) homes and differentiate between the key components of each in terms of training/capacity-building strategies; resident, family and staff support; and advance care planning (ACP) and goals-of-care discussions. METHODS We conducted a scoping review based on established methods to summarize the international literature on palliative models and programs for LTC. We analyzed the data using tabular summaries and content analysis. RESULTS We extracted data from 46 articles related to palliative programs, training/capacity building, family support, ACP and goals of care. Study results highlighted that three key components are needed in a palliative program in LTC: (1) training and capacity building; (2) support for residents, family and staff; and (3) ACP, goals-of-care discussion and informed consent. CONCLUSION This scoping review provided important information about key components to be included in a palliative program in LTC. Future work is needed to develop a model that suits the unique characteristics in the Canadian context.
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Affiliation(s)
| | - Tamara Sussman
- Associate Professor, Faculty of Arts, School of Social Work, McGill University, Montreal, QC
| | - Lynn McCleary
- Professor, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON
| | - Genevieve Thompson
- Associate Professor, College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - Paulette V Hunter
- Associate Professor, St. Thomas More College, University of Saskatchewan, Saskatoon, SK
| | | | - Rose Cook
- Director, Program Administration - Clinical, Toronto Central Local, Health Integration Network, Toronto, ON
| | | | - Lorraine Venturato
- Associate Professor, Chair in Gerontology, Faculty of Nursing, University of Calgary, Calgary, AB
| | - Alexandra Papaioannou
- Professor, Department of Medicine, Division of Geriatrics, GERAS Centre, Hamilton Health Sciences, Hamilton, ON
| | - John You
- Associate Professor, Department of Medicine, McMaster University, Hamilton, ON
| | - Deborah Parker
- Professor of Nursing Aged Care (Dementia), Faculty of Health, University of Technology Sydney Ultimo, NSW
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Kaasalainen S, Sussman T, McCleary L, Thompson G, Hunter PV, Wickson-Griffiths A, Cook R, Bello-Haas VD, Venturato L, Papaioannou A, You J, Parker D. A Stakeholder Analysis of the Strengthening a Palliative Approach in Long-Term Care Model. ACTA ACUST UNITED AC 2020; 32:27-39. [PMID: 31714205 DOI: 10.12927/cjnl.2019.25974] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to conduct a stakeholder analysis of the strengthening a palliative approach to long-term care (SPA-LTC) model and refine it based on feedback from long-term care (LTC) residents and their families, staff, researchers and decision makers. METHODS We used a mixed-methods design to conduct a stakeholder analysis of the SPA-LTC model that consisted of two sequential components: qualitative focus groups with LTC staff followed by a quantitative survey with key stakeholders. RESULTS Twenty-one LTC staff provided feedback about the SPA-LTC model after residents relocated to LTC, during advanced illness and at end of life and in the period of grief and bereavement. This feedback helped to guide revisions of the model. According to the survey results, the SPA-LTC model was well received by 35 stakeholders, but its feasibility was questioned. CONCLUSION The Canadian SPA-LTC model is evidence based and endorsed by LTC staff and stakeholders. Efforts are needed to determine the feasibility of implementing the model to ensure that residents' needs are made a priority while in LTC.
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Affiliation(s)
| | - Tamara Sussman
- Associate Professor, Faculty of Arts, School of Social Work, McGill University, Montreal, QC
| | - Lynn McCleary
- Professor, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON
| | - Genevieve Thompson
- Associate Professor, College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - Paulette V Hunter
- Associate Professor, St. Thomas More College, University of Saskatchewan, Saskatoon, SK
| | | | - Rose Cook
- Director, Program Administration - Clinical, Toronto Central Local Health Integration Network, Toronto, ON
| | | | - Lorraine Venturato
- Associate Professor, Chair in Gerontology, Faculty of Nursing, University of Calgary, Calgary, AB
| | - Alexandra Papaioannou
- Professor, Department of Medicine, Division of Geriatrics, GERAS Centre, Hamilton Health Sciences, Hamilton, ON
| | - John You
- Associate Professor, Department of Medicine, McMaster University, Hamilton, ON
| | - Deborah Parker
- Professor of Nursing Aged Care (Dementia), Faculty of Health, University of Technology Sydney, Ultimo, NSW
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Sussman T, Orav-Lakaski B. "I Didn't Even Make My Bed": Hospital Relocations and Resident Adjustment in Long-Term Care Over Time. Gerontologist 2020; 60:32-40. [PMID: 30428078 DOI: 10.1093/geront/gny141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/12/2018] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY This prospective longitudinal qualitative study sought to identify the conditions that help or hinder older adults' capacities to adjust to long-term care (LTC) when relocating from hospital. DESIGN AND METHODS Informed by the principles of constructivist grounded theory, this study employed semi-structured interviews with LTC home residents. Participants were interviewed 4 weeks after their initial relocation, and again every 6 months until they had either resided in their final LTC home for at least 3 months or been enrolled in the study for 2 years. Transcribed interviews were analyzed using the constant comparative method that employs the principle of comparison to guide the analytic process. FINDINGS A total of nine residents participated in 24 interviews and most had undergone two or more moves. Analysis of the data revealed that multiple forced moves challenged residents' capacities to find home in LTC by contributing to anxiety and uncertainty, hindering resident-staff relations, and interfering with residents' desires to connect with one another. Analysis of the data further revealed that relocation frameworks may require adaptations to more accurately reflect older adults' experiences with relocation from hospital to LTC. IMPLICATIONS Hospital relocations pose many challenges to residents' capacities to find home in LTC, in part, because they initiate a process of multiple moves. Until the moving process from hospital truly acknowledges and explores residents' preferences, offers choices, and supports joint decision making, it will remain challenging for the LTC home sector to help residents find meaning, purpose, and home in LTC.
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Kaasalainen S, Sussman T. PERCEPTIONS OF LONG-TERM CARE RESIDENTS AND THEIR FAMILY MEMBERS ABOUT USING THE CONVERSATION STARTER KIT. Innov Aging 2019. [PMCID: PMC6844815 DOI: 10.1093/geroni/igz038.562] [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: 11/23/2022] Open
Abstract
The need for a palliative approach in long term care (LTC) is widely recognized. However, advance care planning (ACP) is still rare. The purpose of this study was to explore the perceptions of LTC residents and their families about using an ACP tool called The Conversation Starter Kit (CSK). This study utilized a mixed methods approach. Data was collected in four LTC homes in Ontario, Canada from 31 residents and family members during an interview after they had completed the CSK. Data was analyzed using thematic analysis and descriptive statistics. All participants read all sections but only 73% completed all sections of the toolkit. Participants spent an average of 36 minutes discussing it with their family members and/or LTC staff. Participants reported: a better understanding of ACP after using the tool (80%), that the tool helped clarify the available resources and/or choices (53%), and that they felt less apprehensive about ACP after using the tool (60%). Qualitative findings revealed many strengths (e.g., usefulness, ability to start difficult conversations, content and clarification), and weaknesses of the tool (e.g., redundant information, difficulty understanding the content and lack of information regarding medically assisted dying). Family members noted that the toolkit would have been helpful to receive earlier on in their family members’ disease trajectory, perhaps before being admitted into LTC. These study findings support the CSK for residents and family members to have ACP discussions in LTC. Future work is needed to evaluate the effectiveness of the tool with a larger sample.
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Walsh C, Canham SL, Humphries J, Burns VF, Dharshi N, Sussman T, Hangar J. EXPLORING PROMISING PRACTICE MODELS FOR HOUSING OLDER PERSONS EXPERIENCINGHOMELESSNESS. Innov Aging 2019. [PMCID: PMC6846134 DOI: 10.1093/geroni/igz038.3283] [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: 11/13/2022] Open
Abstract
Abstract
The numbers of older persons experiencing homelessness (OPEH) is on the rise globally Yet housing and shelter options that support the varied and complex needs of this population are scarce. In order to understand effective solutions for housing OPEH, it is critical to explore promising practices that support aging in the right place for OPEH. In an effort to inform this critical gap, 100 OPEH and service providers were purposefully selected and invited to attend one of three World Café workshops held in three major urban cities in Canada: Vancouver, Calgary, and Montréal. Participants engaged in facilitated discussions aimed at supporting knowledge exchange and generating dialogue about gaps, opportunities and promising local housing options. Thematic analyses of audiotaped deliberations revealed three themes: 1) The limited nature of current housing options and programs in each locality; 2) The importance of supporting integrative housing models that increase access to formal health and social support staff, transportation, and income supports; and 3) The significance of supporting sustainability, by conducting regular program evaluations, increasing public awareness of homelessness issues, and involving multi-sector stakeholders. Findings highlight how meeting the unique health and psychosocial needs of OPEH requires a nuanced understanding of the development, design, and sustainability of effective housing options. World Café dialogues revealed that identifying and sustaining existing promising practice models provides an avenue to supporting aging in the right place for OPEH.
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Affiliation(s)
| | - Sarah L Canham
- Simon Fraser University, Vancouver, British Columbia, Canada
| | - Joe Humphries
- Simon Fraser University, Burnaby, British Columbia, Canada
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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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Downar J, Moorhouse P, Goldman R, Grossman D, Sinha S, Sussman T, Kaasalainen S, MacDonald S, Moser A, You JJ. Improving End-of-Life Care and Advance Care Planning for Frail Older Adults in Canad. J Frailty Aging 2019; 7:240-246. [PMID: 30298172 DOI: 10.14283/jfa.2018.33] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We present five Key Concepts that describe priorities for improving end-of-life care for frail older adults in Canada, and recommendations based on each Key Concept. Key Concept #1: Our end-of-life care system is focused on cancer, not frailty. Key Concept #2: We need better strategies to systematically identify frail older adults who would benefit from a palliative approach. Key Concept #3: The majority of palliative and end-of-life care will be, and should be, provided by clinicians who are not palliative care specialists. Key Concept #4: Organizational change and innovative funding models could deliver far better end-of-life care to frail individuals for less than we are currently spending. Key Concept #5: Improving the quality and quantity of advance care planning for frail older adults could reduce unwanted intensive care and costs at the end of life, and improve the experience for individuals and family members alike.
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Affiliation(s)
- J Downar
- James Downar, MDCM, MHSc, Interdepartmental Division of Critical Care Medicine and Palliative Care, Department of Medicine, University of Toronto, 200 Elizabeth St. 9N-926, Toronto, ON, M5G 2C4, canada, T. (416) 340-4800 x2674, F. (416) 340-4823. E.
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Smith-MacDonald L, Venturato L, Hunter P, Kaasalainen S, Sussman T, McCleary L, Thompson G, Wickson-Griffiths A, Sinclair S. Perspectives and experiences of compassion in long-term care facilities within Canada: a qualitative study of patients, family members and health care providers. BMC Geriatr 2019; 19:128. [PMID: 31060500 PMCID: PMC6503362 DOI: 10.1186/s12877-019-1135-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 03/20/2018] [Accepted: 04/11/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION This paper details a subset of the findings from a participatory action research project exploring a palliative intervention in long-term care sites across Canada. The findings presented in this paper relate to understanding compassion within the context of a palliative approach to long-term care. METHODS Findings presented are drawn from qualitative interviews and focus groups with residents, family members, healthcare providers, and managers from 4 long-term care sites across 4 provinces in Canada. In total, there were 117 individuals (20 residents, 16 family members, 72 healthcare providers, and 9 managers) who participated in one of 19 focus groups. Data was analyzed by multiple members of the research team in accordance with thematic analysis. Individual concepts were organized into themes across the different focus groups and the results were used to build a conceptual understanding of compassion within Long Term Care . FINDINGS Two themes, each comprised of 5 sub-themes, emerged from the data. The first theme 'Conceptualizing Compassion in Long-Term Care generated a multidimensional understanding of compassion that was congruent with previous theoretical models. 'Organizational Compassion: resources and staffing', the second major theme, focused on the operationalization of compassion within the practice setting and organizational culture. Organizational Compassion subthemes focused on how compassion could support staff to enact care for the residents, the families, one another, and at times, recognizing their pain and supporting it through grief and mourning. CONCLUSIONS Results suggest that compassion is an essential part of care and relationships within long-term care, though it is shaped by personal and professional relational aspects of care and bound by organizational and systemic issues. Findings suggest that compassion may be an under-recognised, but essential element in meeting the promise of person-centred care within long-term care environments.
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Affiliation(s)
- Lorraine Smith-MacDonald
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Lorraine Venturato
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.,Dementia and Cognitive Impairment NeuroTeam, Hotchkiss Brain Institute, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Paulette Hunter
- St. Thomas More College, University of Saskatchewan, 1437 College Drive, Saskatoon, SK, S7N 0W6, Canada
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, 845 Sherbrooke Street West, Montreal, QC, H3A 0G4, Canada
| | - Lynn McCleary
- Department of Nursing, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - Genevieve Thompson
- College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba, Helen Glass Centre for Nursing, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | | | - Shane Sinclair
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. .,Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. .,Compassion Research Lab, Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N1N4, Canada.
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