Evaluating Canada's Compassionate Care Benefit using a utilization-focused evaluation framework: successful strategies and prerequisite conditions

The utility of evaluation in optimizing implementation and improvement of HIV prevention programming

The objective of this article is to describe Project PrIDE (PrEP Implementation, Data to Care, and Evaluation) through the lens of Evaluation Utilization and provide examples of how twelve funded health departments (HD) utilized evaluation findings to make decisions related to improving PrEP awareness and uptake, and/or enhancing capacity for data to care (D2C) activities. Each HD conducted a local evaluation (LE) and reported ongoing and planned utilization of evaluation findings in the final LE reports. Information from all reports was abstracted for qualitative analysis to identify main evaluation utilization themes. Findings showed that program evaluation was incorporated as early as the project development phase and designed with the goal of improving, and not just demonstrating the efficacy of the programs. Evaluation data were effectively utilized to improve PrEP and D2C activities, for example, by increasing community engagement throughout LEs, enhancing social media implementation, prioritizing the most effective referral sources at re-linking clients into HIV care, reducing client wait time between receiving PrEP referral and obtaining appointment with provider, and incorporating evaluation findings into program planning and development. Project PrIDE highlights the importance of a planned evaluation in providing ongoing improvements to HIV prevention services to better serve priority populations.

Implementation Models of Compassionate Communities and Compassionate Cities at the End of Life: A Systematic Review

In the last decade, we have seen a growth of Compassionate Communities and Cities (CCC) at the end of life. There has been an evolution of organizations that help construct Community-Based Palliative Care programs. The objective is to analyze the implementation, methodology and effectiveness of the CCC models at the end of life. We conducted a systematic review following PRISMA ScR Guideline. The protocol was registered on PROSPERO (CRD42017068501). Five databases (MEDLINE, EMBASE, Web of Science, CINAHL and Google Scholar) were searched for studies (from 2000 to 2018) using set eligibility criteria. Three reviewers screened full-texts articles and extracted study data. Outcomes were filled in a registration form which included a narrative synthesis of each article. We screened 1975 records. We retrieved 112 articles and included 31 articles for the final analysis: 17 descriptive studies, 4 interventions studies, 4 reviews and 6 qualitative studies. A total of 11 studies regard the development models of CCC at the end of life, 15 studies were about evaluation of compassionate communities' programs and 5 studies were about protocols for the development of CCC programs. There is poor evidence of the implementation and evaluation models of CCC at the end of life. There is little and low-/very low-quality evidence about CCC development and assessment models. We found no data published on care intervention in advance disease and end of life. A global model for the development and evaluation of CCC at the end of life seems to be necessary.

Canada's Compassionate Care Benefit: is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care?

BACKGROUND

An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canada's Compassionate Care Benefit (CCB)--a contributory benefits social program aimed at informal P/EOL caregivers--operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model.

METHODS

As part of a national evaluation of Canada's Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework.

RESULTS

Informal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants.

CONCLUSIONS

This study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to transform the CCB so that it may fulfill the potential it holds for serving as one public health response to caregiver burden that forms part of a healthy public policy that addresses the determinants of this burden.