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Vilapakkam Nagarajan S, Poulos CJ, Clayton JM, Atee M, Morris T, Lovell MR. Australian residential aged care home staff experiences of implementing an intervention to improve palliative and end-of-life care for residents: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5588-e5601. [PMID: 36068671 PMCID: PMC10087131 DOI: 10.1111/hsc.13984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/26/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Access to high-quality and safe evidence-based palliative care (PC) is important to ensure good end-of-life care for older people in residential aged care homes (RACHs). However, many barriers to providing PC in RACHs are frequently cited. The Quality End-of-Life Care (QEoLC) Project was a multicomponent intervention that included training, evidence-based tools and tele-mentoring, aiming to equip healthcare professionals and careworkers in RACHs with knowledge, skills and confidence in providing PC to residents. This study aims to understand: (1) the experiences of healthcare professionals, careworkers, care managers, planners/implementers who participated in the implementation of the QEoLC Project; and (2) the barriers and facilitators to the implementation. Staff from two RACHs in New South Wales, Australia were recruited between September to November 2021. Semi-structured interviews and thematic data analysis were used. Fifteen participants (seven health professionals [includes one nurse, two clinical educators, three workplace trainers, one clinical manager/nurse], three careworkers and five managers) were interviewed. Most RACH participants agreed that the QEoLC Project increased their awareness of PC and provided them with the skills/confidence to openly discuss death and dying. Participants perceived that the components of the QEoLC Project had the following benefits for residents: more appropriate use of medications, initiation of timely pain management and discussions with families regarding end-of-life care preferences. Key facilitators for implementation were the role of champions, the role of the steering committee, regular clinical meetings to discuss at-risk residents and mentoring. Implementation barriers included: high staff turnover, COVID-19 pandemic, time constraints, perceived absence of executive sponsorship, lack of practical support and systems-related barriers. The findings underline the need for strong leadership, supportive organisational culture and commitment to the implementation of processes for improving the quality of end-of-life care. Furthermore, the results highlight the need for codesigning the intervention with RACHs, provision of dedicated staff/resources to support implementation, and integration of project tools with existing systems for achieving effective implementation outcomes.
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Affiliation(s)
- Srivalli Vilapakkam Nagarajan
- The Palliative CentreHammondCare, Greenwich HospitalSydneyNew South WalesAustralia
- Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Christopher J. Poulos
- Centre for Positive AgeingHammondCareSydneyNew South WalesAustralia
- School of Population HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Josephine M. Clayton
- The Palliative CentreHammondCare, Greenwich HospitalSydneyNew South WalesAustralia
- Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Mustafa Atee
- The Dementia CentreHammondCareOsborne ParkWestern AustraliaAustralia
| | - Thomas Morris
- The Dementia CentreHammondCareSt LeonardsNew South WalesAustralia
| | - Melanie R. Lovell
- The Palliative CentreHammondCare, Greenwich HospitalSydneyNew South WalesAustralia
- Sydney Medical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
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Lee JE, Lee J, Lee H, Park JK, Park Y, Choi WS. End-of-life care needs for noncancer patients who want to die at home in South Korea. Int J Nurs Pract 2020; 26:e12808. [PMID: 31975562 DOI: 10.1111/ijn.12808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/10/2019] [Accepted: 11/10/2019] [Indexed: 11/27/2022]
Abstract
AIM The awareness for the need for end-of-life care has increased among noncancer patients. However, studies on the topic have rarely targeted the needs of noncancer patients who want to die at home. This study assessed the end-of-life care needs of noncancer patients who were receiving care and wanted to die at home. METHODS A cross-sectional study design was used and involved 200 participants who were diagnosed as noncancer patients and receiving home care nursing. Data were collected on demographics, disease, Palliative Performance Scale (PPS) scores, and end-of-life care needs, in April and May, 2016. RESULTS Among the six areas of care, "supporting fundamental needs" of patients required the most care, followed by "coordination among family or relatives." Multivariate analysis revealed that the duration of home care nursing held a significant association with end-of-life care needs. CONCLUSION By reflecting on the comprehensive care needs of patients with chronic illnesses and including them in the care process, it will be possible to provide better quality palliative care to patients at home in the end-of-life stages.
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Affiliation(s)
- Jong-Eun Lee
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | - Jiwon Lee
- College of Nursing, Ajou University, Suwon, Republic of Korea
| | - Hanul Lee
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | | | - Younghye Park
- Team Manager in Home Care, Seoul St. Mary's Hospital, Seoul, Korea
| | - Whan Seok Choi
- Department of Family Care Medicine, Seoul St. Mary's Hospital, Seoul, Korea
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Kuruvilla L, Weeks G, Eastman P, George J. Medication management for community palliative care patients and the role of a specialist palliative care pharmacist: A qualitative exploration of consumer and health care professional perspectives. Palliat Med 2018; 32:1369-1377. [PMID: 29793391 DOI: 10.1177/0269216318777390] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pharmacists have a key role to play in optimisation of medication regimens and promotion of medication safety. The role of specialist pharmacists as part of the multidisciplinary palliative care team, especially in the primary care setting, is not widely recognised. AIM To explore the perspectives of stakeholders about the gaps in the current model of community palliative care services in relation to medication management and to assess their opinions pertaining to the role of a specialist palliative care pharmacist in addressing some of those gaps. DESIGN Qualitative study utilising three focus groups involving 20 stakeholders. Thematic analysis was carried out using a framework approach and interpreted in the context of the Chronic Care Model for improving primary care for patients with chronic illness. SETTING/PARTICIPANTS Setting was a large regional Australian palliative care service. Participants included palliative care consumers and clinicians specifically patients, caregivers, physicians, nurses and pharmacists. RESULTS Five major themes emerged from the focus groups: access to resources, medicines and information; shared care; challenges of polypharmacy; informal caregiver needs and potential roles of a palliative care pharmacist. Gaps in access to medicines/resources, training for generalist practitioners, communication between treating teams and lack of support for patients and carers were cited as factors adversely impacting medication management in community-based palliative care. CONCLUSION While community-based palliative care is an essential aspect of meeting the health care demands of an ageing society, the current model has several gaps and limitations. An appropriately qualified and skilled pharmacist within the palliative care team may help to address some of the gaps in relation to medication access and appropriateness.
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Affiliation(s)
- Lisha Kuruvilla
- 1 Pharmacy Department, Barwon Health, Geelong, VIC, Australia.,2 Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Greg Weeks
- 1 Pharmacy Department, Barwon Health, Geelong, VIC, Australia.,2 Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Peter Eastman
- 3 Department of Palliative Care, Barwon Health, Geelong, VIC, Australia
| | - Johnson George
- 2 Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.,4 School of Public Health and Preventative Medicine, Faculty of Medcine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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van de Mortel TF, Marr K, Burmeister E, Koppe H, Ahern C, Walsh R, Tyler-Freer S, Ewald D. Reducing avoidable admissions in rural community palliative care: a pilot study of care coordination by General Practice registrars. Aust J Rural Health 2016; 25:141-147. [PMID: 27380901 DOI: 10.1111/ajr.12309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the feasibility of using a General Practice registrar (GPR) to coordinate rural palliative care services. DESIGN A quasi-experimental design was used. Intervention group participants received the GPR service, which involved liaison among the patient, family, General Practitioner, specialist palliative care team and community nurses. Specified risk assessment, care planning and continuity of care were provided. Patients in the comparison group received the standard service. SETTING Rural community palliative care. PARTICIPANTS One hundred and ninety-one rural community palliative care patients (99 intervention and 92 control patients). MAIN OUTCOME MEASURES Hospital admissions per 100 patient-days, bed-days per 100 patient-days and proportion of deaths at home. RESULTS Patients receiving standard care were twice as likely to spend ≥8 bed-days in hospital (OR 2.09 (95%CI 1.10-3.97); P = 0.02) and were more likely to have ≥ 2 admissions to hospital (OR 3.37 (95%CI 1.83-6.21); P < 0.001), per 100 patient-days than the intervention group after adjusting for diagnosis group (cancer or not) and residence in residential aged care. Controls were significantly less likely to die at home than the intervention group (OR 0.41 (95%CI 0.20-0.86); P = 0.02). CONCLUSION This is a small proof of concept pilot study limited by lack of randomisation. The results demonstrate the feasibility of using a GPR to manage continuity of care for rural community palliative care patients. Given the potential confounding factors, further investigation via a larger randomised trial is required.
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Affiliation(s)
- Thea F van de Mortel
- School of Nursing & Midwifery, Griffith University, Southport, Queensland, Australia.,School of Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Kenneth Marr
- Northern NSW Local Health District, Lismore, New South Wales, Australia
| | | | - Hilton Koppe
- North Coast GP Training, Ballina, New South Wales, Australia
| | - Christine Ahern
- North Coast GP Training, Ballina, New South Wales, Australia
| | - Robert Walsh
- Tintenbar Medical Centre, Tintenbar, New South Wales, Australia
| | | | - Dan Ewald
- North Coast Primary Health Network, Ballina, New South Wales, Australia.,School of Medicine, Sydney University, Sydney, New South Wales, Australia
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The positioning of palliative care in acute care: A multiperspective qualitative study in the context of metastatic melanoma. Palliat Support Care 2015; 14:259-68. [PMID: 26456174 DOI: 10.1017/s1478951515000917] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The positioning and meaning of palliative care within the healthcare system lacks clarity which adds a level of complexity to the process of transition to palliative care. This study explores the transition to the palliative care process in the acute care context of metastatic melanoma. METHOD A theoretical framework drawing on interpretive and critical traditions informs this research. The pragmatism of symbolic interactionism and the critical theory of Habermas brought a broad orientation to the research. Integration of the theoretical framework and grounded-theory methods facilitated data generation and analysis of 29 interviews with patients, family carers, and healthcare professionals. RESULTS The key analytical findings depict a scope of palliative care that was uncertain for users of the system and for those working within the system. Becoming "palliative" is not a defined event; nor is there unanimity around referral to a palliative care service. As such, ambiguity and tension contribute to the difficulties involved in negotiating the transition to palliative care. SIGNIFICANCE OF RESULTS Our findings point to uncertainty around the scopes of practice in the transition to palliative care. The challenge in the transition process lies in achieving greater coherency of care within an increasingly specialized healthcare system. The findings may not only inform those within a metastatic melanoma context but may contribute more broadly to palliative practices within the acute care setting.
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Abstract
ABSTRACTObjective:The difficulties in conducting palliative care research have been widely acknowledged. In order to generate the evidence needed to underpin palliative care provision, collaborative research is considered essential. Prior to formalizing the development of a research network for the state of Victoria, Australia, a preliminary study was undertaken to ascertain interest and recommendations for the design of such a collaboration.Method:Three data-collection strategies were used: a cross-sectional questionnaire, interviews, and workshops. The questionnaire was completed by multidisciplinary palliative care specialists from across the state (n = 61); interviews were conducted with senior clinicians and academics (n = 21) followed by two stakeholder workshops (n = 29). The questionnaire was constructed specifically for this study, measuring involvement of and perceptions of palliative care research.Results:Both the interview and the questionnaire data demonstrated strong support for a palliative care research network and aided in establishing a research agenda. The stakeholder workshops assisted with strategies for the formation of the Palliative Care Research Network Victoria (PCRNV) and guided the development of the mission and strategic plan.Significance of results:The research and efforts to date to establish the PCRNV are encouraging and provide optimism for the evolution of palliative care research in Australia. The international implications are highlighted.
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Love AW, Liversage LM. Barriers to accessing palliative care: A review of the literature. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x13y.0000000055] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Palliative care needs of terminally ill people living alone: A service provider perspective. Collegian 2013; 20:179-85. [DOI: 10.1016/j.colegn.2012.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Broom A, Kirby E, Good P, Wootton J, Adams J. The art of letting go: referral to palliative care and its discontents. Soc Sci Med 2012; 78:9-16. [PMID: 23219848 DOI: 10.1016/j.socscimed.2012.11.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 11/03/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
Abstract
Accompanying patients from active treatment towards specialist palliative care is a complex sphere of clinical practice that can be fraught with interpersonal and emotional challenges. While medical specialists are expected to break 'bad news' to their patients and ease their transitions to specialist palliative care if required, few have received formal training in such interpersonal complexities. Furthermore, there also often exists clinical ambiguity around whether to continue active treatment vis-à-vis refocusing on quality of life and palliation. In this paper we explore the experiences of twenty Australian medical specialists, focussing on issues such as: dilemmas around when and how to talk about dying and palliation; the art of referral and practices of representation; and, accounts of emotion and subjective influences on referral. The results illustrate how this transitional realm can be embedded in emotions, relationships and the allure of potentially life-prolonging intervention. We argue that the practice of referral should be understood as a relational and contextually-bound process.
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Affiliation(s)
- Alex Broom
- School of Social Science, University of Queensland, St. Lucia, QLD 4072, Australia.
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Reymond L, Israel FJ, Charles MA. A residential aged care end-of-life care pathway (RAC EoLCP) for Australian aged care facilities. AUST HEALTH REV 2011; 35:350-6. [PMID: 21871198 DOI: 10.1071/ah10899] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 11/10/2010] [Indexed: 11/23/2022]
Abstract
The objective of this study was to develop, implement and evaluate an end-of-life (terminal) care pathway and associated infrastructure suitable for Australian residential aged care facilities that improves resident and health system outcomes. The residential aged care end-of-life care pathway was developed by a multidisciplinary collaboration of government and non-government professionals and incorporated best clinical management for dying residents to guide care and increase palliative care capacity of generalist staff. Implementation included identifying and up-skilling Link Nurses to champion the pathway, networking facilities with specialist palliative care services, delivering education to generalists and commencing a Palliative Care Medication Imprest System in each facility. The primary outcome measure for evaluation was transfer to hospital; secondary measures included staff perceived changes in quality of palliative care provided and family satisfaction with care. Results indicated that the pathway, delivered within a care framework that guides provision of palliative care, resulted in improved resident outcomes and decreased inappropriate transfers to acute care settings.
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Affiliation(s)
- Liz Reymond
- Brisbane South Palliative Care Collaborative, Queensland Health and Griffith University School of Medicine, Eight Mile Plains, QLD 4113, Australia.
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O'Brien M, Jack B. Barriers to dying at home: the impact of poor co-ordination of community service provision for patients with cancer. HEALTH & SOCIAL CARE IN THE COMMUNITY 2010; 18:337-345. [PMID: 20039968 DOI: 10.1111/j.1365-2524.2009.00897.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
For patients dying of cancer, there is an emphasis on giving choice regarding preferred location for care, with the option of dying at home, which is integral to UK government health initiatives such as the End of Life Care Programme. However, patients continue to be admitted to hospital in the terminal phase of their illness when they have expressed a desire to die at home. A qualitative study, using two audio tape-recorded focus group interviews, with a purposive sample of district nurses and community specialist palliative care nurses (19) was undertaken across two primary care trusts in the north west of England. Data were analysed using a thematic analysis approach. From a service provision perspective, the results reveal that poor discharge planning and co-ordination, difficulty in establishing additional equipment and services together with inadequate out of hours medical provision were all factors contributing to hospital admissions for patients with cancer in the last hours and days of life, and thus were barriers to dying at home.
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Affiliation(s)
- Mary O'Brien
- Evidence-based Research Centre, Faculty of Health, Edge Hill University, St Helen's Road, Ormskirk, Lancashire, UK.
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