1
|
Gill A, Meadows L, Ashbourne J, Kaasalainen S, Shamon S, Pereira J. 'Confidence and fulfillment': a qualitative descriptive study exploring the impact of palliative care training for long-term care physicians and nurses. Palliat Care Soc Pract 2024; 18:26323524241235180. [PMID: 38449569 PMCID: PMC10916492 DOI: 10.1177/26323524241235180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
Objective To explore the impact of a 2-day, in-person interprofessional palliative care course for staff working in long-term care (LTC) homes. Methods A qualitative descriptive study design was employed. LTC staff who had participated in Pallium Canada's Learning Essential Approaches to Palliative Care LTC Course in Ontario, Canada between 2017 and 2019 were approached. Semi-structured interviews were conducted, using an online videoconferencing platform in mid-2021 in Ontario, Canada. These were done online, recorded, and transcribed. Data were coded inductively. Results Ten persons were interviewed: four registered practical nurses, three registered nurses, one nurse practitioner, and two physicians. Some held leadership roles. Participants described ongoing impact on themselves and their ability to provide end-of-life (EOL) care (micro-level), their services and institutions (meso-level), and their healthcare systems (macro-level). At a micro-level, participants described increased knowledge and confidence to support residents and families, and increased work fulfillment. At the meso-level, their teams gained increased collective knowledge and greater interprofessional collaboration to provide palliative care. At the macro level, some participants connected with other LTC homes and external stakeholders to improve palliative care across the sector. Training provided much-needed preparedness to respond to the impact of the COVID-19 pandemic, including undertaking advance care planning and EOL conversations. The pandemic caused staff burnout and shortages, creating challenges to applying course learnings. Significance of results The impact of palliative care training had ripple effects several years after completing the training, and equipped staff with key skills to provide care during the COVID-19 pandemic. Palliative care education of staff remains a critical element of an overall strategy to improve the integration of palliative care in LTC.
Collapse
Affiliation(s)
- Ashlinder Gill
- Division of Palliative Care, Department of Family Medicine, McMaster University, 5th Floor, 100 Main Street West, Hamilton, ON, Canada L8P 1H6
| | - Lynn Meadows
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jessica Ashbourne
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Sharon Kaasalainen
- Faculty of Health Sciences, Division of Palliative Care, Department of Family Medicine, School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Sandy Shamon
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Temmy Latner Centre for Palliative Care, Toronto, ON, Canada
| | - José Pereira
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Pallium Canada, Ottawa, ON, Canada
| |
Collapse
|
2
|
Shamon S, Gill A, Meadows L, Kruizinga J, Kaasalainen S, Pereira J. Providing palliative and end-of-life care in long-term care during the COVID-19 pandemic: a qualitative study of clinicians' lived experiences. CMAJ Open 2023; 11:E745-E753. [PMID: 37607749 PMCID: PMC10449019 DOI: 10.9778/cmajo.20220238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND A disproportionate number of COVID-19-related deaths in Canada occurred in long-term care homes, affecting residents, families and staff alike. This study explored the experiences of long-term care clinicians with respect to providing palliative and end-of-life care during the COVID-19 pandemic. METHODS We used a qualitative research approach. Long-term care physicians and nurse practitioners (NPs) in Ontario, Canada, participated in semistructured interviews between August and September of 2021. Interviews were undertaken virtually, and results were analyzed using thematic analysis. RESULTS Twelve clinicians (7 physicians and 5 NPs) were interviewed. We identified 5 themes, each with several subthemes: providing a palliative approach to care, increased work demands and changing roles, communication and collaboration, impact of isolation and visitation restrictions, and impact on the providers' personal lives. Clinicians described facing several concurrent challenges, including the uncertainty of COVID-19 illness, staffing and supply shortages, witnessing many deaths, and distress caused by isolation. These resulted in burnout and feelings of moral distress. Previous training and integration of the palliative care approach in the long-term care home, access to resources, increased communication and interprofessional collaboration, and strong leadership mitigated the impact and led to improved palliative care and a sense of pride while facing these challenges. INTERPRETATION The pandemic had a considerable impact on clinicians caring for residents in long-term care homes at the end of life. It is important to address these lived experiences and use the lessons learned to identify strategies to improve palliative care in long-term care homes and reduce the impact of future pandemics with respect to palliative care.
Collapse
Affiliation(s)
- Sandy Shamon
- Division of Palliative Care (Shamon, Gill, Pereira), Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Community Health Sciences, Cumming School of Medicine (Meadows), University of Calgary, Calgary, Alta.; School of Nursing (Kruizinga, Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Pallium Canada (Pereira), Ottawa, Ont.
| | - Ashlinder Gill
- Division of Palliative Care (Shamon, Gill, Pereira), Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Community Health Sciences, Cumming School of Medicine (Meadows), University of Calgary, Calgary, Alta.; School of Nursing (Kruizinga, Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Pallium Canada (Pereira), Ottawa, Ont
| | - Lynn Meadows
- Division of Palliative Care (Shamon, Gill, Pereira), Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Community Health Sciences, Cumming School of Medicine (Meadows), University of Calgary, Calgary, Alta.; School of Nursing (Kruizinga, Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Pallium Canada (Pereira), Ottawa, Ont
| | - Julia Kruizinga
- Division of Palliative Care (Shamon, Gill, Pereira), Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Community Health Sciences, Cumming School of Medicine (Meadows), University of Calgary, Calgary, Alta.; School of Nursing (Kruizinga, Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Pallium Canada (Pereira), Ottawa, Ont
| | - Sharon Kaasalainen
- Division of Palliative Care (Shamon, Gill, Pereira), Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Community Health Sciences, Cumming School of Medicine (Meadows), University of Calgary, Calgary, Alta.; School of Nursing (Kruizinga, Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Pallium Canada (Pereira), Ottawa, Ont
| | - José Pereira
- Division of Palliative Care (Shamon, Gill, Pereira), Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Department of Community Health Sciences, Cumming School of Medicine (Meadows), University of Calgary, Calgary, Alta.; School of Nursing (Kruizinga, Kaasalainen), Faculty of Health Sciences, McMaster University, Hamilton, Ont.; Pallium Canada (Pereira), Ottawa, Ont
| |
Collapse
|
3
|
Seow H, Bainbridge D, Winemaker S, Stajduhar K, Pond G, Kortes-Miller K, Marshall D, Kilbertus F, Myers J, Steinberg L, Incardona N, Levine O, Pereira J. Increasing palliative care capacity in primary care: study protocol of a cluster randomized controlled trial of the CAPACITI training program. BMC Palliat Care 2023; 22:2. [PMID: 36604714 PMCID: PMC9813458 DOI: 10.1186/s12904-022-01124-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Primary care providers play a critical role in providing early palliative care to their patients. Despite the availability of clinical education on best practices in palliative care, primary care providers often lack practical guidance to help them operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to provide an early palliative approach to care. The entire program consists of 12 sessions (1 h each), divided evenly across three modules: (1) Identify and Assess; (2) Enhance Communication Skills; (3) Coordinate for Ongoing Care. We report the protocol for our planned evaluation of CAPACITI on its effectiveness in helping primary care providers increase their identification of patients requiring a palliative approach to care and to strengthen other core competencies. METHODS A cluster randomized controlled trial evaluating two modes of CAPACITI program delivery: 1) self-directed learning, consisting of online access to program materials; and 2) facilitated learning, which also includes live webinars where the online materials are presented and discussed. The primary outcomes are 1) percent of patients identified as requiring palliative care (PC), 2) timing of first initiation of PC, and self-reported PC competency (EPCS tool). Secondary outcomes include self-reported confidence in PC, practice change, and team collaboration (AITCS-II tool), as well as qualitative interviews. Covariates that will be examined are readiness for change (ORCA tool), learning preference, and team size. Primary care teams representing interdisciplinary providers, including physicians, nurse practitioners, registered nurses, care coordinators, and allied health professionals will be recruited from across Canada. The completion of all three modules is expected to take participating teams a total of six months. DISCUSSION CAPACITI is a national trial aimed at behavior change in primary care providers. This research will help inform future palliative care educational initiatives for generalist health care providers. Specifically, our findings will examine the effectiveness of the two models of education delivery and the participant experience associated with each modality. TRIAL REGISTRATION ClinicalTrials.gov NCT05120154.
Collapse
Affiliation(s)
- Hsien Seow
- grid.25073.330000 0004 1936 8227Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Daryl Bainbridge
- grid.25073.330000 0004 1936 8227Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Samantha Winemaker
- grid.25073.330000 0004 1936 8227Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Kelli Stajduhar
- grid.143640.40000 0004 1936 9465School of Nursing, University of Victoria, Victoria, BC Canada
| | - Gregory Pond
- grid.25073.330000 0004 1936 8227Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Kathy Kortes-Miller
- grid.258900.60000 0001 0687 7127Department of Social Work, Lakehead University, Thunder Bay, ON Canada
| | - Denise Marshall
- grid.25073.330000 0004 1936 8227Department of Family Medicine, McMaster University, Hamilton, ON Canada
| | - Frances Kilbertus
- grid.436533.40000 0000 8658 0974Northern Ontario School of Medicine University, Thunder Bay, ON Canada
| | - Jeff Myers
- grid.17063.330000 0001 2157 2938Division of Palliative Care, University of Toronto, Toronto, ON Canada
| | - Leah Steinberg
- grid.17063.330000 0001 2157 2938Division of Palliative Care, University of Toronto, Toronto, ON Canada
| | - Nadia Incardona
- grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada
| | - Oren Levine
- grid.25073.330000 0004 1936 8227Department of Oncology, McMaster University, Hamilton, ON Canada
| | - Jose Pereira
- grid.25073.330000 0004 1936 8227Department of Family Medicine, McMaster University, Hamilton, ON Canada
| |
Collapse
|
4
|
Seow H, Bainbridge D, Stajduhar K, Marshall D, Howard M, Brouwers M, Barwich D, Burge F, Kelley ML. Building Palliative Care Capacity for Generalist Providers in the Community: Results From the Capaciti Pilot Education Program. Am J Hosp Palliat Care 2022:10499091221134709. [PMID: 36269212 DOI: 10.1177/10499091221134709] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Primary care providers play an important role in providing early palliative care, however they often lack practical supports to operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to help primary care providers offer an early palliative approach to care. The CAPACITI pilot program consisted of 10 facilitated, monthly training sessions, covering identification and assessment, communication, and engaging caregivers and specialists. We present the findings of an evaluation of the pilot program. Method: We conducted a single cohort study of primary care providers who participated in CAPACITI. Study outcomes were the change in the percentage of caseload reported as requiring palliative care and improved confidence in competencies measured on a 20-item, study-created survey. Pre and post survey data were analyzed using paired t-tests. Results: Twenty-two teams representing 127 care providers (including 36 physicians and 28 Nurse Practitioners) completed CAPACITI. Paired comparisons showed a moderate improvement in confidence across the competencies covered (.6 to 1.3 mean improvement across items using seven-point scales, all P < .05). Pre-CAPACITI, clinician prescribers (N = 32) identified a mean of 1.2% of their caseload requiring a palliative approach to care, which increased to 1.6% post-program (P = .02). Said differently, the total group of paired clinician prescribers identified 338 patients as requiring palliative care in their caseloads at baseline vs 482 patients following the intervention, for an overall increase of 144 patients in their collective caseloads. Conclusion: CAPACITI improved self-assessed palliative care identification and provider confidence in core competencies. The program demonstrated potential for building palliative care capacity in primary care teams.
Collapse
Affiliation(s)
- Hsien Seow
- Department of Oncology, 3710McMaster University, Hamilton, ON, Canada
| | - Daryl Bainbridge
- Department of Oncology, 3710McMaster University, Hamilton, ON, Canada
| | - Kelli Stajduhar
- Department of School of Nursing and Institute on Aging and Lifelong Health, 8205University of Victoria, Victoria, BC, Canada
| | - Denise Marshall
- Department of Health Sciences, 62703McMaster University, Hamilton, ON, Canada
| | - Michelle Howard
- Department of Family Medicine, 152996McMaster University, Hamilton, ON, Canada
| | - Melissa Brouwers
- School of Epidemiology and Public Health, 177403University of Ottawa, Ottawa, ON, Canada
| | - Doris Barwich
- 12358The University of British Columbia, Vancouver, BC, Canada
| | - Fred Burge
- Department of Family Medicine, 152980Dalhousie University, Halifax, NS, Canada
| | - Mary Lou Kelley
- School of Social Work, 157782Lakehead University, Thunder Bay, ON, Canada
| |
Collapse
|
5
|
Pereira J, Meadows L, Kljujic D, Strudsholm T, Parsons H, Riordan B, Faulkner J, Fisher K. Learner Experiences Matter in Interprofessional Palliative Care Education: A Mixed Methods Study. J Pain Symptom Manage 2022; 63:698-710. [PMID: 34998952 DOI: 10.1016/j.jpainsymman.2021.12.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/09/2021] [Accepted: 12/31/2021] [Indexed: 12/17/2022]
Abstract
CONTEXT Interprofessional collaboration is needed in palliative care and many other areas in health care. Pallium Canada's two-day interprofessional Learning Essential Approaches to Palliative care Core courses aim to equip primary care providers from different professions with core palliative care skills. OBJECTIVES Explore the learning experience of learners from different professions who participated in Learning Essential Approaches to Palliative care Core courses from April 2015 to March 2017. METHODS This mixed methods study was designed as a secondary analysis of existing data. Learners had completed a standardized course evaluation survey online immediately post-course. The survey explored the learning experience across several domains and consisted of seven closed ended (Likert Scales; 1 = "Total Disagree", 5 = "Totally Agree") and three open-ended questions. Quantitative data were analyzed using descriptive statistics and Kruskal-Wallis non-parametric test tests, and qualitative data underwent thematic analysis. RESULTS During the study period, 244 courses were delivered; 3045 of 4636 participants responded (response rate 66%); physicians (662), nurses (1973), pharmacists (74), social workers (80), and other professions (256). Overall, a large majority of learners (96%) selected "Totally Agree" or "Agree" for the statement "the course was relevant to my practice". A significant difference was noted across profession groups; X2 (4) = 138; p < 0.001. Post-hoc analysis found the differences to exist between physicians and pharmacists (X2 = -4.75; p < 0.001), and physicians and social workers (X2 = -6.63; p < 0.001). No significant differences were found between physicians and nurses (X2 = 1.31; p = 1.00), and pharmacists and social workers (X2 = -1.25; p = 1.00). Similar results were noted for five of the other statements. CONCLUSION Learners from across profession groups reported this interprofessional course highly across several learning experience parameters, including relevancy for their respective professions. Ongoing curriculum design is needed to fully accommodate the specific learning needs of some of the professions.
Collapse
Affiliation(s)
- José Pereira
- Pallium (J.P., B.R., J.F.), Ontario, Canada; Division of Palliative Care, Department of Family Medicine (J.P.), McMaster University, Hamilton, Canada; Institute for Culture and Society (ICS) (J.P.), University of Navara, Pamplona, Spain.
| | - Lynn Meadows
- Department of Community Health Sciences (L.M.), Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dragan Kljujic
- Database Manager and Analyst (D.K.), Independent Consultant, Brampton, Canada
| | - Tina Strudsholm
- School of Health Sciences (T.S.), University of Northern British Columbia, Prince George, Canada
| | - Henrique Parsons
- Division of Palliative Care (H.P.), Department of Medicine, University of Ottawa; The Ottawa Hospital Research Institute Clinical Epidemiology Program; Bruyere Research Institute, Ontario, Canada
| | | | | | - Kathryn Fisher
- School of Nursing, Faculty of Health Sciences (K.F.), McMaster University, Hamilton, Canada
| |
Collapse
|
6
|
Pereira J, Meadows L, Kljujic D, Strudsholm T. Do learners implement what they learn? Commitment-to-change following an interprofessional palliative care course. Palliat Med 2022; 36:866-877. [PMID: 35260018 PMCID: PMC9087309 DOI: 10.1177/02692163221081329] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Palliative care educators should incorporate strategies that enhance application into practice by learners. Commitment-to-change is an approach to reinforce learning and encourage application into practice; immediately post-course learners commit to making changes in their practices as a result of participating in the course ("statements") and then several weeks or months later are prompted to reflect on their commitments ("reflections"). AIM Explore if and how learners implemented into practice what they learned in a palliative care course, using commitment-to-change reflections. DESIGN Secondary analysis of post-course commitment statements and 4-months post-course commitment reflections submitted online by learners who participated in Pallium Canada's interprofessional, 2-day, Learning Essential Approaches to Palliative Care (LEAP) Core courses. SETTING/PARTICIPANTS Primary care providers from across Canada and different profession who attended LEAP Core courses from 1 April 2015 to 31 March 2017. RESULTS About 1063 of 4636 learners (22.9%) who participated in the 244 courses delivered during the study period submitted a total of 4250 reflections 4 months post-course. Of these commitments, 3081 (72.5%) were implemented. The most common implemented commitments related to initiating palliative care early across diseases, pain and symptom management, use of clinical instruments, advance care planning, and interprofessional collaboration. Impact extended to patients, services, and colleagues. Barriers to implementation into practice included lack of time, and system-level factors such as lack of support by managers and untrained colleagues. CONCLUSIONS Examples of benefits to patients, families, services, colleagues, and themselves were described as a result of participating in the courses.
Collapse
Affiliation(s)
- José Pereira
- Pallium Canada, Ottawa, Canada (Non-profit Foundation).,Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, Canada.,Institute for Culture and Society (ICS), University of Navara, Spain
| | - Lynn Meadows
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Tina Strudsholm
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
| |
Collapse
|