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Peters MDJ, Marnie C, Helms C. Enablers and barriers to nurse practitioners working in Australian aged care: A scoping review. Int J Nurs Stud 2024; 158:104861. [PMID: 39121578 DOI: 10.1016/j.ijnurstu.2024.104861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 06/19/2024] [Accepted: 07/13/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To identify evidence reporting on nurse practitioners working in aged care in Australia and to categorise the reported factors found to be barriers or facilitators to operation in terms of establishment, sustainability, and expansion. INTRODUCTION Nurse practitioners work in a variety of aged care contexts throughout Australia but are underutilised and uncommon. Despite evidence for their effectiveness, it is unclear what barriers or enabling factors contribute to the successful and sustainable implementation of nurse practitioners working in this sector. METHODS Based on an a-priori protocol the JBI methodology for scoping reviews was used and the review reported against the PRISMA extension for scoping reviews (PRISMA-ScR). Databases searched included MEDLINE, Embase, Emcare, Web of Science, and Scopus. Peer reviewed and grey literature describing the role of Australian nurse practitioners in aged care were included. RESULTS Of 2968 retrieved sources, 18 were included representing studies of a variety of designs from all Australian states and territories. Residential care and in-home care contexts as well as metropolitan, regional, and remote locations were represented. Overall, 123 individual barriers and facilitators were identified across seven inductively derived categories: staff/individual, organisational, system, operational, resource, data, and consumers/clients/residents. In many cases, factors appeared across both positive (facilitators) and negative (barriers) categories. CONCLUSIONS Nurse practitioners can improve the quality of care being provided to older people accessing aged care in Australia. When establishing or maintaining nurse practitioner roles in aged care knowledge users should have a comprehensive understanding of the range of factors potentially contributing to or limiting success or sustainability. As implementation is highly contextual, various types of organisational and sectoral factors as well as individual and overarching factors related to the regulation of nurse practitioners practice should be considered.
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Affiliation(s)
- Micah D J Peters
- University of South Australia, UniSA Clinical and Health Sciences, Rosemary Bryant AO Research Centre, Adelaide, South Australia, Australia; Australian Nursing and Midwifery Federation (Federal Office), Melbourne, Victoria, Australia; University of Adelaide, School of Public Health, Health Evidence Synthesis, Recommendations and Impact (HESRI), Adelaide, South Australia, Australia; University of Adelaide, Faculty of Health and Medical Sciences, Adelaide Nursing School, Adelaide, South Australia, Australia; The Danish Centre of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence, Department of Clinical Medicine, Aalborg University, Denmark.
| | - Casey Marnie
- University of South Australia, UniSA Clinical and Health Sciences, Rosemary Bryant AO Research Centre, Adelaide, South Australia, Australia; Australian Nursing and Midwifery Federation (Federal Office), Melbourne, Victoria, Australia
| | - Christopher Helms
- Charles Darwin University, Faculty of Health, School of Nursing, Australia
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Forbat L, Macgregor A, Spilsbury K, McCormack B, Rutherford A, Hanratty B, Hockley J, Davison L, Ogden M, Soulsby I, McKenzie M. Using Palliative Care Needs Rounds in the UK for care home staff and residents: an implementation science study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-134. [PMID: 39046763 DOI: 10.3310/krwq5829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Background Care home residents often lack access to end-of-life care from specialist palliative care providers. Palliative Care Needs Rounds, developed and tested in Australia, is a novel approach to addressing this. Objective To co-design and implement a scalable UK model of Needs Rounds. Design A pragmatic implementation study using the integrated Promoting Action on Research Implementation in Health Services framework. Setting Implementation was conducted in six case study sites (England, n = 4, and Scotland, n = 2) encompassing specialist palliative care service working with three to six care homes each. Participants Phase 1: interviews (n = 28 care home staff, specialist palliative care staff, relatives, primary care, acute care and allied health practitioners) and four workshops (n = 43 care home staff, clinicians and managers from specialist palliative care teams and patient and public involvement and engagement representatives). Phase 2: interviews (n = 58 care home and specialist palliative care staff); family questionnaire (n = 13 relatives); staff questionnaire (n = 171 care home staff); quality of death/dying questionnaire (n = 81); patient and public involvement and engagement evaluation interviews (n = 11); fidelity assessment (n = 14 Needs Rounds recordings). Interventions (1) Monthly hour-long discussions of residents' physical, psychosocial and spiritual needs, alongside case-based learning, (2) clinical work and (3) relative/multidisciplinary team meetings. Main outcome measures A programme theory describing what works for whom under what circumstances with UK Needs Rounds. Secondary outcomes focus on health service use and cost effectiveness, quality of death and dying, care home staff confidence and capability, and the use of patient and public involvement and engagement. Data sources Semistructured interviews and workshops with key stakeholders from the six sites; capability of adopting a palliative approach, quality of death and dying index, and Canadian Health Care Evaluation Project Lite questionnaires; recordings of Needs Rounds; care home data on resident demographics/health service use; assessments and interventions triggered by Needs Rounds; semistructured interviews with academic and patient and public involvement and engagement members. Results The programme theory: while care home staff experience workforce challenges such as high turnover, variable skills and confidence, Needs Rounds can provide care home and specialist palliative care staff the opportunity to collaborate during a protected time, to plan for residents' last months of life. Needs Rounds build care home staff confidence and can strengthen relationships and trust, while harnessing services' complementary expertise. Needs Rounds strengthen understandings of dying, symptom management, advance/anticipatory care planning and communication. This can improve resident care, enabling residents to be cared for and die in their preferred place, and may benefit relatives by increasing their confidence in care quality. Limitations COVID-19 restricted intervention and data collection. Due to an insufficient sample size, it was not possible to conduct a cost-benefit analysis of Needs Rounds or calculate the treatment effect or family perceptions of care. Conclusions Our work suggests that Needs Rounds can improve the quality of life and death for care home residents, by enhancing staff skills and confidence, including symptom management, communications with general practitioners and relatives, and strengthen relationships between care home and specialist palliative care staff. Future work Conduct analysis of costs-benefits and treatment effects. Engagement with commissioners and policy-makers could examine integration of Needs Rounds into care homes and primary care across the UK to ensure equitable access to specialist care. Study registration This study is registered as ISRCTN15863801. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128799) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 19. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Liz Forbat
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Aisha Macgregor
- Faculty of Social Science, University of Stirling, Stirling, UK
| | | | - Brendan McCormack
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
- Queen Margaret University Edinburgh, Scotland, UK
- Østfold University College, Norway
| | | | - Barbara Hanratty
- Faculty of Medical Sciences, University of Newcastle, England, UK
| | - Jo Hockley
- College of Medicine and Veterinary Science, University of Edinburgh, UK
| | - Lisa Davison
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Margaret Ogden
- Patient and Public Involvement and Engagement, Faculty of Social Science, University of Stirling, UK
| | - Irene Soulsby
- Patient and Public Involvement and Engagement, Faculty of Social Science, University of Stirling, UK
| | - Maisie McKenzie
- Patient and Public Involvement and Engagement, Faculty of Social Science, University of Stirling, UK
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Bowers B, Antunes BCP, Etkind S, Hopkins SA, Winterburn I, Kuhn I, Pollock K, Barclay S. Anticipatory prescribing in community end-of-life care: systematic review and narrative synthesis of the evidence since 2017. BMJ Support Palliat Care 2024; 13:e612-e623. [PMID: 37236648 PMCID: PMC10850730 DOI: 10.1136/spcare-2022-004080] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/15/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The anticipatory prescribing of injectable medications is recommended practice in controlling distressing symptoms in the last days of life. A 2017 systematic review found practice and guidance was based on inadequate evidence. Since then, there has been considerable additional research, warranting a new review. AIM To review the evidence published since 2017 concerning anticipatory prescribing of injectable medications for adults at the end-of-life in the community, to inform practice and guidance. DESIGN Systematic review and narrative synthesis. METHODS Nine literature databases were searched from May 2017 to March 2022, alongside reference, citation and journal hand-searches. Gough's Weight of Evidence framework was used to appraise included studies. RESULTS Twenty-eight papers were included in the synthesis. Evidence published since 2017 shows that standardised prescribing of four medications for anticipated symptoms is commonplace in the UK; evidence of practices in other countries is limited. There is limited data on how often medications are administered in the community. Prescriptions are 'accepted' by family caregivers despite inadequate explanations and they generally appreciate having access to medications. Robust evidence of the clinical and cost-effectiveness of anticipatory prescribing remains absent. CONCLUSION The evidence underpinning anticipatory prescribing practice and policy remains based primarily on healthcare professionals' perceptions that the intervention is reassuring, provides effective, timely symptom relief in the community and prevents crisis hospital admissions. There is still inadequate evidence regarding optimal medications and dose ranges, and the effectiveness of these prescriptions. Patient and family caregiver experiences of anticipatory prescriptions warrant urgent investigation. PROSPERO REGISTRATION CRD42016052108.
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Affiliation(s)
- Ben Bowers
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
- Queen's Nursing Institute, London, UK
| | | | - Simon Etkind
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Sarah A Hopkins
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Isaac Winterburn
- Department of Psychiatry, Cambridge University, Cambridge, Cambridgeshire, UK
| | - Isla Kuhn
- School of Clinical Medicine, Cambridge University, Cambridge, Cambridgeshire, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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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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Eltaybani S, Yasaka T, Fukui C, Inagaki A, Takaoka M, Suzuki H, Maruyama M, Igarashi A, Noguchi-Watanabe M, Sakka M, Weller C, Yamamoto-Mitani N. Family-oriented interventions in long-term care residential facilities for older people: A scoping review of the characteristics and outcomes. Nurs Forum 2022; 57:800-818. [PMID: 35810335 DOI: 10.1111/nuf.12768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/17/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Family-oriented interventions in long-term care (LTC) residential facilities are heterogenous in design, characteristics, and outcomes. OBJECTIVES To synthesize characteristics (e.g., type, provider, and duration) and outcomes of family-oriented interventions in LTC residential facilities. METHODS We followed the JBI methodology and searched seven databases for quantitative, qualitative, and mixed method studies that reported family-oriented interventions in LTC residential settings for older people; defined in this review as ≥60 years. Interventions that included residents, resident families, health professionals, or any combinations of these three were included if the study reported post-intervention assessment of at least one family-related outcome. RESULTS Thirteen studies met the inclusion criteria. Interventions were found to be multifaceted, and education was the most common element. Nurses were the most common intervenors, and most interventions had more than one target (residents, resident families, or staff). Most outcomes were related to family involvement, satisfaction with care, quality of life, communication, symptom management, and shared decision making, and none of the studies reported a negative impact. CONCLUSIONS Family-oriented interventions were associated with high care quality and better resident-staff-family partnership. Staff education and staff-family conversation are relatively cheap interventions to help family involvement, facilitate shared decision-making, and improve family satisfaction.
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Affiliation(s)
- Sameh Eltaybani
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Taisuke Yasaka
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Chie Fukui
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Asa Inagaki
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Manami Takaoka
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Haruno Suzuki
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Miyuki Maruyama
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Ayumi Igarashi
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Maiko Noguchi-Watanabe
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
- Department of Home Care Nursing, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mariko Sakka
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Carolina Weller
- School of Nursing and Midwifery Monash University, Monash, Australia
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
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Macgregor A, McCormack B, Spilsbury K, Hockley J, Rutherford A, Ogden M, Soulsby I, McKenzie M, Hanratty B, Forbat L. Supporting care home residents in the last year of life through 'Needs Rounds': Development of a pre-implementation programme theory through a rapid collaborative online approach. FRONTIERS IN HEALTH SERVICES 2022; 2:1019602. [PMID: 36925884 PMCID: PMC10012649 DOI: 10.3389/frhs.2022.1019602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023]
Abstract
Background Realist evaluation aims to address the knowledge to practice gap by explaining how an intervention is expected to work, as well as what is likely to impact upon the success of its implementation, by developing programme theories that link contexts, mechanisms and outcomes. Co-production approaches to the development of programme theories offer substantial benefits in addressing power relations, including and valuing different types of knowledge, and promoting buy-in from stakeholders while navigating the complex social systems in which innovations are embedded. This paper describes the co-production of an initial programme theory of how an evidence based intervention developed in Australia - called 'Palliative Care Needs Rounds' - might work in England and Scotland to support care home residents approaching their end of life. Methods Using realist evaluation and iPARIHS (integrated Promoting Action on Research Implementation in Health Services) we sought to determine how contexts and mechanisms of change might shape implementation outcomes. Pre-intervention online interviews (n = 28) were conducted (February-April 2021), followed by four co-design online workshops with 43 participants (April-June 2021). The online interviews and workshops included a range of stakeholders, including care home staff, specialist palliative care staff, paramedics, general practitioners, and relatives of people living in care homes. Results This methodology paper reports developments in realist evaluation and co-production methodologies, and how they were used to develop context, mechanisms, outcomes (CMOs) configurations, and chains of inference. The initial (pre-intervention) programme theory is used to illustrate this process. Two developments to iPARIHS are described. First, involving stakeholders in the collaborative co-design workshops created opportunities to commence facilitation. Second, we describe developing iPARIHS' innovation component, to include novel stakeholder interpretations, perceptions and anticipated use of the intervention as they participated in workshop discussions. Conclusions This rapid and robust co-production methodology draws on interactive collaborative research practices (interviews, workshop discussions of data, illustrative vignettes and visual methods). These innovative and engaging methods can be packaged for online processes to develop, describe and interrogate the CMOs in order to co-produce a programme theory. These approaches also commence facilitation and innovation, and can be adopted in other implementation science and realist studies.
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Affiliation(s)
- Aisha Macgregor
- Faculty of Social Sciences, University of Stirling, Stirling, Scotland
| | - Brendan McCormack
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
| | | | - Jo Hockley
- College of Medicine and Veterinary Science, University of Edinburgh, Scotland
| | | | | | | | | | | | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, Scotland
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Koerner J, Johnston N, Samara J, Liu WM, Chapman M, Forbat L. Context and mechanisms that enable implementation of specialist palliative care Needs Rounds in care homes: results from a qualitative interview study. BMC Palliat Care 2021; 20:118. [PMID: 34294068 PMCID: PMC8299598 DOI: 10.1186/s12904-021-00812-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background Improving quality of palliative and end of life care in older people’s care homes is essential. Increasing numbers of people die in these settings, yet access to high quality palliative care is not routinely provided. While evidence for models of care are growing, there remains little insight regarding how to translate evidence-based models into practice. Palliative Care Needs Rounds (hereafter Needs Rounds) have a robust evidence base, for providing palliative care in care homes, reducing resident hospitalisations, improving residents’ quality of death, and increasing staff confidence in caring for dying residents. This study aimed to identify and describe the context and mechanisms of change that facilitate implementation of Needs Rounds in care homes, and enable other services to reap the benefits of the Needs Rounds approach to care provision. Methods Qualitative interviews, embedded within a large randomised control trial, were conducted with a purposive sample of 21 staff from 11 care homes using Needs Rounds. The sample included managers, nurses, and care assistants. Staff participated in individual or dyadic semi-structured interviews. Implementation science frameworks and thematic analysis were used to interpret and analyse the data. Results Contextual factors affecting implementation included facility preparedness for change, leadership, staff knowledge and skills, and organisational policies. Mechanisms of change that facilitated implementation included staff as facilitators, identifying and triaging residents, strategizing knowledge exchange, and changing clinical approaches to care. Care home staff also identified planning and documentation, and shifts in communication. The outcomes reported by staff suggest reductions in hospitalisations and problematic symptoms for residents, improved staff skills and confidence in caring for residents in their last months, weeks and days of life. Conclusions The significance of this paper is in offering care homes detailed insights into service contexts and mechanisms of change that will enable them to reap the benefits of Needs Rounds in their own services. The paper thus will support the implementation of an approach to care that has a robust evidence base, for a population under-served by specialist palliative care. Trial registration ACTRN12617000080325. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00812-4.
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Affiliation(s)
- Jane Koerner
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Nikki Johnston
- Faculty of Health, University of Canberra, Canberra, Australia
| | | | - Wai-Man Liu
- College of Business and Economics, Australian National University, Canberra, Australia
| | - Michael Chapman
- Department of Palliative Care, Canberra Health Services, Canberra, Australia.,College of Health and Medicine, Australian National University, Canberra, Australia
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, Scotland, UK.
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McCaughan E, Semple CJ, Hanna JR. 'Don't forget the children': a qualitative study when a parent is at end of life from cancer. Support Care Cancer 2021; 29:7695-7702. [PMID: 34143326 PMCID: PMC8550711 DOI: 10.1007/s00520-021-06341-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/06/2021] [Indexed: 01/04/2023]
Abstract
Purpose Preparation for end of life is one of the greatest challenges faced by parents with cancer who have dependent children (< 18 years old), with requirement for support from professionals. The aim of this study is to explore how parents can be best supported in relation to their children, when a parent is at end of life from cancer. Methods This is an interpretive qualitative study, using 79 semi-structured interviews with parents at end of life (n3), bereaved parents (n21), health and social care professionals (HSCPs) (n32) and funeral directors (n23). Data were analysed thematically and triangulated. Results Parents are central to preparing their children for the death of a parent. Striving for everyday ordinariness, maximising social networks, maintaining hope and making preparations for the future are helpful for families when a parent is at end of life. Most HSCPs were unaware of the challenges faced by parents at end of life, and psychosocial support was often left outside the caring realm. As a result, funeral directors noted complexities faced by the families after the death. Results are discussed under four themes: (1) communication with the children as a process, (2) coping throughout the unfolding end of life experience, (3) tension and complexities at end of life and (4) preparing for the future. Conclusions Parents should be reassured that by involving the children early in the end of life experience when the ill-parent is ‘well enough’ to parent enables them to be actively involved in supporting their child through one of the greatest life changing event. A number of recommendations are discussed for professionals. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06341-3.
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Affiliation(s)
- Eilís McCaughan
- School of Nursing, Ulster University, Cromore Road, Coleraine, BT52 1SA, Co. L'Derry, UK
| | - Cherith J Semple
- School of Nursing, Ulster University, Shore Road, Newtownabbey, BT37 0QB, Co, Antrim, UK.,South Eastern Health and Social Care Trust, Cancer Services, Ulster Hospital, Upper Newtownards Road, Belfast, BT16 1RH, UK
| | - Jeffrey R Hanna
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK.
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Mitchell G, Melaku M, Moss A, Chaille G, Makoni B, Lewis L, Mutch A. Evaluation of a commissioned end-of-life care service in Australian aged care facilities. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1905146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Geoffrey Mitchell
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Megdelawit Melaku
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | | | | | | | | | - Allyson Mutch
- Faculty of Medicine, The University of Queensland, Herston, Australia
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Samara J, Liu WM, Kroon W, Harvie B, Hingeley R, Johnston N. Telehealth Palliative Care Needs Rounds During a Pandemic. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Macgregor A, Rutherford A, McCormack B, Hockley J, Ogden M, Soulsby I, McKenzie M, Spilsbury K, Hanratty B, Forbat L. Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK. BMJ Open 2021; 11:e049486. [PMID: 33619205 PMCID: PMC7903098 DOI: 10.1136/bmjopen-2021-049486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Palliative and end-of-life care in care homes is often inadequate, despite high morbidity and mortality. Residents can experience uncontrolled symptoms, poor quality deaths and avoidable hospitalisations. Care home staff can feel unsupported to look after residents at the end of life. Approaches for improving end-of-life care are often education-focused, do not triage residents and rarely integrate clinical care. This study will adapt an evidence-based approach from Australia for the UK context called 'Palliative Care Needs Rounds' (Needs Rounds). Needs Rounds combine triaging, anticipatory person-centred planning, case-based education and case-conferencing; the Australian studies found that Needs Rounds reduce length of stay in hospital, and improve dying in preferred place of care, and symptoms at the end of life. METHODS AND ANALYSIS This implementation science study will codesign and implement a scalable UK model of Needs Rounds. The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to identify contextual barriers and use facilitation to enable successful implementation. Six palliative care teams, working with 4-6 care homes each, will engage in two phases. In phase 1 (February 2021), stakeholder interviews (n=40) will be used to develop a programme theory to meet the primary outcome of identifying what works, for whom in what circumstances for UK Needs Rounds. Subsequently a workshop to codesign UK Needs Rounds will be run. Phase 2 (July 2021) will implement the UK model for a year. Prospective data collection will focus on secondary outcomes regarding hospitalisations, residents' quality of death and care home staff capability of adopting a palliative approach. ETHICS AND DISSEMINATION Frenchay Research Ethics Committee (287447) approved the study. Findings will be disseminated to policy-makers, care home/palliative care practitioners, residents/relatives and academic audiences. An implementation package will be developed for practitioners to provide the tools and resources required to adopt UK Needs Rounds. REGISTRATION DETAILS Registration details: ISRCTN15863801.
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Affiliation(s)
- Aisha Macgregor
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | - Brendan McCormack
- Divisions of Nursing, Occupational Therapy & Arts Therapies, Queen Margaret University, Edinburgh, UK
| | - Jo Hockley
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Margaret Ogden
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Irene Soulsby
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Maisie McKenzie
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
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12
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Balmer DG, Frey R, Gott M, Collier A, Boyd M. A Place to Live and to Die: A Qualitative Exploration of the Social Practices and Rituals of Death in Residential Aged Care. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:38-58. [PMID: 32576125 DOI: 10.1177/0030222820935217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In many countries, an increasing proportion of deaths occur in residential aged care (RAC) (nursing homes) meaning that these have become both a place to live - a home- and a place to die. This paper reports on death practices and rituals in 49 RAC facilities in Aotearoa/New Zealand narrated in semi-structured interviews with staff. Themes coalesced around 'good death'. Dying alone was not seen as a good death and the demands of trying to prevent this caused tension for staff. Meeting family wishes, post death decision-making, after death practices and rituals, including communicating and remembrance of the death, were explored as part of good death. Overall, death rituals in RAC were limited. Balancing the needs of the living, the dying and the dead created tension. The rituals and practices facilities are currently enacting in death/post-death require attention, since more people will die in RAC with increasingly diverse needs.
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Affiliation(s)
- D G Balmer
- School of Nursing, University of Auckland, New Zealand
| | - R Frey
- School of Nursing, University of Auckland, New Zealand
| | - M Gott
- School of Nursing, University of Auckland, New Zealand
| | - A Collier
- School of Nursing, University of Auckland, New Zealand
| | - M Boyd
- School of Nursing, University of Auckland, New Zealand
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Forbat L, Liu WM, Koerner J, Lam L, Samara J, Chapman M, Johnston N. Reducing time in acute hospitals: A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes. Palliat Med 2020; 34:571-579. [PMID: 31894731 DOI: 10.1177/0269216319891077] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Care home residents are frequently transferred to hospital, rather than provided with appropriate and timely specialist care in the care home. AIM To determine whether a model of care providing specialist palliative care in care homes, called Specialist Palliative Care Needs Rounds, could reduce length of stay in hospital. DESIGN Stepped-wedge randomised control trial. The primary outcome was length of stay in acute care (over 24-h duration), with secondary outcomes being the number and cost of hospitalisations. Care homes were randomly assigned to cross over from control to intervention using a random number generator; masking was not possible due to the nature of the intervention. Analyses were by intention to treat. The trial was registered with ANZCTR: ACTRN12617000080325. Data were collected between 1 February 2017 and 30 June 2018. SETTING/PARTICIPANTS 1700 residents in 12 Australian care homes for older people. RESULTS Specialist Palliative Care Needs Rounds led to reduced length of stay in hospital (unadjusted difference: 0.5 days; adjusted difference: 0.22 days with 95% confidence interval: -0.44, -0.01 and p = 0.038). The intervention also provided a clinically significant reduction in the number of hospitalisations by 23%, from 5.6 to 4.3 per facility-month. A conservative estimate of annual net cost-saving from reduced admissions was A$1,759,011 (US$1.3 m; UK£0.98 m). CONCLUSION The model of care significantly reduces hospitalisations through provision of outreach by specialist palliative care clinicians. The data offer substantial evidence for Specialist Palliative Care Needs Rounds to reduce hospitalisations in older people approaching end of life, living in care homes.
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Affiliation(s)
- Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK.,Australian Catholic University, Canberra, ACT, Australia
| | - Wai-Man Liu
- Australian National University, Canberra, ACT, Australia
| | - Jane Koerner
- Australian Catholic University, Canberra, ACT, Australia
| | - Lawrence Lam
- University of Technology Sydney, Ultimo, NSW, Australia
| | | | - Michael Chapman
- Australian National University, Canberra, ACT, Australia.,ACT Health, Canberra Hospital, Canberra, ACT, Australia
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14
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Temelli G, Cerit B. Perceptions of Palliative Care Nurses Related to Death and Palliative Care Practices. OMEGA-JOURNAL OF DEATH AND DYING 2019; 84:378-398. [PMID: 31841067 DOI: 10.1177/0030222819890457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This study has been conducted with the purpose of identifying the perceptions of palliative nurses about death and determining palliative care practices. We conducted qualitative interviews with 23 palliative care nurses in Turkey. Content analysis was used in the evaluation of the data. Three themes have been identified about perception of death. Furthermore, three themes have been identified about palliative care practices. It was concluded that the palliative nurses perceive death as a natural and inevitable process and that as long as their working period increases, they become desensitized. It was identified that the participants generally perform the following procedures in palliative care practices.
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Affiliation(s)
- Gülnur Temelli
- Fundamentals of Nursing Department, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Turkey
| | - Birgül Cerit
- Fundamentals of Nursing Department, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Turkey
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15
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Rainsford S, Johnston N, Liu WM, Glasgow N, Forbat L. Palliative care Needs Rounds in rural residential aged care: A mixed-methods study exploring experiences and perceptions of staff and general practitioners. PROGRESS IN PALLIATIVE CARE 2019. [DOI: 10.1080/09699260.2019.1698177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Suzanne Rainsford
- Medical School, Australian National University, Canberra, Australia
- Calvary Health Care Bruce – Clare Holland House, Canberra, Australia
| | - Nikki Johnston
- Calvary Health Care Bruce – Clare Holland House, Canberra, Australia
| | - Wai-Man Liu
- Research School of Finance, Actuarial Studies and Statistics, College of Business and Economics, Australian National University, Canberra, Australia
| | - Nicholas Glasgow
- Medical School, Australian National University, Canberra, Australia
- Calvary Health Care Bruce – Clare Holland House, Canberra, Australia
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
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16
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Liu WM, Koerner J, Lam L, Johnston N, Samara J, Chapman M, Forbat L. Improved Quality of Death and Dying in Care Homes: A Palliative Care Stepped Wedge Randomized Control Trial in Australia. J Am Geriatr Soc 2019; 68:305-312. [PMID: 31681981 DOI: 10.1111/jgs.16192] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Mortality in care homes is high, but care of dying residents is often suboptimal, and many services do not have easy access to specialist palliative care. This study examined the impact of providing specialist palliative care on residents' quality of death and dying. DESIGN Using a stepped wedge randomized control trial, care homes were randomly assigned to crossover from control to intervention using a random number generator. Analysis used a generalized linear and latent mixed model. The trial was registered with ANZCTR: ACTRN12617000080325. SETTING Twelve Australian care homes in Canberra, Australia. PARTICIPANTS A total of 1700 non-respite residents were reviewed from the 12 participating care homes. Of these residents, 537 died and 471 had complete data for analysis. The trial ran between February 2017 and June 2018. INTERVENTION Palliative Care Needs Rounds (hereafter Needs Rounds) are monthly hour-long staff-only triage meetings to discuss residents at risk of dying without a plan in place. They are chaired by a specialist palliative care clinician and attended by care home staff. A checklist is followed to guide discussions and outcomes, focused on anticipatory planning. MEASUREMENTS This article reports secondary outcomes of staff perceptions of residents' quality of death and dying, care home staff confidence, and completion of advance care planning documentation. We assessed (1) quality of death and dying, and (2) staff capability of adopting a palliative approach, completion of advance care plans, and medical power of attorney. RESULTS Needs Rounds are associated with staff perceptions that residents had a better quality of death and dying (P < .01; 95% confidence interval [CI] = 1.83-12.21), particularly in the 10 facilities that complied with the intervention protocol (P < .01; 95% CI = 6.37-13.32). Staff self-reported perceptions of capability increased (P < .01; 95% CI = 2.73-6.72). CONCLUSION The data offer evidence for monthly triage meetings to transform the lives, deaths, and care of older people residing in care homes. J Am Geriatr Soc 68:305-312, 2020.
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Affiliation(s)
- Wai-Man Liu
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jane Koerner
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | | | - Nikki Johnston
- Calvary Public Hospital, Canberra, Australian Capital Territory, Australia
| | - Juliane Samara
- Calvary Public Hospital, Canberra, Australian Capital Territory, Australia
| | - Michael Chapman
- Australian National University, Canberra, Australian Capital Territory, Australia.,ACT Health, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Liz Forbat
- Australian Catholic University, Canberra, Australian Capital Territory, Australia.,University of Stirling, Stirling, United Kingdom
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Forbat L, Johnston N, Mitchell I. Defining 'specialist palliative care': findings from a Delphi study of clinicians. AUST HEALTH REV 2019; 44:313-321. [PMID: 31248475 DOI: 10.1071/ah18198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/20/2019] [Indexed: 11/23/2022]
Abstract
Objective This study aimed to achieve consensus regarding what distinguishes specialist from non-specialist palliative care to inform service organisation and delivery to patients with life-limiting conditions. Methods A three-phase Delphi study was undertaken, involving qualitative interviews and two questionnaire cycles. Thirty-one clinicians (nurses, doctors and social workers) working with a wide range of patients participated in interviews, of whom 27 completed two questionnaire cycles. Results Consensus was gained on 75 items that define specialist palliative care and distinguish it from non-specialist palliative care. Consensus was gained that specialist palliative care clinicians have advanced knowledge of identifying dying, skills to assess and manage complex symptoms to improve quality of life, have advanced communication skills and perform distinct clinical practices (e.g. working with the whole family as the unit of care and providing support in complex bereavement). Non-specialist palliative care involves discussions around futile or burdensome treatments, and care for people who are dying. Conclusions Areas of connection were identified: clinicians from disease-specific specialties should be more involved in leading discussions on futile or burdensome treatment and providing care to people in their last months and days of life, in collaboration with specialists in palliative care when required. What is known about the topic? At present there is no evidence-based definition or agreement about what constitutes specialist palliative care (as opposed to palliative care delivered by non-specialists) in the Australian Capital Territory. An agreed definition is needed to effectively determine the workforce required and its clinical skill mix, and to clarify roles and expectations to mitigate risks in not adequately providing services to patients with life-limiting conditions. What does this paper add? This paper offers, for the first time, an evidence-based definition that distinguishes specialist palliative care from non-specialist palliative care. End of life care and bereavement support are not just the remit of specialist palliative care clinicians. Clinicians from beyond specialist palliative care should lead discussions about futile or burdensome treatment. What are the implications for practitioners? The findings of this study can facilitate implementation of palliative care strategies by enabling practitioners and patients to distinguish who should be delivering what care.
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Affiliation(s)
- Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK; and Faculty of Health Sciences, Australian Catholic University, Canberra, ACT 2600, Australia; and Corresponding author.
| | | | - Imogen Mitchell
- Medical School, Australian National University, Florey Building, 54 Mills Road, Canberra, ACT 2601, Australia. ; and Canberra Hospital, Building 4, Level 2, Garran, ACT 2605, Australia
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Forbat L, Chapman M, Lovell C, Liu WM, Johnston N. Improving specialist palliative care in residential care for older people: a checklist to guide practice. BMJ Support Palliat Care 2017; 8:347-353. [PMID: 28768680 DOI: 10.1136/bmjspcare-2017-001332] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/15/2017] [Accepted: 05/24/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Palliative care needs rounds are triage meetings that have been introduced in residential care for older adults to help identify and prioritise care for people most at risk for unplanned dying with inadequately controlled symptoms. This study sought to generate an evidence-based checklist in order to support specialist palliative care clinicians integrate care in residential nursing homes for older people. METHODS A grounded theory ethnographic study, involving non-participant observation and qualitative interviews. The study was conducted at four residential facilities for older people in one city. Observations and recordings of 15 meetings were made, and complimented by 13 interviews with staff attending the needs rounds. RESULTS The palliative care needs round checklist is presented, alongside rich description of how needs rounds are conducted. Extracts from interviews with needs rounds participants illustrate the choice of items within the checklist and their importance in supporting the evolution towards efficient and effective high-quality specialist palliative care input to the care of older people living in residential care. CONCLUSIONS The checklist can be used to support the integration of specialist palliative care into residential care to drive up quality care, provide staff with focused case-based education, maximise planning and reduce symptom burden for people at end of life.
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Affiliation(s)
- Liz Forbat
- Calvary Public Hospital, Canberra, Australia.,Australian Catholic University, Canberra, Australia
| | | | | | - Wai-Man Liu
- Australian National University, Canberra, Australia
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Chapman M, Johnston N, Lovell C, Forbat L, Liu WM. Avoiding costly hospitalisation at end of life: findings from a specialist palliative care pilot in residential care for older adults. BMJ Support Palliat Care 2016; 8:102-109. [PMID: 27496356 DOI: 10.1136/bmjspcare-2015-001071] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/12/2016] [Accepted: 07/14/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Specialist palliative care is not a standardised component of service delivery in nursing home care in Australia. Specialist palliative care services can increase rates of advance care planning, decrease hospital admissions and improve symptom management in such facilities. New approaches are required to support nursing home residents in avoiding unnecessary hospitalisation and improving rates of dying in documented preferred place of death. This study examined whether the addition of a proactive model of specialist palliative care reduced resident transfer to the acute care setting, and achieved a reduction in hospital deaths. METHODS A quasi-experimental design was adopted, with participants at 4 residential care facilities. The intervention involved a palliative care nurse practitioner leading 'Palliative Care Needs Rounds' to support clinical decision-making, education and training. Participants were matched with historical decedents using propensity scores based on age, sex, primary diagnosis, comorbidities and the Aged Care Funding Instrument rating. Outcome measures included participants' hospitalisation in the past 3 months of life and the location of death. RESULTS The data demonstrate that the intervention is associated with a substantial reduction in the length of hospital stays and a lower incidence of death in the acute care setting. While rates of hospitalisation were unchanged on average, length of admission was reduced by an average of 3.22 days (p<0.01 and 95% CI -5.05 to -1.41), a 67% decrease in admitted days. CONCLUSIONS The findings have significant implications for promoting quality outcomes through models of palliative care service delivery in residential facilities.
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Affiliation(s)
- Michael Chapman
- Department of Palliative Care, Canberra Regional Cancer Centre, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Nikki Johnston
- Clare Holland House, Calvary Health Care ACT, Canberra, Australian Capital Territory, Australia
| | - Clare Lovell
- Clare Holland House, Calvary Health Care ACT, Canberra, Australian Capital Territory, Australia
| | - Liz Forbat
- Director for the Calvary Centre for Palliative Care Research, Calvary Health Care Bruce and the Australian Catholic University, Canberra, Australian Capital Territory, Australia
| | - Wai-Man Liu
- Research School of Finance, Actuarial Studies & Statistics, Australian National University, Canberra, Australian Capital Territory, Australia
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