Enhancing Care for Long-Term Care Residents Approaching End-of-Life: A Mixed-Methods Study Assessing a Palliative Care Transfer Form

Author(s):  
Madelaine Baetz-Dougan ◽  
Leora Reiter ◽  
Laura Quigley ◽  
Daphna Grossman

Background: Many barriers exist in providing quality end-of-life care in long-term care (LTC), including transitions of care between acute care and LTC. Transfer forms can be beneficial in ensuring resident’s end-of-life care needs are coordinated between different settings. The NYGH-LTC Transfer Form is a newly developed tool created to enhance care for residents transferred from acute care back to their LTC home for end-of-life. Study Aim: Assess the perceived ease of use, usefulness, and care-enhancing potential of the NYGH-LTC Transfer Form by interprofessional LTC staff. Methods: The study population included interprofessional staff members at 2 LTC homes in Toronto, Canada. Quantitative data was obtained through surveys and qualitative data was obtained through focus groups. Results: There were a total of 34 participants. 79.4% of participants agreed the form was easy to use and 82.4% agreed it would improve care. Subgroup analysis demonstrated that participants with greater than 20 years experience were less likely to agree that it would improve care (p = 0.01). Qualitative analysis generated 4 themes: 1) Strengths, 2) Areas of Improvement, 3) Information Sharing, and 4) Communication. Conclusions: The NYGH-LTC Transfer Form was overall well-evaluated. The form was seen as most useful for those with less experience or less confidence in palliative care. Communication was identified as a major barrier to successful transitions of care and increased bidirectional verbal communication is needed in addition to the form.

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e037466
Author(s):  
Patricia Harasym ◽  
Sarah Brisbin ◽  
Misha Afzaal ◽  
Aynharan Sinnarajah ◽  
Lorraine Venturato ◽  
...  

ObjectiveThe COVID-19 pandemic has highlighted ongoing challenges to optimal supportive end-of-life care for adults living in long-term care (LTC) facilities. A supportive end-of-life care approach emphasises family involvement, optimal symptom control, multidisciplinary team collaboration and death and bereavement support services for residents and families. Community-based and palliative care specialist physicians who visit residents in LTC facilities play an important role in supportive end-of-life care. Yet, perspectives, experiences and perceptions of these physicians remain unknown. The objective of this study was to explore barriers and facilitators to optimal supportive end-of-life palliative care in LTC through the experiences and perceptions of community-based and palliative specialist physicians who visit LTC facilities.DesignQualitative study using semi-structured interviews, basic qualitative description and directed content analysis using the COM-B (capability, opportunity, motivation - behaviour) theoretical framework.SettingResidential long-term care.Participants23 physicians who visit LTC facilities from across Alberta, Canada, including both in urban and rural settings of whom 18 were community-based physicians and 5 were specialist palliative care physicians.ResultsMotivation barriers include families’ lack of frailty knowledge, unrealistic expectations and emotional reactions to grief and uncertainty. Capability barriers include lack of symptom assessment tools, as well as palliative care knowledge, training and mentorship. Physical and social design barriers include lack of dedicated spaces for death and bereavement, inadequate staff, and mental health and spiritual services of insufficient scope for the population.ConclusionFindings reveal that validating families’ concerns, having appropriate symptom assessment tools, providing mentorship in palliative care and adapting the physical and social environment to support dying and grieving with dignity facilitates supportive, end-of-life care within LTC.


2010 ◽  
Vol 26 (2) ◽  
pp. 122-129 ◽  
Author(s):  
Joanie Sims-Gould ◽  
Elaine Wiersma ◽  
Lise Arseneau ◽  
Mary Lou Kelley ◽  
Jean Kozak ◽  
...  

2018 ◽  
Vol 13 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Tomoko Terada ◽  
Keiko Nakamura ◽  
Kaoruko Seino ◽  
Masashi Kizuki ◽  
Naohiko Inase

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S669-S669
Author(s):  
Kelly Shryock ◽  
Jacinta Dickens ◽  
Anisha Thomas ◽  
Suzanne Meeks

Abstract Research on end-of-life care in nursing homes comes largely from the viewpoint of staff or family members. We examined patient perspectives on end-of-life care, preferences for care, and quality of life in long-term care settings. We hypothesized that fulfillment of the Self Determination Theory (SDT) needs of autonomy, competence, and relatedness would be related to better well-being and that the degree to which end-of-life care preferences are seen as possible in the setting would be related to SDT need fulfillment and well-being. Preliminary data, collected from older individuals at the end of life (over 55, presence of significant chronic disease, in long term care setting) (n= 72), demonstrated that autonomy, competence, and relatedness measures were moderately and significantly correlated with well-being as measured by life satisfaction, higher positive affect, lower negative affect, and overall quality of life measures The degree to which residents believed that their end-of-life care preferences could be honored in the setting was also significantly correlated with autonomy, competence, relatedness, positive affect, and psychological quality of life. These results are consistent with SDT and suggest that if long term care settings can promote autonomy, connection, and competence in making end of life decisions, possibly by discovering and fulfilling preferences for end of life care, individuals who end their lives on those settings have potential for greater satisfaction and happiness. These results suggest that SDT is a useful framework for ongoing research on how to improve the end of life experiences of older adults in long term care.


2011 ◽  
Vol 27 (3) ◽  
pp. 229-237 ◽  
Author(s):  
Carole Gill ◽  
Loretta M. Hillier ◽  
Jacqueline M. Crandall ◽  
Julie Johnston

2021 ◽  
pp. 38-63
Author(s):  
Sabrina Ching Yuen Luk ◽  
Hui Zhang ◽  
Peter P. Yuen

2006 ◽  
Vol 1 (1) ◽  
pp. 45-50 ◽  
Author(s):  
Katherine A. Froggatt ◽  
Donna Wilson ◽  
Christopher Justice ◽  
Margaret MacAdam ◽  
Karen Leibovici ◽  
...  

2002 ◽  
Vol 23 (6) ◽  
pp. 296-301 ◽  
Author(s):  
Barbara M. Raudonis ◽  
Ferne C.N. Kyba ◽  
Terri A. Kinsey

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