scholarly journals Evaluation of an Interprofessional Academic-Practice Partnership in End of Life Care

2021 ◽  
Vol 12 (4) ◽  
pp. 22
Author(s):  
Katie F Leslie ◽  
M. Kate Probst ◽  
Taylor L Hawkins
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Value Added ◽  
Retrospective Chart Review ◽  
Life Care ◽  
Academic Practice ◽  
Team Members ◽  
Interprofessional Care ◽  
Group 2 ◽  
Group 1

Introduction: The purpose of this mixed-methods study was to evaluate an interprofessional academic-practice partnership in end of life care by examining patient medication outcomes, the contributions of student pharmacists and a pharmacy preceptor to care teams, and student learning experiences. Methods: Retrospective chart review assessed polypharmacy differences in hospice patients with a primary terminal diagnosis of non-Alzheimer’s dementia between two patient groups; Group 1 managed on interprofessional care teams within the pharmacy partnership, and Group 2, managed on teams without a pharmacist. Team members who interacted with student pharmacists and the pharmacy preceptor participated in semi-structured key informant interviews to document perceptions of pharmacy contributions to care teams and the organization. At the end of their APPE, students completed reflective writings regarding their learning.   Results: Patients in Group 1 were on statistically significant fewer medications than Group 2 at both week 4 and weeks 7-12 following admission.  Five conceptual themes emerged from interviews: pharmacists as team medication experts, improved patient outcomes, interprofessional collaboration, patient/caregiver trust in medication regimens, and desire for sustainability. Student reflections included the following learning themes: teamwork, respect, value, and patient-centered care. Conclusions: The addition of a pharmacist on interprofessional care teams decreased the average number of medications in the non-Alzheimer’s end of life patient population. Team members identified value-added contributions of student pharmacists and the pharmacy preceptor that enhanced team efficiency and patient care. Student pharmacists recognized these contributions and the experience served as an exemplar of interprofessional practice.

Situating requests for medical aid in dying within the broader context of end-of-life care: ethical considerations

2018 ◽  
Vol 45 (2) ◽  
pp. 106-111 ◽  
Author(s):  
Lori Seller ◽  
Marie-Ève Bouthillier ◽  
Veronique Fraser
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Ethical Issues ◽  
Retrospective Chart Review ◽  
Median Number ◽  
Life Care ◽  
Ethical Considerations ◽  
Term Care ◽  
Medical Aid ◽  
Aid In Dying

BackgroundMedical aid in dying (MAiD) was introduced in Quebec in 2015. Quebec clinical guidelines recommend that MAiD be approached as a last resort when other care options are insufficient; however, the law sets no such requirement. To date, little is known about when and how requests for MAiD are situated in the broader context of decision-making in end-of-life care; the timing of MAiD raises potential ethical issues.MethodsA retrospective chart review of all MAiD requests between December 2015 and June 2017 at two Quebec hospitals and one long-term care centre was conducted to explore the relationship between routine end-of-life care practices and the timing of MAiD requests.ResultsOf 80 patients requesting MAiD, 54% (43) received the intervention. The median number of days between the request for MAiD and the patient’s death was 6 days. The majority of palliative care consults (32%) came less than 7 days prior to the MAiD request and in another 25% of cases occurred the day of or after MAiD was requested. 35% of patients had no level of intervention form, or it was documented as 1 or 2 (prolongation of life remains a priority) at the time of the MAiD request and 19% were receiving life-prolonging interventions.InterpretationWe highlight ethical considerations relating to the timing of MAiD requests within the broader context of end-of-life care. Whether or not MAiD is conceptualised as morally distinct from other end-of-life options is likely to influence clinicians’ approach to requests for MAiD as well as the ethical importance of our findings. We suggest that in the wake of the 2015 legislation, requests for MAiD have not always appeared to come after an exploration of other options as professional practice guidelines recommend.

scholarly journals Meeting complexity with collaboration: a proposed conceptual framework for participatory community-based music therapy research in end of life-care

2018 ◽  
Vol 2 (3) ◽  
Author(s):  
Wolfgang Schmid
Keyword(s):  
Music Therapy ◽  
Conceptual Framework ◽  
End Of Life ◽  
End Of Life Care ◽  
Quality Care ◽  
Life Care ◽  
Educational Strategies ◽  
Community Based ◽  
Team Members ◽  
Participatory Music

Research in end-of-life care is complex with specific ethical and practical challenges related to epistemology, methodology and recruitment of people approaching the end of life. However, to ensure the provision of high-quality care research efforts need to be aligned with the priorities of patients, their families, and interdisciplinary team members. A more systematic engagement of all three groups in research is needed to promote tailored and appropriate end-of-life care. In this methodological article I propose a conceptual framework for community-based participatory music therapy research in end-of-life care scenarios as one promising strategy to respond to ethical and practical challenges, to handle complexity and advance integration of perspectives. The conceptual framework consists of two thematic clusters i) Participlinarity across contexts, and ii) Community-based participatory music therapy research in end-of-life care scenarios. Though in the early stages of development, the framework addresses issues of educational strategies and continuity of care, and aims to contribute to innovative music therapy research in the future.

Reasoning about truth-telling in end-of-life care of patients with acute stroke

2016 ◽  
Vol 24 (1) ◽  
pp. 100-110 ◽  
Author(s):  
Åsa Rejnö ◽  
Gunilla Silfverberg ◽  
Britt-Marie Ternestedt
Keyword(s):  
Acute Stroke ◽  
End Of Life ◽  
End Of Life Care ◽  
Common Morality ◽  
Life Care ◽  
Best Interest ◽  
Truth Telling ◽  
Team Members ◽  
Individual Interviews ◽  
Stroke Team

Background: Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as ‘incompetent’ decision makers regarding their own care. Objective: The aim of the study was to deepen the understanding of stroke team members’ reasoning about truth-telling in end-of-life care due to acute stroke. Research design: Qualitative study based on individual interviews utilizing combined deductive and inductive content analysis. Participants and research context: A total of 15 stroke team members working in stroke units of two associated county hospitals in western Sweden participated. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Findings: The main findings were the team members’ dynamic movement between the categories ‘Truth above all’ and ‘Hide truth to protect’. Honesty was highly valued and considered as a reason for always telling the truth, with the argument of truth as common morality. However, the carers also argued for hiding the truth for different reasons such as not adding extra burden in the sorrow, awaiting a timely moment and not being a messenger of bad news. Withholding truth could both be seen as a way of protecting themselves from difficult conversations and to protect others. Discussion: The results indicate that there are various barriers for truthfulness. Interpreted from a virtue of ethics perspective, withholding of truth might also be seen as an expression of sound judgement to put the patient’s best interest first. Conclusion: The carers may need support in the form of supervision to be given space to reflect on their experience and thereby promote ethically justified care. Here, the multi-professional team can be of great value and contribute through inter-professional sharing of knowledge.

scholarly journals “It’s given me confidence”: a pragmatic qualitative evaluation exploring the perceived benefits of online end‐of‐life education on clinical care

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Deidre D Morgan ◽  
Caroline Litster ◽  
Megan Winsall ◽  
Kim Devery ◽  
Deb Rawlings
Keyword(s):  
Online Education ◽  
End Of Life ◽  
Health Professionals ◽  
End Of Life Care ◽  
Clinical Care ◽  
Self Report ◽  
Care Provision ◽  
Life Care ◽  
Perceived Benefits ◽  
Team Members

Abstract Background Hospital admissions for end-of-life care are increasing exponentially across the world. Significant numbers of health professionals are now required to provide end-of-life care with minimal training. Many health professionals report they lack confidence to provide this care, particularly those in acute hospital settings. This study explored the perceived benefits of online education on health professionals’ capacity to provide end-of-life care. Methods This qualitative study adopted a pragmatic approach. Thirty semi-structured interviews were conducted with allied health professionals, nurses and doctors who had completed a minimum of three End-of-Life Essentials online education modules. Interviews were held on line and face-to-face, audio-recorded and transcribed verbatim. Demographic data were also collected. Three major themes and one minor theme were constructed from the data using inductive thematic analysis. Results Themes were (1). Perceptions of preparedness to provide end-of-life care, (2). Shifts in approaching end-of-life discussions and (3). Motivation for engagement with online modules. Participants reported validation of knowledge and improved confidence to have end-of-life discussions with patients, carers and team members. They also noted improved ability to recognise the dying process and improved conversations with team members about patient and carer needs. Videos portraying a novice and then more able end-of-life discussions were particularly valued by participants. Modules provided practical guidance on how to engage in discussions about the end of life and care needs. Participants were self-motivated to improve their knowledge and skills to enhance end-of-life care provision. Continuing professional development requirements were also a motivator for module completion. Conclusions This study explored health professionals’ perspectives about the perceived benefits of online education modules on their clinical practice. Module completion enhanced participant confidence and self-reported improved competence in end-of-life care provision. Findings build on existing research that supports the valuable role online education plays in supporting confidence and ability to actively engage with patients, carers and colleagues about provision of end-of-life care; however, self-report cannot be used as a proxy for improved clinical competence.

Confidence and skills for cystic fibrosis end-of-life care

2020 ◽  
pp. bmjspcare-2020-002274
Author(s):  
Eva Harris-Skillman ◽  
Stephen Chapman ◽  
Aoife Lowney ◽  
Mary Miller ◽  
William Flight
Keyword(s):  
Cystic Fibrosis ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Further Education ◽  
Palliative Care Team ◽  
Care Team ◽  
Life Care ◽  
Team Members ◽  
Palliative Care Teams

ObjectivesOptimal cystic fibrosis (CF) end-of-life care (EOLC) is a challenge. There is little formal guidance about who should deliver this and how CF multi-disciplinary teams should interact with specialist palliative care. We assessed the knowledge, experience and preparedness of both CF and palliative care professionals for CF EOLC.MethodsAn electronic questionnaire was distributed to all members of the Oxford adult CF and palliative care teams.Results35 of a possible 63 members responded (19 CF team; 16 palliative care). Levels of preparedness were low in both groups. Only 11% of CF and 19% of palliative care team members felt fully prepared for EOLC in adult CF. 58% of CF members had no (21%) or minimal (37%) general palliative care training. Similarly, 69% of the palliative care team had no CF-specific training. All respondents desired additional education. CF team members preferred further education in general EOLC while palliative care team members emphasised a need for more CF-specific knowledge.ConclusionsFew members of either the CF or palliative care teams felt fully prepared to deliver CF EOLC and many desired additional educations. They expressed complementary knowledge gaps, which suggests both could benefit from increased collaboration and sharing of specialist knowledge.

Validation of the Living With Cancer (LWC) PRO tool for identifying patients (pts) with cancer appropriate for end-of-life care consultations.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 85-85 ◽  
Author(s):  
Dhakshila Paramanathan ◽  
Andrew Pecora ◽  
Eric Schultz ◽  
Hyun gi Noh ◽  
Katherine DeMarco ◽  
...  
Keyword(s):  
End Of Life ◽  
Predictive Value ◽  
End Of Life Care ◽  
Therapy Group ◽  
Performance Status ◽  
Latent Trait ◽  
Life Care ◽  
Consultation Rate ◽  
Group 2 ◽  
Continue Therapy

85 Background: End-of-life care (EOLC) discussions for pts with advanced malignancies are often delayed resulting in unwanted, wasteful treatment. COTA Inc has developed a 7-item PRO instrument (LWC) to facilitate identification of pts in distress. A pilot study of 433 pts at a single institution was able to determine a threshold distress score (> 28) correlating with physician assessment of appropriateness for EOLC consultation (2015 ASCO Palliative Care Symposium). Methods: LWC explores 4 personhood and clinical domains (performance status, pain, burden, and depression). Each question presents a 5-level Likert scale supplemented by a pt derived weighting of importance. The PRO was completed by 700 pts at Regional Cancer Care Associates throughout NJ between Sept 2015 and Apr 2016. The primary oncologists separately/independently classified 611 pts as appropriate to continue therapy (Group 1) and 89 pts as appropriate to curtail therapy (Group 2). Results: A score of 29 on LWC (range 0-112) was the threshold achieving optimal sensitivity (51%) and specificity (78%) in identifying pts in Group 2 (51% of pts whose oncologists felt appropriate to curtail therapy scored > 29; 78% of pts whose oncologists felt appropriate to continue therapy scored < 29). The threshold had positive predictive value 25% and 8% false omission rate (1 - negative predictive value) (25% pts scoring > 29 should be in Group 2; 8% scoring < 29 should be in group 2). A score 29 was 2.3 times more likely in pts belonging to Group 2 (likelihood ratio), and was a predictor of physician category (logistic regression p < 0.0001). LWC had a Cronbach’s alpha coefficient 0.85, indicating internal consistency and ability to measure a single latent construct. 3 questions (Performance Status, Wants, and Lack of Pleasure) contained the most information (estimate the latent trait with precision) and had high discrimination parameters (discriminate between pts lacking latent trait and displaying latent trait). Conclusions: The LWC instrument is able to identify cancer pts for whom EOLC discussions may be appropriate. A study to determine the correlation between the threshold score, EOLC consultation rate and overall survival is underway.

Strategies for handling ethical problems in end of life care: obstacles and possibilities

2014 ◽  
Vol 22 (7) ◽  
pp. 778-789 ◽  
Author(s):  
Åsa Rejnö ◽  
Linda Berg
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Ethical Reasoning ◽  
Best Interests ◽  
Life Care ◽  
Unexpected Death ◽  
Ethical Problems ◽  
Team Members ◽  
Starting Point ◽  
Stroke Team

Background: In end of life care, ethical problems often come to the fore. Little research is performed on ways or strategies for handling those problems and even less on obstacles to and possibilities of using such strategies. A previous study illuminated stroke team members’ experiences of ethical problems and how the teams managed the situation when caring for patients faced with sudden and unexpected death from stroke. These findings have been further explored in this study. Objective: The aim of the study was to illuminate obstacles and possibilities perceived by stroke team members in using strategies for handling ethical problems when caring for patients afflicted by sudden and unexpected death caused by stroke. Research design: A qualitative method with combined deductive and inductive content analysis was utilized. Participants and research context: Data were collected through individual interviews with 15 stroke team members working in stroke units of two associated county hospitals in western Sweden. Ethical considerations: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Permission was also obtained from the director of each stroke unit. Findings: All the studied strategies for handling of ethical problems were found to have both obstacles and possibilities. Uncertainty is shown as a major obstacle and unanimity as a possibility in the use of the strategies. The findings also illuminate the value of the concept “the patient’s best interests” as a starting point for the carers’ ethical reasoning. Conclusion: The concept “the patient’s best interests” used as a starting point for ethical reasoning among the carers is not explicitly defined yet, which might make this value difficult to use both as a universal concept and as an argument for decisions. Carers therefore need to strengthen their argumentation and reflect on and use ethically grounded arguments and defined ethical values like dignity in their clinical work and decisions.

Dysphagia in Hospice Care: The Roles of Social Work and Speech-Language Pathologists

2014 ◽  
Vol 23 (4) ◽  
pp. 173-186 ◽  
Author(s):  
Deborah Hinson ◽  
Aaron J. Goldsmith ◽  
Joseph Murray
Keyword(s):  
Social Work ◽  
End Of Life ◽  
Case Studies ◽  
End Of Life Care ◽  
Hospice Care ◽  
Patient Communication ◽  
Life Care ◽  
Speech Language Pathologists ◽  
Four Levels

This article addresses the unique roles of social work and speech-language pathologists (SLPs) in end-of-life and hospice care settings. The four levels of hospice care are explained. Suggested social work and SLP interventions for end-of-life nutrition and approaches to patient communication are offered. Case studies are used to illustrate the specialized roles that social work and SLP have in end-of-life care settings.

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