Improving Staff-Family End-of-Life Communication at Israeli Geriatric Facilities by Using a Mobile App

Family caregivers (FCs) of persons institutionalized at geriatric facilities present significant unmet communication needs regarding receiving regular updates about their loved one’s condition and having available healthcare professionals (HPs) to approach when needed. We developed and tested a mobile-app for staff-family communication with both parties having active roles in app planning to tailor it to their needs and abilities. The app includes a daily-update module for FCs and a chat option for FCs and HPs. App use was piloted at one geriatric-medical-center for 15 months (unit-level randomization resulted in one complex-care and one assisted-ventilation unit in each group- intervention and control) and one single-unit nursing-home for three months. Personal interviews were conducted with 55 FCs (28 from intervention-group and 27 FCs from control-group) before-and-after app use (with mean duration of use 1.6[S.D.=.6] months. Most participants were women and the children of the patients; their mean age was 55.9 years (S.D.=12.4). Repeated-measures Analysis-of-Variance for the end-of-life communication sub-scale on the Quality-of-communication questionnaire yielded a main effect for time (F(1,53)=8.31, p=.006) with both groups’ ratings increasing over time and an interaction effect (F(1,53)=4.78, p=.033) with a greater increase for intervention-group compared to control-group. Intervention-group participants rated the app as convenient to use. Qualitative data revealed that FCs perceived app use as improving quality of communication with the HPs who used it and improving their own well-being. The app offers a feasible and an effective mode of communication that incorporates technology in daily communication between FCs and HPs while addressing FCs’ unmet needs.

Teaching end-of-life communication: priorities, challenges, scope—systematic review

BackgroundWithout a well-rounded syllabus to teach end-of-life (EOL) communication, medical providers find it challenging to enhance their patients’ quality of life at the final stage of life.AimThe aim of this scoping review was to explore studies about the teaching of EOL communication and to detail how educators can approach the teaching of EOL communication.MethodsA scoping review of both qualitative and quantitative studies was conducted according to the methodological framework of scoping review. The PsycINFO, PubMed, ERIC, CINAHL and EMBASE databases were searched for studies using the keywords ‘teach’, ‘educat*’, ‘end of life’, ‘terminal care’, ‘communication’ and ‘palliative care’. Sixteen studies were appraised, and none was rejected on the grounds of quality.ResultsThe search strategy yielded 22 278 entries and 16 studies were included. Two themes were identified from the priorities in teaching EOL communication: (1) challenges to teaching EOL communication and (2) methods of teaching EOL communication. To present a comprehensive overview of EOL communication teaching, we provide directions for priorities of topics and approaches when teaching EOL communication.ConclusionsThe review detailed the complexity of teaching EOL communication, which indicates the need for a well-rounded syllabus that includes skills such as non-verbal social cues, communication strategies and understanding EOL communication in various cultural contexts to facilitate a well-rounded EOL communication experience for students’ future practice.

Quality of Communication Questionnaire for Hospitalized Patients Hospitalized in Intensive and Palliative Care Unit: Validity Evidence for Use in Brazil

The Quality of Communication Questionnaire (QoC) was culturally adapted for Brazil due to its importance and use in several studies and different scenarios. The objective of this study was to evaluate the validity evidence of the Brazilian version of the QoC. A validation study was carried out involving 253 patients admitted to five public hospitals in Southern Brazil. Data were analyzed using descriptive analysis, Cronbach's alpha (α) to assess internal consistency, exploratory factor analysis, and goodness-of-fit index. One hundred and three patients were in intensive care (IC), and 150 were in palliative care (PC). The participants’ mean age was 51 years (SD = 14.2). QoC,and its general communication subscale, and end-of-life communication subscale means were 5.5 (SD = 1.6), 8.8 (SD = 1.5), and 5.5 (SD = 1.6) respectively. Among patients in IC, QoC Cronbach’s alpha was .75, and .84 in the general communication subscale and .51 in the end-of-life communication subscale. Among patients in PC, QoC Cronbach’s alpha was .83, and .88 in the general communication subscale, and .71 in the end-of-life communication subscale. The root mean square error of approximation was .07 (90% CI: .04 – .08); Tucker-Lewis index was .97 (95% CI: .95 – .98); comparative fit index was .98 (95% CI: .97 – .99), and χ2/df ratio was 1.33 (χ2[53] = 70.858, p = .05). The authors conclude that the general communication subscale of QoC Brazilian version has good validity evidence for patients in IC and PC, whereas the end-of-life communication subscale is only valid for patient in PC.

This Is Us: An Analysis of Mediated Family Communication at End-of-Life

Death is a ubiquitous theme in television dramas and we argued that mediated depictions of end-of-life experiences have the potential to provide glimpses into the ways in which characters experience real-life issues and can serve as conversation starters within family viewers. The study aimed to identify how a popular television drama, This is Us, depicted end-of-life communication. Analysis of season one revealed 54 conversations about end-of-life, two explicit death scenes, and three implied death scenes. Results also illustrate how the storyline within the show clearly depicts the impact end-of-life has on the family system, emphasizing the ongoing interdependence, hierarchy, and boundary (re)negotiation as a result of death. Findings advance understanding of how mediated narratives can illustrate end-of-life scenarios and conversations within the family system and can provide observational opportunities for modeling end-of-life communication behaviors within their families.

Continuums of Change in a Competence-Building Initiative Addressing End-of-Life Communication in Swedish Elder Care

Conversations about values for the end-of-life (EoL) between residents, relatives, and staff may allow EoL preparation and enable value-concordant care, but remain rare in residential care home (RCH) practice. In this article, longitudinal qualitative analysis was used to explore changes in staff discussions about EoL conversations throughout workshop series based on reflection and knowledge exchange to promote EoL communication in RCHs. We identified three overall continuums of change: EoL conversations became perceived as more feasible and valuable; conceptualizations of quality EoL care shifted from being generalizable to acknowledging individual variation; and staff’s role in facilitating EoL communication as a prerequisite for care decision-making was emphasized. Two mechanisms influenced changes: cognitively and emotionally approaching one’s own mortality and shifting perspectives of EoL care. This study adds nuance and details about changes in staff reasoning, and the mechanisms that underlie them, which are important aspects to consider in future EoL competence-building initiatives.