Developing rural palliative care: validating a conceptual model

Kelley, Mary Lou; Williams, Allison; DeMiglio, Lily; Mettam, Hilary

doi:10.22605/rrh1717

Cited by 14 publications

(16 citation statements)

References 13 publications

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“…shown that in communities where people are generally content with their current situation, they do not see the need for developing a compassionate community. [16][17][18][19] Progress in that case is unlikely.…”

Section: The Developing a Compassionate Community Modelmentioning

confidence: 99%

“…Previous research has shown that communities lacking infrastructure have more challenges providing community care to the end of life. 16,17,19 The activities in a compassionate community. The model describes a fully developed compassionate community as having five activity streams.…”

Section: Local Leadershipmentioning

confidence: 99%

“…17 It is accepted as a practice theory to guide developing palliative care in rural, remote, and underserviced areas of Canada and is a practical guide for use in rural communities. 18 In subsequent years, Kelley's research on community capacity development extended beyond rural communities and the model evolved to incorporate new learnings. She conducted participatory action research with First Nations communities 19,20 and frontline staff in long-term care homes 21,22 to improve care for people at the end of life.…”

Section: Introductionmentioning

confidence: 99%

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Developing a compassionate community: a Canadian conceptual model for community capacity development

Kelley

2023

Palliat�Care

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The purpose of this article is to share a Canadian model called Developing a Compassionate Community (DCC) in which aging, dying, caregiving, and grieving are everyone’s responsibility. The model provides a research-informed practice guide for people who choose to adopt a community capacity development approach to developing a compassionate community. Based on 30 years of Canadian research by the author in rural, urban, First Nations communities, and long-term care homes, the DCC model offers a practice theory and practical tool. The model incorporates the principles of community capacity development which are as follows: change is incremental and in phases, but nonlinear and dynamic; the change process takes time; development is essentially about developing people; development builds on existing resources (assets); development cannot be imposed from the outside; and development is ongoing (never-ending). Community capacity development starts with citizens who want to make positive changes in their lives and their community. They become empowered by gaining the knowledge, skills, and resources they need. The community mobilizes around finding solutions rather than discussing problems. Passion propels their action and commitment drives the process. The strategy for change is engaging, empowering, and educating community members to act on their own behalf. It requires mobilizing networks of families, friends, and neighbors across the community, wherever people live, work, or play. Community networks are encouraged to prepare for later life, and for giving and getting help among themselves. This Canadian model offers communities one approach to developing a compassionate community and is a resource for implementing a public health approach to end-of-life care in Canada. The model is also available to be evaluated for its applicability beyond Canada and is designed to be adapted to new contexts if desired.

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Section: The Developing a Compassionate Community Modelmentioning

confidence: 99%

Section: Local Leadershipmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Developing a compassionate community: a Canadian conceptual model for community capacity development

Kelley

2023

Palliat�Care

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“…34,35,38,39,43,44,46 When developing care plans for rurally located patients, the focus must: remain on understanding the rural context; enhance existing capacity; and harness local problem-solving. 49,[56][57][58][59] Extensive work by Kelley and colleagues using participatory action research to develop, implement and evaluate a framework to build capacity within a rural setting to deliver palliative care services has helped dismantle an urban-centric view, and enable service development in First Nations communities. 57,58,60 The connection between specialist involvement, care coordination and community resources to meet the anticipatory needs of dying rural patients warrants further exploration by an adequately powered high-level study.…”

Section: What This Study Adds?mentioning

confidence: 99%

Evidence-based models of rural palliative care: A systematic review

2023

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Background: Forty-five percent of the world’s population lives in rural areas, yet their access to palliative care is quite limited. Identifying the care elements rural populations with palliative care needs require is critical to improving care outcomes. Aim: To identify the key care elements that optimise palliative care for people in rural communities. Design and data sources: A systematic review of articles studying the impact of novel rural model of care interventions was undertaken in May 2022. This study is reported using the PRISMA Statement and was registered with Prospero (CRD42020154273). Three databases were searched, and the data analysed according to Popay’s narrative synthesis, and elements classified using the WHO Innovative Care for Chronic Conditions (ICCC) Framework. Results: Of the 9508 identified papers, 15 met the inclusion criteria, reporting on 14 studies involving 1820 rural patients. Care received spanned 12/18 of the WHO ICCC Framework elements, with wide variability in how these elements were operationalised. The five elements that signal improved outcomes were: (1) Promote continuity and coordination; (2) Prepared, informed and motivated health care teams; (3) Prepared, informed and motivated patients and families; (4) Organise and equip health care teams and (5) Promote consistent financing. Conclusions: A well-coordinated multidisciplinary team approach, led by clinicians with specialist palliative care expertise, integrated across local health care settings, using information systems and care planning, is critical to optimising rural palliative care patient outcomes. Rural patients and their families require timely input from specialist palliative care clinicians and information to address their needs. Prospero registration ID: CRD42020154273 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=154273

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“…CA-PACITI was developed based on an extensive review of existing palliative care training programs and input from national experts. We integrated training materials and clinical tools from effective and relevant palliative care education programs, such as the Gold Standards Framework in the United Kingdom, 19 the Palliative Care Program Development Framework, 36 and the Practice Support Program in British Columbia. 37 Each CAPACITI module comprised three components: practice support education in the form of expert advice and tips; evidence-based tools; and high-facilitation and expert coaching for adaptation to local context (see Figure 1 for CAPACITI education components).…”

Section: Interventionmentioning

confidence: 99%

Building Palliative Care Capacity for Generalist Providers in the Community: Results From the Capaciti Pilot Education Program

Seow

Bainbridge

Stajduhar

et al. 2022

Am J Hosp Palliat Care

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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.

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Developing rural palliative care: validating a conceptual model

Cited by 14 publications

References 13 publications

Developing a compassionate community: a Canadian conceptual model for community capacity development

Developing a compassionate community: a Canadian conceptual model for community capacity development

Evidence-based models of rural palliative care: A systematic review

Building Palliative Care Capacity for Generalist Providers in the Community: Results From the Capaciti Pilot Education Program

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