Multi-disciplinary supportive end of life care in long-term care: an integrative approach to improving end of life

Abstract

Background Optimal supportive end of life care for frail, older adults in long term care (LTC) homes involves symptom management, family participation, advance care plans, and organizational support. This 2-phase study aimed to combine multi-disciplinary opinions, build group consensus, and identify the top interventions needed to develop a supportive end of life care strategy for LTC. Methods A consensus-building approach was undertaken in 2 Phases. The first phase deployed modified Delphi questionnaires to address and transform diverse opinions into group consensus. The second phase explored and prioritized the interventions needed to develop a supportive end of life care strategy for LTC. Development of the Delphi questionnaire was based on findings from published results of physician perspectives of barriers and facilitators to optimal supportive end of life care in LTC, a literature search of palliative care models in LTC, and published results of patient, family and nursing perspectives of supportive end of life care in long term care. The second phase involved World Café Style workshop discussions. A multi-disciplinary purposive sample of individuals inclusive of physicians; staff, administrators, residents, family members, and content experts in palliative care, and researchers in geriatrics and gerontology participated in round one of the modified Delphi questionnaire. A second purposive sample derived from round one participants completed the second round of the modified Delphi questionnaire. A third purposive sample (including participants from the Delphi panel) then convened to identify the top priorities needed to develop a supportive end-of-life care strategy for LTC. Results 19 participants rated 75 statements on a 9-point Likert scale during the first round of the modified Delphi questionnaire. 11 participants (participation rate 58 %) completed the second round of the modified Delphi questionnaire and reached consensus on the inclusion of 71candidate statements. 35 multidisciplinary participants discussed the 71 statements remaining and prioritized the top clinical practice, communication, and policy interventions needed to develop a supportive end of life strategy for LTC. Conclusions Multi-disciplinary stakeholders identified and prioritized the top interventions needed to develop a 5-point supportive end of life care strategy for LTC.

Factors associated with dietitian referrals to support long‐term care residents advancing towards the end of life

“…19,20 However, the use of comfort feeding orders is not well defined in practice, 21 and very little is currently known about the involvement of dietitians as distinct allied health professionals in the end-of-life care experience for LTC residents. 22 Furthermore, dietitian input is notably absent from the broader palliative care movement, 12,[23][24][25] suggesting that there have been few advances in a palliative approach to nutrition care in LTC to date.…”

‘Confidence and fulfillment’: a qualitative descriptive study exploring the impact of palliative care training for long-term care physicians and nurses

“… 18 , 25 , 26 This has amplified previous calls to improve palliative care in LTC, including the training of staff. 27 – 30 Standards and indicators related to palliative care training and preparedness of staff, legislation in this regards, and inclusion of palliative care in undergraduate and postgraduate curricula across the care professions are all strategies to increase readiness to provide a palliative care approach in LTC facilities.…”