Abstract:Objective: This article explores whether access to illness trajectory pamphlets for five conditions with high prevalence in long-term care (LTC) can encourage residents and families/friends to openly engage in advance care planning (ACP) discussions with one another and with health providers. Method: In all, 57 residents and families/friends in LTC completed surveys and 56 participated in seven focus groups that explored whether the pamphlets supported ACP engagement. Results: Survey results suggested that acc… Show more
“…Current ACP research in LTC a rms the high prevalence of medically-focused ACP materials, as most studies exploring ACP impacts in LTC actually look more speci cally at the implementation of advance medical directives (Capps, Gillen, Haley & Mason, 2018). While outcomes from this work have certainly shown some promise, our ndings suggest such interventions are unlikely to be successfully adopted into usual practice in LTC if psychosocial issues are excluded, such as preferences for family involvement/noninvolvement in EOL care, views about dying alone, spiritual beliefs that may provide comfort at EOL, and values related to quality of life/quality of care (Brinkman-Stoppelenburg et al, 2014;Sussman et al, 2017b).…”
Section: Discussionmentioning
confidence: 96%
“…Guided by the themes emerging from our focus group deliberations, tools were excluded from review if they (1) focused exclusively on recording medically-oriented advance directives or decisions including donot-resuscitate orders or the cessation of particular treatments such as kidney dialysis for advanced renal failure; (2) were not available in printable workbook form; and (3) did not provide su cient information and direction for use by non-clinically trained staff. The research team also decided to exclude tools that were (4) developed for substitute decision-makers only because we were interested in materials that would support the inclusion of residents in their own future care planning (Sussman et al, 2017b;2019).…”
Objectives: Despite known benefits, advance care planning (ACP) is rarely a component of usual practice in long-term care (LTC). A series of tools and workbooks have been developed to support ACP uptake. Yet, their acceptability and relevance for LTC has yet to be examined. This study explored the extent to which available ACP materials hold promise in improving ACP engagement in LTC by (1) exploring LTC home staff’s reactions to tool supported ACP and (2) examining if available ACP tools include content of relevance to LTC. Methods: A combination of focus group deliberations with LTC home staff (N=32) and content analysis of publicly available ACP workbooks (N=32) were used to meet the study aims. Results: Focus group deliberations suggested that tool-directed ACP is a promising approach for LTC, provided tools include psychosocial elements and are paper-based. Content analysis of available tools revealed that only a handful of paper-based ACP tools (32/611, 5%) include, psychosocial content, with most encouraging psychosocially-oriented reflections (30/32, 84%), and far fewer providing direction around other elements of ACP such as communicating psychosocial preferences (14/32, 44%) or transforming preferences into a documented plan (7/32, 22%).Conclusions: Tool-supported ACP appears acceptable to LTC staff. To improve ACP uptake in LTC selected tools should include psychosocial content that can be supported by a range of clinical and non-clinical staff. Available ACP tools may require infusion of scenarios pertinent to frail older persons, and a better balance between psychosocial content that elicits reflections and psychosocial content that supports communication.
“…Current ACP research in LTC a rms the high prevalence of medically-focused ACP materials, as most studies exploring ACP impacts in LTC actually look more speci cally at the implementation of advance medical directives (Capps, Gillen, Haley & Mason, 2018). While outcomes from this work have certainly shown some promise, our ndings suggest such interventions are unlikely to be successfully adopted into usual practice in LTC if psychosocial issues are excluded, such as preferences for family involvement/noninvolvement in EOL care, views about dying alone, spiritual beliefs that may provide comfort at EOL, and values related to quality of life/quality of care (Brinkman-Stoppelenburg et al, 2014;Sussman et al, 2017b).…”
Section: Discussionmentioning
confidence: 96%
“…Guided by the themes emerging from our focus group deliberations, tools were excluded from review if they (1) focused exclusively on recording medically-oriented advance directives or decisions including donot-resuscitate orders or the cessation of particular treatments such as kidney dialysis for advanced renal failure; (2) were not available in printable workbook form; and (3) did not provide su cient information and direction for use by non-clinically trained staff. The research team also decided to exclude tools that were (4) developed for substitute decision-makers only because we were interested in materials that would support the inclusion of residents in their own future care planning (Sussman et al, 2017b;2019).…”
Objectives: Despite known benefits, advance care planning (ACP) is rarely a component of usual practice in long-term care (LTC). A series of tools and workbooks have been developed to support ACP uptake. Yet, their acceptability and relevance for LTC has yet to be examined. This study explored the extent to which available ACP materials hold promise in improving ACP engagement in LTC by (1) exploring LTC home staff’s reactions to tool supported ACP and (2) examining if available ACP tools include content of relevance to LTC. Methods: A combination of focus group deliberations with LTC home staff (N=32) and content analysis of publicly available ACP workbooks (N=32) were used to meet the study aims. Results: Focus group deliberations suggested that tool-directed ACP is a promising approach for LTC, provided tools include psychosocial elements and are paper-based. Content analysis of available tools revealed that only a handful of paper-based ACP tools (32/611, 5%) include, psychosocial content, with most encouraging psychosocially-oriented reflections (30/32, 84%), and far fewer providing direction around other elements of ACP such as communicating psychosocial preferences (14/32, 44%) or transforming preferences into a documented plan (7/32, 22%).Conclusions: Tool-supported ACP appears acceptable to LTC staff. To improve ACP uptake in LTC selected tools should include psychosocial content that can be supported by a range of clinical and non-clinical staff. Available ACP tools may require infusion of scenarios pertinent to frail older persons, and a better balance between psychosocial content that elicits reflections and psychosocial content that supports communication.
“…Documentation guides (Staff Planning Guide, Physician Fax Sheet, Good Palliative Care Plan, PCC Summary; all available upon request) from the Palliative Approach Toolkit were adapted for this study based on local contexts and to ensure they were consistent with the jurisdictional legal framework. Condition-specific pamphlets for five conditions of high prevalence in LTC were made available in participating LTC home via display boards of through staff distribution [15,16]. Because these resources evolved from feedback received during the course of the project, no formalized protocol for administration was developed.…”
Section: Spa-ltc Programmentioning
confidence: 99%
“…It is consistent with the SPA-LTC model, that was developed based on a scoping review [ 13 ] of the literature and stakeholder analysis [ 14 ]. As such, the SPA-LTC program consists of the following core, evidence-informed components: (a) an interdisciplinary palliative champion team (to provide leadership and support implementation); (b) condition-specific pamphlets (to provide information about condition-specific end of life trajectories to residents and families) [ 15 , 16 ], (c) the Palliative Performance Scale (PPS) (to trigger end of life discussions) [ 17 ]; (d) Palliative Care Conferences (PCCs) (to provide a forum for family communication about end-of life preferences and needs) [ 18 ]; (e) Comfort Care Rounds (to support peer education, team building and case discussions) [ 19 ]; and (f) post-bereavement follow up (to offer families grief support and links to community services) [ 20 ]. Fig.…”
Background: Despite increased annual mortality in long-term care (LTC) homes, research has shown that care of dying residents and their families is currently suboptimal in these settings. The purpose of this study was to evaluate resident and family outcomes associated with the Strengthening a Palliative Approach in LTC (SPA-LTC) program, developed to help encourage meaningful end of life discussions and planning. Methods: The study employs a mixed method design in four LTC homes across Southern Ontario. Data were collected from residents and families of the LTC homes through chart reviews, interviews, and focus groups. Interviews with family who attended a Palliative Care Conference included both closed-ended and open-ended questions. Results: In total, 39 residents/families agreed to participate in the study. Positive intervention outcomes included a reduction in the proportion of emergency department use at end of life and hospital deaths for those participating in SPA-LTC, improved support for families, and increased family involvement in the care of residents. For families who attended a Palliative Care Conference, both quantitative and qualitative findings revealed that families benefited from attending them. Residents stated that they appreciated learning about a palliative approach to care and being informed about their current status. Conclusions: The benefits of SPA-LTC for residents and families justify its continued use within LTC. Study results also suggest that certain enhancements of the program could further promote future integration of best practices within a palliative approach to care within the LTC context. However, the generalizability of these results across LTC homes in different regions and countries is limited given the small sample size.
“…It is consistent with the SPA-LTC model, that was developed based on a scoping review 13 of the literature and stakeholder analysis. 14 As such, the SPA-LTC program consists of the following core, evidence-informed components: (a) an interdisciplinary palliative champion team (to provide leadership and support implementation); (b) condition-specific pamphlets (to provide information about condition-specific end of life trajectories to residents and families), 15,16 (c) the Palliative Performance Scale (PPS) (to trigger end of life discussions); 17 (d) Palliative Care Conferences (PCCs) (to provide a forum for family communication about end-of life preferences and needs) 18 ; (e) Comfort Care Rounds (to support peer education, team building and case discussions) 19 ; (f) post-bereavement follow up (to offer families grief support and links to community services). 20 To support implementation and sustainability in the real world, the program was refined in collaboration with study sites and leveraged existing palliative resources outside of the LTC home sector to provide guidance to LTC staff.…”
Background: Despite increased annual mortality in long-term care (LTC) homes, research has shown that care of dying residents and their families is currently suboptimal in these settings. The purpose of this study was to evaluate resident and family outcomes associated with the Strengthening a Palliative Approach in LTC (SPA-LTC) program, developed to help encourage meaningful end of life discussions and planning.
Methods: The study employs a mixed method design in four LTC homes across Southern Ontario. Data were collected from residents and families of the LTC homes through chart reviews, interviews, and focus groups.
Results: In total, 39 residents/families agreed to participate in the study. Positive intervention outcomes included a reduction in the proportion of emergency department use at end of life and hospital deaths for those participating in SPA-LTC, improved support for families, and increased family involvement in the care of residents. Residents stated that they appreciated learning about a palliative approach to care and being informed about their current status.
Conclusions: The benefits of SPA-LTC for residents and families justify its continued use within LTC. Study results also suggest that certain enhancements of the program could further promote future integration of best practices within a palliative approach to care within the LTC context.
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