Palliative Care Models in Long-Term Care: A Scoping Review

Abstract

Objective: The goal of this scoping review was to identify existing palliative models in long-term care (LTC) homes and differentiate between the key components of each in terms of training/capacity-building strategies; resident, family and staff support; and advance care planning (ACP) and goals-of-care discussions. Methods: We conducted a scoping review based on established methods to summarize the international literature on palliative models and programs for LTC. We analyzed the data using tabular summaries and content analysis. Results: We extracted data from 46 articles related to palliative programs, training/ capacity building, family support, ACP and goals of care. Study results highlighted that three key components are needed in a palliative program in LTC: (1) training and capacity building; (2) support for residents, family and staff; and (3) ACP, goals-ofcare discussion and informed consent. Conclusion: This scoping review provided important information about key components to be included in a palliative program in LTC. Future work is needed to develop a model that suits the unique characteristics in the Canadian context.

A pilot evaluation of the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) program

“…1). 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) conditionspecific 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].…”

“…In response, a number of initiatives have been implemented to improve the quality of living and dying for LTC residents with a life-limiting illness and their families [10][11][12][13]. Features that appear to support effective and sustained palliative care implementation and show some promise in improving care delivery include: (a) mechanisms that allow for the assessment and identification of gaps in current practices and philosophies, (b) mechanisms to help staff identify and activate a change in care planning based on key transition points, (c) formalized opportunities for communication between staff, residents and families, and (d) team-building strategies, champions or resource teams and collaborative learning opportunities.…”

Barriers and facilitators to optimal supportive end-of-life palliative care in long-term care facilities: a qualitative descriptive study of community-based and specialist palliative care physicians’ experiences, perceptions and perspectives

“…One of the key components to providing palliative care within LTC includes advanced care planning and goals of care discussions. 38 Symptom management Another significant finding is how participants, who visit LTC facilities, perceive and respond to the problem of differentiating, assessing and managing pain and responsive behaviours of residents. Studies using surveys have identified pain and responsive behaviours in LTC as having the greatest impact on care providers and residents.…”

A Pilot Evaluation of the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) Program

“…9 In response, a number of initiatives have been implemented to improve the quality of living and dying for LTC residents with a life-limiting illness and their families. [10][11][12][13] Features that appear to support effective and sustained palliative care implementation and show some promise in improving care Figure 1). It is consistent with the SPA-LTC model, that was developed based on a scoping review 13 of the literature and stakeholder analysis.…”

“…[10][11][12][13] Features that appear to support effective and sustained palliative care implementation and show some promise in improving care Figure 1). 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).…”