ABSTRACT
Purpose: Integrated care pathway (ICP) is structured multidisciplinary care plan that aim to improve the quality of care. ICP could be effective in providing quality End-of-Life (EOL) care in long-term care facilities (LTCFs). However, the outcomes and components of ICP for EOL care in LTCFs are not clear. Methods: We conducted a scoping review to identify the outcomes and components. We searched electronic databases (PubMed, CINAHL, Cochrane Library, PsycINFO, Ichushi) and conducted an additional hand search for relevant journal articles related to EOL care. We searched intervention and implementation studies for ICP in EOL care in LTCFs. Results: Thirteen papers met the inclusion criteria. We identified the following components of ICP: documents, education regarding EOL care and ICP, support by experts, and regular conferences among care providers. The effects of ICP were reported as reductions in transfers to hospitals and improvement in staff confidence regarding EOL care. Conclusion: With reference to the components of ICP identified in this study, ICP should be developed based on the characteristics of LTCFs, and the effects of intervention or implementation studies using a more robust design should be examined.
ABSTRACT
Long-term care facilities have important roles providing end-of-life-care in Japan. The purpose of this literature review was to examine the current research trend regarding quality evaluation and improvement for end-of-life-care in Japanese long-term care facilities. From a search of key medical databases, potential articles regarding end of life at long-term care facilities were retrieved. We classified retrieved 23 literatures into four research types; four intervention studies, three surveys for development educational / quality improvement tool, thirteen cross-sectional surveys, three qualitative studies. Despite the current increment of the literatures, intervention studies were a few. Related factors of the death in the facilities included administrators’ policy regarding end of life care, and collaboration with the medical institutions, and clear family decision making regarding end of life care. Some research indicated that staffs in long-term care facilities felt difficulty in collaborating with medical institutions, conducting interdisciplinary work, and confirming residents’ intention regarding end-of-life. The results indicate that conducting quality intervention study, supporting administrators of long-term care facilities, promoting residents and family decision making and education for the staffs in long-term care facilities might be effective to improve quality of end-of-life care in long-term care facilities.