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1.
Health & Social Care in the Community ; : 1, 2022.
Article in English | Academic Search Complete | ID: covidwho-2019300

ABSTRACT

Access to high‐quality and safe evidence‐based palliative care (PC) is important to ensure good end‐of‐life care for older people in residential aged care homes (RACHs). However, many barriers to providing PC in RACHs are frequently cited. The Quality End‐of‐Life Care (QEoLC) Project was a multicomponent intervention that included training, evidence‐based tools and tele‐mentoring, aiming to equip healthcare professionals and careworkers in RACHs with knowledge, skills and confidence in providing PC to residents. This study aims to understand: (1) the experiences of healthcare professionals, careworkers, care managers, planners/implementers who participated in the implementation of the QEoLC Project;and (2) the barriers and facilitators to the implementation. Staff from two RACHs in New South Wales, Australia were recruited between September to November 2021. Semi‐structured interviews and thematic data analysis were used. Fifteen participants (seven health professionals [includes one nurse, two clinical educators, three workplace trainers, one clinical manager/nurse], three careworkers and five managers) were interviewed. Most RACH participants agreed that the QEoLC Project increased their awareness of PC and provided them with the skills/confidence to openly discuss death and dying. Participants perceived that the components of the QEoLC Project had the following benefits for residents: more appropriate use of medications, initiation of timely pain management and discussions with families regarding end‐of‐life care preferences. Key facilitators for implementation were the role of champions, the role of the steering committee, regular clinical meetings to discuss at‐risk residents and mentoring. Implementation barriers included: high staff turnover, COVID‐19 pandemic, time constraints, perceived absence of executive sponsorship, lack of practical support and systems‐related barriers. The findings underline the need for strong leadership, supportive organisational culture and commitment to the implementation of processes for improving the quality of end‐of‐life care. Furthermore, the results highlight the need for codesigning the intervention with RACHs, provision of dedicated staff/resources to support implementation, and integration of project tools with existing systems for achieving effective implementation outcomes. [ FROM AUTHOR] Copyright of Health & Social Care in the Community is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

2.
BMC palliative care ; 21(1):154, 2022.
Article in English | MEDLINE | ID: covidwho-2009386

ABSTRACT

BACKGROUND: Palliative care (PC) is a strongly emerging discipline worldwide. Despite efforts to integrate this important topic in the medical curriculum in Belgium, still little time is spent on PC and its implementation during theoretical and practical training. MATERIALS & METHODS: We had two cohorts of second master's year MD students at the University of Antwerp complete a survey compromising a custom-built PC knowledge test and a self-confidence assessment of communicative skills used in end-of-life conversations. We evaluated students' self-confidence regarding end-of-life-conversations before and after a PC training program. We also explored whether the PC classes enabled the students to adequately reflect on factors that might influence end-of-life conversations with an open-end question about the potential implications of the COVID-19 pandemic on advance care planning (ACP) conversations. Finally, we compared the results of the respondents having enjoyed face-to-face training (cohort 1) with those having received online training only (cohort 2, COVID-19 pandemic). RESULTS: Although the respondents in both cohorts indicated that the overall curriculum did not pay enough attention to PC training, their average scores on the theoretical questions were good. Feeling confident about their communicative skills in general, they indicated to be less confident when it came to communications concerning PC and ACP in particular. The COVID-19 pandemic was initially equally deemed to impede and facilitate ACP and end-of-life conversations, but after the ACP training class more respondents saw the pandemic as an opportunity to broach end-of-life issues. Finally, we found no differences in scores between online and regular classroom teaching. CONCLUSION: Students experience a lack of confidence in communication skills used in end-of-life conversations and ACP. To help improve skills and competencies in conducting end-of-life conversations, it is recommended to have medical students assess PC/ACP training programs regularly and to modify the curriculum and course content based on these outcomes and current developments.

3.
BMJ Supportive and Palliative Care ; 12:A20, 2022.
Article in English | EMBASE | ID: covidwho-2005497

ABSTRACT

Background Anticipated severe illness at the start of the COVID-19 pandemic bought increased endorsement, awareness and provision of advance care planning in adults with serious illness. Place of death is often considered a surrogate quality indicator for end-of-life care. Aim To examine the impact of advance care planning on place of death for patients who died during the COVID-19 pandemic with a Coordinate My Care (CMC) record, the Electronic Palliative Care Coordination System currently commissioned in London. Methods Retrospective non-interventional cohort analysis of CMC records for patients aged over 18 who died between 20/03/20 and 05/03/21 with recorded place of death. Patient demographics, socio-economic position and advance care planning related factors associated with achieving preferred place of death were explored using logistic regression. Results 11,913 records were included. 76.9% patients died in their preference place of death (57.7% Home, 31.4% Care Home, 7.5% Hospice, 3.3% Hospital, 0.1% Other). A higher likelihood of dying in the preferred place was associated with a 'Not for resuscitation' (DNACPR) status (OR=1.55, 95% CI 1.23 to 1.95), a Ceiling of Treatment for 'Symptomatic Treatment' (when compared to 'Full active treatment', OR=3.55, 95% CI 2.78 to 4.53), discussions with family regarding resuscitation recommendations (OR=1.53, 95% CI 1.34 to 1.74) and at least 2 non-urgent care record views in the 30days before death (OR=1.27, 95% CI 1.23 to 1.43). Patients from areas of lower socio-economic position had a decreased likelihood of dying in their preferred place (OR= 0.65, 95% CI 0.54 to 0.79). Conclusion Components of Advance care planning carry potential to significantly influence place of death, even in times of crisis and when controlling for socio-economic and demographic determinants. Effective advance care planning is fundamental to achieving patient-centred, high-quality end-oflife care and factors relating to it must be considered in ongoing research on end-of-life outcomes.

4.
BMJ Supportive and Palliative Care ; 12:A17, 2022.
Article in English | EMBASE | ID: covidwho-2005489

ABSTRACT

Background The ongoing Coronavirus-19 (CV-19) pandemic has had worldwide impact with over 240 million cases globally1 to date. As with most the UK, The Dudley Group NHS Foundation Trust (DGFT) has cared for patients with the virus since Spring 2020 and we reviewed if the types of patients who died (all causes) changed in the pandemic on a local level. Method Retrospective review of adult inpatients who died at DGFT - looking at November 2019 (before CV-19) and April 2020 (early in first-wave). A list of adults who were coded as dying as an inpatient in these two periods was compiled by the Informatics Team and data collected from 45 notes for each month. Results There were 148 adult inpatient deaths in November 2019, which increased 77% to 262 in April 2020. Median ages at death were similar (77 years) but fewer females (27%). 4% were known to Specialist Palliative Care before admission. Average lengths of stay were similar (5-6 days) and approaching end of life was recognised in the majority of cases. In April 2020, there was a decreased number of patients with recent hospital admissions (24%) and a threefold increase in those with an unimpaired functional status (29%). Fewer were admitted from home but more from care homes (18%). 25% of those with CV-19 as cause of death had no documented comorbidities (all aged over 74). Conclusions There appears an increase of inpatient deaths at the start of the Coronavirus-19 pandemic in three main groups: care home residents, those with comorbidities and older people with no comorbidities/unimpaired functioning. Promoting advance care planning with these groups as a priority may be beneficial for future waves - especially wishes for hospital admission and preferred place of care. (Assessment of impacts of the CV-19 vaccination programme on these patient groups could be considered).

5.
BMJ Open ; 12(8), 2022.
Article in English | EMBASE | ID: covidwho-1997242

ABSTRACT

Objectives When resources are strained during communicable disease outbreaks, novel palliative care interventions may be required to optimally support people who use substances with life-limiting illnesses. Therefore, we asked the question, € what is known about communicable disease outbreaks, palliative care and people who use substances?', such as palliative care interventions that can improve the quality of life of patients with life-limiting illnesses. Design We conducted a scoping review that involved comprehensive searches in six bibliographic databases from inception to April 2021 (Medline ALL (Medline and Epub Ahead of Print and In-Process and Other Non-Indexed Citations), Embase Classic+Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trial, PsycInfo all from the OvidSP platform, Scopus from Elsevier) and grey literature searches. We included English and French records about people ≥18 years old with life-limiting illnesses who use substances during communicable disease outbreaks. We identified, summarised and presented the findings about palliative care interventions in figures, tables and narrative descriptions. Results We identified 32 records about palliative care interventions for people who use substances during communicable disease outbreaks. The majority focused on palliative care for people who use substances with AIDS during HIV epidemics (n=27, 84.4%), and approximately half were published in the USA (n=15, 46.9%). Most common substances used were alcohol (n=18, 56.3%), opioids (n=14, 43.8%) and cocaine (n=10, 31.3%). Four groups of palliative care interventions were identified: (1) symptom management (n=20, 62.5%), (2) psychosocial support (n=15, 46.9%), (3) advance care planning (n=8, 25.0%) and (4) healthcare provider training (n=6, 18.8%). Conclusions Beyond studies on HIV epidemics, there is limited knowledge about palliative care interventions for people who use substances during communicable disease outbreaks. Research and guidance are needed about how best to provide palliative care to this population with complex needs including in resource-limited countries. Protocol Buchman DZ, Ding P, Lo S, et al. Palliative care for people who use substances during communicable disease epidemics and pandemics. BMJ Open 2021;11: e053124

7.
Palliat Med Rep ; 3(1): 98-104, 2022.
Article in English | MEDLINE | ID: covidwho-1973070

ABSTRACT

Background: With the rapid progress of medical technology, the number of children with medical complexities who require advanced medical care, including mechanical ventilators, has been increasing steadily in Japan. Accordingly, the issue of how to provide holistic care and support for the entire life of the children with severe motor and intellectual disabilities (SMID) who live at home has become a new challenge. Case Presentation: We present the case of a three-year-old boy with SMID due to HHV-6B-induced hemorrhagic shock encephalopathy who was cared for at home by the home visit medical team of Osaka Developmental Rehabilitation Center (ODRC; residential facilities with the department of home medical treatment and care). He developed septic shock triggered by an urinary tract infection and was admitted to Osaka General Medical Center (OGMC; acute care facility not directly affiliated with ODRC), where he deteriorated to a terminal stage. After discussing advance care planning (ACP) with his parents, along with the medical team, an ACP document with parental wishes was created through collaboration between the two facilities. The document was approved by the Ethics Committee at OGMC and the parents signed the document. Special end-of-life care planning was given by nurses at OGMC based on the best interests of the patient and the family. The patient passed away peacefully surrounded by his family in a private room of OGMC according to the ACP, despite special limitations caused by the coronavirus disease 2019 (COVID-19) pandemic. Conclusions: ACP provides a good opportunity to think about the best total care for a child with SMID, for whom it is too difficult to express his or her wishes, together with the parents, who are the legal representatives. The collaboration between two institutions with different roles brought out the best of each, and the resulting ACP was beneficial to the patient and their family.

8.
Health Expect ; 25(4): 1945-1953, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1961584

ABSTRACT

INTRODUCTION: Patient participation is essential for quality palliative care, and physicians play a crucial role in promoting participation. This study explores physicians' perceptions of patients and family caregivers' involvement in the different phases of the palliative pathway and employs a qualitative design with thematic analysis and a hermeneutic approach. METHODS: A purposive sampling included physicians who worked in different phases of the palliative pathway. In-depth, semi-structured interviews were conducted with 13 physicians in Norway between May and June 2020. RESULTS: Three main themes illustrate physicians' perceptions of patients' and family caregivers' involvement: (1) beneficence for the patient and the family caregivers in the early phase, (2) autonomy and shared decision-making in the middle phase, and (3) family involvement in the terminal phase. CONCLUSION: The physicians perceived bereavement conversations as essential, particularly if the pathway had been challenging. They also perceived patient participation and family caregivers' involvement as contextual. The results reveal that participation differs across the different phases of the palliative pathway. This type of knowledge should be included in the education of health-care professionals. Future research should explore elements vital to successful patient participation and family involvement in the different phases of care. PATIENT OR PUBLIC CONTRIBUTIONS: Family caregivers were involved in a previous study through individual interviews. The same interview guide used for the family caregivers was used when interviewing the physicians. The family caregivers' contribution led to nuanced questions in the interviews with the physicians, questions leaning on their stories told.


Subject(s)
Caregivers , Palliative Care , Patient Participation , Physicians , Bereavement , Caregivers/psychology , Humans , Norway , Palliative Care/methods , Palliative Care/psychology , Patient Participation/psychology , Physicians/psychology , Qualitative Research
9.
Journal of Pain and Symptom Management ; 64(2):205-211, 2022.
Article in English | EMBASE | ID: covidwho-1936857
10.
Supportive Care in Cancer ; 30:S120, 2022.
Article in English | EMBASE | ID: covidwho-1935794

ABSTRACT

Introduction Early palliative care, delivered in oncology palliative care clinics (OPCCs) typically involves in-person visits, but virtual care visits were adopted during the COVID-19 pandemic. This study aimed to explore patients' experiences of virtual visits to an OPCC at a tertiary cancer centre in Toronto, Canada during the pandemic. Methods One-on-one telephone interviews were conducted with patients who had a) at least one in-person visit to the OPCC prior to the pandemic, with subsequent virtual follow-up, or b) virtual visits only. Purposive sampling was used to ensure representation based on sex, age, distance from the cancer centre, and mode of virtual visits (telephone vs. video). Interviews were recorded and professionally transcribed;thematic analysis was used. Results Twenty-six patients were interviewed (17 had an in-person visit, 9 virtual only). Patients reported overall satisfaction with virtual care, appreciating that it reduced care disruption during the pandemic. An initial in-person visit was felt to assist with rapport-building with the team. Many participants wished to continue with virtual care beyond the pandemic, especially during periods of relative health stability. At transition points in care, or when advance care planning discussions were anticipated, inperson visits were preferred. Conclusions Virtual visits to the OPCC during the COVID-19 pandemic were feasible and appreciated by patients. The role of virtual care for select scenarios beyond the pandemic should be further explored.

11.
Palliative Medicine ; 36(1 SUPPL):12, 2022.
Article in English | EMBASE | ID: covidwho-1916777

ABSTRACT

Introduction: Staff and the public have limited access to information about advance care planning. Yet, during the pandemic there was an urgency to complete advance care plans (ACP) in long term care facilities (LTCFs) or 'Emergency care plans' which focussed upon future care choices relating to hospital admission and resuscitation status. Materials and Methods: Three studies addressed ACP in care homes: Evaluating experiences of LTCFs during the pandemic including their experiences of ACP. Semi-structured interviews with staff (16), community staff (11), residents (3) and families (5) from 11 LTCFs analysed using thematic analysis. International implementation case study of ACP training for staff caring for residents with advanced dementia, which was adapted from in person to asynchronous online training during the pandemic. Evaluation interviews in the UK were conducted with staff (78) and families (34). Bespoke online training and informational resources about advance care planning during COVID-19 was developed for staff and families. Semistructured interviews conducted with families (37) and staff (35) from eight LTCFs. Findings: Staff were concerned about the initiation of ACPs from external agencies and why they were implemented. Staff felt abandoned thinking ACPs meant they were going to be left to manage on their own, adding to their emotional distress. Differences were found between the two training mechanisms, which will be discussed but related to mode of delivery. In study 3, the bespoke training, (https://covidacpcarehomes.com/care-staff/units-training/), was found to be accessible and easier to engage with compared to information from other agencies. Staff felt it gave them permission to engage in these conversations, recognise when a resident gave them cues to have an ACP discussion, when they needed input from senior staff. Staff revised their ACP procedures. Similarly, families felt emboldened to challenge decisions. They shared training with other family members, increasing dissemination. A section on supporting yourself was particularly well evaluated as this met the emotional burden staff and family had identified in study 1. Different implementation challenges were identified in study 2 and 3. Working remotely meant homes need to have appropriate and functioning technology. Building relationships with families was critical and challenging when engaging remotely. Recruiting and establishing meaningful relationships with staff and family carers was critical and challenging in the context of buy-in and willingness to participate. Study 3 involved skilling up staff whereas study 3 involved both skilling up and arranging a family conference, which was less successful perhaps due to the constraints of the pandemic. Conclusion: Whilst advance planning had initially raised concerns for staff, the training helped staff and families' understanding of advance care planning. Bespoke training was particularly well received but involving families remotely was challenging. It is possible for staff to be upskilled and do ACP during a pandemic, but it is difficult, and we need to be aware of the many contextual factors - including how studies can be designed to be workable in difficult circumstances. More research is needed on facilitators and barriers to ACP in LTCF both during a pandemic and more generally.

12.
Palliative Medicine ; 36(1 SUPPL):33-34, 2022.
Article in English | EMBASE | ID: covidwho-1916771

ABSTRACT

Background/aims: Mortality forecasts associated with COVID-19 pandemic stressed a need to prepare adults with advanced disease for possible severe illness and engage with Advance Care Planning (ACP). We aimed to examine ACP engagement and activity during the COVID-19 pandemic. Methods: A retrospective non-interventional cohort study, comparing the creation, content and use of Coordinate My Care (CMC) records that include an ACP component, in London, prior to and during the onset of COVID-19. Records for people aged 18+, created and published in prepandemic period (2018-2019) and 'wave 1' (W1) of COVID-19 (20/03/20- 04/07/20) were extracted. Demographics, ACP-related content and the use of CMC records created were analysed and compared using standard descriptive statistics. Results: 56,343 records were included, 35,108 from the pre-pandemic period and 21,235 records from W1. The average records created each week rose by 296.9% (P<0.005) in W1. There were fewer records in W1 for those aged 80 years (60.8% vs 64.9% pre-pandemic, P<0.005) and who had WHO performance status of 4 (34.8% vs 44.2% pre pandemic, P<0.005). More people who created records during W1 had an estimated prognosis of at least a year (73.3% vs 53.0% pre-pandemic, P<0.005), were “For Resuscitation” (38.2% vs 29.8% pre-pandemic, P<0.005) and had a Ceiling of Treatment of “Full Active Treatment” (32.4% vs 25.7%, P<0.005). More people in W1 listed hospital as their preferred place of care (PPC) and preferred place of death (PPD) (PPC: 13.3% vs 5.8% pre-pandemic, P<0.005. PPD: 14.0% vs 7.9%, P<0.005). Average monthly non-urgent and urgent record views rose by 320.3% (P=0.02) and 154.3% (P=0.01) in W1. Conclusions: A large uptake in engagement with ACP is demonstrated during the 1st wave of the pandemic. An increase in use among younger, more independent patients with longer prognoses, with a higher preference for hospital care creating records in W1 compared to before the pandemic, suggests heightened awareness and provision of ACP at this time.

13.
Palliative Medicine ; 36(1 SUPPL):103-104, 2022.
Article in English | EMBASE | ID: covidwho-1916770

ABSTRACT

Background/aims: At the beginning on the COVID-19 pandemic, advance care planning (ACP) was widely encouraged and endorsed for adults with serious illness to ensure their treatment and care preferences would be honoured, including location of death, often considered a surrogate quality indicator for end-of-life care. Coordinate My Care (CMC) represents the UK's largest Electronic Palliative Care Coordination System that comprises an ACP component. We aimed to examine the impact of ACP on place of death for people who died during the COVID-19 pandemic with a CMC record. Methods: Retrospective cohort analysis of CMC records for people aged over 18 who died between 20/03/20 and 05/03/21 with recorded place of death. Socio-demographic, clinical and ACP-related factors associated with achieving preferred place of death (PPD) were examined using logistic regression. Results: 11,913 records were included. 76.9% patients died in their preferred place location of death (57.7% Home, 31.4% Care Home, 7.5% Hospice, 3.3% Hospital, 0.1% Other). An increased likelihood of dying in PPD was associated with a 'Not for resuscitation' (DNACPR) status (OR=1.55, 95% CI 1.23 to 1.95), a Ceiling of Treatment for Symptomatic Treatment (when compared to Full active treatment, OR=3.55, 95% CI 2.78 to 4.53), documented family discussions regarding resuscitation recommendations (OR=1.53, 95% CI 1.34 to 1.74) and 2+ non-urgent care record views in the 30 days before death (OR=1.27, 95% CI 1.23 to 1.43). People from materially deprived areas had a decreased likelihood of dying in their PPD (OR= 0.65, 95% CI 0.54 to 0.79). Conclusions: Modifiable elements of ACP significantly influence place of death, even when controlling for socio-economic and demographic determinants. In times of crisis, effective ACP is central to delivering high quality end-of-life care;ACP related factors must be considered in ongoing research on end-of-life outcomes.

14.
J Palliat Med ; 25(6): 888-896, 2022 06.
Article in English | MEDLINE | ID: covidwho-1868243

ABSTRACT

Aim: Our aim is to characterize code status documentation for patients hospitalized with novel coronavirus 2019 (COVID-19) during the first peak of the pandemic, when prognosis, resource availability, and provider safety were uncertain. Methods: This retrospective cohort study was performed at a single tertiary academic medical center. Adult patients admitted between March 1, 2020 and October 31, 2020 who tested positive for COVID-19 were included. Demographic and hospital outcome data were collected. Code status orders during this admission and prior admissions were trended. Data were analyzed with multivariable analysis to identify predictors of code status choice. Results: A total of 720 patients were included. The majority (70%) were full code and 12% were in do-not-attempt resuscitation (DNAR) status on admission; by discharge, 20% were DNAR. Age (p < 0.001), time in the intensive care unit (ICU) (p < 0.001), and having Medicaid (p = 0.04) compared to private insurance were predictors of DNAR. Fourteen percent had no code status order. Older age (p < 0.001), time in the ICU (p = 0.01), and admission to a teaching service (p < 0.001) were associated with having an order. Of patients with a prior admission (n = 227), 33.5% previously had no code status order and 44.5% had a different code status for their COVID-19 admission. Of those with a change, most transitioned to less aggressive resuscitation preferences. Conclusions: Most patients hospitalized with COVID-19 in our study elected to be full code. Almost half of patients with prepandemic admissions had a different code status during their COVID-19 admission, with a trend toward less aggressive resuscitation preference.


Subject(s)
COVID-19 , Resuscitation Orders , Adult , Hospitalization , Humans , Retrospective Studies , SARS-CoV-2
15.
Age and Ageing ; 51(4), 2022.
Article in English | EMBASE | ID: covidwho-1868246
16.
Health Expect ; 25(3): 1016-1028, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1861341

ABSTRACT

INTRODUCTION: Traditional advance care planning focuses on end-of-life planning in the context of a certain or imminent death. It is not tailored for serious illness planning, where the 'death' outcome is uncertain. The Plan Well Guide™ (PWG) is a decision aid that empowers lay persons to better understand different types of care and prepares them, and their substitute decision-makers, to express both their authentic values and informed treatment preferences in anticipation of serious illness. A cultural adaptation was necessary to make the material suitable to the context of Quebec, a French-speaking Canadian province. METHODS: We engaged lay collaborators and experts in a panel, involving three phases of consultation and data collection. These included an online questionnaire, focused interviews and virtual focus groups that identified elements within the francophone PWG affecting its feasibility, adaptation and integration, as well as items that should be modified. RESULTS: We engaged 22 collaborators between April and September 2021. The majority (82%) ranked the first translation as good or very good; most (70%) stated that they would recommend the final adaptation. Both lay and expert panel members suggested simplifying the language and framing the tool better within the context of other advance medical planning processes in Quebec. Translation was considered in a cultural context; the challenges identified by the research team or by collaborators were addressed during the focus group. Examples of wording that required discussion include translating 'getting the medical care that's right for you' when referring to the PWG's goal. An equivalent expression in the French translation was believed to invoke religious associations. Using the term 'machines' to describe life-sustaining treatments was also deliberated. CONCLUSION: Our collaborative iterative adaptation process led to the first French advanced serious illness planning tool. How acceptable and user-friendly this French adaptation of the PWG is in various Canadian French-speaking environments requires further study. CONTRIBUTION: We organized a focus group inviting both lay collaborators and experts to contribute to the interpretation of the results of the previous phases. This choice allowed us to add more value to our results and to the final PWG in French.


Subject(s)
Advance Care Planning , Canada , Decision Support Techniques , Humans , Quebec , Surveys and Questionnaires
17.
BMC Geriatr ; 22(1): 419, 2022 05 13.
Article in English | MEDLINE | ID: covidwho-1846796

ABSTRACT

BACKGROUND: Advance care planning in nursing homes is important to ensure the wishes and preferences of residents are recorded, especially during the COVID-19 pandemic. However, care staff and family members frequently report feeling unprepared for these conversations. More resources are needed to support them with these necessary discussions. This research aimed to develop, implement and evaluate a website intervention for care staff and family members to provide training and information about advance care planning during COVID-19. METHODS: The research was a primarily qualitative case study design, comprising multiple UK nursing home cases. Data collection included semi-structured interviews with care staff and family members which were coded and analysed thematically. A narrative synthesis was produced for each case, culminating in a thematic cross-case analysis of the total findings. Theoretical propositions were refined throughout the research. RESULTS: Eight nursing homes took part in the study, involving 35 care staff and 19 family members. Findings were reported according to the RE-AIM framework which identified the reach, effectiveness, adoption, implementation and maintenance of the intervention. Themes included: website content that was well received; suggestions for improvement; implementation barriers and facilitators; examples of organisational and personal impact. CONCLUSIONS: Four theoretical propositions relating to advance care planning in nursing homes are presented, relating to: training and information needs, accessibility, context, and encouraging conversations. Implications for practice and training include an awareness of diverse learning styles, re-enforcing the right to be involved in advance care planning and encouraging opportunities for facilitated discussion. TRIAL REGISTRATION: ISRCTN registry (ID 18003630 ) on 19.05.21.


Subject(s)
Advance Care Planning , COVID-19 , COVID-19/epidemiology , Humans , Nursing Homes , Pandemics , United Kingdom/epidemiology
18.
International Journal of Environmental Research and Public Health ; 19(9):5358, 2022.
Article in English | ProQuest Central | ID: covidwho-1837912

ABSTRACT

Advance care planning (ACP) facilitates individuals to proactively make decisions on their end-of-life care when they are mentally competent. It is highly relevant to older adults with frailty because they are more vulnerable to cognitive impairment, disabilities, and death. Despite devoting effort to promoting ACP among them, ACP and advance directive completion rates remain low. This study aims to explore the experiences among frail older adults who did not complete an advance directive after an ACP conversation. We conducted a thematic analysis of audiotaped nurse-facilitated ACP conversations with frail older adults and their family members. We purposively selected ACP conversations from 22 frail older adults in the intervention group from a randomized controlled trial in Hong Kong who had ACP conversation with a nurse, but did not complete an advance directive upon completing the intervention. Three themes were identified: “Refraining from discussing end-of-life care”, “Remaining in the here and now”, and “Relinquishing responsibility over end-of-life care decision-making”. Participation in ACP conversations among frail older adults and their family members might improve if current care plans are integrated so as to increase patients’ motivation and support are provided to family members in their role as surrogate decision-makers.

19.
Age and Ageing ; 51(SUPPL 1):i16, 2022.
Article in English | EMBASE | ID: covidwho-1815971

ABSTRACT

Background: Advance care planning (ACP) is an ongoing conversation where healthcare professionals explore patients' and families' wishes in order to act within their best interests. The COVID19 pandemic continues to highlight the importance of timely ACP, namely while our patients have capacity. We noted that despite advancing age, accumulating co-morbidities and high clinical frailty scores (CFS);ACP discussions were not taking place within our elderly department. We aimed to increase ACP conversations and ensure documentation on ReSPECT forms to allow continuity within primary care. Methods: 10 patients per ward were randomly selected. 69 patients met inclusion criteria (over 65 with CFS ≥5 or any patient with dementia). We reviewed electronic and paper records and defined evidence of ACP as ReSPECT form including preferred place of death (PPoD), or discussion with patient or relative in medical notes. We randomly selected a pilot ward and applied interventions over 4 weeks: • Small group teaching to junior doctors • Visiting ward MDTs to identify appropriate patients for ACP • Presenting baseline data to geriatricians • Visual aids from the palliative care team and prompt sheets for doctors. Results: Prior to our interventions, 22% of our sample had evidence of advance care planning, 33% of discussions documented on ReSPECT form. Following our intervention period we reviewed medical notes on our pilot ward. 58% patients now had evidence of ACP, with 66% documented on a ReSPECT form. Conclusion: We achieved a significant increase in advance care planning within our elderly medicine department, and are therefore better equipped to provide personalised care alongside our patients' wishes and values. Next steps: • Expanding teaching across the multi-disciplinary team • ACP 'champions' to highlight appropriate patients • Expansion of initial interventions across the departmentWe hope to embed and maintain this change through education, training and inspiring others.

20.
Palliat Care Soc Pract ; 15: 26323524211019056, 2021.
Article in English | MEDLINE | ID: covidwho-1808293

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has led to death and hardship around the world, and increased popular discourse about end-of-life circumstances and conditions. The extent to which this discourse and related pandemic experiences have precipitated advance care planning (ACP) activities was the focus of this study with a particular emphasis on sexual orientation. METHODS: A large, national online survey was conducted between 10 August and 10 October 2020 in Canada. The final sample of 3923 persons aged 55 and older was recruited using social media, direct email, and Facebook advertising and in conjunction with community groups. Women comprised almost 78% of the sample; just more than 7% of the sample identified as lesbian, gay, and bisexual (LGB). Measures included demographic variables and a series of questions on ACP, including documents and discussions undertaken prior to the pandemic and since its onset. RESULTS: Descriptive analyses revealed few gender or sexual orientation differences on documents and discussions prior to the pandemic; since its onset, LGB persons have completed or initiated wills, powers of attorney, advance directives, representation agreements, and have engaged in ACP discussions in greater proportion than heterosexuals. Logistic regressions reveal the increased likelihood of pre-pandemic ACP engagement by age, gender (women), and education; since the pandemic onset, gender, education, and sexual orientation were predictive of greater ACP engagement. Care discussions were more likely undertaken by women and LGB persons since the pandemic most often with spouses, family, and friends, especially among LGB persons. DISCUSSION: Gender roles and previous pandemic experiences (HIV/AIDS, in particular) are implicated in this pattern of results; opportunities for educational interventions are considered.

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