Evaluating Toronto Hospitals' COVID-19 Visitor Policy Using Accountability for Reasonableness.

In March 2020, the Toronto Region COVID-19 Hospital Operations Table developed a policy to guide visitor restrictions at six hospitals (Toronto Region COVID-19 Hospital Operations Table 2021). We conducted nine interviews with the developers and implementers of the policy based on the accountability for reasonableness (A4R) framework. Participants agreed that the A4R principles were met suggesting fair development and implementation of the policy. However, recurrent themes suggested that the policy disadvantaged those unable to advocate for themselves and that there were unaccounted costs to patients, such as lost time and function. We suggest that visitor policies incorporate equity considerations upfront and predetermine metrics to measure harms to patients.

Voluntary stopping of eating and drinking in the age of medical assistance in dying: ethical considerations for physicians.

Since 2016, when medical assistance in dying (MAiD) became legal in Canada, healthcare professionals (HCPs) have become familiar with exploring and acting upon patients' wishes to hasten death (WTHD). In contrast to MAiD, the literature on the voluntary stopping of eating and drinking (VSED) is very limited and there are no standards of practice or legal guidance to support HCPs. In this article, the legal and ethical literature as regards VSED is critically reviewed and new standards of practice are proposed.

Short Graphic Values History Tool for decision making during serious illness.

OBJECTIVES: To develop and validate a values clarification tool, the Short Graphic Values History Tool (GVHT), designed to support person-centred decision making during serious illness. METHODS: The development phase included input from experts and laypersons and assessed acceptability with patients/family members. In the validation phase, we recruited additional participants into a before-after study. Our primary validation hypothesis was that the tool would reduce scores on the Decisional Conflict Scale (DCS) at 1-2 weeks of follow-up. Our secondary validation hypotheses were that the tool would improve values clarity (reduce scores) more than other DCS subscales and increase engagement in advance care planning (ACP) processes related to identification and discussion of one's values. RESULTS: In the development phase, the tool received positive overall ratings from 22 patients/family members in hospital (mean score 4.3; 1=very poor; 5=very good) and family practice (mean score 4.5) settings. In the validation phase, we enrolled 157 patients (mean age 71.8 years) from family practice, cancer clinic and hospital settings. After tool completion, decisional conflict decreased (-6.7 points, 95% CI -11.1 to -2.3, p=0.003; 0-100 scale; N=100), with the most improvement seen in the values clarity subscale (-10.0 points, 95% CI -17.3 to -2.7, p=0.008; N=100), and the ACP-Values process score increased (+0.4 points, 95% CI 0.2 to 0.6, p=0.001; 1-5 scale; N=61). CONCLUSIONS: The Short GVHT is acceptable to end users and has some measure of validity. Further study to evaluate its impact on decision making during serious illness is warranted.

Church Services in a Complex Continuing Care Hospital: Why Bother?

This research aimed to explore patient motivation for attending hospital-run church services in a complex continuing care hospital setting, as well as the perceived spiritual benefits as categorized by Fitchett's 7 × 7 Model for Spiritual Assessment. Invitations to participate in one-to-one interviews were offered to all patient attendees at both an ecumenical and a Roman Catholic service over the course of several weeks. We collected 20 interviews before performing a qualitative analysis, at which point we determined that saturation of content had been reached. The key findings were that participants identified the strongest perceived benefits in Experiences and Emotions, and Rituals and Practice, suggesting that access to the ritual of Sunday church services contributes meaningfully to participants' coping strategies and overall quality of life.