Collaborative and participatory approaches to building community capacity for palliative and end of life care.

People living in rural and smaller urban areas near Calgary experience difficulty accessing palliative care services which are concentrated in metropolitan areas. The Cumming School of Medicine, Alberta Health Services and community hospice palliative care societies in two rural communities have been working to develop a partnership that incorporates local health system resources and community initiatives in supporting individuals and families living with progressive, life-limiting illnesses. This presentation will provide an understanding of how academic institutions and health services can collaborate with community members to enhance capacity for end of life care, and enrich communities in the process. The Cumming School of Medicine, Alberta Health Services and community hospice palliative care societies have been collaboratively working together to enhance community capacity to support individuals and their families in providing end of life care. This presentation will explore this relationship and how it enriches communities in the process.

OA58†Community capacity development for enhanced hospice palliative care: exploring the value of community engagement.

BACKGROUND: Over time, palliative care has become "professionalised", placing a burden on health care systems to manage the suffering of individuals and families with advancing, life-limiting illness. The need to develop resources, infrastructure and policy to enhance the capacity for communities to facilitate and support individuals and families can add value to communities, enrich hospice-palliative care and reduce health care system burden. AIM: Few examples of communities developing such capacity exist, however, this oral presentation will describe the results of one study that examined, in one rural community in western Canada, key factors that influenced their ability to address their own hospice palliative care needs. We will report on factors that helped and factors that hindered them in their initial stages of planning for better care. A follow up study that is just at its initial stages (i.e. to start in Jan./Feb., 2015) will examine the value and outcomes of a model where communities collaborate with health care providers to strengthen their hospice palliative care community level capacities. In two rural communities in western Canada, such questions asked will be: What expertise and infrastructure is required to nurture community-based palliative care initiatives? What criteria constitute community engagement and leadership in hospice palliative care development? When using a model where communities collaborate with health care providers to strengthen their hospice palliative care, what are the direct outcomes? And are these of value, and if so, in what way, and if not why not? METHODS: The two studies use multiple research methods. Both use a case study approach and framework. Results are also generated from a systematic literature review; semi-structured key informant interviews and focus group interviews. RESULTS: Results from the first study reveal significant barriers to a community planning their hospice palliative care needs, such as: a lack of provincial guidelines or funds; unforeseen workload; community expectations for a hospice building versus improved care; and an overall fear of failure. Key factors supporting their planning were: improved community awareness; putting hospice palliative 'on the map' at a provincial level; substantial donations for new services etc. Although our second, follow study to determine more concrete outcomes to community leadership and collaboration with health care providers are unknown, we imagine results will speak to the need for specific and tangible resources, infrastructure and specific policy direction.

Treatment of genotype 2 and genotype 3 hepatitis C virus (HCV) infection in human immunodeficiency virus positive patients.

Approximately 25 % of persons living with the human immunodeficiency virus (HIV) are coinfected with the hepatitis C virus (HCV). In cohort studies of HIV-HCV coinfection, HCV genotypes 2 and 3 account for 15 %-64 % of disease. Compared with HCV monoinfection, liver disease is accelerated in coinfected patients, and anti-HCV treatment is less successful. This article reviews the current knowledge and recommendations for management of HCV genotype 2 and 3 infection in patients living with HIV. While pegylated interferon (PEG-IFN)/ ribavirin (RBV) remains the standard treatment for HCV genotype 2/3 infection, ongoing clinical trials with more effective therapies will soon be available. In particular, an IFN sparing regimen of sofosbuvir/RBV may become available in 2014. It is also evident that HCV genotypes 2 and 3 respond differently to therapy and should be approached differently both in practice and in clinical trials. Issues including drug-drug interactions between anti-HCV and anti-HIV therapies are addressed.

Development of quality indicators of care for patients undergoing hepatic resection for metastatic colorectal cancer using a Delphi process.

BACKGROUND: Very few quality indicators of care exist for surgical procedures. These may be used to both score the quality of care received, and as a method of improving the quality of care delivered (quality improvement initiatives). MATERIALS AND METHODS: The goal of this study was to develop a set of evidence-based quality indicators by expert consensus for patients undergoing hepatic resection of colorectal metastases to the liver. A Delphi approach was used to develop a set of evidence-based quality indicators for patients undergoing hepatic resection of colorectal metastases to liver. A panel of experts was formed through nomination by members of the Canadian Hepatopancreaticobiliary Society (CHPBS). The Delphi process consisted of three iterations of questionnaires. During each round, the panel members were asked to score the potential indicators and suggest any new indicators. RESULTS: A list of 70 potential indicators was generated from the literature, of which 27 achieved consensus for inclusion in the final list of quality indicators. After consolidating similar or redundant indicators, the final list had 18 quality indicators. All of the indicators in the final list were from our original literature search. CONCLUSIONS: This Delphi process has used the best available evidence, along with a consensus methodology employing the opinion of experts in the field, to identify 18 quality indicators for patients undergoing hepatic resection for metastatic colorectal cancer. These indicators will provide a means for benchmarking quality of care among surgeons, institutions, and health regions.