Resident and Staff Experiences with Palliative Care Services Provided in Nursing Homes: Qualitative Content Analysis of Focus Group Transcripts

The provision of knowledge-based palliative care is rare in nursing homes. There are obstacles to practically performing this because it can be difficult to identify when the final stage of life begins for older persons. Educational interventions in palliative care in nursing homes are a challenge, and joint efforts are needed in an organisation, including preparedness. The aim was to explore professionals’ expectations and preparedness to implement knowledge-based palliative care in nursing homes before an educational intervention. This study has a qualitative focus group design, and a total of 48 professionals working in nursing homes were interviewed with a semi-structured interview guide. Qualitative content analysis with an inductive approach was used for the analysis. One major theme was identified: professionals were hopeful yet doubtful about the organisation’s readiness. The main categories of increased knowledge, consensus in the team, and a vision for the future illustrate the hopefulness, while insufficient resources and prioritisation illustrate the doubts about the organisation’s readiness. This study contributes valuable knowledge about professionals’ expectations and preparedness, which are essential for researchers to consider in the planning phase of an implementation study. The successful implementation of changes needs to involve strategies that circumvent the identified obstacles to organisations’ readiness.

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Healthcare professionals’ experiences of inter-professional collaboration during patient’s transfers between care settings in palliative care: A focus group study

Palliative Medicine ◽

10.1177/0269216320968741 ◽

2020 ◽

pp. 026921632096874

Author(s):

Fien Mertens ◽

Zoë Debrulle ◽

Evelyn Lindskog ◽

Luc Deliens ◽

Myriam Deveugele ◽

...

Keyword(s):

Palliative Care ◽

Focus Group ◽

Home Care ◽

Continuity Of Care ◽

Healthcare Professionals ◽

Family Members ◽

Professional Collaboration ◽

Group Discussions ◽

Care Services ◽

Palliative Care Services

Background: Continuity of care is challenging when transferring patients across palliative care settings. These transfers are common due to the complexity of palliative care, which has increased significantly since the advent of palliative care services. It is unclear how palliative care services and professionals currently collaborate and communicate to ensure the continuity of care across settings, and how patient and family members are involved. Aim: To explore healthcare professionals’ experiences regarding the communicative aspects of inter-professional collaboration and the involvement of patient and family members. Design: Qualitative design, including focus group discussions. Setting/participants: The study focused on one palliative care network in Belgium and involved all palliative care settings: hospital, hospital’s palliative care unit, home care, nursing home. Nine group discussions were conducted, with diverse professionals ( n = 53) from different care settings. Results: Timely and effective inter-professional information exchange was considered fundamental. A perceived barrier for interprofessional collaboration was the lack of a shared electronic health record. Efficiency regarding multidisciplinary team meetings and inter-professional communication were subject to improvement. A striking study finding was the perceived insufficient open communication of specialists towards patients and the lack of shared decision making. This not only hampered advance care planning discussions and early integration of palliative home care, but also the functioning of other professionals. Conclusion: From the perspective of the integrated care framework, several areas of improvement on different levels of care and collaboration are identified. Support from policymakers and researchers is required to achieve integrated palliative care in regional networks.

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Long-Term Care

Oxford Textbook of Palliative Nursing ◽

10.1093/med/9780190862374.003.0049 ◽

2019 ◽

pp. 606-614

Author(s):

Joan Carpenter ◽

Mary Ersek

Keyword(s):

Palliative Care ◽

Nursing Home ◽

Nursing Homes ◽

Nursing Home Residents ◽

Developed Countries ◽

The United States ◽

Nursing Home Population ◽

Care Services ◽

Challenges And Opportunities ◽

Palliative Care Services

This chapter examines palliative care across residential care settings with a focus on nursing homes. It reviews the environment of nursing homes, describes the residents who live there, and provides details about the interdisciplinary team providers who care for the residents. It also discusses the challenges and opportunities for delivering palliative care services to nursing home residents with life-limiting illness. Quality end-of-life care in nursing homes is important because more than 1.4 million Americans live in nursing homes, and more than half of these residents require extensive assistance with bathing, dressing, toileting, and mobility. Of those nursing home residents over 65 years of age, 80% are 75 years or older. Despite the efforts to keep frail elders in the community, the nursing home population is expected to increase as the numbers of older persons in the United States and other developed countries increase. The chapter concludes with a description of models for delivering palliative care in nursing homes.

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Racial Differences in Infection Management and Palliative Care at End-of-Life in Nursing Homes Nationwide

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.133 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s69-s69

Author(s):

Leah Estrada ◽

Andrew Dick ◽

Patricia Stone ◽

Jordan Harrison

Keyword(s):

Palliative Care ◽

Nursing Home ◽

Nursing Homes ◽

End Of Life ◽

Nursing Home Residents ◽

County Level ◽

Infection Management ◽

Care Services ◽

Black Residents ◽

Palliative Care Services

Background: Infections are common at end-of-life in older nursing-home residents. This often leads to the overuse of antibiotics and burdensome treatments. Improving infection management through palliative care at the end of life has been proposed as a key strategy to reducing inappropriate antibiotic use. Black nursing-home residents tend to reside in poorly performing nursing homes. We examined palliative care services in nursing homes with varying proportions of black residents. Methods: Cross-sectional, nationally representative nursing-home survey data (2017–2018) was combined with the Minimum Data Set 3.0 (nursing-home resident characteristics), the Certification and Survey Provider Enhanced Reporting data (nursing-home facility characteristics), and the Multidimensional Deprivation Index (county-level poverty estimates). The survey included 24 validated items on nursing-home palliative care services, as well as the nursing home’s infection control program and integration of infection management and palliative care (summative score, 0–100). We used nursing-home facility-level multivariate regression to estimate the relationship between proportion of black residents and palliative care scores, before and after controlling for county-level poverty estimates, facility characteristics, and resident characteristics. We categorized proportion of black residents using methods reported in the literature (25%). Results: The mean weighted palliative-care score in our sample of 869 nursing homes (weighted n = 15,020) was 47.7 (SE, 0.70). In unadjusted analyses, nursing homes with higher proportions of black residents provided significantly fewer palliative care services than nursing homes with no black residents, with the greatest differences (P = .027) observed between nursing homes with >25% black residents (mean palliative care score, 43.82; SE, 2.31) versus nursing homes with no black residents (mean palliative care score, 49.47; SE, 1.08). These disparities persisted after adjustment for urbanicity and county-level poverty rates (p < 0.01) but were attenuated after further adjustment for resident and facility level characteristics (p=0.138). Conclusions: Our findings demonstrate that wide variations in nursing-home palliative-care services exist with increased proportions of black residents, even after accounting for community characteristics. Further research is needed to identify and understand the specific community characteristics that play a role in the provision of palliative care services. Palliative care is a method to reduce inappropriate antimicrobial use at the end of life and should be expanded with a focus on nursing homes with higher proportions of black residents.Funding: NoDisclosures: None

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The development and evaluation of a multimedia resource for family carers of patients receiving palliative care: A consumer-led project

Palliative & Supportive Care ◽

10.1017/s1478951513001090 ◽

2014 ◽

Vol 13 (3) ◽

pp. 417-423 ◽

Cited By ~ 5

Author(s):

Kristina Thomas ◽

Gaye Moore

Keyword(s):

Palliative Care ◽

Focus Group ◽

Health Professionals ◽

Care Service ◽

Palliative Care Service ◽

Steering Committee ◽

Family Carers ◽

Care Services ◽

Palliative Care Services ◽

Multimedia Resource

AbstractObjective:Previous intervention research has shown that group education sessions for carers are effective but not always feasible due to the demands of the caregiving role and the difficulty in getting carers to attend. This project was a consumer-led research initiative to develop and evaluate a multimedia resource (DVD) providing information and support for carers of people receiving palliative care.Method:Eight carers were recruited from a community palliative care service to form a steering committee for the project. In collaboration with two researchers, the committee discussed the topics that would be included in the resource, developed an interview guide, participated in the filmed interviews, and developed the evaluation program. The steering committee participated in a focus group as part of the evaluation to elicit their experiences of the project. An evaluation was conducted that included the following: questionnaires for 29 carers and 17 palliative care health professionals; follow-up telephone interviews with carers; a focus group with health professionals; and a focus group with the Carer Steering Committee.Results:The carers and health professionals reported that the DVD was informative (93 and 94%, respectively), realistic (96 and 88%), supportive (93 and 88%), and helpful (83 and 100%). All health professionals and carers reported that they would recommend the resource to carers. Carers on the steering committee reported substantial benefits that involved the opportunity to help others and to openly discuss and reflect on their experiences.Significance of Results:This is an important resource that can be utilized to support family carers and introduce palliative care. Currently, 1500 copies have been distributed to palliative care services and professionals nationwide and is available online at centreforpallcare.org/index.php/resources/carer_dvd/. Development of this DVD represents a strong collaboration between carers and researchers to produce a resource that is informative, supportive, and meaningful.

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