Multi-disciplinary supportive end of life care in long-term care: an integrative approach to improving end of life

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Abstract

Background

Optimal supportive end of life care for frail, older adults in long term care (LTC) homes involves symptom management, family participation, advance care plans, and organizational support. This 2-phase study aimed to combine multi-disciplinary opinions, build group consensus, and identify the top interventions needed to develop a supportive end of life care strategy for LTC.

Methods

A consensus-building approach was undertaken in 2 Phases. The first phase deployed modified Delphi questionnaires to address and transform diverse opinions into group consensus. The second phase explored and prioritized the interventions needed to develop a supportive end of life care strategy for LTC. Development of the Delphi questionnaire was based on findings from published results of physician perspectives of barriers and facilitators to optimal supportive end of life care in LTC, a literature search of palliative care models in LTC, and published results of patient, family and nursing perspectives of supportive end of life care in long term care. The second phase involved World Café Style workshop discussions. A multi-disciplinary purposive sample of individuals inclusive of physicians; staff, administrators, residents, family members, and content experts in palliative care, and researchers in geriatrics and gerontology participated in round one of the modified Delphi questionnaire. A second purposive sample derived from round one participants completed the second round of the modified Delphi questionnaire. A third purposive sample (including participants from the Delphi panel) then convened to identify the top priorities needed to develop a supportive end-of-life care strategy for LTC.

Results

19 participants rated 75 statements on a 9-point Likert scale during the first round of the modified Delphi questionnaire. 11 participants (participation rate 58 %) completed the second round of the modified Delphi questionnaire and reached consensus on the inclusion of 71candidate statements. 35 multidisciplinary participants discussed the 71 statements remaining and prioritized the top clinical practice, communication, and policy interventions needed to develop a supportive end of life strategy for LTC.

Conclusions

Multi-disciplinary stakeholders identified and prioritized the top interventions needed to develop a 5-point supportive end of life care strategy for LTC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02271-1.

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Most cited references 33

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Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.

Paul A. Harris, Robert Taylor, Robert Thielke … (2009)

Research electronic data capture (REDCap) is a novel workflow methodology and software solution designed for rapid development and deployment of electronic data capture tools to support clinical and translational research. We present: (1) a brief description of the REDCap metadata-driven software toolset; (2) detail concerning the capture and use of study-related metadata from scientific research teams; (3) measures of impact for REDCap; (4) details concerning a consortium network of domestic and international institutions collaborating on the project; and (5) strengths and limitations of the REDCap system. REDCap is currently supporting 286 translational research projects in a growing collaborative network including 27 active partner institutions.

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The behaviour change wheel: A new method for characterising and designing behaviour change interventions

Susan Michie, Maartje M. van Stralen, Robert H. West (2012)

Background Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations. Methods A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity. Results Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity. Conclusions Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.

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Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological systematic review.

Lukas Radbruch, Saskia Jünger, Sheila Payne … (2017)

The Delphi technique is widely used for the development of guidance in palliative care, having impact on decisions with relevance for patient care.

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Author and article information

Contributors

Jayna M. Holroyd-Leduc: jayna.holroyd-leduc@ahs.ca

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 22 May 2021

Publication date PMC-release: 22 May 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 326

Affiliations

[1 ]GRID grid.22072.35, ISNI 0000 0004 1936 7697, Cumming School of Medicine, , University of Calgary, ; Calgary, Canada

[2 ]GRID grid.17091.3e, ISNI 0000 0001 2288 9830, Faculty of Science, , University of British Columbia, ; Vancouver, Canada

[3 ]GRID grid.413574.0, ISNI 0000 0001 0693 8815, Alberta Health Services, ; Calgary, Canada

[4 ]GRID grid.22072.35, ISNI 0000 0004 1936 7697, Faculty of Nursing, , University of Calgary, ; Calgary, Canada

[5 ]GRID grid.25073.33, ISNI 0000 0004 1936 8227, School of Nursing, , McMaster University, ; Hamilton, Canada

[6 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Faculty of Medicine, , University of Toronto, ; Toronto, Canada

[7 ]GRID grid.415502.7, St Michael’s Hospital, ; Toronto, Canada

[8 ]GRID grid.14709.3b, ISNI 0000 0004 1936 8649, School of Social Work, , McGill University, ; Montreal, Canada

[9 ]Brenda Strafford Foundation, Calgary, Canada

[10 ]GRID grid.414959.4, ISNI 0000 0004 0469 2139, Foothills Medical Centre, ; 1403-29th Street NW, T2N 2T9 Calgary, Alberta Canada

Article

Publisher ID: 2271

DOI: 10.1186/s12877-021-02271-1

PMC ID: 8140573

PubMed ID: 34022818

SO-VID: 6fc74dac-53b6-46fa-9160-a5aa581353c2

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 6 November 2020

Date accepted : 4 May 2021

Funding

Funded by: Canadian Frailty Network

Award ID: CAT2018-03

Funded by: University of Calgary Brenda Strafford Chair in Geriatric Medicine, for which Dr. Holroyd-Leduc is the Chair holder.

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ScienceOpen disciplines: Geriatric medicine

Keywords: modified delphi questionnaire,world café style workshop,5-point supportive end of life care strategy for ltc

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ScienceOpen disciplines: Geriatric medicine

Keywords: modified delphi questionnaire, world café style workshop, 5-point supportive end of life care strategy for ltc

Multi-disciplinary supportive end of life care in long-term care: an integrative approach to improving end of life

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Supplementary Information

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Hearing Loss and Restoration

Most cited references 33

Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.

The behaviour change wheel: A new method for characterising and designing behaviour change interventions

Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological systematic review.

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