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Assessing family members' satisfaction with information sharing and communication during hospital care at the end of life.

https://arctichealth.org/en/permalink/ahliterature117269
Source
J Palliat Med. 2013 Jan;16(1):82-6
Publication Type
Article
Date
Jan-2013
Author
Kevin Brazil
Cynthia Cupido
Alan Taniguchi
Michelle Howard
Noori Akhtar-Danesh
Andrea Frolic
Author Affiliation
School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom. k.brazil@qub.ac.uk
Source
J Palliat Med. 2013 Jan;16(1):82-6
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Consumer Satisfaction
Cross-Sectional Studies
Female
Humans
Information Dissemination
Linear Models
Male
Ontario
Principal Component Analysis
Professional-Family Relations
Psychometrics
Questionnaires
Reproducibility of Results
Terminal Care
Abstract
Despite the fact that most deaths occur in hospital, problems remain with how patients and families experience care at the end of life when a death occurs in a hospital.
(1) assess family member satisfaction with information sharing and communication, and (2) examine how satisfaction with information sharing and communication is associated with patient factors.
Using a cross-sectional survey, data were collected from family members of adult patients who died in an acute care organization. Correlation and factor analysis were conducted, and internal consistency assessed using Cronbach's alpha. Linear regression was performed to determine the relationship among patient variables and satisfaction on the Information Sharing and Communication (ISC) scale.
There were 529 questionnaires available for analysis. Following correlation analysis and the dropping of redundant and conceptually irrelevant items, seven items remained for factor analysis. One factor was identified, described as information sharing and communication, that explained 76.3% of the variance. The questionnaire demonstrated good content and reliability (Cronbach's alpha 0.96). Overall, family members were satisfied with information sharing and communication (mean total satisfaction score 3.9, SD 1.1). The ISC total score was significantly associated with patient gender, the number of days in hospital before death, and the hospital program where the patient died.
The ISC scale demonstrated good content validity and reliability. The ISC scale offers acute care organizations a means to assess the quality of information sharing and communication that transpires in care at the end of life.
PubMed ID
23317323 View in PubMed
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Barriers to providing palliative care in long-term care facilities.

https://arctichealth.org/en/permalink/ahliterature164918
Source
Can Fam Physician. 2006 Apr;52:472-3
Publication Type
Article
Date
Apr-2006
Author
Kevin Brazil
Michel Bédard
Paul Krueger
Alan Taniguchi
Mary Lou Kelley
Carrie McAiney
Christopher Justice
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. brazilk@mcmaster.ca
Source
Can Fam Physician. 2006 Apr;52:472-3
Date
Apr-2006
Language
English
Publication Type
Article
Keywords
Clinical Competence - statistics & numerical data
Cross-Sectional Studies
Education, Medical, Continuing - statistics & numerical data
Female
Health Care Surveys
Health Facility Environment - statistics & numerical data
Health Knowledge, Attitudes, Practice
Health Manpower
Humans
Long-Term Care - organization & administration - statistics & numerical data
Male
Ontario
Palliative Care - organization & administration - statistics & numerical data
Physician Executives - statistics & numerical data
Principal Component Analysis
Professional Practice - statistics & numerical data
Residential Facilities - organization & administration - statistics & numerical data
Abstract
To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors.
Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses.
All licensed LTC facilities in Ontario with designated medical directors.
Medical directors in the facilities.
Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received.
Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff's capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice guidelines related to assessing and managing palliative care patients (67.8%).
Medical directors in our study reported that their LTC facilities were inadequately staffed and lacked equipment. The study also highlighted the specialized role of medical directors, who identified continuing medical education as a key strategy for improving provision of palliative care.
Notes
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PubMed ID
17327890 View in PubMed
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Enhancing family physician capacity to deliver quality palliative home care: an end-of-life, shared-care model.

https://arctichealth.org/en/permalink/ahliterature153720
Source
Can Fam Physician. 2008 Dec;54(12):1703-1703.e7
Publication Type
Article
Date
Dec-2008
Author
Denise Marshall
Doris Howell
Kevin Brazil
Michelle Howard
Alan Taniguchi
Author Affiliation
McMaster University, Family Medicine, Hamilton, ON, Canada. marshald@mcmaster.ca
Source
Can Fam Physician. 2008 Dec;54(12):1703-1703.e7
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Family Practice - organization & administration
Health Knowledge, Attitudes, Practice
Home Care Services - organization & administration
Humans
Models, organizational
Ontario
Palliative Care - standards
Patient Care Team - standards
Program Evaluation
Quality of Health Care - trends
Terminally ill
Abstract
Family physicians face innumerable challenges to delivering quality palliative home care to meet the complex needs of end-of-life patients and their families.
To implement a model of shared care to enhance family physicians' ability to deliver quality palliative home care, particularly in a community-based setting.
Family physicians in 3 group practices (N = 21) in Ontario's Niagara West region collaborated with an interprofessional palliative care team(including a palliative care advanced practice nurse, a palliative medicine physician, a bereavement counselor, a psychosocial-spiritual advisor, and a case manager) in a shared-care partnership to provide comprehensive palliative home care. Key features of the program included systematic and timely identification of end-of-life patients, needs assessments, symptom and psychosocial support interventions, regular communication between team members, and coordinated care guided by outcome-based assessment in the home. In addition, educational initiatives were provided to enhance family physicians' knowledge and skills.
Because of the program, participants reported improved communication, effective interprofessional collaboration, and the capacity to deliver palliative home care, 24 hours a day, 7 days a week, to end-of-life patients in the community.
Notes
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PubMed ID
19074714 View in PubMed
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Evaluating program integration and the rise in collaboration: case study of a palliative care network.

https://arctichealth.org/en/permalink/ahliterature126626
Source
J Palliat Care. 2011;27(4):270-8
Publication Type
Article
Date
2011
Author
Daryl Bainbridge
Kevin Brazil
Paul Krueger
Jenny Ploeg
Alan Taniguchi
Julie Darnay
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Juravinski Cancer Centre, 699 Concession Street, Room 4-203, Hamilton, Ontario, Canada L8V 5C2. daryl.bainbridge@jcc.hhsc.ca
Source
J Palliat Care. 2011;27(4):270-8
Date
2011
Language
English
Publication Type
Article
Keywords
Advisory Committees
Community Networks - organization & administration
Health Care Surveys
Humans
Interinstitutional Relations
Ontario
Organizational Case Studies
Outcome and Process Assessment (Health Care)
Palliative Care - organization & administration
Program Development
Social Change
Abstract
There is increasing global interest in using regional palliative care networks (PCNs) to integrate care and create systems that are more cost-effective and responsive. We examined a PCN that used a community development approach to build capacity for palliative care in each distinct community in a region of southern Ontario, Canada, with the goal of achieving a competent integrated system.
Using a case study methodology, we examined a PCN at the structural level through a document review, a survey of 20 organizational administrators, and an interview with the network director.
The PCN identified 14 distinct communities at different stages of development within the region. Despite the lack of some key features that would facilitate efficient palliative care delivery across these communities, administrators largely viewed the network partnership as beneficial and collaborative.
The PCN has attempted to recognize specific needs in each local area. Change is gradual but participatory. There remain structural issues that may negatively affect the functioning of the PCN.
PubMed ID
22372281 View in PubMed
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Family caregiver views on patient-centred care at the end of life.

https://arctichealth.org/en/permalink/ahliterature129342
Source
Scand J Caring Sci. 2012 Sep;26(3):513-8
Publication Type
Article
Date
Sep-2012
Author
Kevin Brazil
Daryl Bainbridge
Jenny Ploeg
Paul Krueger
Alan Taniguchi
Denise Marshall
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Source
Scand J Caring Sci. 2012 Sep;26(3):513-8
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Caregivers - psychology
Female
Health Services Accessibility
Humans
Male
Middle Aged
Ontario
Patient-Centered Care
Questionnaires
Terminal Care
Abstract
The purpose of this study was to evaluate the patient-centredness of community palliative care from the perspective of family members who were responsible for the care of a terminally ill family member.
A survey questionnaire was mailed to families of a deceased family member who had been designated as palliative and had received formal home care services in the central west region of the Province of Ontario, Canada. Respondents reported on service use in the last four weeks of life; the Client-Centred Care Questionnaire (CCCQ) was used to evaluate the extent to which care was patient-centred. The accessibility instrument was used to assess respondent perception of access to care. Descriptive and inferential statistics were used for data analyses.
Of the 243 potential participants, 111 (46.0%) family caregivers completed the survey questionnaire. On average, respondents reported that they used five different services during the last four weeks of the care recipient's life. When asked about programme accessibility, care was also perceived as largely accessible and responsive to patients' changing needs (M = 4.3 (SD = 1.04)]. Most respondents also reported that they knew what service provider to contact if they experienced any problems concerning the care of their family member. However, this service provider was not consistent among respondents. Most respondents were relatively positive about the patient-centred care they received. There were however considerable differences between some items on the CCCQ. Respondents tended to provide more negative ratings concerning practical arrangement and the organization of care: who was coming, how often and when. They also rated more negatively the observation that service providers were quick to say something was possible when it was not the case. Bivariate analyses found no significant differences in CCCQ or accessibility domain scores by caregiver age, care recipient age, income, education and caregiver sex.
Patient-centred care represents a service attribute that should be recognized as an important outcome to assess the quality of service delivery. This study demonstrates how this attribute can be evaluated in the provision of care.
PubMed ID
22117607 View in PubMed
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A method to enhance student teams in palliative care: piloting the McMaster-Ottawa Team Observed Structured Clinical Encounter.

https://arctichealth.org/en/permalink/ahliterature134947
Source
J Palliat Med. 2011 Jun;14(6):744-50
Publication Type
Article
Date
Jun-2011
Author
Pippa Hall
Denise Marshall
Lynda Weaver
Anne Boyle
Alan Taniguchi
Author Affiliation
Division of Palliative Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. phall@bruyere.org
Source
J Palliat Med. 2011 Jun;14(6):744-50
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Health Personnel - education
Humans
Ontario
Palliative Care
Patient Care Team - standards
Patient-Centered Care
Psychometrics
Questionnaires
Abstract
The need for palliative and end-of-life care (PEOLC) education in prelicensure education has been identified. PEOLC requires effective collaborative teamwork. The competencies required for effective collaborative teamwork are only now emerging and methods to evaluate them must be developed.
The adaptation of the traditional Objective Structured Clinical Examination (OSCE) for assessment of a student team addressing palliative care issues was undertaken. The McMaster-Ottawa Team Observed Structured Clinical Encounter (TOSCE) is intended as a formative evaluation tool for both competencies in interprofessional collaboration for patient-centered practice and PEOLC.
Three stations based on palliative care scenarios were developed. From January 2007 to January 2008, a total of 141 students and 38 observers participated in the evaluation of three stations, with 6-7 students per group and two observers per station. Observers completed checklists for both PEOLC and interprofessional collaborative competencies and, after completing the TOSCEs, students and observers completed questionnaires on their feasibility and acceptability.
Eighty-nine percent of the students and 44% of the observers were from medicine. Students and observers found the TOSCE to be an acceptable and feasible assessment tool for both sets of competencies. Reliability and validity data show that the items in both the clinical and interprofessional checklists fit well together, and interrater reliability is readily achieved.
The new formative evaluation TOSCE tool, adapted from the traditional OSCE, was acceptable and feasible to students and observers.
PubMed ID
21524192 View in PubMed
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Quality of care for residents dying in Ontario long-term care facilities: findings from a survey of directors of care.

https://arctichealth.org/en/permalink/ahliterature169309
Source
J Palliat Care. 2006;22(1):18-25
Publication Type
Article
Date
2006
Author
Kevin Brazil
Paul Krueger
Michel Bedard
Lou Kelley
Carrie McAiney
Christopher Justice
Alan Taniguchi
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, and St. Joseph's Health System Research Network, Hamilton, Ontario, Canada.
Source
J Palliat Care. 2006;22(1):18-25
Date
2006
Language
English
Publication Type
Article
Keywords
Aged
Attitude of Health Personnel
Clinical Competence - standards
Communication Barriers
Cross-Sectional Studies
Health Knowledge, Attitudes, Practice
Health Personnel - education - organization & administration - psychology
Humans
Inservice training
Interprofessional Relations
Logistic Models
Long-Term Care - organization & administration
Needs Assessment
Nursing Homes - organization & administration
Ontario
Organizational Policy
Personnel Staffing and Scheduling - organization & administration
Physician Executives - psychology
Professional-Family Relations
Quality of Health Care - organization & administration
Questionnaires
Terminal Care - organization & administration
Total Quality Management - organization & administration
Abstract
The purpose of this study was to collect information on the practice of end-of-life (EOL) care in long-term care (LTC) facilities in the Province of Ontario, Canada. A cross-sectional survey of directors of care in all licensed LTC facilities in the province was conducted between September 2003 and April 2004. Directors of care from 426 (76% response rate) facilities completed the postal survey questionnaire. The survey results identified communication problems between service providers and families, inadequate staffing levels to provide quality care to dying residents, and the need for training to improve staff skills in providing EOL care. Directors of care endorsed the use of a number of strategies that would improve the care of dying residents. Logistic regression analysis identified the eight most important items predictive of facility staff having the ability to provide quality EOL care. The findings contribute to the current discussion on policies for meeting the care needs of residents in LTC facilities until life's end.
PubMed ID
16689411 View in PubMed
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Role of the nurse practitioner in providing palliative care in long-term care homes.

https://arctichealth.org/en/permalink/ahliterature106478
Source
Int J Palliat Nurs. 2013 Oct;19(10):477-85
Publication Type
Article
Date
Oct-2013
Author
Sharon Kaasalainen
Jenny Ploeg
Carrie McAiney
Lori Schindel Martin
Faith Donald
Ruth Martin-Misener
Kevin Brazil
Alan Taniguchi
Abigail Wickson-Griffiths
Nancy Carter
Esther Sangster-Gormley
Author Affiliation
Associate Professor, School of Nursing, McMaster University, Ontario, Canada.
Source
Int J Palliat Nurs. 2013 Oct;19(10):477-85
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Attitude of Health Personnel
Attitude to Death
Canada
Family - psychology
Female
Focus Groups
Health Personnel - psychology
Humans
Long-Term Care - methods
Male
Middle Aged
Nurse Practitioners - psychology - statistics & numerical data
Nurse's Role
Nurse-Patient Relations
Nursing Homes
Palliative Care
Physicians
Abstract
The purpose of this study, which was part of a large national case study of nurse practitioner (NP) integration in long-term care (LTC), was to explore the NP role in providing palliative care in LTC.
Using a qualitative descriptive design, data was collected from five LTC homes across Canada using 35 focus groups and 25 individual interviews. In total, 143 individuals working in LTC participated, including 9 physicians, 20 licensed nurses, 15 personal support workers, 19 managers, 10 registered nurse team managers or leaders, 31 allied health care providers, 4 NPs, 14 residents, and 21 family members. The data was coded and analysed using thematic analysis.
NPs provide palliative care for residents and their family members, collaborate with other health-care providers by providing consultation and education to optimise palliative care practices, work within the organisation to build capacity and help others learn about the NP role in palliative care to better integrate it within the team, and improve system outcomes such as accessibility of care and number of hospital visits.
NPs contribute to palliative care in LTC settings through multifaceted collaborative processes that ultimately promote the experience of a positive death for residents, their family members, and formal caregivers.
PubMed ID
24162278 View in PubMed
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