Patricia M Harasym1, Misha Afzaal2, Sarah Brisbin1, Aynharan Sinnarajah1,3, Lorraine Venturato4, Patrick Quail1,3, Sharon Kaasalainen5, Sharon Straus6,7, Tamara Sussman8, Navjot Virk9, Jayna M Holroyd-Leduc10,11,12. 1. Cumming School of Medicine, University of Calgary, Calgary, Canada. 2. Faculty of Science, University of British Columbia, Vancouver, Canada. 3. Alberta Health Services, Calgary, Canada. 4. Faculty of Nursing, University of Calgary, Calgary, Canada. 5. School of Nursing, McMaster University, Hamilton, Canada. 6. Faculty of Medicine, University of Toronto, Toronto, Canada. 7. St Michael's Hospital, Toronto, Canada. 8. School of Social Work, McGill University, Montreal, Canada. 9. Brenda Strafford Foundation, Calgary, Canada. 10. Cumming School of Medicine, University of Calgary, Calgary, Canada. jayna.holroyd-leduc@ahs.ca. 11. Alberta Health Services, Calgary, Canada. jayna.holroyd-leduc@ahs.ca. 12. Foothills Medical Centre, 1403-29th Street NW, T2N 2T9, Calgary, Alberta, Canada. jayna.holroyd-leduc@ahs.ca.
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.
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.
Entities:
Keywords:
5-point supportive end of life care strategy for LTC; World Café Style workshop; modified Delphi questionnaire
Authors: Kevin Brazil; Michel Bédard; Paul Krueger; Alan Taniguchi; Mary Lou Kelley; Carrie McAiney; Christopher Justice Journal: Can Fam Physician Date: 2006-04 Impact factor: 3.275