Barriers and facilitators to optimal supportive end-of-life palliative care in long-term care facilities: a qualitative descriptive study of community-based and specialist palliative care physicians’ experiences, perceptions and perspectives

Abstract

ObjectiveThe COVID-19 pandemic has highlighted ongoing challenges to optimal supportive end-of-life care for adults living in long-term care (LTC) facilities. A supportive end-of-life care approach emphasises family involvement, optimal symptom control, multidisciplinary team collaboration and death and bereavement support services for residents and families. Community-based and palliative care specialist physicians who visit residents in LTC facilities play an important role in supportive end-of-life care. Yet, perspectives, experiences and perceptions of these physicians remain unknown. The objective of this study was to explore barriers and facilitators to optimal supportive end-of-life palliative care in LTC through the experiences and perceptions of community-based and palliative specialist physicians who visit LTC facilities.DesignQualitative study using semi-structured interviews, basic qualitative description and directed content analysis using the COM-B (capability, opportunity, motivation - behaviour) theoretical framework.SettingResidential long-term care.Participants23 physicians who visit LTC facilities from across Alberta, Canada, including both in urban and rural settings of whom 18 were community-based physicians and 5 were specialist palliative care physicians.ResultsMotivation barriers include families’ lack of frailty knowledge, unrealistic expectations and emotional reactions to grief and uncertainty. Capability barriers include lack of symptom assessment tools, as well as palliative care knowledge, training and mentorship. Physical and social design barriers include lack of dedicated spaces for death and bereavement, inadequate staff, and mental health and spiritual services of insufficient scope for the population.ConclusionFindings reveal that validating families’ concerns, having appropriate symptom assessment tools, providing mentorship in palliative care and adapting the physical and social environment to support dying and grieving with dignity facilitates supportive, end-of-life care within LTC.

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

“…A purposive sample of 65 multi-disciplinary stakeholders from across Canada were recruited for the modified Delphi. In addition to a sample of physicians interviewed for the published qualitative interview study [ 13 ], participants were recruited through partner organizations (The Brenda Strafford Foundation [ 18 ], The Brenda Strafford Centre on Aging [ 19 ], and Alberta Health Services Seniors Health Strategic Clinical Network [ 20 ]), and by word of mouth. In addition to physicians, we purposively sampled long-term care registered and practical nurses, healthcare aides, administrators, residents and their family members, content experts in geriatrics and gerontology, and knowledge translation researchers.…”

“…Our research on physician involvement suggests that family and palliative care specialist physicians find end of life symptom assessment and control difficult, and open communication with families and relationships with nurses and healthcare aides to be important, but also associated with challenges [ 13 ]. Physician beliefs that families lack knowledge, have unrealistic expectations and experience grief emotions that cloud clear thinking could constrain open communication between them and families [ 13 ]. Physician perceptions of nursing staff as over-extended and insufficiently trained could impact trust relationships between physicians, nurses, and healthcare aides [ 13 ].…”

“…Physician beliefs that families lack knowledge, have unrealistic expectations and experience grief emotions that cloud clear thinking could constrain open communication between them and families [ 13 ]. Physician perceptions of nursing staff as over-extended and insufficiently trained could impact trust relationships between physicians, nurses, and healthcare aides [ 13 ]. Though the studies discussed identify distinct stakeholder perspectives, none of them use complementary methodologies that would allow stakeholders to integrate diverse perspectives and reach consensus on the primary interventions needed to improve end of life care in long term care homes.…”

Estratégias E Desafios Do Cuidado De Enfermagem Diante Da Pandemia Da Covid-19 / Strategies and Challenges of Nursing Care in the Face of Covid-19 Pandemic

“…Ainda, o cuidar é um mecanismo primordial para que o enfermeiro, como potencializador do cuidado, possa melhorar a qualidade de vida dos pacientes, deixando para traz o obsoleto modelo biomédico e visualizando o paciente como ser biopsicossocial, sendo necessário estabelecer um bom relacionamento enfermeiropaciente (GAUR et al, 2020;HARASYM et al, 2020;SANTOS et al, 2018).…”

Buddhist Monastery, Amulet, Spiritual Support and COVID-19 Outbreak

“…When the outbreak starts, an influx of heaps of patients occurs in several countries and exceeded the facilities limitation of the local hospitals. This leads to the disruption of normal public health system worldwide [15][16][17][18][19]. The disease outbreak becomes an important urgent issue to be managed in any nations.…”