Goals of Care Conversations at the End-of-Life: Perceived Impact of an Interprofessional Training Session on Professional Practices

Fortin, Gabrielle; Dumont, Serge

doi:10.1080/15524256.2021.1897922

Cited by 7 publications

(7 citation statements)

References 10 publications

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“…This was not possible at our study site due to the organization of work that inhibited participation in longitudinal care. Without sufficient knowledge of the patients, clinicians are less equipped to engage in EOL conversations because of a lack of understanding of patients’ illness history and trajectory, and needs around EOL [ 27 , 55 ]. All patients do not require an interprofessional approach, but complex older patients do.…”

Section: Discussionmentioning

confidence: 99%

“I don’t see the whole picture of their health”: a critical ethnography of constraints to interprofessional collaboration in end-of-life conversations in primary care

Carter,

Mohammed,

Upshur

et al. 2023

BMC Prim. Care

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Context Interprofessional collaboration is recommended in caring for frail older adults in primary care, yet little is known about how interprofessional teams approach end-of-life (EOL) conversations with these patients. Objective To understand the factors shaping nurses’ and allied health clinicians’ involvement, or lack of involvement in EOL conversations in the primary care of frail older adults. Methods/setting A critical ethnography of a large interprofessional urban Family Health Team in Ontario, Canada. Data production included observations of clinicians in their day-to-day activities excluding direct patient care; one-to-one semi-structured interviews with clinicians; and document review. Analysis involved coding data using an interprofessional collaboration framework as well as an analysis of the normative logics influencing practice. Participants Interprofessional clinicians (n = 20) who cared for mildly to severely frail patients (Clinical Frailty Scale) at the Family Health Team. Results Findings suggest primary care nurses and allied health clinicians have the knowledge, skills, and inclination to engage frail older adults in EOL conversations. However, the culture of the clinic prioritizes biomedical care, and normalizes nurses and allied health clinicians providing episodic task-based care, which limits the possibility for these clinicians’ engagement in EOL conversations. The barriers to nurses’ and allied health clinicians’ involvement in EOL conversations are rooted in neoliberal-biomedical ideologies that shapes the way primary care is governed and practiced. Conclusions Our findings help to explain why taking an individual-level approach to addressing the challenge of delayed or avoided EOL conversations, is unlikely to result in practice change. Instead, primary care teams can work to critique and redevelop quality indicators and funding models in ways that promote meaningful interprofessional practice that recognize the expertise of nursing and allied health clinicians in providing high quality primary care to frail older patients, including EOL conversations.

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Section: Discussionmentioning

confidence: 99%

“I don’t see the whole picture of their health”: a critical ethnography of constraints to interprofessional collaboration in end-of-life conversations in primary care

Carter,

Mohammed,

Upshur

et al. 2023

BMC Prim. Care

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“…Then, in 2016, a standardized goals of care form aiming to replace a myriad of local and regional forms was implemented in the province 19 . As opposed to advanced medical directives that are carried out without professional guidance, goals of care forms are completed in an institutionalized setting and involve patients and/or substitute decision‐makers, physicians and sometimes other healthcare professionals and providers 18,38,46 . Despite this complexity, and even though provincial reports have highlighted the need to improve the knowledge of the population towards advance medical planning processes, 17 little action has been taken.…”

Section: Discussionmentioning

confidence: 99%

“…19 As opposed to advanced medical directives that are carried out without professional guidance, goals of care forms are completed in an institutionalized setting and involve patients and/or substitute decision‐makers, physicians and sometimes other healthcare professionals and providers. 18 , 38 , 46 Despite this complexity, and even though provincial reports have highlighted the need to improve the knowledge of the population towards advance medical planning processes, 17 little action has been taken. To avoid creating more complexity in the main document, we added precision regarding the embedment of the PWG into the current medical decision‐making landscape in Quebec in the FAQ complement.…”

Section: Discussionmentioning

confidence: 99%

Cultural adaptation of a community‐based advance serious illness planning decision aid to the Quebec context involving end‐users

Plaisance

Skrobik

Moreau

et al. 2022

Health Expectations

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Introduction: Traditional advance care planning focuses on end-of-life planning in the context of a certain or imminent death. It is not tailored for serious illness planning, where the 'death' outcome is uncertain. The Plan Well Guide™ (PWG) is a decision aid that empowers lay persons to better understand different types of care and prepares them, and their substitute decision-makers, to express both their authentic values and informed treatment preferences in anticipation of serious illness.A cultural adaptation was necessary to make the material suitable to the context of Quebec, a French-speaking Canadian province.Methods: We engaged lay collaborators and experts in a panel, involving three phases of consultation and data collection. These included an online questionnaire, focused interviews and virtual focus groups that identified elements within the francophone PWG affecting its feasibility, adaptation and integration, as well as items that should be modified. Results: We engaged 22 collaborators between April and September 2021. The majority (82%) ranked the first translation as good or very good; most (70%) stated that they would recommend the final adaptation. Both lay and expert panel members suggested simplifying the language and framing the tool better within the context of other advance medical planning processes in Quebec. Translation was considered in a cultural context; the challenges identified by the research team or by collaborators were addressed during the focus group. Examples of wording that required discussion include translating 'getting the medical care that's right for you' when referring to the PWG's goal. An equivalent expression in the French translation

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“…The rationale for this cRT stemmed from the initial assumption in the design of the SICP which presumed that only individual clinicians, such as physicians, nurse practitioners, or physician assistants, would be responsible alone for having serious illness conversations with patients. However, insights drawn from studies on team approaches to chronic and complex care suggest that adopting a team-based approach could facilitate the implementation of serious illness conversations within clinical practice (8, 9).…”

Section: Introductionmentioning

confidence: 99%

Impact of a team-based versus individual clinician-focused training approach on primary healthcare professionals’ intention to have serious illness conversations with patients: a theory informed process evaluation of a cluster randomized trial

Souza,

Archambault,

Asmaou Bouba

et al. 2024

Preprint

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BackgroundCluster Randomized Trials (cRTs) conducted in real-world settings face complex challenges due to diverse practices and populations. Process evaluations alongside cRTs can help explain their results by exploring possible causal mechanisms as the trial proceeds.ObjectiveTo conduct a process evaluation alongside a cRT that compared the impact of team-based vs. individual clinician-focused SICP training on primary healthcare professionals’ (PHCPs) intention to have serious illness conversations with patients.MethodsThe cRT involved 45 primary care practices randomized into a team-based (intervention) or individual clinician-focused training program (comparator) and measured primary outcomes at the patient level: days at home and goal of care. Our theory-informed mixed-methods process evaluation alongside the cRT measured intention to have serious illness conversations with patients among the trained PHCPs using the CPD-Reaction tool. Barriers and facilitators to implementing serious illness conversations were identified through open-ended questions and analyzed using the Theoretical Domains Framework. We used the COM-B framework to perform triangulation of data. We reported results using the CONSORT and GRAMMS reporting guidelines.ResultsOf 535 PHCPs from 45 practices, 373 (69.7%) fully completed CPD-Reaction (30.8% between 25-34 years old; 78.0% women; 54.2% had a doctoral degree; 50.1% were primary care physicians). Mean intention scores for the team-based (n=223) and individual clinician-focused arms (n=150) were 5.97 (Standard Error: 0.11) and 6.42 (Standard Error: 0.13), respectively. Mean difference between arms was 0.0 (95% CI −0.30;0.29; p=0.99) after adjusting for age, education and profession. The team-based arm reported barriers with communication, workflow, and more discomfort in having serious illness conversations with patients.ConclusionsTeam-based training did not outperform individual clinician-focused in influencing PHCPs’ intention to have serious illness conversations. Future team-based interventions could foster behaviour adoption by focusing on interprofessional communication, better organized workflows, and better support and training for non-clinician team members.RegistrationClinicalTrials.gov(ID:NCT03577002).

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Goals of Care Conversations at the End-of-Life: Perceived Impact of an Interprofessional Training Session on Professional Practices

Cited by 7 publications

References 10 publications

“I don’t see the whole picture of their health”: a critical ethnography of constraints to interprofessional collaboration in end-of-life conversations in primary care

“I don’t see the whole picture of their health”: a critical ethnography of constraints to interprofessional collaboration in end-of-life conversations in primary care

Cultural adaptation of a community‐based advance serious illness planning decision aid to the Quebec context involving end‐users

Impact of a team-based versus individual clinician-focused training approach on primary healthcare professionals’ intention to have serious illness conversations with patients: a theory informed process evaluation of a cluster randomized trial

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