Key Components for the Delivery of Palliative and End-of-Life Care in Care Homes in Hong Kong: A Modified Delphi Study

Abstract

Integrating the palliative care approach into care home service to address the complex care needs of older adults with frailty or advanced diseases has been increasingly recognized. However, such a service is underdeveloped in Hong Kong owing to socio-cultural and legal concerns. We adopted a modified Delphi study design to identify the key components for the delivery of palliative and end-of-life care in care home settings for the local context. It was an iterative staged method to assimilate views of experts in aged care, palliative care, and care home management. A multidisciplinary expert panel of 18 members consented to participate in the study. They rated their level of agreement with 61 candidate statements identified through a scoping review in two rounds of anonymous surveys. The steering group revised the statements in light of the survey findings. Eventually, the finalized list included 28 key statements concerning structure and process of care in seven domains, namely policy and infrastructure, education, assessment, symptom management, communication, care for dying patients, and family support. The findings of this study underscored concerns regarding the feasibility of statements devised at different levels of palliative care development. This list would be instrumental for regions where the development of palliative and end-of-life care services in care home setting is at an initial stage.

Palliative Care in Older People with Multimorbidities: A Scoping Review on the Palliative Care Needs of Patients, Carers, and Health Professionals

“…Some studies were performed in two or more countries: Belgium, Netherlands, UK, Germany, Hungary [ 67 ]: North America, Australia [ 68 ], UK, Ireland, USA [ 69 ], USA, UK, Australia, Canada, Belgium, Germany, Hong Kong, Japan, Malaysia, Singapore [ 70 ], USA, UK, Sweden, Netherlands, Spain, Canada, Ireland, Australia, New Zealand [ 71 ], South Africa, Kenya, South Korea, United States, Canada, UK, Belgium, Finland, Poland [ 72 ], Australia, New Zealand, UK [ 73 ], Canada, USA, UK [ 74 ]. The rest were in Belgium [ 75 , 76 ], Sweden [ 77 , 78 , 79 ], Brazil [ 80 ], China [ 81 ], Switzerland [ 82 ], the Netherlands [ 83 , 84 ], Norway [ 85 ], New Zealand [ 86 ], Denmark [ 87 ] and Hong Kong [ 88 ]. There were six studies with no information on the country/city where the research was performed [ 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 ].…”

“…(b) Comprehensive and continuous care in PC Professionals considered that a holistic approach to patient care is crucial, starting when curative treatment is no longer realistic, rather than focusing only on physical symptoms [16,21,76,79,88]. The necessity of going beyond the management of pain was underlined, as patients' and their relatives' non-physical needs, such as spiritual and emotional needs, were considered to need further support [16,76].…”

Loneliness at end‐of‐life: A scoping review

“…Therefore, additional information about the prevalence and level of loneliness may improve nurses' awareness of emotional and spiritual needs of adults at EOL. For example, in a Delphi study to identify key components for the delivery of palliative and EOL care (Chan et al, 2022), while managing pain, providing adequate nutrition and controlling symptoms were identified as key components by nurses and other health care professionals, attention to emotional support for loneliness and depression were limited. In response to the lack of reliable data about loneliness at EOL, we recommend loneliness to be assessed routinely in clinical assessment for clients at EOL, regardless of disease types and care settings.…”