Managing risk during care transitions when approaching end of life: A qualitative study of patients’ and health care professionals’ decision making

Coombs, Maureen; Parker, Roses; Vries, Kay de

doi:10.1177/0269216316673476

Cited by 13 publications

(24 citation statements)

References 31 publications

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“…Interprofessional collaboration is also required to share clinical expertise and experience, best inform complex clinical decisions concerning treatment for multimorbidities, and deliver appropriate care [ 13 ]. Integrating these processes across services is widely acknowledged to improve person-centered treatment outcomes for older people with complex needs [ 11 ] and reduce detrimental transitions between settings occurring in the final years of life, such as unplanned hospitalization [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of eHealth to Support Assessment and Decision-making for Residents With Dementia in Long-term Care: Systematic Review

Gillam¹,

Davies²,

Aworinde³

et al. 2022

J Med Internet Res

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Background As dementia progresses, symptoms and concerns increase, causing considerable distress for the person and their caregiver. The integration of care between care homes and health care services is vital to meet increasing care needs and maintain quality of life. However, care home access to high-quality health care is inequitable. eHealth can facilitate this by supporting remote specialist input on care processes, such as clinical assessment and decision-making, and streamlining care on site. How to best implement eHealth in the care home setting is unclear. Objective The aim of this review was to identify the key factors that influence the implementation of eHealth for people living with dementia in long-term care. Methods A systematic search of Embase, PsycINFO, MEDLINE, and CINAHL was conducted to identify studies published between 2000 and 2020. Studies were eligible if they focused on eHealth interventions to improve treatment and care assessment or decision-making for residents with dementia in care homes. Data were thematically analyzed and deductively mapped onto the 6 constructs of the adapted Consolidated Framework for Implementation Research (CFIR). The results are presented as a narrative synthesis. Results A total of 29 studies were included, focusing on a variety of eHealth interventions, including remote video consultations and clinical decision support tools. Key factors that influenced eHealth implementation were identified across all 6 constructs of the CFIR. Most concerned the inner setting construct on requirements for implementation in the care home, such as providing a conducive learning climate, engaged leadership, and sufficient training and resources. A total of 4 novel subconstructs were identified to inform the implementation requirements to meet resident needs and engage end users. Conclusions Implementing eHealth in care homes for people with dementia is multifactorial and complex, involving interaction between residents, staff, and organizations. It requires an emphasis on the needs of residents and the engagement of end users in the implementation process. A novel conceptual model of the key factors was developed and translated into 18 practical recommendations on the implementation of eHealth in long-term care to guide implementers or innovators in care homes. Successful implementation of eHealth is required to maximize uptake and drive improvements in integrated health and social care.

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Section: Introductionmentioning

confidence: 99%

Implementation of eHealth to Support Assessment and Decision-making for Residents With Dementia in Long-term Care: Systematic Review

Gillam¹,

Davies²,

Aworinde³

et al. 2022

J Med Internet Res

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show abstract

“…As numerous adverse consequences have been found to result from care transfers late in an illness trajectory (Coombs et al, 2017; Ersek & Carpenter, 2013), there is much to be gained by adding excellent palliative and EOL care to the capacities of MLTC programs. Despite the challenges encountered by our study participants, they reported some key elements of good palliative care already in place.…”

Section: Discussionmentioning

confidence: 99%

“…Many Americans, including those in long-term care, receive unwanted or essentially futile acute care interventions, including visits to an emergency department, admission to an intensive care unit, and interventions such as feeding tubes that prolong dying and increase suffering with little benefit ( Institute of Medicine [IOM], 2015). Problems are created by changes in location of care close to death, and additional adverse consequences ensue from lack of communication and care coordination during these transitions between care settings (Coombs, Parker, & de Vries, 2017; Ersek & Carpenter, 2013; Huskamp et al, 2012). Family dissatisfaction with EOL care in long-term care is common (Ersek & Carpenter, 2013).…”

Section: Introductionmentioning

confidence: 99%

Changing Focus: End-of-Life Care in a New York State Managed Long-Term Care Program

Meeker

Waldrop

2017

J Appl Gerontol

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In the United States, managed long-term care programs offer a noninstitutional approach to meeting the needs of increasing numbers of frail elders. Providing services that support both quality of life and quality of dying poses unique challenges. Using a qualitative descriptive design, we explored these challenges from the perspectives of care providers. Themes were identified using qualitative content analysis techniques applied to transcripts of 33 semistructured interviews. Professionals comprising an interdisciplinary care team and home health aide direct care providers described cues by which they identified movement into the end-of-life phase, their understandings of how care changed, and their concerns and recommendations for improvement. When the changing care needs could be met, a "good death" ensued, but that was not always possible. Managed long-term care programs are called upon to develop the capacity to integrate the phase of dying into the full story of each life for which they care.

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“…Qualitative approaches with patients and bereaved relatives show that coordination of care (Harrison and Verhoef, 2002), managing risk (Coombs et al, 2017), support across settings, being heard, and dignity (Hanratty et al, 2012) contribute to how transitions are experienced by patients and relatives. Those and other existing studies are focused either on one specific type of transition, have limited sample sizes, and/or are conducted in one setting (e.g., nursing homes).…”

Section: Introductionmentioning

confidence: 99%

Can we determine burdensome transitions in the last year of life based on time of occurrence and frequency? An explanatory mixed-methods study

et al. 2021

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Objective Burdensome transitions are typically defined as having a transition in the last three days or multiple hospitalizations in the last three months of life, which is seldom verified with qualitative accounts from persons concerned. This study analyses types and frequencies of transitions in the last year of life and indicators of burdensome transitions from the perspective of bereaved relatives. Method Cross-sectional explanatory mixed-methods study with 351 surveyed and 41 interviewed bereaved relatives in a German urban area. Frequencies, t-tests, and Spearman correlations were computed for quantitative data. Qualitative data were analyzed using content analysis with provisional and descriptive coding/subcoding. Results Transitions rise sharply during the last year of life. 8.2% of patients experience a transition in the last three days and 7.8% three or more hospitalizations in the last three months of life. An empathetic way of telling patients about the prospect of death is associated with fewer transitions in the last month of life (r = 0.185, p = 0.046). Professionals being aware of the preferred place of death corresponds to fewer hospitalizations in the last three months of life (1.28 vs. 0.97, p = 0.021). Qualitative data do not confirm that burden in transitions is linked to having transitions in the last three days or multiple hospitalizations in the last three months of life. Burden is associated with (1) late and non-empathetic communication about the prospect of death, (2) not coordinating care across settings, and (3) not considering patients’ preferences. Significance of results Time of occurrence and frequency appear to be imperfect proxies for burdensome transitions. The subjective burden seems to be associated rather with insufficient information, preparation, and management of transitions.

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Managing risk during care transitions when approaching end of life: A qualitative study of patients’ and health care professionals’ decision making

Cited by 13 publications

References 31 publications

Implementation of eHealth to Support Assessment and Decision-making for Residents With Dementia in Long-term Care: Systematic Review

Implementation of eHealth to Support Assessment and Decision-making for Residents With Dementia in Long-term Care: Systematic Review

Changing Focus: End-of-Life Care in a New York State Managed Long-Term Care Program

Can we determine burdensome transitions in the last year of life based on time of occurrence and frequency? An explanatory mixed-methods study

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