Strategies for the implementation of palliative care education and organizational interventions in long-term care facilities: A scoping review

Moore, Danni Collingridge; Payne, Sheila; Block, Lieve Van den; Ling, Julie; Froggatt, Katherine; Gatsolaeva, Yuliana; Honinx, Elisabeth; Pivodic, Lara; Miranda, Rose; Onwuteaka-Philipsen, Bregje D.; Hout, Hein van; Pasman, H. Roeline W.; Oosterveld-Vlug, Mariska; Koppel, Maud ten; Piers, Ruth; Noortgate, Nele Van Den; Engels, Yvonne; Vernooij‐Dassen, Myrra; Hockley, Jo; Szczerbińska, Katarzyna; Kylänen, Marika; Gambassi, Giovanni; Pautex, Sophie; Bassal, Catherine; Deliëns, Luc; Smets, Tinne; Adang, Eddy; Andreasen, Paula; Barańska, Ilona; Finne-Soveri, Harriet; Hammar, Teija; Heikkilä, Rauha; Kijowska, Violetta; Leppäaho, Suvi; Mammarella, Federica; Mercuri, Martina; Kuitunen-Kaija, Outi; Pac, Agnieszka; Paula, Emilie Morgan de; Rossi, Paola; Segat, Ivan; Sowerby, Eleanor; Steen, Jenny T. van der; Stodolska, Agata; Tanghe, Marc; Wichmann, Anne

doi:10.1177/0269216319893635

Cited by 41 publications

(29 citation statements)

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“…A recent scoping review on strategies for palliative care education and organisational intervention implementation highlighted the importance of the context and tailored delivery that meets the needs of the setting (Collingridge Moore et al, 2020). Our results also suggest the necessity for considering contextual issues and the use of implementation frameworks to guide intervention.…”

Section: Discussionmentioning

confidence: 99%

Palliative and end‐of‐life educational interventions for staff working in long‐term care facilities: An integrative review of the literature

Iida

Ryan

Hasson

et al. 2020

Int J Older People Nursing

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BackgroundGiven the increase in the number of deaths within long‐term care facilities (LTCFs), the need for palliative and end‐of‐life (EOL) care education among such facilities has been increasing. As such, a systematic synthesis of global palliative and EOL care educational approaches and evaluation can aid further educational development.ObjectiveTo synthesise the current literature on palliative and EOL care educational interventions for staff working in LTCFs and identify barriers to, and facilitators of, intervention implementation.MethodsThe study used an integrative review framework wherein indexed databases, namely, CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, Cochrane Library and Japan Medical Abstract Society, were systematically searched for studies published in English and Japanese between 2007 and 2019. Search terms that are related to palliative care, LTCF, and education were combined to increase search sensitivity. The quality of the papers was assessed using Joanna Briggs Institute Critical Appraisal Tools and the Mixed‐Methods Appraisal Tool.ResultsA total of 52 studies were included in the review. Our results suggested that although studies in this area and setting have been evolving, suboptimal developmental research and educational practices, global variability and unstandardised approaches to education and lacking viewpoints from service users have remained. Barriers to intervention implementation were also reported due to the specific characteristics of LTCFs, which include high staff turnover and considerable variation in professional skills and experience.ConclusionsGiven the different LTCF types, systems and policies across each country or region, further research on standardised educational interventions with contextual considerations using large‐scale studies with robust methodology is needed to meet the increasing demand for palliative and EOL care among the global ageing population.Implications for practicePalliative and EOL care educational intervention for LTCF staff need to include more consideration of context, organisational culture and the user involvement throughout the process of education and research to enhance the quality of care in this complex setting.

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Section: Discussionmentioning

confidence: 99%

Palliative and end‐of‐life educational interventions for staff working in long‐term care facilities: An integrative review of the literature

Iida

Ryan

Hasson

et al. 2020

Int J Older People Nursing

Self Cite

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“…A pilot study of palliative care delivered in care homes via teleconference supported the feasibility of this approach where required. 18 Specialist palliative care provision in care homes is currently variable, 19 – 21 and guidance to support palliative care for people with COVID-19 in nursing homes has been found to be lacking and limited in focus. 22 In contrast, deaths in hospices fell during the time period.…”

Section: Discussionmentioning

confidence: 99%

Changing patterns of mortality during the COVID-19 pandemic: Population-based modelling to understand palliative care implications

et al. 2020

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Background: COVID-19 has directly and indirectly caused high mortality worldwide. Aim: To explore patterns of mortality during the COVID-19 pandemic and implications for palliative care, service planning and research. Design: Descriptive analysis and population-based modelling of routine data. Participants and setting: All deaths registered in England and Wales between 7 March and 15 May 2020. We described the following mortality categories by age, gender and place of death: (1) baseline deaths (deaths that would typically occur in a given period); (2) COVID-19 deaths and (3) additional deaths not directly attributed to COVID-19. We estimated the proportion of people who died from COVID-19 who might have been in their last year of life in the absence of the pandemic using simple modelling with explicit assumptions. Results: During the first 10 weeks of the pandemic, there were 101,614 baseline deaths, 41,105 COVID-19 deaths and 14,520 additional deaths. Deaths in care homes increased by 220%, while home and hospital deaths increased by 77% and 90%, respectively. Hospice deaths fell by 20%. Additional deaths were among older people (86% aged ⩾ 75 years), and most occurred in care homes (56%) and at home (43%). We estimate that 22% (13%–31%) of COVID-19 deaths occurred among people who might have been in their last year of life in the absence of the pandemic. Conclusion: The COVID-19 pandemic has led to a surge in palliative care needs. Health and social care systems must ensure availability of palliative care to support people with severe COVID-19, particularly in care homes.

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“…Although numerous interventions to improve end of life care have been developed and implemented in LTCFs, few have tailored their approach to residents depending on length of stay. In a recent scoping review of implementation strategies for such interventions, prioritising time for staff members to provide end of life care, and ensuring staff are available for residents to develop a relationship with, allowing discussions on end of life to occur, were highlighted as facilitators to successful implementation [56]. An approach which can be tailored to shorter and longer stay residents is needed, including how such an environment can be developed prior to resident admission.…”

Section: Implications For Future Research Policy and Practicementioning

confidence: 99%

Associations between Length of Stay in Long Term Care Facilities and End of Life Care. Analysis of the PACE Cross-Sectional Study

Moore

Payne

Keegan

et al. 2020

IJERPH

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Long term care facilities (LTCFs) are increasingly a place of care at end of life in Europe. Longer residence in an LTCF prior to death has been associated with higher indicators of end of life care; however, the relationship has not been fully explored. The purpose of this analysis is to explore associations between length of stay and end of life care. The analysis used data collected in the Palliative Care for Older People in care and nursing homes in Europe (PACE) study, a cross-sectional mortality follow-back survey of LTCF residents who died within a retrospective 3-month period, conducted in Belgium, England, Finland, Italy, the Netherlands and Poland. Primary outcomes were quality of care in the last month of life, comfort in the last week of life, contact with health services in the last month of life, presence of advance directives and consensus in care. Longer lengths of stay were associated with higher scores of quality of care in the last month of life and comfort in the last week of life. Longer stay residents were more likely to have advance directives in place and have a lasting power of attorney for personal welfare. Further research is needed to explore the underlying reasons for this trend, and how good quality end of life care can be provided to all LTCF residents.Ensuring LTCF residents approaching end of life receive appropriate care is challenging; residents may be frail, with multiple, complex care needs, and may be unable to either establish or communicate their preferences at end of life. Long term care facilities are often staffed by a combination of registered, qualified nurses and care assistants, who may have limited knowledge of end of life care for older adults and limited access to specialist services to support end of life care [7]. In addition, LTCF managers and their staff may lack clarity in defining and identifying end of life, or their role or responsibility in providing subsequent care within the facility [8]. In many European countries, end of life care in LTCFs in not well supported at a national level; in a review of 29 countries only eight had national policies which specifically addressed end of life care in LTCFs [9].Palliative care is defined as "an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual" [10]. The term "end of life care" is often used synonymously with palliative care in the UK, and refers to "an extended period of 1 to 2 years during which the patient/family and health professionals become aware of the life-limiting nature of their illness" [11]. Previous studies have found that the adoption of a palliative care approach in LTCFs led to a reduction in deaths outside the LTCF [12], an increase in the numbers of completed advance directives [13], improvements in end-of-life communication betw...

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Strategies for the implementation of palliative care education and organizational interventions in long-term care facilities: A scoping review

Cited by 41 publications

References 40 publications

Palliative and end‐of‐life educational interventions for staff working in long‐term care facilities: An integrative review of the literature

Palliative and end‐of‐life educational interventions for staff working in long‐term care facilities: An integrative review of the literature

Changing patterns of mortality during the COVID-19 pandemic: Population-based modelling to understand palliative care implications

Associations between Length of Stay in Long Term Care Facilities and End of Life Care. Analysis of the PACE Cross-Sectional Study

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