Please use this identifier to cite or link to this item:
http://hdl.handle.net/11375/26504
Title: | 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 |
Authors: | Harasym P Brisbin S Afzaal M Sinnarajah A Venturato L Quail P Kaasalainen S Straus SE Sussman T Virk N Holroyd-Leduc J |
Keywords: | adult palliative care;geriatric medicine;qualitative research;Adult;Aged;Alberta;Attitude of Health Personnel;Betacoronavirus;COVID-19;Coronavirus Infections;Family;Female;Frail Elderly;Frailty;Health Services Needs and Demand;Hospice Care;Humans;Long-Term Care;Male;Middle Aged;Palliative Care;Pandemics;Physicians;Pneumonia, Viral;Qualitative Research;Respect;SARS-CoV-2;Skilled Nursing Facilities;Specialization;Terminal Care |
Publication Date: | Aug-2020 |
Publisher: | BMJ |
Abstract: | <jats:sec><jats:title>Objective</jats:title><jats:p>The 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.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Qualitative study using semi-structured interviews, basic qualitative description and directed content analysis using the COM-B (capability, opportunity, motivation - behaviour) theoretical framework.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Residential long-term care.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>23 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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Motivation 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.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Findings 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.</jats:p></jats:sec> |
metadata.dc.rights.license: | Attribution - CC BY |
Rights: | Attribution - CC BY This Creative Commons license lets others distribute, remix, tweak, and build upon your work, even commercially, as long as they credit you for the original creation. Recommended for maximum dissemination and use of licensed materials. |
URI: | http://hdl.handle.net/11375/26504 |
metadata.dc.identifier.doi: | https://doi.org/10.1136/bmjopen-2020-037466 |
ISSN: | 2044-6055 2044-6055 |
Appears in Collections: | Faculty Publications (via McMaster Experts) |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
Barriers and facilitators to optimal supportive end-of-life palliative care in long-term care facilities a qualitative descr.pdf | Published version | 278.34 kB | Adobe PDF | View/Open |
Items in MacSphere are protected by copyright, with all rights reserved, unless otherwise indicated.