10 research outputs found
Evaluating Care and Health Outcomes - for the Dying (ECHO-D) : an instrument to assess quality of care and the impact of the Liverpool Care Pathway for the Dying Patient (LCP)
One chance to get it right: improving clinical handovers for better symptom control at the end of life.
Poor communication contributes to morbidity and mortality, not only in general medical care but also at the end oflife. This leads to issues relating to symptom control and quality of care. As part of an international project focused on bereaved relativesâ perceptions about quality of end-of-life care, we undertook a quality improvement (QI) project in a general hospital in CĂłrdoba city, Argentina.
By using two iterative QI cycles, we launched an educational process and introduced a clinical mnemonic tool, I-PASS, during ward handovers. The introduction of the handover tool was intended to improve out-of-hours care.
Our clinical outcome measure was ensuring comfort in at least 60% of dying patients, as perceived by family carers, during night shifts in an oncology ward during the project period (MarchâMay 2019). As process-based measures, we selected the proportion of staff completing the I-PASS course (target 60%) and using I-PASS in at least 60% of handovers. Participatory action research was the chosen method.
During the study period, 13/16 dying patients were included. We received 23 reports from family carers about the level of patient comfort during the previous night.
Sixty-five per cent of healthcare professionals completed the I-PASS training. The percentage of completed handovers increased from 60% in the first Plan-Do-Study-Act (PDSA) cycle to 68% in the second one.
The proportion of positive reports about patient comfort increased from 63% (end of the first PDSA cycle) to 87% (last iterative analysis after 3 months). Moreover, positive responses to âDid doctors and nurses do enough for the patient to be comfortable during the night?â increased from 75% to 100% between the first and the second QI cycle.
In conclusion, we achieved the successful introduction and staff training for use of the I-PASS tool. This led to improved perceptions by family carers, about comfort for dying patients
Assessing quality of care for the dying from the bereaved relativesâ perspective: using pre-testing survey methods across seven countries to develop an international outcome measure
Background:
The provision of care for dying cancer patients varies on a global basis. In order to improve care, we need to be able to evaluate the current level of care. One method of assessment is to use the views from the bereaved relatives.
Aim:
The aim of this study is to translate and pre-test the âCare Of the Dying Evaluationâ (CODETM) questionnaire across seven participating countries prior to conducting an evaluation of current quality of care.
Design:
The three stages were as follows: (1) translation of CODE in keeping with standardised international principles; (2) pre-testing using patient and public involvement and cognitive interviews with bereaved relatives; and (3) utilising a modified nominal group technique to establish a common, core international version of CODE.
Setting/participants:
Hospital settings: for each country, at least five patient and public involvement representatives, selected by purposive sampling, fed back on CODETM questionnaire; and at least five bereaved relatives to cancer patients undertook cognitive interviews. Feedback was collated and categorised into themes relating to clarity, recall, sensitivity and response options. Structured consensus meeting held to determine content of international CODE (i-CODE) questionnaire.
Results:
In total, 48 patient and public involvement representatives and 35 bereaved relatives contributed to the pre-testing stages. No specific question item was recommended for exclusion from CODETM. Revisions to the demographic section were needed to be culturally appropriate.
Conclusion:
Patient and public involvement and bereaved relativesâ perceptions helped enhance the face and content validity of i-CODE. A common, core international questionnaire is now developed with key questions relating to quality of care for the dying
The 'lived experience' of palliative care patients in one acute hospital setting - a qualitative study
Background
There is limited understanding of the âlived experienceâ of palliative care patient within the acute care setting. Failing to engage with and understand the views of patients and those close to them, has fundamental consequences for future health delivery. Understanding âpatient experienceâ can enable care providers to ensure services are responsive and adaptive to individual patient need.
Methods
The aim of this study was to explore the âlived experienceâ of a group of patients with palliative care needs who had recently been in-patients in one acute hospital trust in the north-west of England.
Qualitative research using narrative interviews was undertaken, and data was analysed using thematic analysis. A sample of 20 consecutive patients complying with the inclusion/exclusion criteria were recruited and interviewed.
Results
Patient Sample:
Of the 20 patients recruited, there was a fairly equal gender split; all had a cancer diagnosis and the majority were white British, with an age range of 43â87 years.
Findings from Interviews:
Overall inpatient experience was viewed positively. Individual narratives illustrated compassionate and responsive care, with the patient at the centre. Acts of compassion appeared to be expressed through the âlittle thingsâ staff could do for patients, i.e., time to talk, time to care, humanity and comfort measures. AHSPCT involvement resulted in perceived improvements in pain control and holistic wellbeing. However, challenges were evident, particularly regarding over-stretched staff and resources, and modes of communication, which seemed to impact on patient experience.
Conclusions
Listening to patientsâ experiences of care across the organisation provided a unique opportunity to impact upon delivery of care. Further research should focus on exploring issues such as: why some patients within the same organisation have a positive experience of care, while others may not; how do staff attitudes and behaviours impact on the experience of care; transitions of care from hospital to home, and the role of social networks
Evaluating Care and Health Outcomes - for the Dying (ECHO-D) : an instrument to assess quality of care and the impact of the Liverpool Care Pathway for the Dying Patient (LCP)
One chance to get it right: Improving clinical handovers for better symptom control at the end of life
Poor communication contributes to morbidity and mortality, not only in general medical care but also at the end oflife. This leads to issues relating to symptom control and quality of care. As part of an international project focused on bereaved relativesâ perceptions about quality of end-of-life care, we undertook a quality improvement (QI) project in a general hospital in CĂłrdoba city, Argentina.
By using two iterative QI cycles, we launched an educational process and introduced a clinical mnemonic tool, I-PASS, during ward handovers. The introduction of the handover tool was intended to improve out-of-hours care.
Our clinical outcome measure was ensuring comfort in at least 60% of dying patients, as perceived by family carers, during night shifts in an oncology ward during the project period (MarchâMay 2019). As process-based measures, we selected the proportion of staff completing the I-PASS course (target 60%) and using I-PASS in at least 60% of handovers. Participatory action research was the chosen method.
During the study period, 13/16 dying patients were included. We received 23 reports from family carers about the level of patient comfort during the previous night.
Sixty-five per cent of healthcare professionals completed the I-PASS training. The percentage of completed handovers increased from 60% in the first Plan-Do-Study-Act (PDSA) cycle to 68% in the second one.
The proportion of positive reports about patient comfort increased from 63% (end of the first PDSA cycle) to 87% (last iterative analysis after 3 months). Moreover, positive responses to âDid doctors and nurses do enough for the patient to be comfortable during the night?â increased from 75% to 100% between the first and the second QI cycle.
In conclusion, we achieved the successful introduction and staff training for use of the I-PASS tool. This led to improved perceptions by family carers, about comfort for dying patients
Good Quality Care for Cancer Patients Dying in Hospitals, but Information Needs Unmet: Bereaved Relativesâ Survey within Seven Countries
Background
Recognized disparities in quality of end-of-life care exist. Our aim was to assess the quality of care for patients dying from cancer, as perceived by bereaved relatives, within hospitals in seven European and South American countries.
Materials and Methods
A postbereavement survey was conducted by post, interview, or via tablet in Argentina, Brazil, Uruguay, U.K., Germany, Norway, and Poland. Next of kin to cancer patients were asked to complete the international version of the Care Of the Dying Evaluation (i-CODE) questionnaire 6â8âweeks postbereavement. Primary outcomes were (a) how frequently the deceased patient was treated with dignity and respect, and (b) how well the family member was supported in the patient's last days of life.
Results
Of 1,683 potential participants, 914 i-CODE questionnaires were completed (response rate, 54%). Approximately 94% reported the doctors treated their family member with dignity and respect âalwaysâ or âmost of the timeâ; similar responses were given about nursing staff (94%). Additionally, 89% of participants reported they were adequately supported; this was more likely if the patient died on a specialist palliative care unit (odds ratio, 6.3; 95% confidence interval, 2.3â17.8). Although 87% of participants were told their relative was likely to die, only 63% were informed about what to expect during the dying phase.
Conclusion
This is the first study assessing quality of care for dying cancer patients from the bereaved relativesâ perspective across several countries on two continents. Our findings suggest many elements of good care were practiced but improvement in communication with relatives of imminently dying patients is needed. (ClinicalTrials.gov Identifier: NCT03566732).
Implications for Practice
Previous studies have shown that bereaved relativesâ views represent a valid way to assess care for dying patients in the last days of their life. The Care Of the Dying Evaluation questionnaire is a suitable tool for quality improvement work to help determine areas where care is perceived well and areas where care is perceived as lacking. Health care professionals need to sustain high quality communication into the last phase of the cancer trajectory. In particular, discussions about what to expect when someone is dying and the provision of hydration in the last days of life represent key areas for improvement
Assessing quality of care for the dying from the bereaved relativesâ perspective: Using pre- testing survey methods across seven countries to develop an international outcome measure
Background: The provision of care for dying cancer patients varies on a global basis. In order to improve care, we need to be able to
evaluate the current level of care. One method of assessment is to use the views from the bereaved relatives.
Aim: The aim of this study is to translate and pre-test the âCare Of the Dying Evaluationâ (CODETM) questionnaire across seven
participating countries prior to conducting an evaluation of current quality of care.
Design: The three stages were as follows: (1) translation of CODE in keeping with standardised international principles; (2) pre-testing
using patient and public involvement and cognitive interviews with bereaved relatives; and (3) utilising a modified nominal group
technique to establish a common, core international version of CODE.
Setting/participants: Hospital settings: for each country, at least five patient and public involvement representatives, selected by
purposive sampling, fed back on CODETM questionnaire; and at least five bereaved relatives to cancer patients undertook cognitive
interviews. Feedback was collated and categorised into themes relating to clarity, recall, sensitivity and response options. Structured
consensus meeting held to determine content of international CODE (i-CODE) questionnaire.
Results: In total, 48 patient and public involvement representatives and 35 bereaved relatives contributed to the pre-testing stages.
No specific question item was recommended for exclusion from CODETM. Revisions to the demographic section were needed to be
culturally appropriate.
Conclusion: Patient and public involvement and bereaved relativesâ perceptions helped enhance the face and content validity of
i-CODE. A common, core international questionnaire is now developed with key questions relating to quality of care for the dying
Good Quality Care for Cancer Patients Dying in Hospitals, but Information Needs Unmet: Bereaved Relativesâ Survey within Seven Countries
Background. Recognized disparities in quality of end-of-life
care exist. Our aim was to assess the quality of care for patients
dying from cancer, as perceived by bereaved relatives, within
hospitals in seven European and South American countries.
Materials and Methods. A postbereavement survey was
conducted by post, interview, or via tablet in Argentina,
Brazil, Uruguay, U.K., Germany, Norway, and Poland. Next
of kin to cancer patients were asked to complete the inter-
national version of the Care Of the Dying Evaluation (i-
CODE) questionnaire 6â8 weeks postbereavement. Pri-
mary outcomes were (a) how frequently the deceased
patient was treated with dignity and respect, and (b) how
well the family member was supported in the patientâs
last days of life.
Results. Of 1,683 potential participants, 914 i-CODE
questionnaires were completed (response rate, 54%).
Approximately 94% reported the doctors treated their fam-
ily member with dignity and respect âalwaysâ or âmost of
the timeâ; similar responses were given about nursing staff
(94%). Additionally, 89% of participants reported they were
adequately supported; this was more likely if the patient
died on a specialist palliative care unit (odds ratio, 6.3; 95%
confidence interval, 2.3â17.8). Although 87% of participants
were told their relative was likely to die, only 63% were
informed about what to expect during the dying phase.
Conclusion. This is the first study assessing quality of care for
dying cancer patients from the bereaved relativesâ perspective
across several countries on two continents. Our findings suggest
many elements of good care were practiced but improvement in
communication with relatives of imminently dying patients is
needed. (ClinicalTrials.gov Identifier: NCT03566732)