End-of-life Care and Interprofessional Communication: Not Simply a Matter of More

INTRODUCTION A well-functioning interprofessional team has been identified as a central requirement for high quality palliative care. In particular, interprofessional communication and teamwork have been directly linked to patient and family health outcomes. However, evidence suggests that substandard communication and team collaboration between healthcare providers is a persistent challenge that is heightened during palliative care in in-patient settings. This research examined the mechanisms of communication that shaped and impeded interprofessional team practice and coordinated palliative care on acute medical and long-term care units. METHODS This participatory action research project was informed by planned-action and educative-research strategies. The research team worked with healthcare practitioners who cared for dying people in acute and long-term care settings to develop and change practices and institutional arrangements through concurrent phases of ongoing analysis, dialogue, action, and reflection. Data-gathering methods included audio-recorded baseline interviews, observations and on site interactions with field notes, focused group discussions, and meetings. All data was coded using NVivo 9 and a subsequent second level analysis was conducted using Critical Discourse Analysis and Relational Inquiry as an analytical framework. FINDINGS Two main findings included (a) the way in which participants drew upon socio-cultural knowledge to structure and enact communication processes and to describe and interpret their communication experiences within the team, and (b) four recurring relational disjunctures in which conflicting and/or competing messages, goals, or processes hindered the flow and processes of communication and interprofessional team practice. CONCLUSION Given the way in which ideologies and normative practices shape and contribute to ineffective communicative patterns, the findings suggest that the issue is not only how much communication is happening, but the nature of that communication. Thus, addressing the conflicting and/or competing messages, goals, or processes shaping the flow and processes of communication within the interprofessional team is necessary. In particular, explicitly addressing the complex interplay between autonomous professional practice and interprofessional team collaboration is a crucial step in supporting more effective communication and team cohesion

The experience of men providing at-home care for a dying loved one

The primary purpose of this study was to examine the experience of men who provide care to a dying loved one at home. A qualitative research method, Interpretive Description, was used as the experience had not previously been fully examined. The sample was taken from a larger study examining the social context of home-based palliative caregiving and thus, was a secondary analysis of the original data. Analysis of the data from 13 male caregivers provided a rich description of their experience of caring for a dying loved one at home. Three main themes including (a) leading in, (b) moving into action, and (c) outcomes of male caregiving emerged from the analysis and included several sub-themes. Findings suggest men entered the caregiving role in several ways: previous knowledge of caregiving, support for them as caregivers, a lack of other desirable options, and a strong sense of duty. As they became caregivers the men moved into action by developing strategies and ways of caring for their loved one, some of which were influenced by gender. Caregiving men became informed, learned and did the required tasks, assembled needed equipment, dealt with challenges, and tried to advocate for their dying loved one and themselves. Men also had to take care of themselves, which involved getting help, setting boundaries, and taking time off. A few men were unable and unsupported to take care and had less satisfactory experiences. Several outcomes were identified as a result of caregiving, including the rewards and toll of caregiving for men, outcomes for family members who were supporting the caregiver and outcomes for the dying person. Study findings point to a need to examine the structures and services currently in place and suggest improvements that could be made to more fully support men in a palliative caregiving role.Applied Science, Faculty ofNursing, School ofGraduat

Bereaved family members’ perceptions of the quality of end-of-life care across four types of inpatient care settings

Background: The aims of this study were to gain a better understanding of how bereaved family members perceive the quality of EOL care by comparing their satisfaction with quality of end-of-life care across four different settings and by additionally examining the extent to which demographic characteristics and psychological variables (resilience, optimism, grief) explain variation in satisfaction. Methods A cross-sectional mail-out survey was conducted of bereaved family members of patients who had died in extended care units (n = 63), intensive care units (n = 30), medical care units (n = 140) and palliative care units (n = 155). 1254 death records were screened and 712 bereaved family caregivers were identified as eligible, of which 558 (who were initially contacted by mail and then followed up by phone) agreed to receive a questionnaire and 388 returned a completed questionnaire (response rate of 70%). Measures included satisfaction with end-of-life care (CANHELP- Canadian Health Care Evaluation Project - family caregiver bereavement version; scores range from 0 = not at all satisfied to 5 = completely satisfied), grief (Texas Revised Inventory of Grief (TRIG)), optimism (Life Orientation Test – Revised) and resilience (The Resilience Scale). ANCOVA and multivariate linear regression were used to analyze the data. Results Family members experienced significantly lower satisfaction in MCU (mean = 3.69) relative to other settings (means of 3.90 [MCU], 4.14 [ICU], and 4.00 [PCU]; F (3371) = 8.30, p = .000). Statistically significant differences were also observed for CANHELP subscales of “doctor and nurse care”, “illness management”, “health services” and “communication”. The regression model explained 18.9% of the variance in the CANHELP total scale, and between 11.8% and 27.8% of the variance in the subscales. Explained variance in the CANHELP total score was attributable to the setting of care and psychological characteristics of family members (44%), in particular resilience. Conclusion Findings suggest room for improvement across all settings of care, but improving quality in acute care and palliative care should be a priority. Resiliency appears to be an important psychological characteristic in influencing how family members appraise care quality and point to possible sites for targeted intervention.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofReviewedFacult