Improving Healthcare Provider Knowledge of Hospice and Palliative Medicine

By addressing the diseases symptoms directly, palliative care improves patients feel and can participate in their life by providing indispensable holistic health management and support for patients and families. Hospice is the focused service of palliative care, provided by specially trained healthcare professionals. Evidence suggests that patients are poorly educated on chronic illnesses, providers are failing to have end of life discussions with patients, and providers are poorly educated as to services available to patients at end of life. This quality improvement project was designed to assess provider knowledge of hospice and palliative care utilization. Convenience sampling was used to obtain participants. A pre-recorded educational session was conducted online, during which hospice admission criteria, hospice services, and benefits were reviewed. A pre-test and post-test were administered digitally at the time of the session. One month following the completion of session, another digital questionnaire was administered to reassess the same information along with self-reported practice change. A total of twelve participants completed the pre-test, six completed the post-test, and four completed the follow-up surveys. Although the three questionnaires were evaluated as independent samples and responses were not matched, all providers who completed Questionnaire 2 were participants who had attended sessions and previously completed Questionnaire 1. The nurse practitioners that participated cited lack of knowledge and their own desire to treat patients and preserve life as barriers to referring to hospice. Overall, the statistics indicated that increasing provider education only increased hospice referrals in 25% of respondents. Likewise, only 50% of respondents admitted to having made a practice change, despite 100% reporting that they felt more knowledgeable and believed they would refer more to hospice. It is likely that the limitations of the study had a large impact on the outcome of practice change

An Assessment Of The Utilization Of Geriatric Depression Screenings In Primary Care Providers

The purpose of this study was to determine the practices of primary care providers in relation to screening and treating geriatric depression. According to the Geriatric Mental Health Foundation (GMHF), depression and suicide are significant public health issues for older adults, noting that depression is one of the most common mental disorders experienced by elders. Research indicates the issue of geriatric depression is poorly approached by providers and patients do not receive appropriate care. Depression cannot be measured with lab or diagnostic tests; the only way to assess depression is to screen patients by asking questions. When screening for depression, understanding that follow-up with treatment is equally as important as the diagnosis is imperative. Currently, the United States Preventative Services Task Force (USPSTF) has very narrow guidelines that recommend screening for depression in the general adult population, with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. Permission to conduct the study was initially obtained from the Institutional Review Board at Mississippi University for Women. Providers were asked to complete a multi-question survey created by the researchers, indicating current depression screening practices, which was available on both Survey Monkey and on paper. Upon obtaining 100 surveys, 99 were included in data analysis and 97% of respondents identified as a nurse practitioner. Upon analysis of the statistical data, the research questions were reviewed and are as follows: 1) Do primary care providers perform depression screening on geriatric patients? 2) What barriers exist to performing depression screening on geriatric patients? 3) If geriatric patients are identified as at risk for depression, what interventions are being utilized by primary care providers to address this issue? The data indicated 40% of the surveyed providers reported screening every geriatric patient for depression, but the vast majority do not automatically screen geriatric patients for depression. Data also indicated barriers to screening every geriatric patient for depression included time constraints, patient declination, the screening being deemed unnecessary, or lack of reimbursement. Approximately one-third of providers admitted to not having time to screen patients for depression. Fifteen percent of providers identified the patient declining being screened as a barrier. Twelve percent of providers felt the screening was unnecessary, and researchers were unsure of the criteria utilized by the provider to deem depression screening unnecessary. The researchers determined in the third question what interventions were implemented by providers upon the patients having a score indicative of depression. The options available were medication(s), psychiatry, therapy, or multiple combinations of the three options. The research indicated no statistically significant pattern of treatment is being followed by providers, although medication alone or with other options was used by a majority of respondents. The researchers determined primary care practitioners are not adequately screening and treating geriatric depression

Addressing tobacco in Australian alcohol and other drug treatment settings: a cross-sectional survey of staff attitudes and perceived barriers

Background: Within alcohol and other drug (AOD) services, staff attitudes and beliefs are important influences determining provision of smoking cessation care. This study of AOD staff aimed to examine: a) current attitudes toward smoking cessation care; b) service and staff characteristics associated with unsupportive smoking cessation care attitudes, and c) perceived barriers to providing smoking cessation care. Methods: Between July-October 2014, 506 staff from 31 Australian AOD services completed an online cross-sectional survey which assessed agreement with 6 attitudinal statements (supportive and unsupportive) and 10 perceived barriers to smoking cessation care in the AOD setting. Logistic regressions examined service (sector) and staff (age, gender, smoking status and number of years in AOD field) characteristics associated with unsupportive smoking cessation care attitudes. Results: A large proportion agreed with supportive statements: Smoking cessation care should be part of usual care (87%), smoking cessation care is as important as counselling about other drugs (72%) and staff have the organisational support to provide smoking cessation care (58%). Some respondents agreed with unsupportive statements: AOD clients are not interested in addressing their smoking (40%), increasing smoking restrictions would lead to client aggression (23%), smoking is a personal choice and it is not the service’s role to interfere (16%). Respondents from non-government managed services, current tobacco smokers (compared to ex-smokers) and those with less AOD experience had higher odds of agreeing with unsupportive smoking cessation care statements. The most frequently identified barriers to providing smoking cessation care were: client inability to afford cessation medicines, insufficient funding and lack of a coordinated treatment approach (all 61%). Conclusions: Overall, staff hold largely supportive smoking cessation care attitudes but perceive a large number of barriers to providing smoking cessation care

Smoking cessation in drug and alcohol treatment settings: a qualitative study of staff and client barriers and facilitators

Abstract presented at the Australasian Professional Society on Alcohol and other Drugs Conference 2014, 9-12 November 2014, Adelaide, Australi

Tobacco smoking policies in Australian alcohol and other drug treatment services, agreement between staff awareness and the written policy document

Abstract Background Comprehensive smoke-free policy in the alcohol and other drug (AOD) setting provides an opportunity to reduce tobacco related harms among clients and staff. This study aimed to examine within AOD services: staff awareness of their service’s smoking policy compared to the written policy document and staff and service factors associated with accurate awareness of a total ban and perceived enforcement of a total ban. Methods An audit of written tobacco smoking policy documents and an online cross-sectional survey of staff from 31 Australian AOD services. In addition, a contact at each service was interviewed to gather service-related data. Results Overall, 506 staff participated in the survey (response rate: 57%). Nearly half (46%) perceived their service had a total ban with 54% indicating that this policy was always enforced. Over one-third (37%) reported a partial ban with 48% indicating that this policy was always enforced. The audit of written policies revealed that 19 (61%) services had total bans, 11 (36%) had partial bans and 1 (3%) did not have a written smoking policy. Agreement between staff policy awareness and their service’s written policy was moderate (Kappa 0.48) for a total ban and fair (Kappa 0.38) for a partial ban. Age (1 year increase) of staff was associated with higher odds of correctly identifying a total ban at their service. Conclusions Tobacco smoking within Australian AOD services is mostly regulated by a written policy document. Staff policy awareness was modest and perceived policy enforcement was poor

Integrating Smoking Cessation Care into a Medically Supervised Injecting Facility Using an Organizational Change Intervention: A Qualitative Study of Staff and Client Views

Background: Clients accessing supervised injecting facilities (SIFs) smoke at high rates. An SIF piloted an organizational change intervention to integrate smoking cessation care as routine treatment. This study aims to explore staff acceptability, perceived facilitators, and perceived barriers to implementing six core components of an organizational change intervention to integrate smoking cessation care in an SIF. Staff and client views on the acceptability, facilitators, and barriers to the provision of smoking cessation care were also examined. Methods: This paper presents findings from the qualitative component conducted post-intervention implementation. Face-to-face semi-structured staff interviews (n = 14) and two client focus groups (n = 5 and n = 4) were conducted between September and October 2016. Recruitment continued until data saturation was reached. Thematic analysis was employed to synthesise and combine respondent views and identify key themes. Results: Staff viewed the organizational change intervention as acceptable. Commitment from leadership, a designated champion, access to resources, and the congruence between the change and the facility’s ethos were important facilitators of organizational change. Less engaged staff was the sole barrier to the intervention. Smoking cessation care was deemed suitable. Key facilitators of smoking cessation care included: Written protocols, ongoing training, and visually engaging information. Key barriers of smoking cessation care included: Lack of access to nicotine replacement therapy (NRT) outside of business hours, practical limitations of the database, and concerns about sustainability of NRT. Conclusion: This study develops our understanding of factors influencing the implementation of an organisational change intervention to promote sustainable provision of smoking cessation care in the SIF setting

An organisational change intervention for increasing the delivery of smoking cessation support in addiction treatment centres: study protocol for a randomized controlled trial

Background: The provision of smoking cessation support in Australian drug and alcohol treatment services is sub-optimal. This study examines the cost-effectiveness of an organisational change intervention to reduce smoking amongst clients attending drug and alcohol treatment services. Methods/design: A cluster-randomised controlled trial will be conducted with drug and alcohol treatment centres as the unit of randomisation. Biochemically verified (carbon monoxide by breath analysis) client 7-day-point prevalence of smoking cessation at 6 weeks will be the primary outcome measure. The study will be conducted in 33 drug and alcohol treatment services in four mainland states and territories of Australia: New South Wales, Australian Capital Territory, Queensland, and South Australia. Eligible services are those with ongoing client contact and that include pharmacotherapy services, withdrawal management services, residential rehabilitation, counselling services, and case management services. Eligible clients are those aged over 16 years who are attending their first of a number of expected visits, are self-reported current smokers, proficient in the English language, and do not have severe untreated mental illness as identified by the service staff. Control services will continue to provide usual care to the clients. Intervention group services will receive an organisational change intervention, including assistance in developing smoke-free policies, nomination of champions, staff training and educational client and service resources, and free nicotine replacement therapy in order to integrate smoking cessation support as part of usual client care. Discussion: If effective, the organisational change intervention has clear potential for implementation as part of the standard care in drug and alcohol treatment centres

Outback Quit Pack: Feasibility trial of outreach smoking cessation for people in rural, regional, and remote Australia

Background: Tobacco smoking rates are higher in rural, regional, and remote (RRR) areas in Australia, and strategies to improve access to quit supports are required. This pilot study examined the feasibility of a smoking cessation intervention for people in RRR areas who smoke with the intention of using this data to design a powered effectiveness trial. Methods: A randomised controlled trial (RCT) of the feasibility of a 12-week ‘Outback Quit Pack’ intervention consisting of mailout combination nicotine replacement therapy (NRT) and a proactive referral to Quitline, compared with a minimal support control (1-page smoking cessation support information mailout) was conducted between January and October 2021. Participants recruited via mailed invitation or Facebook advertising, were adults who smoked tobacco (≥10 cigarettes/day) and resided in RRR areas of New South Wales, Australia. Participants completed baseline and 12-week follow-up telephone surveys. Outcomes were feasibility of trial procedures (recruitment method; retention; biochemical verification) and acceptability of intervention (engagement with Quitline; uptake and use of NRT). Results: Facebook advertising accounted for 97% of participant expressions of interest in the study (N = 100). Retention was similarly high among intervention (39/51) and control (36/49) participants. The intervention was highly acceptable: 80% of the intervention group had ≥1 completed call with Quitline, whilst Quitline made 3.7 outbound calls/participant (mean 14:05 mins duration). Most of the intervention group requested NRT refills (78%). No differences between groups in self-reported cessation outcomes. Biochemical verification using expired air breath testing was not feasible in this study. Conclusion: The Outback Quit Pack intervention was feasible and acceptable. Alternative methods for remote biochemical verification need further study. So What?: A powered RCT to test the effectiveness of the intervention to improve access to evidence-based smoking cessation support to people residing in RRR areas is warranted