Healthcare Assistant role in Advance Care Planning Discussions: A QUALITATIVE STUDY INFORMED BY THE THEORY OF PLANNED BEHAVIOUR

Advance care planning is recognised as optimal in promoting patient autonomy and shared decision making, aiming to improve quality of care at end of life. Healthcare assistants are an integral part of the multi-disciplinary team, playing a pivotal role in the provision and application of advance care planning, though they are largely unrecognised and unsupported in this role. In this study we aimed to explore health care assistants’ beliefs, intentions, and behaviour regarding advance care planning via the Theory of Planned Behaviour framework with palliative care patients and their caregivers in the community.  We conducted a qualitative study using semi-structured interviews. From a potential pool of 95 HCAs employed in Northern Ireland, a purposive sample of 9 agreed to take part. Interviews were undertaken online, transcribed, and subject to thematic analysis and informed by the Theory of Planned Behaviour coding process. Nine health care assistants participated. Analysis revealed, healthcare assistants believed they were best placed to hold intimate advance care planning conversations, due to the personal relationship they built with patients and families, however their role was believed to be undervalued and unseen in policy and practice. Normative beliefs identified a lack of role definition and boundaries in advance care planning within the multi-disciplinary team. Participants behavioural intentions were to support patients and families, through barriers relating to role definition and boundaries created uncertainty. Findings of this study inform our understanding of the role of the healthcare assistants in promoting and implementing advance care planning conversations. Results reflect previous research which indicate key barriers in the lack of role clarity for healthcare assistants to promoting advance care planning. Overall, the findings highlight the need for recognition to be given to the healthcare planning role and interventions to be developed to expand this role. <br/

Achieving Consensus for the Design and Delivery of an Online Intervention to Support Midwives in Work-Related Psychological Distress: Results From a Delphi Study

Background Some midwives are known to experience both professional and organizational sources of psychological distress, which can manifest as a result of the emotionally demanding midwifery work, and the traumatic work environments they endure. An online intervention may be one option midwives may engage with in pursuit of effective support. However, the priorities for the development of an online intervention to effectively support midwives in work-related psychological distress have yet to be explored. Objective The aim of this study was to explore priorities in the development of an online intervention to support midwives in work-related psychological distress. Methods A two-round online Delphi study was conducted. This study invited both qualitative and quantitative data from experts recruited via a scoping literature search and social media channels. Results In total, 185 experts were invited to participate in this Delphi study. Of all participants invited to contribute, 35.7% (66/185) completed Round 1 and of those who participated in this first round, 67% (44/66) continued to complete Round 2. Out of 39 questions posed over two rounds, 18 statements (46%) achieved consensus, 21 (54%) did not. Participants were given the opportunity to write any additional comments as free text. In total, 1604 free text responses were collected and categorized into 2446 separate statements of opinion, creating a total of 442 themes. Overall, participants agreed that in order to effectively support midwives in work-related psychological distress, online interventions should make confidentiality and anonymity a high priority, along with 24-hour mobile access, effective moderation, an online discussion forum, and additional legal, educational, and therapeutic components. It was also agreed that midwives should be offered a simple user assessment to identify those people deemed to be at risk of either causing harm to others or experiencing harm themselves, and direct them to appropriate support. Conclusions This study has identified priorities for the development of online interventions to effectively support midwives in work-related psychological distress. The impact of any future intervention of this type will be optimized by utilizing these findings in the development process. </jats:sec