The reflection room: Shifting from death-avoiding to death-discussing

Thinking about dying and death is something we tend not to do, and those who promote Advance Care Planning for the health care in ourlast days, hours and minutes would like us to do more. However, planning requires us to think about how we want to live our final days and then share those wishes with others. This research proposes the question: How might we use human-centred design and qualitative research to go from being a death-avoiding society to a death- discussing society? Human beings are storytellers. Understanding complex challenges through narrative builds empathy. Stories also trigger the imagination for future possibility. We propose that providing places for storytelling — and places for reading the stories of others — might trigger more thinking and break through the social complexity that can be a barrier to discussing dying and death. As part of a year-long research project, we are creating “Reflection Rooms” – both short-term physical spaces across Canada and an online website – where people are invited to write their stories about dying and death and read the stories of others. We will share emerging themes from the research and pose the questions: How might we engage patients and families in shared storytelling as they navigate decision-making at end-of- life? How might collective storytelling about dying and death support the design of human-centred Advance Care Planning experiences? At the RSD5 Conference we also propose to set-up a Reflection Room pop-up for the duration of the conference and invite people to take a few moments to reflect on their own experiences with dying and death and add them to the reflection wall to continue building the collective story

Observe, Coach, Assist, and Report: An Emerging Framework for Integrating Unregulated Healthcare Providers into Interdisciplinary Healthcare Teams

Background: Unregulated healthcare providers known as personal support workers (PSWs) provide the majority of home care services in Ontario, Canada. However, there is little direction to guide their activities as members of interdisciplinary healthcare teams. The purpose of this study was to explore and describe the role of PSWs in interdisciplinary evidence-based stroke care.Methods and Findings: A concurrent triangulation mixed-methods design was used. Data sources included surveys (N = 270), chart audits (N = 234), interviews (N = 28), focus groups (N = 7), textbook review, an advisory committee (N = 14), and knowledge fairs (N = 112). PSWs can participate in team-based stroke care by observing vital information about clients in their homes, coaching clients to follow care plans, assisting to implement recommendations made by other healthcare providers, and reporting client progress, challenges, needs, and preferences to the healthcare team.Conclusions: The Observe, Coach, Assist, and Report (OCAR) themes have the potential to be used as a framework to guide improvements in intra-team communication, information sharing, and awareness of the PSW role, in order to support a more integrated home care experience for clients and families. Next steps include pilot testing the OCAR framework at the point of care in various settings to enhance interdisciplinary collaboration that is inclusive of PSWs

Observe, Coach, Assist, and Report: An Emerging Framework for Integrating Unregulated Healthcare Providers into Interdisciplinary Healthcare Teams

Background: Unregulated healthcare providers known as personal support workers (PSWs) provide the majority of home care services in Ontario, Canada. However, there is little direction to guide their activities as members of interdisciplinary healthcare teams. The purpose of this study was to explore and describe the role of PSWs in interdisciplinary evidence-based stroke care.Methods and Findings: A concurrent triangulation mixed-methods design was used. Data sources included surveys (N = 270), chart audits (N = 234), interviews (N = 28), focus groups (N = 7), textbook review, an advisory committee (N = 14), and knowledge fairs (N = 112). PSWs can participate in team-based stroke care by observing vital information about clients in their homes, coaching clients to follow care plans, assisting to implement recommendations made by other healthcare providers, and reporting client progress, challenges, needs, and preferences to the healthcare team.Conclusions: The Observe, Coach, Assist, and Report (OCAR) themes have the potential to be used as a framework to guide improvements in intra-team communication, information sharing, and awareness of the PSW role, in order to support a more integrated home care experience for clients and families. Next steps include pilot testing the OCAR framework at the point of care in various settings to enhance interdisciplinary collaboration that is inclusive of PSWs

Behaviour in a Canadian Multi-payer, Multi-provider Health Care Market: The Case of the Physiotherapy Market in Ontario

This is a study of several contentious issues in Canadian health policy involving the interaction of public and private payers and for-profit (FP) and not-for-profit (NFP) providers; the influence of health professionals on market structure; and the role of foreign investment. A case study was used, the Ontario physiotherapy market in 2003-2005, with its complex mix of payers and providers and foreign investment opportunities. Key market features were: fragmented but substantial payer influence, effective though uncoordinated cost control across payers, constrained labour supply, and fragmented patient referral sources. These features increased the complexity of providers’ interactions with patients and payers, reducing standardization and therefore favouring local, professional-owned small business FP providers (FP/s) for ambulatory care. NFP Hospitals’ market share declined. The findings generally confirmed expected behavioural differences between FP and NFP providers but expected differences between investor-owned FP providers (FP/c) and FP/s providers were not generally found. FP/s dominated the market, and FP/c providers appeared to mimic FP/s market behaviours, competing in local sub-markets. With no single or dominant payer, cost control difficulties were expected, but all 11 payer categories (public and private) used various cost control mechanisms, resulting in significant collective but uncoordinated influence. Generally, no payer alone supported a provider’s operations. The dominant labour suppliers, regulated physiotherapists, were scarce and exerted significant pressure, affecting market structure by asserting individual preferences and professional interests. FP/s dominance resulted, supported by the traditional patient referral source, physicians in small practices. Very little foreign investment was found despite little protection for domestic providers under NAFTA. In sum, this study showed FP and NFP provider stereotypes are subject to payer pressure: FP/c organizations can adapt by mimicking FP/s, and payers can modify NFPs’ assumed community orientation. Labour shortages and historical referral patterns can make individual professionals and their preferences more influential than their collective profession without diminishing the importance of professional interests. The degree and structure of payer control can make a market unattractive to foreign investors. Finally, this market – neither a planned or standard market – had a service provision pattern more broadly influenced by professionalism and practitioner interests than policies or prices.Ph

Organization-level principles and practices to support spiritual care at the end of life: a qualitative study

Abstract Background Though most models of palliative care specifically include spiritual care as an essential element, secular health care organizations struggle with supporting spiritual care for people who are dying and their families. Organizations often leave responsibility for such care with individual care providers, some of whom are comfortable with this role and well supported, others who are not. This study looked to hospice programs founded and operated on specific spiritual foundations to identify, if possible, organizational-level practices that support high-quality spiritual care that then might be applied in secular healthcare organizations. Methods Forty-six digitally-recorded interviews were conducted with bereaved family members, care providers and administrators associated with four hospice organizations in North America, representing Buddhist, Catholic, Jewish, and Salvation Army faith traditions. The interviews were analyzed iteratively using the constant comparison method within a grounded theory approach. Results Nine Principles for organizational support for spiritual care emerged from the interviews. Three Principles identify where and how spiritual care fits with the other aspects of palliative care; three Principles guide the organizational approach to spiritual care, including considerations of assessment and of sacred places; and three Principles support the spiritual practice of care providers within the organizations. Organizational practices that illustrate each of the principles were provided by interviewees. Conclusions These Principles, and the practices underlying them, could increase the quality of spiritual care offered by secular health care organizations at the end of life

Resource Utilization Groups in transitional home care: validating the RUG-III/HC case-mix system in hospital-to-home care programs

Abstract Background Transitional hospital-to-home care programs support safe and timely transition from acute care settings back into the community. Case-mix systems that classify transitional care clients into groups based on their resource utilization can assist with care planning, calculating reimbursement rates in bundled care funding models, and predicting health human resource needs. This study evaluated the fit and relevance of the Resource Utilization Groups version III for Home Care (RUG-III/HC) case-mix classification system in transitional care programs in Ontario, Canada. Methods We conducted a retrospective analysis of clinical assessment data and administrative billing records from a cohort of clients (n = 1,680 care episodes) in transitional home care programs in Ontario. We classified care episodes into established RUG-III/HC groups based on clients’ clinical and functional characteristics and calculated four case-mix indices to describe care relative resource utilization in the study sample. Using these indices in linear regression models, we evaluated the degree to which the RUG-III/HC system can be used to predict care resource utilization. Results A majority of transitional home care clients are classified as being Clinically complex (41.6%) and having Reduced physical functions (37.8%). The RUG-III/HC groups that account for the largest share of clients are those with the lowest hierarchical ranking, indicating low Activities of Daily Living limitations but a range of Instrumental Activities of Daily Living limitations. There is notable heterogeneity in the distribution of clients in RUG-III/HC groups across transitional care programs. The case-mix indices reflect decreasing hierarchical resource use within but not across RUG-III/HC categories. The RUG-III/HC predicts 23.34% of the variance in resource utilization of combined paid and unpaid care time. Conclusions The distribution of clients across RUG-III/HC groups in transitional home care programs is remarkably different from clients in long-stay home care settings. Transitional care programs have a higher proportion of Clinically complex clients and a lower proportion of clients with Reduced physical function. This study contributes to the development of a case-mix system for clients in transitional home care programs which can be used by care managers to inform planning, costing, and resource allocation in these programs

Additional file 1: of Organization-level principles and practices to support spiritual care at the end of life: a qualitative study

Question Sets for Interviewees. The interviews were conducted with the questions in this file in hand, as primers for a conversation. These were potential questions, and the entire set was not asked in each case, and not in the order listed. (PDF 85 kb

Using a Modified ADAPTE Process to Enable Effective Implementation of Electrical Stimulation Therapy for Treating Pressure Ulcers in Persons With Spinal Cord Injury

Objectives: To apply a modified ADAPTE process to adapt best practices to a local context for successful implementation of electrical stimulation therapy (EST) for treating pressure injuries in persons with spinal cord injury (SCI). Participants: An expert team of health care professionals and a consumer participated in a 2-day workshop to assist in the development of the locally adapted EST document in Southwest Ontario, Canada. Results: A process map illustrating the flow of activities to initiate EST for treating pressure injuries in persons with SCI based on the challenges and opportunities existing within this region was created. The team also developed a summary of roles and responsibilities delineating tasks specific to providing EST and identified a set of challenges likely to be encountered. Conclusions: The modified ADAPTE process provided a clear and flexible structure to adaptation when used for implementation planning. This article shares some challenges associated with using this process for local adaptation and shares strategies of improvement for future studies aimed at adapting a practice to their local environment

What older adults and their caregivers need for making better health-related decisions at home: a participatory mixed methods protocol

Introduction Shared decision making is an interpersonal process whereby healthcare providers collaborate with and support patients in decision-making. Older adults receiving home care need support with decision-making. We will explore what older adults receiving home care and their caregivers need for making better health-related decisions.Methods and analysis This two-phase sequential exploratory mixed methods study will be conducted in a pan-Canadian healthcare organisation, SE Health. First, we will create a participant advisory group to advise us throughout the research process. In phase 1 (qualitative), we will recruit a convenience sample of 15–30 older adults and caregivers receiving home care to participate in open-ended semi-structured interviews. Phase 1 participants will be invited to share what health-related decisions they face at home and what they need for making better decisions. In phase 2 (quantitative), interdisciplinary health and social care providers will be invited to answer a web-based survey to share their views on the decisional needs of older adults and their caregivers. The survey will include questions informed by findings from qualitative interviews in phase 1, and a workbook for assessing decisional needs based on the Ottawa Decision Support Framework. Finally, qualitative and quantitative results will be triangulated (by methods, investigator, theory and source) to develop a comprehensive understanding of decision-making needs from the perspective of older adults, caregivers and health and social care providers. We will use the quality of mixed methods studies in health services research guidelines and the Checklist for Reporting the Results of Internet E-Surveys checklist.Ethics and dissemination Ethics approval was obtained from the research ethics boards at Southlake Regional Health Centre and Université Laval. This study will inform the design of decision support interventions. Further dissemination plans include summary briefs for study participants, tailored reports for home care decision makers and policy makers, and peer-reviewed publications.Trial registration number NCT04327830

New Analysis of High Pressure Data for Olivine Deformation

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