Death education : simulating the end of life to beginning healthcare providers

The national Quality End-of-Life Care Coalition of Canada report advocates that professional healthcare education must become even more important for a systems-wide approach to handling hospice palliative and end-of-life care in order to ensure that the soaring numbers of dying Canadians receive quality care in all settings where they die over the next 10 years. Recognizing this critical societal need and addressing it as an educational challenge, this grounded theory study examines undergraduate student experiences with high fidelity simulation labs in death education or interprofessional palliative care. This study is guided by the central questions: What forms of knowledge and processes of learning are generated in an interprofessional palliative care simulation learning environment? And what is the experience and impacts of the interprofessional palliative care simulation from the undergraduate healthcare learner’s perspective? This research study recognized that learner participation in the instructional technological platform of simulation prompts questions about the nature of experiential learning and how it is that learning arises out of simulation. The design for this study followed standard processes in grounded theory by using constant comparisons throughout the data analysis process and by adopting a constructivist perspective toward the research process. Nine participants, all enrolled in an Ontario university and accredited an Introduction to Palliative Care course, completed two palliative care simulation lab experiences designed to provide opportunity to test drive their knowledge using a palliative approach, and to start a conversation about their role as future palliative care practitioners. The data were collected from student group debrief sessions following the simulation labs; from the study’s 3 phases’ interviews that each participant individually engaged in (each participant x 3 interviews); and finally, from my own extensive observations and field note journals. Analysis followed grounded theory procedures and initial, focused, axial and theoretical coding was performed. The substantive emergent theory is an explanatory model to address the studied phenomenon: the undergraduate interprofessional palliative care learning experience using high fidelity simulation. This new theory, 3H of Head, Heart & Hands, attempts to capture the student experience in simulated death education as it pertains to learning processes, perceptions of learning, impacts on learning, and meanings associated with learning that resulted from their participation in the study. The findings and 3H theory that emerged have significance and implications at individual, organizational, and societal levels of analysis pertaining to the fields of simulation in higher education, undergraduate interprofessional programs, and palliative care of the dying and their families

Healthcare and End-of-Life Needs of Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults: A Scoping Review

Lesbian, gay, bisexual, and transgender (LGBT) older adults face a number of challenges with respect to access to healthcare especially towards end-of-life. Through a systematic search and scoping review of the literature, we sought to answer two related research questions. In particular, the purpose of this scoping review was to determine the healthcare needs of LGBT older adults nearing end-of-life as well as the factors that contribute to a good death experience among older adults who identify as LGBT. A systematic search of electronic databases for articles published between 2005 and 2016 as well as screening for relevance resulted in 25 results. The data were charted and grouped according to the themes of: social support and chosen family, intimacy, health status, fear of discrimination and lack of trust, lack of knowledge and preparedness, and cultural competence in the healthcare system. The results suggest a role for health and social service workers in contributing to a positive care experience for LGBT older adults by becoming knowledgeable about the unique needs of this population and being unassuming and accepting of individuals’ sexuality. Many of the articles reviewed collected data outside of Canada, limiting generalizability and highlighting a need for Canadian data on LGBT aging and end-of-life

Implementing palliative care education into primary care practice: a qualitative case study of the CAPACITI pilot program

Abstract Background CAPACITI is a virtual education program that teaches primary care teams how to provide an early palliative approach to care. After piloting its implementation, we conducted an in-depth qualitative study with CAPACITI participants to assess the effectiveness of the components and to understand the challenges and enablers to virtual palliative care education. Methods We applied a qualitative case study approach to assess and synthesize three sources of data collected from the teams that participated in CAPACITI: reflection survey data, open text survey data, and focus group transcriptions. We completed a thematic analysis of these responses to gain an understanding of participant experiences with the intervention and its application in practice. Results The CAPACITI program was completed by 22 primary care teams consisting of 159 participants across Ontario, Canada. Qualitative data was obtained from all teams, including 15 teams that participated in focus groups and 21 teams that provided reflection survey data on CAPACITI content and how it translated into practice. Three major themes arose from cross-analysis of the data: changes in practice derived from involvement in CAPACITI, utility of specific elements of the program, and barriers and challenges to enacting CAPACITI in practice. Importantly, participants reported that the multifaceted approach of CAPACITI was helpful to them building their confidence and competence in applying a palliative approach to care. Conclusions Primary care teams perceived the CAPACITI facilitated program as effective towards incorporating palliative care into their practices. CAPACITI warrants further study on a national scale using a randomized trial methodology. Future iterations of CAPACITI need to help mitigate barriers identified by respondents, including team fragmentation and system-based challenges to encourage interprofessional collaboration and knowledge translation