Lessons learned from the Dying2Learn MOOC : pedagogy, platforms and partnerships

(1) Background: Massive Open Online Courses (MOOCs) are becoming more commonplace in the delivery of free online education and a Dying2Learn MOOC was offered by a team at Palliative and Supportive Services, Flinders University, South Australia; (2) Methods: Working with the OpenLearning platform developer, a research study and MOOC evaluation were embedded in the course, and content was delivered in innovative ways without compromising pedagogical approaches; (3) Results: This MOOC provided the facilitators with the opportunity to view education as an intervention, with testing undertaken, including measuring attitudinal change. Research, clinical and community partnerships were developed or reaffirmed and the value of ongoing partnerships with developers in creating platforms and tools that can expand the options for online learning is highlighted. Opportunities for future health professional and consumer education were also explored; (4) Conclusion: MOOCs can provide innovative opportunities to redesign educational approaches, which can be achieved by working with new technologies and with platform developers, while still adhering to pedagogical principles

A pilot evaluation of the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) program

Background: Despite increased annual mortality in long-term care (LTC) homes, research has shown that care of dying residents and their families is currently suboptimal in these settings. The purpose of this study was to evaluate resident and family outcomes associated with the Strengthening a Palliative Approach in LTC (SPA-LTC) program, developed to help encourage meaningful end of life discussions and planning. Methods: The study employs a mixed method design in four LTC homes across Southern Ontario. Data were collected from residents and families of the LTC homes through chart reviews, interviews, and focus groups. Interviews with family who attended a Palliative Care Conference included both closed-ended and open-ended questions. Results: In total, 39 residents/families agreed to participate in the study. Positive intervention outcomes included a reduction in the proportion of emergency department use at end of life and hospital deaths for those participating in SPA-LTC, improved support for families, and increased family involvement in the care of residents. For families who attended a Palliative Care Conference, both quantitative and qualitative findings revealed that families benefited from attending them. Residents stated that they appreciated learning about a palliative approach to care and being informed about their current status. Conclusions: The benefits of SPA-LTC for residents and families justify its continued use within LTC. Study results also suggest that certain enhancements of the program could further promote future integration of best practices within a palliative approach to care within the LTC context. However, the generalizability of these results across LTC homes in different regions and countries is limited given the small sample size

Moving from research generation to knowledge translation in end-of-life care in long term care

The recognition and importance of the need for palliative or end-of-life care in long term care has, over the last two decades, led to increased research, education and practice development initiatives in most developed countries. The breadth and depth of some of these initiatives has been catalogued by the European Association of Palliative Care Taskforce on Palliative Care in Long Term Care Settings for Older People.1,2 In total over 60 initiatives across 13 European countries were identified. These initiatives were mapped by level of change – that is at the national, regional, organisational, team or individual level, with many targeting more than one level. Unfortunately not possible as part of this mapping activity, was an evaluation to examine if any of these initiatives successfully translated into sustained knowledge or practice change. What is vital for improving end-of-life care for residents and families in long term care is for clinicians, researchers and policy makers to engage, not only in the generation of knowledge by engaging in research and knowledge dissemination from the publication of results in academic journals, but also the transfer of research-based knowledge into a form that can be used. This process is often referred to as knowledge translation (KT).3 KT focuses on methods or processes to increase clinician’s practice knowledge to improve outcomes and reduce the evidence–practice gap. The nexus between knowledge generation and KT is the synthesis of what is known on a topic (the best evidence available) and what will work in a local context

The development and implementation of evidence-based palliative care guidelines for residential care : lessons for other countries

Guidelines are ‘systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances’ (1). In the last decade there has been worldwide interest in development and use of evidence-based guidelines. This has been driven by the imperative to limit variations in clinical practice for people with the same condition, uncertainty about the effectiveness of interventions in making a change in people’s health, and making the best of limited health resources within fiscal constraints. Whilst initially the focus was on how guidelines should be developed, this is now well defined and in Australia the National Health and Medical Research Council (NHMRC) (1) provides details of this process as does the National Institute for Health and Clinical Excellence (NICE) (2) in the UK. Several countries such as Australia, the UK, the USA, and Canada have national bodies that collate, synthesize, and publish evidence

Care homes and long-term care for people with dementia

A significant proportion of people living with dementia will live and stay in long-term care settings. Consequently, care homes have an important role to play in the provision of supportive care for people with dementia. This chapter initially describes the care home context, as this shapes the experiences of living and dying for people with dementia residing in care homes. It draws on two recent studies, both considering the provision of palliative care for people who are living and dying in care homes: one from the UK (Froggatt) and one from Australia (Parker). From this empirical research it identifies two key challenges that face care homes as they support people with dementia living in such settings: how do we, on the one hand, create a culture of openness to people's experiences of living and dying alongside, on the other hand, maintaining people's identities? These both require attention in the care home setting if person-centred supportive care is to be provided throughout a person's life until their death

Development of palliative care in long term-care facilities : a new evidence base

Guest editoria

Care of Older Adults: A Strengths-Based Approach

One of life’s truisms is that we will all experience ageing. Most of us won’t think about it until the effects of ageing give us either a gentle nudge or a hard wake-up call. Either way, when we are confronted with its effects, quite reasonably we won’t want it to define us. Rather the effects and changes of ageing will be woven into the fabric of what makes us unique as individuals

Community based home visiting service in Korea : City of Gwangmyeong

There has been growing interest in enhancing the quality of life of the economically vulnerable through programs aimed at improving the equality of and accessibility to public health services for these people

Can exposure to online conversations about death and dying influence death competence? : an exploratory study within an Australian Massive Open Online Course

A Massive Open Online Course, Dying2Learn, was designed to foster community death conversations and strengthen community awareness of palliative care and death as a normal process. This exploratory study used a pre–post prospective design to determine if participation in Dying2Learn and exposure to online conversations about death and dying resulted in any significant influence on death competence in 134 participants who completed the Coping-with-Death-Scale both at the beginning and end of the course in 2016. Death competence refers to a range of attitudes and capabilities people have for dealing with death. Results at the end of the course indicated that engagement in Dying2Learn led to significant improvements in death competence scores over time (medium-to-large effect size). The positive impact was greater for those who completed more of the course, and effectiveness did not depend on sociodemographic characteristics. In conclusion, this study found that an online learning platform in the form of a Massive Open Online Course could engage community members in meaningful social discussion about death and dying, and that exposure to these conversations was beneficial for all participants regardless of previous exposure to death. Further exploration is required to determine whether this change in death competence will have an impact on participant’s behavior in the community regarding death conversations and preparedness