Conference Theme: Clinical, Legal and Administrative ChallengesFree Paper Presentation Ipublished_or_final_versio

Lam, SH

Lou, VW

Tang, JCS

Tsui, AKM

Wong, SWP

HKU Scholars Hub

TitleChanges in Staff Expectations, Competence, and Confidence inProviding EOL Care after Launching a 2-year End-of-life CarePilot Project in Care and Attention HomeAuthor(s) Lou, VW; Tang, JCS; Wong, SWP; Lam, SH; Tsui, AKMCitationAsia Pacific Regional Conference on End of Life and PalliativeCare in Long Term Care Settings, Hong Kong, China, 26-28September 2013Issued Date 2013URL http://hdl.handle.net/10722/201790Rights Creative Commons: Attribution 3.0 Hong Kong LicenseChanges in staff expectations, competence, and confidence in providing EOL care after launching a 2-year End-of-Life care pilot project in Care and Attention Home setting in Hong KongVivian W. Q. LOU1, Jervis C.S. TANG2, Sandy W.P. WONG2, S.H.LAM2, Amy K.M. TSUI21   Department of Social Work & Social Administration, Sau Po Centre on Ageing, The University of Hong Kong1 , 2   Elderly Services Section, Community Services Division, Tung Wah Group of Hospitals (TWGHs)2Contents • Background• Objectives • Methodology• Findings• Conclusions• ReferencesBackground• Tung Wah Group of Hospitals Shuen Wan Complex for the Elderly– Pao Siu Loong Care & Attention Home (PSLC&AH)– Wu York Yu Care & Attention Home (WYYC&AH) – Wu Chiang Wai Fong Care & Attention Home (WCWFC&AH) Phases Homes Establishment CapacityI PSLC&AH June 1985 191II WYYC&AH June 1994 255III WCWFC&AH August 2002 203649Background II• Surging demands on End-of-Life care services from elderly residents living in long-term care facilities• launched a two-year End-of-Life (EOL) care project – June 2011 to May 2013– promote the autonomy of elderly residents  on  EOL care issues • offering them chances to formulate their Advance Care Planning ; • providing intensive medical, nursing  and psychosocial support to elderly residents with end-stage diseasesBackground III• A total of 17 EOL cases being recruited into the Project• Apart from the core built-in project team, a part-time Medical Officer, a Project Manager and a Project Officer , all other staffs are engaged in the project in three Phases Phase 1• EOL care seminars• Case screening• Workshops/site visits• Physical care• Psychosocial care• Spiritual care Phase 2• Provision of EOL care  together with the project  team• Attending meetings• Debriefing sessionsPhase 3• Good practice consolidation• Staff focus groupObjectives• To examine impacts of EOL project implementation on formal care workers on their – attitudes and expectations on EOL care– perceived competence and confidence in providing EOL care to elderly residents residing in Care & Attention Homes • Over a period of 22 monthsMethodology• Quantitative survey– Voluntary and Anonymous• Sample– All staffs in three C & A homes– Baseline (T0) • N=135 (54% professional staff)– 22 months after project implementation (T22)• N= 218 (33% professional staff)• Measures– Attitudes and expectations on EOL care (35 items)– Perceived competence • 21 items for professional staff  • 18 Items for non-professional staff– Perceived confidence (1 item)Sample Characteristics IProfessional StaffT0 T22Pre-test : Yes Pre-test : NoFreq. (%) Freq. (%) Freq. (%)N 73 28 39Gender (Female) 62 (84.9) 24(85.7) 30(76.9)Age29 or below 18 (24.7) 5(17.9) 24(61.5)30-39 20 (27.4) 7(25.0) 6(15.4)40-59 22 (30.1) 9(32.1) 6(15.4)50 or above 13 (17.8) 7(25.0) 3(7.7)ReligionNo religion 39 (53.4) 17(60.7) 21(53.8)Chinese Traditional Beliefs/Buddhism/ Daoism6 (8.2) 1(3.6%) 2(5.1)Christian/ Catholics 28 (38.4) 8(28.6) 12(30.8)Notes. p<.001Sample Characteristics IIProfessional StaffT0 T22Pre-test : Yes Pre-test : NoFreq. (%) Freq. (%) Freq. (%)Year of working in elder care fieldLess than 1 year    5 (6.8) 0(0.0) 6(15.4)1-5 year(s) 20 (27.4) 10(35.7) 18(46.2)6-10 years 25 (34.2) 8(28.6) 7(17.9)More than 10 years 23 (31.5) 10(35.7) 8(20.5)Sample Characteristics IIINon-professional StaffT0 T22Pre-test : Yes Pre-test : NoFreq. (%) Freq. (%) Freq. (%)N 62 38 79Gender (Female) 58 (93.5) 37(97.4) 75(94.9)Age29 or below 7 (11.3) 2(5.4) 11(13.4)30-39 9 (14.5) 4(10.8) 11(13.4)40-59 22 (35.5) 8(21.6) 25(30.5)50 or above 24 (38.7) 23(62.2) 35(42.7)ReligionNo religion 24 (38.7) 19(51.4) 49(61.3)Chinese Traditional Beliefs/Buddhism/ Daoism24 (38.7) 12(32.4) 20(25.0)Christian/ Catholics 14 (22.6) 5(13.5) 10(12.5)Sample Characteristics IVNon-professional StaffT0 T22Pre-test : Yes Pre-test : NoFreq. (%) Freq. (%) Freq. (%)Year of working in elder care fieldLess than 1 year 9 (14.5) 0(0.0) 8(9.8)1-5 year(s) 15 (24.2) 7(18.4) 26(31.7)6-10 years 16 (25.8) 9(23.7) 19(23.2)More than 10 years 22 (35.5) 22(57.9) 29(35.4)Notes. p<.05Attitudes and Expectations on EOL Care ITotal sampleProfessional staff Non-professional  staffT0 (n=73) T22 (n=59) T0 (n=62) T22 (n=107)Mean(SD) Mean(SD) Mean(SD) Mean(SD)Attitudes and expectations 4.25(0.40) 4.15(0.46)  4.10 (0.39) 4.06(0.43) Participants who participated the Pre-testProfessional staff Non-professional  staffT0 (n=73) T22 (n=27) T0 (n=62) T22 (n=34)Mean(SD) Mean(SD) Mean(SD) Mean(SD)Attitudes and expectations 4.25(0.40) 4.30 (0.32)  4.10 (0.39) 4.12(0.38) Attitudes and Expectations on EOL Care IIParticipate who participated in the Pre-testVey important / Important Professional staff Non-professional  staffT0 (n=73) T22 (n=27) T0 (n=62) T22 (n=34)% % % %Not to be kept alive on life support when there is little hope for a meaningful recovery 當長者的病情無好轉的希望時，他/她可以不使用儀器去維持生命78.1 89.3  41.9 68.6** Elder/family member can be involved in decisions about the treatments and care that the elder received長者及家人可以參與去決定長者的治療及照顧安排89.0 100a   88.7 85.1 Notes. ap<.1; *p<.05; **p<.01; ***p<.001Attitudes and Expectations on EOL Care IIIParticipant who participated in the Pre-testVey important / Important Professional staff Non-professional  staffT0 (n=73) T22 (n=27) T0 (n=62) T22 (n=34)Freq. (%) Freq. (%) Freq. (%) Freq. (%)Elder/family member have a sense of control over decisions about the care長者及家人感到他們能控制有關長者的照顧決定68.5 92.6*  54.8 68.7a Elder is able to die in the location of his/her choice長者可以在他/她所選擇的地方終老83.6 96.3a  74.2 87.2* Notes. ap<.1; *p<.05; **p<.01; ***p<.001Perceived Competence in EOL Care ITotal sampleProfessional staff Non-professional  staffT0 (n=73) T22 (n=59) T0 (n=62) T22 (n=107)Mean(SD) Mean(SD) Mean(SD) Mean(SD)Perceived competence 3.41(0.61) 3.66(0.47) * 3.52 (0.56) 3.57(0.62) Participants who participated in the Pre-testProfessional staff Non-professional  staffT0 (n=73) T22 (n=27) T0 (n=62) T22 (n=34)Mean(SD) Mean(SD) Mean(SD) Mean(SD)Perceived competence 3.41(0.61) 3.73(0.42) * 3.52 (0.56) 3.52(0.64) Notes. ap<.1; *p<.05; **p<.01; ***p<.001Perceived Competence in EOL Care IIParticipants who participated in the Pre-testStrongly agree/ Agree Professional staff Non-professional  staffT0 (n=73) T22 (n=27) T0 (n=62) T22 (n=34)% % % %Residential home is a better place than hospital for elders to spend their last days of life院舍的環境比起醫院更適合長者終老50.0 69.2a  49.2 41.2 My care have positive influence on dying residents’ and families’ experiences 我的照顧對於瀕死的院友及家人的經歷有正面的影響57.8 80.0* 56.1 56.1Notes. ap<.1; *p<.05; **p<.01; ***p<.001Perceived Competence in EOL Care IIIParticipants who participated in the Pre-testStrongly agree/ Agree Professional staff Non-professional  staffT0 (n=73) T22 (n=27) T0 (n=62) T22 (n=34)% % % %I’m comfortable talking with residents and families about death and dying我能自在地與院友及家人談及臨終和死亡的話題40.0 65.4*  30.2 37.5 I can assess and manage symptoms that occur at EOL stage我懂得評估及處理其它在臨終期間會出現的徵狀及情況40.4 66.7* / /I can assess and report other symptoms that occur at EOL我懂得評估及適時報告院友在臨終期間可能出現的徵狀及情況/ / 75.8 47.4**Notes. ap<.1; *p<.05; **p<.01; ***p<.001Perceived Competence in EOL Care IVParticipants who participated in the Pre-testStrongly agree/ Agree Professional staff Non-professional  staffT0 (n=73) T22 (n=27) T0 (n=62) T22 (n=34)% % % %Most of my experiences with EOL care in elderly homes have been positive我在院舍內照顧瀕死院友的經驗大部分是正面的57.7 80.0a  63.9 62.9 I am comfortable providing care at the time of death我能自在地照顧瀕死的院友41.9 88.0***  45.0 45.3 Notes. ap<.1; *p<.05; **p<.01; ***p<.001Perceived Confidence in EOL Care  All sampleProfessional staff Non-professional  staffT0 (n=73) T22 (n=59) T0 (n=62) T22 (n=107)Mean(SD) Mean(SD) Mean(SD) Mean(SD)Perceived confidence 3.37(0.99) 3.51(0.91)  3.56 (0.91) 3.64(1.02) Selected sample with participation in Pre-testProfessional staff Non-professional  staffT0 (n=73) T22 (n=27) T0 (n=62) T22 (n=34)Mean(SD) Mean(SD) Mean(SD) Mean(SD)Perceived confidence 3.37(0.99) 3.59(0.93)  3.56 (0.91) 3.62(0.92) Discussion• After the implementation of EOL project for 22 months– more staff (with participation in Pre-test, T0) found autonomy / sense of control  of elderly residents in EOL care are important– Staff perceived competence is found increased especially for professional staff– training needs on providing EOL care for non-professional staff  is highly indicated– Staff perceived confidence in providing EOL care  is found  increased• Changes may be due to training offered and experiences in providing EOL care Discussion• Limitations– Individual comparison is impossible  due to anonymity – Relatively low percentage of participants (28%) indicate joining both surveys at baseline (T0) and Post-test (T22)Conclusions • Positive impacts on staff attitudes / expectations, perceived competence, and perceived confidence in providing EOL care are observed before and after launching the End-of-Life care project for 22 months. 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Changes in Staff Expectations, Competence, and Confidence in Providing EOL Care after Launching a 2-year End-of-life Care Pilot Project in Care and Attention Home

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Changes in Staff Expectations, Competence, and Confidence in Providing EOL Care after Launching a 2-year End-of-life Care Pilot Project in Care and Attention Home

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