As of March 2021, there are 2076 long term care (LTC) facilities in Canada1. Within these facilities are physicians, nurses and other healthcare workers providing supportive end of life care to older adult residents. Supportive end of life care is defined by Nicholson et al. (2017)2 as the provision of physical, psychological, and spiritual services focused on symptom control for those nearing end of life.
The Canadian authors of a 2021 study3, Harasym et al. aimed to identify and understand what strategies may be needed to optimize supportive end of life care in Canadian LTC facilities. To do so, the study was completed in two phases. The first phase of the study involved collecting opinions and ideas from experts using a series of questionaries. In total, 19 experts were surveyed, including healthcare providers, administrative staff, as well as LTC residents and their families. In the second phase, researchers took the 71 statements gathered in the first phase and held a World Café Style Consensus Workshop. During the workshop, 35 interdisciplinary participants and stakeholders discussed the presented statements.
The two-phase study revealed three broad improvement categories, clinical practice change, communication and culture change, and organizational and policy change. Within these categories are interventions developed by the participants of the study to improve LTC supportive care at end of life. The full list of interventions is as follows:
Figure from: Multi-disciplinary supportive end of life care in long term care: an integrative approach to improving end of life. Harasym et al. (2021).
From this comprehensive list, authors distilled three main recommendations:
- Accessible and relevant training resources for all members of care team
- Establish connections to form interdisciplinary care team
- Develop meaningful policies that address patient needs
Authors Harasym et al. explain that the results from this study can be utilized in education initiatives and policy changes. However, it is noted that most participants of the study were health care providers or administrative staff, meaning disproportionately few were LTC residents of family members. As such, the recommendations may favour the perspectives of healthcare providers rather than the recipients of care.
However, this study successfully facilitated discussions about the current state of supportive end of life care in Canada’s LTC facilities. To this end, researchers brought together a variety of individuals together who share a common goal of equitable and comprehensive care. As a result of participants’ collective knowledge and the expertise of Harasym and colleagues, researchers were able to make meaningful recommendations focussed on advancing palliative care for LTC residents.
Citations:
1. Canadian Institute for Health Information. (2020). Long‐term care homes in Canada: How many and who owns them?. Retrieved from: https://www.cihi.ca/en/long-term-care-homes-in-canada-how-many-and-who-owns-them
2. Nicholson, C., Morrow, E. M., Hicks, A., & Fitzpatrick, J. (2017). Supportive care for older people with frailty in hospital: An integrative review. International journal of nursing studies, 66, 60-71. https://doi.org/10.1016/j.ijnurstu.2016.11.015
3. Harasym, P. M., Afzaal, M., Brisbin, S., Sinnarajah, A., Venturato, L., Quail, P., … & Holroyd-Leduc, J. M. (2021). Multi-disciplinary supportive end of life care in long-term care: an integrative approach to improving end of life. BMC geriatrics, 21(1), 1-10. https://doi.org/10.1186/s12877-021-02271-1
