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. 2021 May 22;21(1):326.
doi: 10.1186/s12877-021-02271-1.

Multi-disciplinary supportive end of life care in long-term care: an integrative approach to improving end of life

Patricia M Harasym  1 , Misha Afzaal  2 , Sarah Brisbin  1 , Aynharan Sinnarajah  1   3 , Lorraine Venturato  4 , Patrick Quail  1   3 , Sharon Kaasalainen  5 , Sharon Straus  6   7 , Tamara Sussman  8 , Navjot Virk  9 , Jayna M Holroyd-Leduc  10   11   12
Affiliations

Multi-disciplinary supportive end of life care in long-term care: an integrative approach to improving end of life

Patricia M Harasym et al. BMC Geriatr. .

Abstract

Background: Optimal supportive end of life care for frail, older adults in long term care (LTC) homes involves symptom management, family participation, advance care plans, and organizational support. This 2-phase study aimed to combine multi-disciplinary opinions, build group consensus, and identify the top interventions needed to develop a supportive end of life care strategy for LTC.

Methods: A consensus-building approach was undertaken in 2 Phases. The first phase deployed modified Delphi questionnaires to address and transform diverse opinions into group consensus. The second phase explored and prioritized the interventions needed to develop a supportive end of life care strategy for LTC. Development of the Delphi questionnaire was based on findings from published results of physician perspectives of barriers and facilitators to optimal supportive end of life care in LTC, a literature search of palliative care models in LTC, and published results of patient, family and nursing perspectives of supportive end of life care in long term care. The second phase involved World Café Style workshop discussions. A multi-disciplinary purposive sample of individuals inclusive of physicians; staff, administrators, residents, family members, and content experts in palliative care, and researchers in geriatrics and gerontology participated in round one of the modified Delphi questionnaire. A second purposive sample derived from round one participants completed the second round of the modified Delphi questionnaire. A third purposive sample (including participants from the Delphi panel) then convened to identify the top priorities needed to develop a supportive end-of-life care strategy for LTC.

Results: 19 participants rated 75 statements on a 9-point Likert scale during the first round of the modified Delphi questionnaire. 11 participants (participation rate 58 %) completed the second round of the modified Delphi questionnaire and reached consensus on the inclusion of 71candidate statements. 35 multidisciplinary participants discussed the 71 statements remaining and prioritized the top clinical practice, communication, and policy interventions needed to develop a supportive end of life strategy for LTC.

Conclusions: Multi-disciplinary stakeholders identified and prioritized the top interventions needed to develop a 5-point supportive end of life care strategy for LTC.

Keywords: 5-point supportive end of life care strategy for LTC; World Café Style workshop; modified Delphi questionnaire.

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Conflict of interest statement

The authors have no competing interests to declare related to this work.

Figures

Fig. 1
Fig. 1
A supportive end of life care strategy for long term care based on the Michie Behaviour Change Wheel [17]
See this image and copyright information in PMC

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