Multidisciplinary Stakeholders Provide Input on Improving End-of-Life Care

To optimize end-of-life care in long-term care settings, a group of multidisciplinary stakeholders advised changes in the areas of clinical practice, communication and culture, and organizational policies, according to a study published in BMC Geriatrics.  

“Supportive end-of-life care for frail older adults within long-term care homes is an emergent practice in Canada and around the world,” wrote a team of Canadian researchers. “Frail, older adults have complex medical and functional needs, and families, nurses, and care aides desire meaningful involvement and collaboration with physicians in end-of-life comfort care decision-making.” 

The study employed a 2-phase consensus-building approach using modified Delphi questionnaires and discussions. Physicians, staff, administrators, residents, family members, palliative care experts, and researchers in geriatrics and gerontology were involved in the process. 

The first of several key recommendations involved establishing knowledge and training expectations for long-term staff and physicians that address palliative care, communication, and collaboration. Specific interventions called for the creation of a dying pathway for when death is imminent; the creation of a communication checklist that physicians can use in conversations with residents and family for consistent messaging; and including pain as a vital sign in assessments. 

Second, stakeholders requested better connections among all parties involved in end-of-life care. This included timely and open conversations between family and care providers; consistent end-of-life language in documents and face-to-face conversations; and not valuing professional expertise over lay expertise. 

The third recommendation was for policies and funds to support end-of-life comfort care. Physical design factors, such as a government policy mandating private spaces in long-term care when death is imminent and solitary spots for family conversation and reflection, were included in the recommendation. 

“Clinician educators can use our results to support the provision of palliative education and skills training, as well as mentorships,” researchers wrote. “Administrators should explore opportunities to reconfigure long-term care culture through communication changes, as well as the physical environment through facility design modifications.” 

Reference:
Harasym PM, Afzaal M, Brisbin S, et al. Multi-disciplinary supportive end of life care in long-term care: an integrative approach to improving end of life. BMC Geriatr. 2021;21(1):326. Published 2021 May 22. doi:10.1186/s12877-021-02271-1