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An Analysis of Documents Guiding Palliative Care in Five Canadian Provinces

  • Carolyn Hill (a1), Wendy Duggleby (a2), Lorraine Venturato (a3), Pamela Durepos (a1), Pereya Kulasegaram (a1), Paulette Hunter (a4), Lynn McCleary (a5), Tamara Sussman (a6), Genevieve Thompson (a7), Doug Surtees (a4), Abigail Wickson-Griffiths (a8) and Sharon Kaasalainen (a1)...

Abstract

The purpose of this study was to analyse the consistency and extent of palliative content across high-level guiding documents related to the care of persons residing in Canadian long-term care homes. A systematic search was conducted examining documents at the national level and across five provinces (Alberta, Ontario, Saskatchewan, Manitoba, and Quebec). Twenty-five documents were selected based on inclusion criteria from 273 documents identified in the systematic search. The majority of these documents were created nationally (48%) or in Ontario (28%). Documents varied in palliative topics discussed, and long-term care was discussed minimally. A minimal number of palliative care guiding documents were found. Long-term care specific documents were absent, and all documents lacked consistency on palliative topics. It is imperative that palliative principles are present and consistent in high-level documents in order to improve the quality of life and care for long-term care residents across Canada.

Cette étude avait pour but d’analyser le niveau de concordance et la portée du contenu en matière de soins palliatifs dans les documents directeurs de haut niveau visant les soins pour les personnes résidant en centres de soins de longue durée au Canada. Une recherche systématique a été menée en vue d’analyser les documents de niveau national et ceux provenant de cinq provinces (Alberta, Ontario, Saskatchewan, Manitoba, Québec). Vingt-cinq documents ont été sélectionnés en fonction des critères d’inclusion à partir de 273 documents identifiés dans la recherche systématique. La majorité de ces documents ont été créés sur le plan national (48 %) ou en Ontario (28 %). Les sujets abordés variaient en matière de soins palliatifs et les soins de longue durée n’étaient que minimalement traités. Un nombre restreint de documents directeurs sur les soins palliatifs ont été relevés. Aucun de ces documents ne traitait spécifiquement des soins de longue durée, et les documents identifiés manquaient d’uniformité en matière de soins palliatifs. Il est essentiel que les principes encadrant les soins palliatifs soient présentés et concordants dans les documents directeurs afin d’améliorer la qualité de vie et les soins pour les résidents en soins de longue durée à travers le Canada.

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Corresponding author

La correspondance et les demandes de tirés-à-part doivent être adressées à : / Correspondence and requests for offprints should be sent to: Sharon Kaasalainen, R.N., Ph.D. McMaster University 1280 Main St. W Hamilton, ON L8S 4L8 Canada (kaasal@mcmaster.ca)

Footnotes

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This work was supported by the Canadian Institutes of Health Research Grant No. 337678, Ontario Ministry of Health and Long-Term Care Grant No. 06718, Saskatchewan Health Research Foundation Grant No. 454 3316, Manitoba Health Research Council Grant No. PHE-141804, Alberta Innovates Health Solutions Grant No. 10012108 and Extendicare Canada.

We thank the McMaster University School of Nursing Librarian, Laura Banfield, for her contributions to our search strategy and gratefully acknowledge the Partnerships for Health System Improvement team and their contributions to our completed study and manuscript.

The authors have no competing interests to declare. The funders provided funding based on the research grant application. They had no role in the design of the study; data collection, analysis, and interpretation; or writing of the manuscript.

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References

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Alberta Health Services. (2014). Palliative and end of life care: Alberta provincial framework 2014. Retrieved 19 April 2017 from http://www.albertahealthservices.ca/assets/info/seniors/if-sen-provincial-palliative-end-of-life-care-framework.pdf
Ampe, S., Sevenants, A., Smets, T., Declercq, A., & Van Audenhove, C. (2016). Advance care planning for nursing home residents with dementia: Policy vs. practice. Journal of Advanced Nursing, 72(3), 569581. doi: 10.1111/jan.12854
Ampe, S., Sevenants, A., Smets, T., Declercq, A., & Van Audenhove, C. (2017). Advance care planning for nursing home residents with dementia: Influence of ’we DECide’ on policy and practice. Patient Education and Counseling, 100(1), 139146. doi: 10.1016/j.pec.2016.08.010
Badger, F., Clifford, C., Hewison, A., & Thomas, K. (2009). An evaluation of the implementation of a programme to improve end-of-life care in nursing homes. Palliative Medicine, 23(6), 502511. doi: 10.1177/0269216309105893
Bosma, H., Johnston, M., Cadell, S., Wainwright, W., Abernathy, N., Feron, A, et al (2008). Canadian social work competencies for hospice palliative care: A framework to guide education and practice at the generalist and specialist levels. Retrieved 10 April 2017 from http://www.chpca.net/media/7868/Social_Work_Competencies_July_2009.pdf
Bowen, G. A. (2009). Document analysis as a qualitative research method. Qualitative Research Journal, 9(2), 2740. doi: 10.3316/QRJ0902027
Canadian Hospice Palliative Care Association. (2010). Policy brief on hospice palliative care: Quality end-of-life care? It depends on where you live and where you die. Retrieved 2 February 2017, from http://www.chpca.net/media/7682/HPC_Policy_Brief-Systems_Approach-June_2010.pdf
Canadian Hospice Palliative Care Association. (2013). A model to guide hospice palliative care. Ottawa: Author. Retrieved 12 January 2017 from http://www.chpca.net/media/319547/norms-of-practice-eng-web.pdf
Canadian Hospice Palliative Care Association. (2014). The Way Forward National Framework: A roadmap for the integrated palliative approach to care. Retrieved 11 May 2017 from http://www.hpcintegration.ca/media/54625/TWF-framework-doc-Eng-2014-final.pdf
Canadian Institute for Health Information. (2007). Health care use at the end of life in Western Canada. Retrieved 22 March 2017 from https://secure.cihi.ca/free_products/end_of_life_report_aug07_e.pdf
Canadian Medical Association. (2014). End-of-life care: A national dialogue. Retrieved 20 April 2017 from https://www.cma.ca/Assets/assets-library/document/en/advocacy/end-of-life-care-report-e.pdf
Canadian Medical Association. (2016). Palliative care. Retrieved 30 April 2017 from http://policybase.cma.ca/dbtw-wpd/Policypdf/PD16-01.pdf
Canadian Nurses Association. (2015). The palliative approach to care and the role of the nurse. Retrieved 31 March 2017 from https://www.cna-aiic.ca/∼/media/cna/page-content/pdf-en/the-palliative-approach-to-care-and-the-role-of-the-nurse_e.pdf
Carstairs, S. (2010). Raising the bar: A roadmap for the future of palliative care in Canada. Retrieved 8 March 2017 from http://www.chpca.net/media/7859/Raising_the_Bar_June_2010.pdf
College and Association of Registered Nurses of Alberta. (2013). Older adults policy pillar. Retrieved 25 April 2017 from http://www.nurses.ab.ca/content/dam/carna/pdfs/Interpretive%20Docs/Older_Adults_Policy_Pillar.pdf
Collège des Médecins du Québec. (2016). Medical care in the last days of life. Retrieved 1 April 2017 from http://www.cmq.org/publications-pdf/p-1-2015-05-01-en-soins-medicaux-derniers-jours-de-la-vie.pdf
Cooper, D., Barnes, P., Horst, G., Sinclair, S., & Associates. (2013). How spiritual care practitioners provide care in Canadian hospice palliative care settings: Recommended advanced practice guidelines and commentary. Retrieved 22 March 2017 from http://www.chpca.net/media/319456/chpca_spiritual_advisors-recommended_practice_guidelines-31october_2013.pdf
Durepos, P., Wickson-Griffiths, A., Hazzan, A. A., Kaasalainen, S., Vastis, V., Battistella, L., et al (2017). Assessing palliative care content in dementia care guidelines: A systematic review. Journal of Pain and Symptom Management, 53(4), 804813. doi: http://dx.doi.org/10.1016/j.jpainsymman.2016.10.368
Elo, S., & Kyngas, H. (2007). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107115. doi: 10.1111/j.1365-2648.2007.04569.x
Estabrooks, C. A., Hoben, M., Poss, J. W., Chamberlain, S. A., Thompson, G. N., Silvius, J. L., et al (2015). Dying in a nursing home: Treatable symptom burden and its link to modifiable features of work context. Journal of the American Medical Directors Association, 16(6), 515520. doi: 10.1016/j.jamda.2015.02.007
Finucane, A. M., Stevenson, B., Moyes, R., Oxenham, D., & Murray, S. A. (2013). Improving end-of-life care in nursing homes: Implementation and evaluation of an intervention to sustain quality of care. Palliative Medicine, 27(8), 772778. doi: 10.1177/0269216313480549
Fraser, J. (2016). Palliative and end-of-life care provincial roundtable report: A report from parliamentary assistant John Fraser to the minister of health and long-term care. Retrieved 11 April 2017 from http://www.health.gov.on.ca/en/public/programs/palliative/pdf/palliative_report.pdf
Government of Canada. (2006). Legislation and guidelines. Retrieved 12 June 2017 from https://www.canada.ca/en/health-canada/corporate/about-health-canada/legislation-guidelines.html
Holland, S. K., Evered, S. R., & Center, B. A. (2014). Long-term care benefits may reduce end-of-life medical care costs. Population Health Management, 17(6), 332339. doi: 10.1089/pop.2013.0116
Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 12771288. doi: 10.1177/1049732305276687
Huskamp, H. A., Kaufmann, C., & Stevenson, D. G., (2012). The intersection of long-term care and end-of-life care. Medical Care Research & Review, 69(1), 344.
Kaasalainen, S., Ploeg, J., McAiney, C., Schindel Martin, L., Donald, F., Martin-Misener, R., et al (2013). Role of the nurse practitioner in providing palliative care in long-term care homes. International Journal of Palliative Nursing, 19(10). doi: 10.12968/ijpn.2013.19.10.477
Kayser-Jones, J., Schell, E., Lyons, W., Kris, A. E., Chan, J., & Beard, R. L. (2003). Factors that influence end-of-life care in nursing homes: The physical environment, inadequate staffing, and lack of supervision. The Gerontologist, 43(2), 7684. doi: 10.1093/geront/43.suppl_2.76
Kinley, J., Froggatt, K., & Bennett, M. I. (2013). The effect of policy on end-of-life care practice within nursing care homes: A systematic review. Palliative Medicine, 27(3), 209220. doi: 10.1177/0269216311432899
Manitoba Health. (2014). Advanced continuing care: A blueprint to support system change. Winnipeg, MB: Author. Retrieved 18 April 2017 from https://www.gov.mb.ca/health/documents/blueprint.pdf
Miller, S., Lima, J., & Mor, V. (2014). Residents’ end-of-life hospital use is lower in nursing homes with substantial palliative care knowledge. Journal of Pain and Symptom Management, 47(2), 436437. http://dx.doi.org/10.1016/j.jpainsymman.2013.12.105
Miller, S., Tyler, D., & Shield, R. (2015). Disseminating palliative care knowledge and practice in nursing homes: Lessons from the nursing home culture change movement. Journal of Pain and Symptom Management, 49(2), 340341. http://dx.doi.org/10.1016/j.jpainsymman.2014.11.050
Ministère de la Santé et des Services Sociaux. (2016). Soins palliatifs et de fin de vie: Plan de développement 2015–2020. Retrieved 9 June 2017 from http://publications.msss.gouv.qc.ca/msss/fichiers/2015/15-828-01W.pdf
Moher, D., Liberati, A, Tetzlaff, J., & Altman, D. G., & The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses. The PRISMA Statement. PLosMed 6(7): e1000097. doi: 10.1371/1000097
Ontario Health Technology Advisory Committee End-of-Life Collaborative. (2014). Health care for people approaching the end of life: An evidentiary framework. Retrieved 23 March 2017 from: http://www.hqontario.ca/Portals/0/Documents/evidence/reports/evidentiary-framework-eol-health-care-1411-en.pdf
Ontario Medical Association. (2014). Palliative care: Backgrounder OMA’s end of life care strategy. Retrieved 17 April 2017 from https://www.oma.org/wp-content/uploads/palliativecare.pdf
Parliamentary Committee on Palliative and Compassionate Care. (2011). Not to be forgotten: Care of vulnerable Canadians. Retrieved 24 March 2017 from https://www.mcgill.ca/palliativecare/files/palliativecare/parliamentary_report_eng_dec_2011.pdf
Patton, M. Q. (2015). Qualitative research and methods: Integrating theory and practice. London: SAGE.
Provincial End of Life Care Network. (2010). A provincial system design framework. Retrieved 23 April 2017 from http://hpco.ca/qhpcco/System_Design_Framework_-_Oct_2010.pdf
Quality End-of-Life Care Coalition of Canada. (2010). Blueprint for Action 2010 to 2020: A progress report. Retrieved 24 March 2017 from http://www.qelccc.ca/media/3743/blueprint_for_action_2010_to_2020_april_2010.pdf
Quality Hospice Palliative Care Coalition of Ontario. (2010). Creating an integrated hospice palliative care system in Ontario: Setting the stage for change. Retrieved 2 February 2017, from http://ocfp.on.ca/docs/publications/creating-an-integrated-hpc-system-in-ontario-november-29-2010.pdf?sfvrsn=2
Quality Hospice Palliative Care Coalition of Ontario. (2011). Advancing high quality, high value palliative care in Ontario: A declaration of partnership and commitment to action. Retrieved 28 April 2017 from http://health.gov.on.ca/en/public/programs/ltc/docs/palliative%20care_report.pdf
Radwany, S., Albanese, T., Hoiles, E., Hudak, C., & McGranahan, K. (2013). Building a palliative care consult service in long-term care facilities: Strategy, business model, and outcomes (S704). Journal of Pain and Symptom Management, 45(2), 418. doi: http://dx.doi.org/10.1016/j.jpainsymman.2012.10.121
Registered Nurses Association of Ontario. (2011). End-of-life care during the last days and hours. Retrieved 24 March 2017 from http://rnao.ca/sites/rnao-ca/files/End-of-Life_Care_During_the_Last_Days_and_Hours_0.pdf
Service Ontario. (2017). Long-term care homes. Retrieved 18 June 2017 from https://www.ontario.ca/page/find-long-term-care-home
Silvester, W., Fullam, R. S., Parslow, R. A., Lewis, V. J., Sjanta, R., Jackson, L., et al (2013). Quality of advance care planning policy and practice in residential aged care facilities in Australia. BMJ Supportive & Palliative Care, 3(3), 349357. doi: http://dx.doi.org/10.1136/bmjspcare-2012-000262
Statistics Canada. (2015). Living arrangements of seniors. Retrieved 25 May 2017, from http://www12.statcan.gc.ca/census-recensement/2011/as-sa/98-312-x/98-312-x2011003_4-eng.cfm#bx2
Statistics Canada. (2016). An aging population. Retrieved 25 May 2017, from http://www.statcan.gc.ca/pub/11-402-x/2010000/chap/pop/pop02-eng.htm
Venturato, L., Kellett, U., & Windsor, C. (2007). Nurses’ experiences of practice and political reform in long-term aged care in Australia: Implications for the retention of nursing personnel. Journal of Nursing Management, 15(1), 411. doi: 10.1111/j.1365-2934.2006.00610.x
Venturato, L., Moyle, W., & Steel, A. (2011). Exploring the gap between rhetoric and reality in dementia care in Australia: Could practice documents help bridge the great divide? Dementia, 12(2), 251267. doi: 10.1177/1471301211421837
Vohra, J. U., Brazil, K., Hanna, S., & Abelson, J. (2004). Family perceptions of end-of-life care in long-term care facilities. Journal of Palliative Care, 20(4), 297. http://journals.sagepub.com/home/pala
Williams, A. M., Crooks, V. A., Whitfield, K., Kelley, M., Richards, J., DeMiglio, L., et al (2010). Tracking the evolution of hospice palliative care in Canada: A comparative case study analysis of seven provinces. BMC Health Services, 10, 115. https://doi.org/10.1186/1472-6963-10-147

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