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Family care conferences in long-term care: Exploring content and processes in end-of-life communication

Published online by Cambridge University Press:  29 December 2017

Pamela Durepos ,
Sharon Kaasalainen ,
Tamara Sussman ,
Deborah Parker ,
Kevin Brazil ,
Susan Mintzberg  and
Alyssa Te
Pamela Durepos
Affiliation:
School of Nursing, McMaster University, Hamilton, Ontario, Canada
Sharon Kaasalainen*
Affiliation:
School of Nursing, McMaster University, Hamilton, Ontario, Canada
Tamara Sussman
Affiliation:
Faculty of Social Work, McGill University, Montreal, Quebec, Canada
Deborah Parker
Affiliation:
Faculty of Health, University of Technology–Sydney, Sydney, New South Wales, Australia
Kevin Brazil
Affiliation:
School of Nursing and Midwifery, Queen's University–Belfast, Belfast, Northern Ireland, United Kingdom
Susan Mintzberg
Affiliation:
Faculty of Social Work, McGill University, Montreal, Quebec, Canada
Alyssa Te
Affiliation:
School of Nursing, McMaster University, Hamilton, Ontario, Canada
*
Address correspondence and reprint requests to: Sharon Kaasalainen, Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, Ontario L8N 3Z5, Canada. E-mail: kaasal@mcmaster.ca.
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Abstract

Objective:

End-of-life (EoL) communication in long-term care (LTC) homes is often inadequate and delayed, leaving residents dying with unknown preferences or goals of care. Poor communication with staff contributes to families feeling unprepared, distressed, and dissatisfied with care. Family care conferences (FCCs) aim to increase structured systematic communication around goals and plans for the end of life. As part of the Strengthening a Palliative Approach to Care (SPA–LTC) project, FCCs were implemented in four LTC sites in Ontario, Canada. The purpose of this substudy was to examine FCC content and such guiding processes as documentation and multidisciplinary staff participation.

Method:

A total of 24 FCCs were held for residents with a Palliative Performance Scale score of 40% (nearing death). Data were collected from conference forms (i.e., Family Questionnaires, Care Plan Conference Summaries), site-specific electronic chart documents, and fieldnotes. Directed content analysis of data was informed by the Canadian Hospice Palliative Care Association's Square of Care Model, which describes eight domains of care: disease management, physical, psychological, social, practical, spiritual, EoL, and loss/bereavement.

Results:

The FCCs addressed an average of 71% of the content domains, with physical and EoL care addressed most frequently and loss/bereavement addressed the least. Two goals and five interventions were documented and planned on average per FCC. Examination of the processes supporting EoL communication found: (1) advantages to using FCC forms versus electronic charts; and (2) high levels of multidisciplinary participation overall but limited participation of personal support workers (PSWs) and physicians.

Significance of Results:

Communication around the end of life in LTC can be supported through the use of FCCs. Description of content and FCC processes provides guidance to persons implementing FCCs. Recommendations for tailoring conferences to optimize communication include use of specific conference forms, increased bereavement discussion, and further engagement of PSWs and physicians.

Keywords

End of lifeConferencesFamily meetingsLong-term carePalliative care
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Issue 5 , October 2018 , pp. 590 - 601
Copyright
Copyright © Cambridge University Press 2017 

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