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Augment is produced quarterly and highlights some of the recent literature and web resources relevant to clinicians with an interest in palliative care in residential and community aged care.
Some of the articles or documents included in this newsletter may require a subscription to read in full. You can register to receive Augment via email or you can view previous editions on the Decision Assist website.
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What’s New in the Literature?
What’s New on the Web?
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What’s New in the Literature?
Collier A, Morgan DD, Swetenham K, To TH, Currow DC, Tieman JJ.
Palliat Med. 2015 Aug 19. pii: 0269216315600113.
Telehealth technologies are an emerging resource opening up the possibility of greater support if they have utility for patients, carers and clinicians. They may also help to meet health systems’ imperatives for improved service delivery within current budgets. Clinicians’ experiences and attitudes play a key role in the implementation of any innovation in service delivery.
This study aims to explore clinicians’ perspectives on and experiences of the utilisation of a pilot telehealth model and its integration into a specialist community palliative care programme.
Data was generated through focus groups and interviews and these were analysed through the lens of a realistic evaluation theoretical framework.
The study was conducted in a metropolitan specialist palliative care service in South Australia. Ten clinicians were involved in the delivery of community specialist palliative care and the piloting of a telehealth programme participated.
Service providers consider telehealth resources as a means to augment current service provision in a complementary way rather than as a replacement for face-to-face assessments. Introducing this technology, however, challenged the team to critically explore aspects of current service provision. The introduction of technologies also has the potential to alter the dynamic of relationships between patients and families and community palliative care clinicians.
Implementation of a pilot telehealth programme in a specialist palliative community team needs to involve clinical staff in service redesign from the outset. Reliable IT infrastructure and technical support is critical for telehealth models to be effective and will aid uptake
Broom A, Kirby E, Good P, Lwin Z.
Health (London). 2015 Jul 24. pii: 1363459315595845.
The shift from life-prolonging to palliative care can be fraught with interpersonal complexities as patients face dilemmas around mortality and the dying process. Nurses can play a central role in managing these moments, often with a focus on promoting and enhancing communication around: the meaning of palliative care, the nature of futility and the dying process more broadly.
These sites of nurse-patient communication can be highly charged and pose unique challenges to nurses including how to balance nursing perspectives versus those of other stakeholders including doctors. Here, drawing on interviews with nurses, the authors explore their accounts of communication about futility and the process of transitioning to palliative care.
The interviews reveal nurses' perspectives on the following: the art of conversing around futility and managing patient resistance, the influence of guilt and individual biographies in shaping communication, the importance of non-verbal and the informal in communication, the impact of conflicting organisational expectations on nurses and the process of learning to effectively communicate. The authors conclude that these transitional moments articulate important, and at times problematic, aspects of contemporary nursing and nurse-medical relations.
Warren LA, Shi Q, Young K, Borenstein A, Martiniuk A.
Int Psychogeriatr. 2015 Jun 19:1-12.
Indigenous populations may be at increased risk, compared with majority populations, for the development of dementia due to lower education levels and socio-economic status, higher rates of diabetes, hypertension, cardiovascular disease and alcohol abuse, an aging population structure, and poorer overall health. This is the first systematic review investigating the prevalence and incidence of dementia in indigenous populations worldwide.
This systematic review was conducted in accordance with PRISMA guidelines. We searched MEDLINE, Embase, and PsycInfo for relevant papers published up to April 2015. Studies were included if they reported prevalence or incidence, the disease typically occurred after the age of 45, the study population included indigenous people, and the study was conducted in the general population.
Fifteen studies representing five countries (Canada, Australia, the USA, Guam, Brazil) met the inclusion criteria. Dementia prevalence ranged from 0.5% to 20%. Retrospective studies relying on medical records for diagnoses had much lower prevalence rates and a higher risk of bias than population-based prospective studies performing their own diagnoses with culturally appropriate cognitive assessment methods.
The prevalence of dementia among indigenous populations appears to be higher than it is for non-indigenous populations. Despite a building body of evidence supporting the need for dementia research among indigenous populations, there is a paucity of epidemiological research, none of which is of high quality.
Morphet J, Innes K, Griffiths DL, Crawford K, Williams A.
Emerg Med Australas. 2015 Oct;27(5):412-8.
Residents from aged care facilities make up a considerable proportion of ED presentations. There is evidence that many residents transferred from aged care facilities to EDs could be managed by primary care services. The present study aimed to describe the characteristics of residents transferred from residential aged care facilities to EDs, and to evaluate the appropriateness and cost of these presentations.
A retrospective review of ED records was undertaken for residents transferred from residential aged care facilities to two EDs in Melbourne, Victoria, in 2012. Data examined included residents' mode and time of arrival to ED, presenting complaint, triage category, procedures within ED, diagnosis, length of stay, and disposition. Data were examined against a previously established tool to identify resident transfers that might be 'potentially avoidable'.
There were 2880 resident transfers included in the sample, of which 408 transfers were randomly selected for scrutiny of documentation. Seventy-one residents (17.4%) were identified as being potentially avoidable transfers.
The authors conclude that many resident transfers might have been avoided with better primary care services in place. Future strategies to improve resident care might include aged care staff skill mix and the availability of outreach or primary care services.
The Care4Dementia App
The Dementia Collaborative Research Centres (DCRCs) have launched a new dementia care app (Care4Dementia) to provide guidance to carers about the behavioural changes associated with dementia.
This app is based on printed guides developed by the DCRC for Assessment and Better Care (DCRC ABC) at the University of NSW, which are also available in app form for clinicians (BPSD Guide app).
Nearly all people with dementia present with some form of behavioural or psychological symptoms throughout the course of their condition. The app includes information for carers on:
- What these behaviours look like;
- Why they might be happening;
- What can be done do to help; and
- Understanding why behavioural changes are occurring.
For behaviours of concern, carers should always seek specific guidance from a GP or other health professional who is experienced in the management of behavioural changes in dementia. Both the Care4Dementia and BPSD Guide apps are available via the iTunes and Google Play app stores.
Resolving family conflicts in palliative and aged care settings
Anita Frayman, Elder Solutions
Palliative Care Victoria Online Library - Podcast
This podcast discusses the use of mediation and family conferences to resolve family conflicts in palliative care and aged care settings. The attachment links to both the audio and PowerPoint files.
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The Decision Assist Clinical Audit for GPs
Due to the changing demographics of death in Australia and in general practice, GPs increasingly care for greater numbers of people with advanced chronic conditions that will soon lead to death. Such deaths are expected, and GPs can play a pivotal role in proactively planning and preparing for these deaths to achieve quality outcomes.
Through Decision Assist, Australian and New Zealand Society of Palliative Medicine (ANZSPM) is providing a range of educational activities for GPs accredited by RACGP and ACRRM including a/n:
These educational options are based on a framework of palliative care, a tool that uses three prognostic trajectories, to support GPs to proactively manage their patients’ care as it transitions from curative to palliative and to facilitate a quality end-of-life according to patient preferences.
The framework is founded on work undertaken both the UK (The Gold Standards Framework) and in Australia (The Palliative Approach (PA) Toolkit - Module 1: Integrating a palliative approach 374kb PDF) developed by The University of Queensland; Brisbane 2012.
More information: www.decisionassist.org.au
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