Palliative care Needs Rounds in rural residential aged care: A mixed-methods study exploring experiences and perceptions of staff and general practitioners
Date
2019
Authors
Rainsford, Suzanne
Johnston, Nikki
Liu, Wai-Man
Glasgow, Nicholas
Forbat, Liz
Journal Title
Journal ISSN
Volume Title
Publisher
Taylor & Francis
Abstract
New approaches are needed to assist residential aged care (RAC) staff increase their skills and confidence in
identifying when residents are nearing the dying phase and managing symptoms. One new evidence-based
approach to improve palliative and end-of-life care in RAC is outreach Specialist Palliative Care Needs
Rounds (monthly triage and risk stratification meetings – hereafter Needs Rounds); as yet untried in rural
settings which may face unique enablers or challenges. Needs Rounds were introduced into two RAC
facilities in the rural Snowy Monaro region of New South Wales, Australia. This study explored staff and
general practitioners’(GPs’) experiences and perceptions of palliative and end-of-life care in rural RAC,
and staff confidence and capability in providing such care, prior to, and after the introduction of Needs
Rounds. A mixed-methods, pre- and post-intervention approach was taken, utilizing a Likert-scale written
questionnaire and face-to-face semi-structured interviews. Between March and November 2018, 61
questionnaires were completed by 48 RAC staff (33 pre-, 28 post-intervention); eight staff and three GPs
were interviewed. Despite system and site-specific barriers, staff self-reported that Needs Rounds
increased their capability in providing end-of-life care (p = 0.04; 95% CI 0.20–7.66), and improved staff:
(1) awareness of end of life, reflective practice, and critical thinking; (2) end-of-life decision making and
planning; and (3) pain management. Needs Rounds are acceptable and feasible in rural RAC. Palliative
and end-of-life care for residents may be improved through education, collaboration, communication, and
planning. Further studies should explore running Needs Rounds via telehealth and/or utilizing a
multidisciplinary approach.
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Keywords
Homes for the aged, palliative care, end of life care, older persons, goals of care, Needs Rounds, mixed methods research
Citation
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Source
Progress in Palliative Care
Type
Journal article
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Access Statement
Open Access
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