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Strengthening Community End-of-Life Care through Implementing Measurement-Based Palliative Care

Author

Listed:
  • Margaret H. Sandham

    (School of Clinical Sciences, Auckland University of Technology (AUT), North Shore Campus, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand)

  • Emma Hedgecock

    (Oceania Healthcare, Waikato 3420, New Zealand)

  • Mevhibe Hocaoglu

    (Cicely Saunders Institute of Palliative Care, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College, London WC2R 2LS, UK)

  • Celia Palmer

    (Hospice West Auckland, Te Atatu, Auckland 0610, New Zealand)

  • Rebecca J. Jarden

    (Department of Nursing, Melbourne School of Health Sciences, 161 Barry Street, Carlton, VIC 3053, Australia)

  • Ajit Narayanan

    (School of Engineering, Computing and Mathematical Sciences, Auckland University of Technology (AUT), AUT Tower, 2-14 Wakefield Street, Auckland 1010, New Zealand)

  • Richard J. Siegert

    (School of Clinical Sciences, Auckland University of Technology (AUT), North Shore Campus, 90 Akoranga Drive, Northcote, Auckland 0627, New Zealand)

Abstract

The increasing demand for palliative care in New Zealand presents a potential threat to the quality of service delivery. One strategy to overcome this is through the implementation of valid and reliable patient-reported outcome measures. This mixed-methods study aimed to (1) implement measurement-based palliative care (MBPC) in a community palliative care service in Auckland, New Zealand; (2) evaluate the clinical utility of MBPC perceived by clinicians; (3) describe patient characteristics as measured by the Integrated Palliative Care Outcome Scale (IPOS), the Australasian Modified Karnofsky Performance Scale (AKPS), and Phase of Illness (POI); and (4) evaluate the internal consistency of the IPOS. Participants were over 18 years of age from a community outpatient palliative care service. In a phased approach to implementation, healthcare staff were educated on each instrument used for patient assessment. Uptake and internal consistency were evaluated through descriptive statistics. An interpretive descriptive methodology was used to explore the clinical utility of MBPC through semi-structured interviews with seven clinical staff members. Individual patient assessments ( n = 1507) were undertaken predominantly on admission, with decreasing frequency as patients advanced through to the terminal phase of their care. Mean total IPOS scores were 17.97 (SD = 10.39, α = 0.78). The POI showed that 65% of patients were in the stable phase, 20% were in the unstable phase, 9% were in the deteriorating phase, and 2% were in the terminal phase. Clinicians reported that MBPC facilitated holistic and comprehensive assessments, as well as the development of a common interdisciplinary language. Clinicians expressed discomfort using the psychosocial and spiritual items. Measurement-based palliative care was only partially implemented but it was valued by staff and perceived to increase the quality of service delivery. Future research should determine the optimal timing of assessments, cultural responsivity for Māori and Pacific patients, and the role of MBPC in decision support for clinicians.

Suggested Citation

  • Margaret H. Sandham & Emma Hedgecock & Mevhibe Hocaoglu & Celia Palmer & Rebecca J. Jarden & Ajit Narayanan & Richard J. Siegert, 2022. "Strengthening Community End-of-Life Care through Implementing Measurement-Based Palliative Care," IJERPH, MDPI, vol. 19(13), pages 1-12, June.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:13:p:7747-:d:846739
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    References listed on IDEAS

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