Chart based data as a resource for tracking and improving a person-centred palliative approach in long-term care.

AIMS AND OBJECTIVES: To enhance the practice of a person-centred palliative approach in long-term care. BACKGROUND: Implementing a person-centred palliative approach in long-term care entails placing residents at the centre of care planning that attends to the 'whole' person, rather than prioritising biomedical needs. DESIGN: We conducted a four-stage directed content analysis of long-term care progress notes to meet our study aims and applied the EQUATOR guidelines for qualitative research publication (COREQ). METHODS: We qualitatively analysed 78 resident charts across three long-term care homes in southern Ontario to capture the extent to which person-centred care was absent, initiated or implemented in different types of documented care interactions. RESULTS: Most residents had interactions related to daily care activities (65/78, 83%), social concerns (65/78, 83%) and treatment decisions (53/78, 68%). By contrast, interactions around pain and discomfort (34/78, 44%) and spirituality (27/78, 35%) were documented for less than half of the residents. Almost all (92%) residents had at least one progress note where staff initiated person-centred care by documenting their preference for a certain type of care, but only a third had at least one progress note that suggested their preference was implemented (35%). CONCLUSIONS: While person-centred care is often initiated by nurses and other allied health professionals, changes to care plans to address resident preferences are implemented less often. Nurses and other allied health professionals should be encouraged to elicit care preferences crucial for holistic care planning and equipped with the skills and support to enact collaborative care planning. RELEVANCE TO CLINICAL PRACTICE: Collaborative care planning appears relatively absent in charted progress notes, constraining the full implementation of a person-centred palliative approach to care. PATIENT OR PUBLIC CONTRIBUTION: An advisory group consisting of long-term care resident and staff representatives informed the overall study design and dissemination of the results.

Multi-disciplinary supportive end of life care in long-term care: an integrative approach to improving end of life.

BACKGROUND: Optimal supportive end of life care for frail, older adults in long term care (LTC) homes involves symptom management, family participation, advance care plans, and organizational support. This 2-phase study aimed to combine multi-disciplinary opinions, build group consensus, and identify the top interventions needed to develop a supportive end of life care strategy for LTC. METHODS: A consensus-building approach was undertaken in 2 Phases. The first phase deployed modified Delphi questionnaires to address and transform diverse opinions into group consensus. The second phase explored and prioritized the interventions needed to develop a supportive end of life care strategy for LTC. Development of the Delphi questionnaire was based on findings from published results of physician perspectives of barriers and facilitators to optimal supportive end of life care in LTC, a literature search of palliative care models in LTC, and published results of patient, family and nursing perspectives of supportive end of life care in long term care. The second phase involved World Café Style workshop discussions. A multi-disciplinary purposive sample of individuals inclusive of physicians; staff, administrators, residents, family members, and content experts in palliative care, and researchers in geriatrics and gerontology participated in round one of the modified Delphi questionnaire. A second purposive sample derived from round one participants completed the second round of the modified Delphi questionnaire. A third purposive sample (including participants from the Delphi panel) then convened to identify the top priorities needed to develop a supportive end-of-life care strategy for LTC. RESULTS: 19 participants rated 75 statements on a 9-point Likert scale during the first round of the modified Delphi questionnaire. 11 participants (participation rate 58 %) completed the second round of the modified Delphi questionnaire and reached consensus on the inclusion of 71candidate statements. 35 multidisciplinary participants discussed the 71 statements remaining and prioritized the top clinical practice, communication, and policy interventions needed to develop a supportive end of life strategy for LTC. CONCLUSIONS: Multi-disciplinary stakeholders identified and prioritized the top interventions needed to develop a 5-point supportive end of life care strategy for LTC.

Effects of a Brief Mindfulness-Based Attentional Intervention on Threat-Related Perceptual Decision-Making.

OBJECTIVES: Threat-related cues and contexts facilitate perceptual decision-making, yet it is unclear whether this threat-driven tuning of perceptual decision-making is modifiable by top-down attentional control. Since state and dispositional mindfulness are linked to improved attentional control, we examined whether these factors assist the use of prior knowledge to detect threatening stimuli. METHODS: Participants were randomly assigned to a brief mindfulness-based intervention (N=32) or a physics lecture audio recording (N=31) and then asked to perform a task in which they used threatening and neutral cues to discriminate between threatening and neutral faces. RESULTS: Results showed that threatening cues led to faster and more sensitive perceptual decision-making, specifically for threatening faces. Furthermore, higher levels of dispositional mindfulness were associated with improved ability to use cues to discriminate between threatening and neutral stimuli in the group that underwent a brief mindfulness induction but not in the control group. CONCLUSIONS: Our findings highlight how top-down attention-related dispositions and strategies can influence our ability to detect threats in our environment.

The role of imagery in threat-related perceptual decision making.

Visual perception is heavily influenced by "top-down" factors, including goals, expectations, and prior knowledge about the environmental context. Recent research has demonstrated the beneficial role threat-related cues play in perceptual decision making; however, the psychological processes contributing to this differential effect remain unclear. Since visual imagery helps to create perceptual representations or "templates" based on prior knowledge (e.g., cues), the present study examines the role vividness of visual imagery plays in enhanced perceptual decision making following threatening cues. In a perceptual decision-making task, participants used threat-related and neutral cues to detect perceptually degraded fearful and neutral faces presented at predetermined perceptual thresholds. Participants' vividness of imagery was measured by the Vividness of Visual Imagery Questionnaire-2 (VVIQ-2). Our results replicated prior work demonstrating that threat cues improve accuracy, perceptual sensitivity, and speed of perceptual decision making compared to neutral cues. Furthermore, better performance following threat and neutral cues was associated with higher VVIQ-2 scores. Importantly, more precise and rapid perceptual decision making following threatening cues was associated with greater VVIQ-2 scores, even after controlling for performance related to neutral cues. This association may be because greater imagery ability allows one to conjure more vivid threat-related templates, which facilitate subsequent perception. While the detection of threatening stimuli is well studied in the literature, our findings elucidate how threatening cues occurring prior to the stimulus aid in subsequent perception. Overall, these findings highlight the necessity of considering top-down threat-related factors in visual perceptual decision making. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

What Does Death Preparedness Mean for Family Caregivers of Persons With Dementia?

PURPOSE:: The purpose of this study was to clarify the concept of death preparedness for family caregivers in dementia. Conceptualization was required to support the assessment, promotion, and operationalization (ie, measurement) of death preparedness through palliative care interventions such as advance care planning. METHODS:: Rodgers evolutionary method of concept analysis was selected to guide this study because of the dynamic nature of death preparedness influenced by context, setting, and time. A comprehensive literature search was conducted. Authors performed constant comparative analysis to identify and interpret surrogate/related concepts, attributes, antecedents, and consequences of death preparedness. RESULTS:: Most importantly attributes included (1) knowing and recognizing the symptoms of decline in dementia and what dying looks like; (2) understanding emotions and grief responses; (3) accessing and appraising supports needed to manage and care for dying; (4) organizing affairs and completing tasks in advance; (5) accepting that losses are inevitable and imminent; (6) reflecting on caregiving and finding meaning, "a silver-lining"; and (7) closing, reconciling, and renewing relationship bonds and completing the family member's life. DISCUSSION:: This study contributed a full definition of death preparedness in dementia. Findings aligned with/expanded upon Hebert et al Theoretical Framework of Preparedness for End-of-Life. The use of problem- and emotion-based coping strategies by caregivers with support from health-care providers to promote feelings of death preparedness (including self-efficacy and control) and minimize uncertainty was the implication of this study. Development of a holistic preparedness instrument is underway.