Use, usability, and impact of a card-based conversation tool to support communication about end-of-life preferences in residential elder care - a qualitative study of staff experiences.
Advance care planning
Content analysis
Go wish cards
Palliative care
Patient-provider communication
Person-centered care
Qualitative research
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
02 04 2022
02 04 2022
Historique:
received:
26
08
2021
accepted:
07
03
2022
entrez:
3
4
2022
pubmed:
4
4
2022
medline:
6
4
2022
Statut:
epublish
Résumé
Proactive conversations about individual preferences between residents, relatives, and staff can support person-centred, value-concordant end-of-life (EOL) care. Nevertheless, prevalence of such conversations is still low in residential care homes (RCHs), often relating to staff's perceived lack of skills and confidence. Using tools may help staff to facilitate EOL conversations. While many EOL-specific tools are script-based and focus on identifying and documenting treatment priorities, the DöBra card tool is developed to stimulate reflection and conversation about EOL care values and preferences. In this study, we explore staff's experiences of use, usability, and perceived impact of the DöBra cards in supporting discussion about EOL care in RCH settings. This qualitative study was based on data from two participatory action research processes in which RCH staff tested and evaluated use of DöBra cards in EOL conversations. Data comprise 6 interviews and 8 group meetings with a total of 13 participants from 7 facilities. Qualitative content analysis was performed to identify key concepts in relation to use, usability, and impact of the DöBra cards in RCH practice. Based on participants' experiences of using the DöBra cards as an EOL conversation tool in RCHs, we identified three main categories in relation to its usefulness. Outcomes of using the cards (1) included the outlining of content of conversations and supporting connection and development of rapport. Perceived impact (2) related to enabling openings for future communication and aligning care goals between stakeholders. Use and usability of the cards (3) were influenced by supporting and limiting factors on the personal and contextual level. This study demonstrates how the DöBra cards was found to be useful by staff for facilitating conversations about EOL values, influencing both the content of discussion and interactions between those present. The tool encouraged reflection and interaction, which staff perceived as potentially helpful in building preparedness for future care-decision making. The combination of providing a shared framework and being adaptable in use appeared to be key features for the DöBra cards usability in the RCH setting.
Sections du résumé
BACKGROUND
Proactive conversations about individual preferences between residents, relatives, and staff can support person-centred, value-concordant end-of-life (EOL) care. Nevertheless, prevalence of such conversations is still low in residential care homes (RCHs), often relating to staff's perceived lack of skills and confidence. Using tools may help staff to facilitate EOL conversations. While many EOL-specific tools are script-based and focus on identifying and documenting treatment priorities, the DöBra card tool is developed to stimulate reflection and conversation about EOL care values and preferences. In this study, we explore staff's experiences of use, usability, and perceived impact of the DöBra cards in supporting discussion about EOL care in RCH settings.
METHODS
This qualitative study was based on data from two participatory action research processes in which RCH staff tested and evaluated use of DöBra cards in EOL conversations. Data comprise 6 interviews and 8 group meetings with a total of 13 participants from 7 facilities. Qualitative content analysis was performed to identify key concepts in relation to use, usability, and impact of the DöBra cards in RCH practice.
RESULTS
Based on participants' experiences of using the DöBra cards as an EOL conversation tool in RCHs, we identified three main categories in relation to its usefulness. Outcomes of using the cards (1) included the outlining of content of conversations and supporting connection and development of rapport. Perceived impact (2) related to enabling openings for future communication and aligning care goals between stakeholders. Use and usability of the cards (3) were influenced by supporting and limiting factors on the personal and contextual level.
CONCLUSIONS
This study demonstrates how the DöBra cards was found to be useful by staff for facilitating conversations about EOL values, influencing both the content of discussion and interactions between those present. The tool encouraged reflection and interaction, which staff perceived as potentially helpful in building preparedness for future care-decision making. The combination of providing a shared framework and being adaptable in use appeared to be key features for the DöBra cards usability in the RCH setting.
Identifiants
pubmed: 35366816
doi: 10.1186/s12877-022-02915-w
pii: 10.1186/s12877-022-02915-w
pmc: PMC8976536
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
274Informations de copyright
© 2022. The Author(s).
Références
BMC Geriatr. 2018 Aug 13;18(1):178
pubmed: 30103672
Palliat Med. 2019 Jul;33(7):743-756
pubmed: 31057042
Palliat Med. 2018 Feb;32(2):329-336
pubmed: 29017018
J Adv Nurs. 2008 Apr;62(1):107-15
pubmed: 18352969
PLoS One. 2015 Feb 13;10(2):e0116629
pubmed: 25679395
Prog Palliat Care. 2016 Jan 2;24(1):19-24
pubmed: 27134417
BMJ Support Palliat Care. 2020 Jun;10(2):164-174
pubmed: 32241957
Int J Palliat Nurs. 2017 Dec 2;23(12):596-604
pubmed: 29272197
Qual Health Res. 2021 Aug;31(10):1904-1917
pubmed: 33980082
Palliat Med. 2020 Jul;34(7):917-924
pubmed: 32383636
J Clin Nurs. 2019 Dec;28(23-24):4276-4297
pubmed: 31494997
Psychol Rev. 1977 Mar;84(2):191-215
pubmed: 847061
J Pain Symptom Manage. 2019 Aug;58(2):311-335
pubmed: 31004772
Qual Health Res. 2005 Nov;15(9):1277-88
pubmed: 16204405
J Cancer Educ. 2018 Dec;33(6):1362-1363
pubmed: 28211021
Healthcare (Basel). 2018 Jun 14;6(2):
pubmed: 29899220
J Am Med Dir Assoc. 2017 Dec 1;18(12):1000-1009.e4
pubmed: 28623155
BMC Palliat Care. 2012 Nov 27;11:24
pubmed: 23186392
J Adv Nurs. 2016 Mar;72(3):569-81
pubmed: 26558358
Implement Sci. 2018 Jan 4;13(1):1
pubmed: 29301543
BMC Palliat Care. 2019 Jan 8;18(1):1
pubmed: 30621703
Australas J Ageing. 2019 Sep;38(3):173-181
pubmed: 30873713
Collegian. 2014;21(4):337-43
pubmed: 25632731
BMC Geriatr. 2018 Feb 14;18(1):47
pubmed: 29444645
J Am Med Dir Assoc. 2016 Apr 1;17(4):284-93
pubmed: 26861748
J Am Med Dir Assoc. 2020 Mar;21(3):331-337
pubmed: 31272854
Lancet Oncol. 2017 Sep;18(9):e543-e551
pubmed: 28884703
Patient Educ Couns. 2017 Mar;100(3):425-435
pubmed: 27765378
J Palliat Med. 2020 Sep;23(9):1214-1222
pubmed: 32216645
Maturitas. 2016 Sep;91:101-9
pubmed: 27451328
J Pain Symptom Manage. 2010 Apr;39(4):637-43
pubmed: 20413053
J Community Health. 2017 Oct;42(5):926-934
pubmed: 28353007
BMC Palliat Care. 2021 Sep 22;20(1):148
pubmed: 34551749
Palliat Support Care. 2018 Aug;16(4):470-478
pubmed: 28629488
Palliat Med. 2018 Sep;32(8):1419-1427
pubmed: 29767578
J Palliat Med. 2021 Apr;24(4):514-519
pubmed: 32746685
Death Stud. 2022;46(4):803-815
pubmed: 31858889
BMC Geriatr. 2018 Jan 25;18(1):26
pubmed: 29370766
Am J Hosp Palliat Care. 2021 Jun;38(6):650-657
pubmed: 33499666
Trials. 2014 Jul 05;15:267
pubmed: 24996765
Nurse Educ Today. 2004 Feb;24(2):105-12
pubmed: 14769454
J Am Med Dir Assoc. 2019 Mar;20(3):227-248
pubmed: 30471947
JAMA. 2000 Nov 15;284(19):2476-82
pubmed: 11074777
Palliat Med. 2017 Jun;31(6):526-536
pubmed: 27683475
BMJ. 2020 May 18;369:m1927
pubmed: 32423988
BMC Geriatr. 2016 May 18;16:107
pubmed: 27193395
Am J Hosp Palliat Care. 2018 Apr;35(4):592-600
pubmed: 28782376
Palliat Support Care. 2021 Jun 23;:1-6
pubmed: 34158146
Swiss Med Wkly. 2018 Dec 30;148:w14706
pubmed: 30594990
BMC Palliat Care. 2016 Jul 07;15:55
pubmed: 27388766
BMC Palliat Care. 2020 Nov 26;19(1):179
pubmed: 33243203
Clin Interv Aging. 2017 Mar 03;12:475-484
pubmed: 28424546
J Palliat Med. 2007 Apr;10(2):297-303
pubmed: 17472498
Am J Hosp Palliat Care. 2019 Aug;36(8):697-704
pubmed: 30871338
J Gen Intern Med. 2000 Sep;15(9):620-5
pubmed: 11029675
Palliat Support Care. 2020 Feb;18(1):69-81
pubmed: 31030693
BMC Geriatr. 2018 Dec 4;18(1):302
pubmed: 30514221
Gerontologist. 2020 Sep 15;60(7):1332-1342
pubmed: 32201894
BMC Palliat Care. 2019 Dec 12;18(1):113
pubmed: 31830967