Integrating quality of life assessments into acute care for older adults with chronic life-limiting illness

This Quality of Life Assessment and Practice Support System (QPSS) will consist of carefully selected questions that nurses can use to obtain patients’ and family caregivers’ perspectives about their quality of life (QOL) concerns and care needs. It will also inform the practice of health care professionals by providing appropriate suggestions about how to manage the QOL concerns identified during the assessment.

About the Project

Older adults who have advancing chronic and life-limiting illnesses present significant challenges for health care delivery in hospital-based settings. They often have complex problems that affect their ability to function and their overall QOL. Routine assessment of their perceived health care needs and their QOL make patients’ and family caregivers’ concerns more visible to health care professionals, so that they can be effectively monitored and addressed. These types of assessments involve asking people about their symptoms, their physical, psychological, social and existential/spiritual wellbeing and their experiences with health care.

This project involves the design and implementation of an electronic (tablet-based) practice support tool for clinicians in hospital-based care settings to assess health-related concerns relevant to the QOL of older people with chronic life-limiting illnesses, and that of their family caregivers. The QPSS will be developed and tested in collaboration with health care professionals, patients and family caregivers.

Project Team

Principal Investigators:

Richard Sawatzky, PhD, MSc, BSc, RN — Trinity Western University

Robin Cohen, PhD, MSc, BSc — Jewish General Hospital

Co-Investigators:

Kristofer Årestedt, PhD — Ersta Sköndal University College

Joan Bottorff, PhD — University of British Columbia

Stirling Bryan, PhD — University of British Columbia

Peter Dodek, MD, MHSc — Providence Health Care

Anne Gadermann, PhD — Providence Health Care

Daren Heyland, MD, MSc, BSc — Kingston General Hospital

Naomi Kogan, MSW — Jewish General Hospital

Sandra Lauck, PhD — Providence Health Care

Joakim Öhlén, PhD — Ersta Sköndal University College

Sheryl Reimer Kirkham, PhD — Trinity Western University

Kara Schick-Makaroff, PhD, RN — University of Alberta

Kelli Stajduhar, PhD, MSN, BN, RN — University of Victoria

Henry Stelfox, BMSc, MD, PhD — University of Calgary

Herbert Tsang, PhD — Trinity Western University

Knowledge Users and Partners:

Sharon Baxter, Executive Director — Canadian Hospice Palliative Care Association

Stuart Brown — Abbotsford Regional Hospital

Shelly Cory, MA — Canadian Virtual Hospice

Kathleen Cuthbertson — B.C. Ministry of Health

Joanne Friesen — Abbotsford Regional Hospital

Ella Garland, RN, MN, CHPCN(C) — Providence Health Care Research Institute (B.C.)

Neil Hilliard, MD, MCFP(PC) — Fraser Health Authority

Christie Kay — Abbotsford Regional Hospital

Janis McGladrey, MA, BScN, RN, CHE — Providence Health Care Research Institute (B.C.)

Barbara McLeod, MSN — Fraser Health Authority

Stephen Mitchinson, MD — Abbotsford Regional Hospital

Amanjit Poonian — Abbotsford Regional Hospital

Della Roberts, RN, MSN, CHPCN(C) — Fraser Health Authority

Simin Tabrizi — Providence Health Care Research Institute (B.C.)

Carolyn Tayler, RN, MSA, CON(C) — Fraser Health Authority

André Tourigny, MD, MBA — Institut national de santé publique

Becky Williams — Abbotsford Regional Hospital

Daphne Williscroft, RN — Fraser Health Authority

Project Contact: Richard Sawatzky — rick.sawatzky@twu.ca

CAT 2013-51

Key words: quality of life; patient-reported outcomes; patient-centred care; life-limiting illness; older adults

Key Findings for Families

The electronic quality of life assessment system can be used by clinicians to get important information from older adults and their family caregivers to understand their healthcare needs and concerns.

In the context of hospital-based palliative care, this research explored the feedback of the users of the system, examined the factors associated with the implementation of this system, and provided recommendations to help improve this system and make it more clinically useful
Several issues related to the use of this electronic quality of life assessment system were identified: the organizational context (how they fit into work-flow), the technology (is it easy to use and lightweight), consulting with users of the tool (how could they best use it), education (being taught how and when to use the tool), and the cost-benefit ratio
The feedback from the users of the tool will help to improve the electronic quality of life assessment system and its use

Why This Matters

Older adults who are very sick can be difficult for healthcare providers to care for in hospital-based settings. They often have complex problems that affect their ability to function and their overall QOL. The use of standardized assessment tools such as this system can help make patients’ and family caregivers’ concerns more visible to healthcare professionals, so that they can be effectively monitored and addressed.

About This Study

Barriers and facilitators to the use of the electronic (tablet-based) tool embedded with standardized QOL assessment questionnaires in clinical practice were evaluated
Focus groups and interview with key stakeholders (clinicians, patients, family members, caregivers and healthcare administrators) were conducted to generate input on the usability and integration of the assessment system
Iterative description was used to identify users’ behavioral and perceptional patterns and to understand the factors and relationships associated with its use in the clinical setting
Formative evaluation was used to understand and monitor the development of this systemand the use of the quality of life assessments in clinical practice

Key Findings for Policy

The electronic QPSS can help healthcare providers understand the needs of patients faced with chronic life-limiting illnesses.

The desirable features of the electronic QPSS related to its use and workflow and implementation in practice were identified through clinician engagement
The factors that had resulted in limited uptake of the system in clinical practice include technical workflow challenges, institutional context, differing perspectives among clinicians regarding the use of standardized tools
The need of further education and ongoing support for clinicians on the use of technology and standardized questionnaires has been recommended for successful integration of such technology in daily clinical practice

Why This Study was Needed

Older adults who have advancing chronic and life-limiting illnesses present significant challenges for healthcare delivery in hospital-based settings. They often have complex problems that affect their ability to function and their overall QOL. The use of the electronic QPSS embedded with standardized assessment tools, can help make patients’ and family caregivers’ concerns more visible to healthcare professionals, so that their health care needs can be effectively and efficiently monitored and addressed.

The electronic QPSS can help clinicians to obtain important information from older adults and their family caregivers regarding their healthcare needs and concerns. This research provides an essential understanding of the needs of the users of this electronic system in the context of hospital-based palliative care.

Study Summary

Barriers and facilitators to the use of this system, an electronic (tablet based) embedded with standardized QOL assessment questionnaires, in practice were evaluated
Focus groups and interview with key stakeholders (clinicians, patients, family members, caregivers and healthcare administrators) were conducted to generate input on the usability and integration of such electronic system
Iterative description was used to identify behavioural patterns and differing perspectives in clinical practice and to understand perceived benefits and tensions associated with the use of such system in the clinical setting, and to make recommendations for future clinical practice
Formative evaluation was used to understand and modify the process of developing and integrating such electronic system in the clinical setting

Key Findings for Researchers

The electronic QPSS can help healthcare providers understand the needs of patients faced with chronic life-limiting illnesses.

The desirable features of QPSS in terms of its use and workflow and implementation in practice were identified through clinician engagement
The factors that had resulted in limited uptake of QPSS in clinical practice include technical workflow challenges, institutional context, differing perspectives among clinicians regarding the use of standardized tools
The need of further education and ongoing support for clinicians on the use of technology and standardized questionnaires has been recommended for successful integration of QPSS-like technology in daily clinical practice

The electronic QPSS can be used by clinicians to obtain important information from older adults and their family caregivers regarding their healthcare needs and concerns. This research provides an essential understanding of the needs of the users of such electronic system in the context of hospital-based palliative care.

Why This Study was Needed

Older adults who have advancing chronic and life-limiting illnesses present significant challenges for healthcare delivery in hospital-based settings. They often have complex problems that affect their ability to function and their overall QOL. The use of the QPSS embedded with standardized QOL assessment tools can help make patients’ and family caregivers’ concerns more visible to healthcare professionals, so that their health needs can be effectively monitored and addressed.

How This Study Addresses the Gap

Barriers and facilitators to the use of the QPSS, an electronic (tablet-based) standardized QOL assessment system, in practice have been identified
Feedback and perceptions of key stakeholders (clinicians, patients, family members, caregivers, and healthcare administrators) have been generated on the usability and integration of such system in clinical practice and patient care
The behavioural patterns and differing perspectives of clinicians associated with using the QPSS have been examined, thus resulting in interpretations and recommendations related to future clinical practice. Challenges have been identified in the implementation process of the QPSS. This has led to better understandings of this integration in the institutional context

Future Research

To further understand organizational context, clinician’s previous experiences of using the QPSS, the patterns of interdisciplinary communication and workflow
To further foster conceptual evolution in clinicians on the use of electronic standardized QOL assessments in practice and the realization of technical challenges associated with the implementation of such system
To further develop clinical competency in using electronic standardized QOL assessments, and to provide education that enables clinicians to increase such competency in their routine practice

Presentations

Presentations

Laforest, E., Sawatzky, R., Schick-Makaroff, K., Stajduhar, K., Krawczyk, M., Wang, R., Hilliard, N., Neufeld, C., Lett, J., Tayler, C., Voth, J., Cohen, R. (October 2016). Desirable features of a Quality of Life Assessment and Practice Support System (QPSS) in Palliative Acute and Home Care. The 21st International Congress on Palliative Care. Montréal, QC.

Schick-Makaroff, K., King, G., Laforest, E., Cohen, R., Neufeld, C., Lett, J., Voth, J., Sawatzky, R. (October 2015). Integrating quality of life assessments into acute care for older adults with chronic life-limiting illnesses. The 22nd International Society of Quality of Life Conference. Vancouver, BC.

Laforest, E., Schick-Makaroff, K., King, G., Wang, R., Cohen, R., Neufeld, C., Lett, J., Voth, J., Sawatzky, R. (September 2015). Quality of life Assessment and Practice Support System (QPSS) in acute care. The 3rd Annual Conference on Improving Care for the Frail Elderly. Toronto, ON.

King, G., Voth, J., Schick-Makaroff, K., Neufeld, C., Lett, J., Sawatzky, R. (September 2014). Integration of Quality of Life Assessments into Acute Care for Older Adults with Chronic Life-Limiting Illness: Clinician Perspectives. The 2nd Annual Conference on Improving Care for the Frail Elderly. Toronto, ON.

Webinars

CFN Webinar (April 20, 2016): An electronic quality of life and practice support system (QPSS) for person-centred older adult care