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A Multi-Stage Process To Develop Quality Indicators For Community-Based Palliative Care Using Interrai Data, Dawn M. Guthrie, Nicole Williams, Cheryl Beach, Emma Buzath, Joachim Cohen, Anna Declercq, Kathryn Fisher, Brant E. Fries, Donna Goodridge, Kirsten Hermans, John P. Hirdes, Hsien Seow, Maria Silveira, Aynharan Sinnarajah, Susan Stevens, Peter Tanuseputro, Deanne Taylor, Christina Vadeboncoeur, Tracy Lyn Wityk Martin

Health Sciences Faculty Publications

Background: Individuals receiving palliative care (PC) are generally thought to prefer to receive care and die in their homes, yet little research has assessed the quality of home- and community-based PC. This project developed a set of valid and reliable quality indicators (QIs) that can be generated using data that are already gathered with interRAI assessments-an internationally validated set of tools commonly used in North America for home care clients. The QIs can serve as decision-support measures to assist providers and decision makers in delivering optimal care to individuals and their families.

Methods: The development efforts took part in multiple …

The Interrai Chess Scale Is Comparable To The Palliative Performance Scale In Predicting 90-Day Mortality In A Palliative Home Care Population, Nicole Williams, Kirsten Hermans, Joachim Cohen, Anja Declercq, Ahmed Jakda, James Downar, Dawn M. Guthrie, John P. Hirdes

Health Sciences Faculty Publications

Background: Prognostic accuracy is important throughout all stages of the illness trajectory as it has implications for the timing of important conversations and decisions around care. Physicians often tend to over-estimate prognosis and may under-recognize palliative care (PC) needs. It is therefore essential that all relevant stakeholders have as much information available to them as possible when estimating prognosis.

Aims: The current study examined whether the interRAI Changes in Health, End-Stage Disease, Signs and Symptoms (CHESS) Scale is a good predictor of mortality in a known PC population and to see how it compares to the Palliative Performance Scale (PPS) …

Prognosis Does Not Change The Landscape: Palliative Home Care Clients Experience High Rates Of Pain And Nausea, Regardless Of Prognosis, Nicole Williams, Kirsten Hermans, Tara Stevens, John P. Hirdes, Anja Declercq, Joachim Cohen, Dawn M. Guthrie

Health Sciences Faculty Publications

Background: Most individuals who typically receive palliative care (PC) tend to have cancer and a relatively short prognosis (< 6 months). People with other life-limiting illnesses can also benefit from a palliative care approach. However, little is known about those who receive palliative home care in Ontario, Canada's largest province. To address this gap, the goal of this project was to understand the needs, symptoms and potential differences between those with a shorter (< 6 months) and longer prognosis (6+ months) for individuals receiving PC in the community.

Methods: A cross-sectional analysis was conducted using interRAI Palliative Care (interRAI PC) assessment data collected between 2011 and 2018. Individuals with a shorter prognosis (< 6 months; n = 48,019 or 64.1%) were compared to those with a longer prognosis (6+ months; n = 26,945) across several clinical symptoms. The standardized difference (stdiff), between proportions, was calculated to identify statistically meaningful differences between those with a shorter and longer prognosis. Values of the stdiff of 0.2 or higher (absolute value) indicated a statistically significant difference.

Results: Overall, cancer was the most prevalent diagnosis (83.2%). Those with a shorter prognosis were significantly more likely to experience fatigue (75.3% vs. 59.5%; stdiff = 0.34) and shortness of breath at rest (22.1% vs. 13.4%; stdiff = 0.23). However, the two groups were similar in terms of severe pain (73.5% vs. 66.5%; stdiff = - …

“The System Is Well Intentioned, But Complicated And Fallible” Interviews With Caregivers And Decision Makers About Palliative Care In Canada, Nicole Luymes, Nicole Williams, Liz Garrison, Donna Goodridge, Maria Silveira, Dawn M. Guthrie

Health Sciences Faculty Publications

Background: Canadian palliative care (PC) philosophy seeks to support individuals in a person-centered and sensitive manner. Unfortunately, philosophy does not necessarily translate into practice and this divide may leave patients without appropriate care at the end of life, causing distress for some families. The primary goal of the study was to identify key factors affecting perceptions of quality PC from the perspective of informal caregivers and decision makers (e.g., program managers) and to understand how their experiences within the health care system may have influenced their perceptions.

Methods: Nine caregivers and 11 decision makers from Yukon Territory, British Columbia, Alberta, …

Cross-Sectional Nutrition Profile Of Palliative Home Care Clients In Ontario And Performance Of The Interrai Palliative Care Nutrition Clinical Assessment Protocol, Tara Stevens, Heather Keller, Nicole Williams, James Downar, Dawn M. Guthrie

Health Sciences Faculty Publications

Background: The nutrition profile of palliative home care clients is unknown. This study describes this group and their nutrition issues and evaluates the performance of the interRAI nutrition Clinical Assessment Protocol (CAP).

Methods: This was a cross-sectional secondary analysis using Ontario interRAI Palliative Care (interRAI PC) Assessment data. The sample represents 74,963 unique Ontario home care clients assessed between 2011 and 2018. Frequencies and standardized differences (stdiffs) of nutrition characteristics were presented for cancer (n = 62,394) and noncancer (n = 12,569) diagnostic subgroups. Rates of triggering the nutrition CAP were presented by nutrition issue to evaluate its performance.

Results: …

Potential Quality Indicators For Seriously Ill Home Care Clients: A Cross-Sectional Analysis Using Resident Assessment Instrument For Home Care (Rai-Hc) Data For Ontario, Lisa E. Harman, Dawn M. Guthrie, Joachim Cohen, Anja Declercq, Kathryn Fisher, Donna Goodridge, John P. Hirdes, Hsien Seow

Health Sciences Faculty Publications

Background

Currently, there are no formalized measures for the quality of home based palliative care in Ontario. This study developed a set of potential quality indicators for seriously ill home care clients using a standardized assessment.

Methods

Secondary analysis of Resident Assessment Instrument for Home Care data for Ontario completed between 2006 and 2013 was used to develop quality indicators (QIs) thought to be relevant to the needs of older (65+) seriously ill clients. QIs were developed through a review of the literature and consultation with subject matter experts in palliative care. Serious illness was defined as a prognosis of …