Medicine and Health Sciences Commons^™

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, …

A Newly Identified Impairment In Both Vision And Hearing Increases The Risk Of Deterioration In Both Communication And Cognitive Performance, Dawn M. Guthrie, Nicole Williams, Jennifer Campos, Paul Mick, Joseph B. Orange, M. Kathleen Pichora-Fuller, Marie Y. Savundranayagam, Walter Wittich, Natalie A. Phillips

Health Sciences Faculty Publications

Vision and hearing impairments are highly prevalent in adults 65 years of age and older. There is a need to understand their association with multiple health-related outcomes. We analyzed data from the Resident Assessment Instrument for Home Care (RAI-HC). Home care clients were followed for up to 5 years and categorized into seven unique cohorts based on whether or not they developed new vision and/or hearing impairments. An absolute standardized difference (stdiff) of at least 0.2 was considered statistically meaningful. Most clients (at least 60%) were female and 34.9 per cent developed a new sensory impairment. Those with a new …

The Relationship Between Caregiver Burden And Depressive Symptoms In Ontario Home Care Clients, Nicole Williams, Samantha Jamal, Dawn M. Guthrie

Health Sciences Faculty Publications

The onset of depressive symptoms is common in home care clients and their caregivers. Understanding the experience of the informal caregiver can assist clinicians in providing services to maximize the well-being of both the client and their caregivers. The objectives of this article are to examine risk factors for the development of depressive symptoms. A longitudinal analysis design was completed for clients with 2+ assessments. The development of depressive symptoms was defined as a Depression Rating Scale score of 3+ on re-assessment. The results-overall, 10.7% of clients experienced new depressive symptoms and clients with a caregiver who was feeling distressed, …