Table 2:
Subgroups and Timing of Intervention Strategies
| Intervention | Description | Subgroup | Timing of Intervention |
|---|---|---|---|
| Usual care | Current patterns of EoL care; decedents were identified with a palliative prognosis if they received at least 1 palliative care service (e.g., physician billing for palliative consultation) | All decedents (with and without a palliative prognosis in their last year of life); the former received additional interventions listed below | Current patterns of EoL care observed from linked health administrative databases at ICES |
| Palliative Team Care | |||
| PTC: In-home | An interprofessional core team that coordinates and delivers palliative services in the home, including the patient and family, a physician, nurse, social worker, and other team members (e.g., a bioethicist, a chaplain) (21) | Decedents with a palliative prognosis who received home care | When a palliative prognosis is detected in a decedent receiving home care |
| PTC: Inpatient | A team that includes a palliative care physician, a nurse, a hospital social worker, and a chaplain. The team assesses the needs of patients with respect to symptom management, psychosocial and spiritual support, and EoL care planning, and provides care and support for patients and informal caregivers (28;29) | Decedents with a palliative prognosis who received inpatient care | When a palliative prognosis is detected in a decedent receiving hospital care |
| PTC: Comprehensive | A team with an outpatient clinic and an inpatient consultant team. The core intervention includes consultation and follow-up in the clinic by a physician and a nurse. The team communicates with family physicians. Home care physicians from the team provide back-up support to family physicians doing house calls or direct care (30) | Decedents with a palliative prognosis who received home care or inpatient care | When a palliative prognosis is detected in a decedent receiving home care or hospital care |
| Patient Care Planning Discussions | |||
| PCPDs: Identifying LTC residents with EoL goals and preferences for EPC | A structured interview is used to identify LTC residents with a palliative prognosis. Residents’ physicians are notified and asked to authorize a visit by a member of an in-home palliative care team (31) | Decedents with a palliative prognosis in LTC | When a palliative prognosis is detected in a LTC resident |
| PCPDs: Ethics consultation for ICU patients with treatment conflicts | ICU nurses identify ICU patients with treatment conflicts that could lead to incompatible courses of action. An ethics consultant discusses the conflicts in easily understood ethical terms with the involved parties (e.g., patients, family, attending physicians), facilitates communication, and explores ways to address and resolve the conflicts (32) | Decedents admitted to ICU in the last month of life | When treatment conflicts are identified by ICU nurses |
| PCPDs: Improving family conferences for relatives of patients dying in the ICU | A proactive EoL conference involving the ICU team members caring for the patient and family and a brochure to facilitate communication during the conference. The aim of the family conference is to lessen the effects of bereavement for caregivers (33) | Decedents in the ICU and their families | Last ICU stay |
| Educational Interventions for Patients and Caregivers | |||
| Multicomponent psycho-educational interventions for patients and families | Education is delivered by APNs with palliative care specialty training. The APNs conduct 4 initial structured educational and problem-solving sessions by phone with the patient and caregiver. The educational approach is designed to encourage patient activation, self-management, and empowerment. The APNs also conduct monthly telephone follow-up until the patient dies (34–36) | Decedents with a palliative prognosis and their families | When a palliative prognosis is detected |
| Supportive Interventions for Informal Caregivers | |||
| Supportive interventions for informal caregivers | Direct support for caregivers (e.g., breaks from caregiving), increasing coping skills (e.g., by providing programs that develop problem-solving) and enhancing well-being (e.g., by providing counselling, relaxation or psychotherapy) (37) | Caregivers of decedents with a palliative prognosis | When a palliative prognosis is detected |
Abbreviations: APN, advance practice nurse; EoL, end-of-life; EPC, early palliative care; ICES, Institute for Clinical Evaluative Sciences; ICU, intensive care unit; LTC, long-term care; PCPD, patient care planning discussion; PTC, palliative team care.