Evaluation of the Encouraging Better Practice in Aged Care (ebpac) Initiative Final Report

12Palliative Approach Toolkit survey results

Respondents were asked to rate the workshop in terms of meeting their expectations. Figure shows that the Palliative Approach Toolkit workshop met, exceeded or greatly exceeded the expectations of the vast majority of respondents (n=272, 98.5%).

Figure Palliative Approach Toolkit workshop meeting expectations

Figure shows that the majority of respondents felt PowerPoint slides, handouts and other resources used during the workshop assisted their learning, with 264 (94.9%) respondents in either agreement or strong agreement.

Figure Palliative Approach Toolkit PowerPoint slides, handouts and other resources used during workshop assisting learning

Figure shows that the majority of respondents felt that the length of the workshop was ‘about right’ (n=245, 88.8%). Only a small number of respondents (n=23, 8.3%) felt the workshop was too short, and even fewer felt the workshop was too long (n=8, 2.9%)

Figure Length of the Palliative Approach Toolkit workshop

230 respondents provided a response to the question ‘What was most valuable about the [Palliative Approach Toolkit] workshop?’ A variety of aspects of the Palliative Approach Toolkit workshop were identified as most valuable. Overwhelmingly, most respondents felt the Palliative Approach Toolkit itself was most valuable. It was seen as a great resource which could be utilised in the workplace by all staff, not just those in attendance at the workshop. The documentation and materials contained within the toolkit, for instance end of life care pathways, were seen by many to be very useful. Learning about the different components of the toolkit and how to utilise them was also valued.

Another common positive theme was the delivery of the workshop, in particular the high quality presenters, who were described as experienced, passionate and interactive. The ability to ask the presenters questions and receive thoughtful responses was also valued.

The opportunity to network with staff from other facilities was another key theme that emerged. Many respondents noted that they valued the chance to have discussions with colleagues and learn from each other’s experiences.

A number of respondents seemed to be encouraged by what they learnt at the workshop confirming to them that they were ‘on the right track’ in terms of their palliation practices.

While the knowledge and skills acquired were important to many, others found the workshop revealed to them the significance of evidence based palliative care. For example one respondent stated ‘[the workshop] enhanced my awareness of the importance of providing a high standard of palliative care in aged care facilities’.

Several respondents noted that all aspects of the workshop were valuable.

When asked ‘What was least valuable about the [Palliative Approach Toolkit] workshop?’ 164 respondents answered, of which 104 (63.4%) said nothing was least valuable, because, as many of these respondents stated, ‘All was valuable’. Of the respondents that did identify least valuable aspects, most commonly identified was that the length of workshop was too short (although as shown in Figure this was a relatively small proportion of respondents) and problems with the venue (e.g. seating arrangements, too many attendees, audio problems), by nine respondents respectively. Five respondents identified small group sessions as least valuable, however, as discussed earlier group sessions were identified by some respondents as the most valuable aspect of the workshop, and as can also be seen in Figure , the majority of respondents found small group activities supported their learning. This reflects differences in individual learning preferences. Other least valuable aspects mentioned by at least two participants were:

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  Lack of recognition of existing tools, systems and process to deliver high quality palliative care
  
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  Lack of locally specific / relevant information
  
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  Lack of focus on community care because too much focus on residential care
  
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  Length of workshop was too long
  
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  Not receiving the toolkit or receiving it late
  
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  No information on medications.
  

Figure shows responses to nine ‘yes-no’ questions. The vast majority responded positively to most of the questions, indicating that, overall, the workshop was a success. Specifically:

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  Attending a workshop was the preferred mode of delivery of this type of education for almost all respondents (n=265, 97.1%). Seven respondents indicated they would prefer an online/webinar format, while hands on training at the facility, having smaller groups, and a workshop conducted locally were each suggested by one respondent respectively.
  
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  Almost all respondents would recommend the workshop to a colleague (n=267, 98.2%).
  
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  Small group activities used in the workshops supported the learning of most (n=256, 94.1%).
  
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  227 (88.3%) respondents reported that their knowledge/skills increased as a result of participating in the workshop. Various examples of increased knowledge/skills were provided by 74 respondents, including (but not limited to): improved knowledge of the palliative approach generally; more specifically improved knowledge/skills relating to assessment of clients/residents, legal aspects, trajectories, end of life pathways, advanced care planning, pain management, oral care, medications and clinical conferencing. Other examples were improving workplace palliative care documentation, being better able to pass on training to staff, knowledge about commencing and implementing the toolkit in the facility, becoming familiar with tools/resources/support available and greater awareness of the need to support families and share information with colleagues. A number of respondents also noted that existing skills and knowledge were reinforced or refreshed.
  
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  The Palliative Approach Toolkit has largely been supported by management (n=225, 87.2%). Of those who indicated that it was not supported (n=23, 8.9%) or they did not know (n=10, 3.9%), reasons given included already having a palliative toolkit in place, not having infrastructure in place, not having provided training to staff, facility not promoting advance care planning, competing priorities of facility/service (e.g. implementing the Living Well Dying Well project), lack of staffing numbers and lack of time for implementation. Some respondents had changed facility since the workshop and one respondent did not receive the toolkit. Nonetheless, a number of these respondents who stated the Palliative Approach Toolkit has not been supported by management explained that the issue may be more about delays (e.g. changeovers in senior management delaying formation of a working party and subsequent implementation) and lack of management time, rather than opposition to the toolkit, and felt that support and implementation may be achieved at a later date.
  
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  Twenty-one (83.7%) respondents indicated that the Palliative Approach Toolkit (at least one aspect/component of it) had been used within their facility, and gave various example of how it had been used, including using the resources to develop local information and documentation generally, and more specifically end of life pathways, the implementation guide, the DVDs and using the delirium education for a resident with delirium. Twenty-seven respondents who had not used any component or aspect of the toolkit provided several reasons why it had not been used. The main reasons were that management (and other staff) still required education and engagement to support implementation or that their current practices and approach were adequate and similar to those of the toolkit or that more long-term planning was required. Other respondents stated that implementation was scheduled to commence shortly.
  
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  Most respondents were optimistic about sustaining changes in practice relating to a palliative approach (n=231, 94.7%). Of those who indicated they did not think they could sustain changes in practice, a number of reasons were given. Two respondents cited management as the reason, another two respondents cited no change yet being made, and another two cited lack of time to roll out/support team to sustain change. Other reasons given were lack of education to support staff, the toolkit not being accessible and unwillingness of staff to change practices. One respondent saw the change in practice (and sustaining this change) as a long term endeavour, stating it ‘will be a two year project’.
  

Again, the same two questions that received less positive responses in the Champions for Skin Integrity (CSI) survey were also less positive in the Palliative Approach Toolkit survey. These were ‘Have staff at your facility who did not attend a workshop been trained in the use of any aspect(s) of the Palliative Approach Toolkit?’ and ‘As a result of attending the workshop was there anything you changed or did differently to manage your residents’ palliative care?’ These less positive results suggest that greater focus on dissemination, training and change management may be required, as 35.6% of respondents indicated that facility staff that did not attend the workshop had not been trained in the use of any aspect(s) of the Palliative Approach Toolkit. The fact that 30.6% of respondents reported that no change in palliative care had occurred is disappointing, but perhaps not unexpected, due to the complexities of implementing change in workplace practices.

Figure Responses related to Palliative Approach Toolkit workshop delivery and outcomes

Respondents were asked whether they have ‘Anything else to add’, to which 108 responses were provided.

Most final comments were positive. Compliments about the workshop and the Palliative Approach Toolkit were most common, which were seen by many as high quality and practically helpful. A number of respondents stated it was the best education session they had attended, and that they ‘love’ the toolkit. The following quotes are illustrative of this positive sentiment:

Using the toolkit has streamlined and improved palliative care delivery ... staff have fully embraced the use of the toolkit.

This training was invaluable to my continued learning and skills set, to ensure the best possible outcome for my residents.

The supportiveness of local management and palliative care committees was also noted by a number of respondents, which was perceived as important in promoting best practice standards and in the implementation of the Palliative Approach Toolkit.

Despite being positive about the workshop and toolkit, some respondents noted that implementation had not yet occurred. Nonetheless, there seemed to optimism and enthusiasm for implementation from most of these respondents.

Many respondents indicated they would like to attend more education sessions, and a number also stated that the availability of this education needs to increase to more categories of staff, in all facilities. The need to develop education (and a toolkit) for the community setting was also noted by several respondents. Ongoing support for incremental change was also requested.

Various changes to practice that have occurred since attending the workshop were listed by several respondents, including:

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  Increased input from family, residents, pastoral care, nursing and support staff, etc.
  
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  Policies and procedures relating to palliative care reviewed by working parties with improvements made
  
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  Contacted pharmacist regarding emergency stock of medicines
  
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  Increased palliative care education for staff of all categories
  
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  Improved documentation regarding case conferencing
  
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  Family information nights held with resources relating to palliative and end of life care provided and encouragement to complete Advance Health Directives.
  

The following quote is illustrative of positive comments and demonstrates the significant impact the workshop and toolkit had on some attendees:

Very worthy project … Great outcomes for residents and their loved ones … I'm enjoying aged care nursing much more since the Palliative Approach Toolkit workshop.

Although describing the workshop and toolkit positively, a number of respondents emphasised that their service already had an adequate palliative approach. For instance, they were already using the end of life pathways, conducting palliative and end-of life case conferences, and utilising advanced care planning.

A small number of final comments highlighted areas for improvement. These included:

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  Frustration with the lack of standardisation in palliative care documentation nationally
  
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  Problems claiming case conferences from Medicare due to the requirement of having three multidisciplinary team members present which can be difficult in nursing homes
  
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  Problems with the venue and large attendee numbers
  
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  Delays in receiving resources and delays in feedback (e.g. regarding after death audits)
  
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  Confusion regarding whether after death audits still need to be submitted and if new pathways will be implemented
  
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  More information and education directed at GPs to increase cooperation and support
  
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  Lack of engagement with the workshop and toolkit by AINs despite incentives being offered.