- Title
- Improving care of the imminently dying: a three-stage implementation science project to develop, pilot and assess a care bundle for the dying
- Creator
- Clark, Katherine
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2016
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Even though the majority of Australians are likely to die in an acute hospital setting, imminently dying in-patients are not universally guaranteed to receive high quality health care based on their specific needs. As a result, the experiences of many dying patients and their families are sub-optimal. Given the numbers of deaths in hospital are predicted to exponentially rise over the next 25 years there is an urgent need exists to address this situation. This project was undertaken to investigate first how appropriate and care processes identified as efficacious in other cohorts could be incorporated into a care bundle with this bundle then introduced into the routine care of imminently dying inpatients; and second ways to measure the potential impact of the care bundle on patients, their families and health care professionals. An implementation research approach to undertaking this project was selected given the main tasks selected for this work included the introduction and testing of the impact of evidence-based care processes. The whole project was organised according to the Promoting Action on Research Implementation in Health Services framework which uses a sequential three stage approach with each stage informing the next. Stage 1 was undertaken to define the extent to which care at the end of life is routinely provided in a quality context and to identify the actual existing care gaps. Stage 2 summarised the development of the care bundle and the implementation plan. Stage 3 described the piloting of the bundle and tests the feasibility of assessing the impact of the bundle on patients’, families’ and staffs’ experiences. The whole project is described as a thesis which is composed of eight chapters. Chapter 1 is the introductory chapter which presents essential background information to help contextualise this work and details the aims of the whole project. Chapter 2 is a narrative that explores and defines quality health care for this work with this chapter highlighting that unlike other patient cohorts, people dying in hospital are at risk of not receiving quality health care. As a result, dying patients are less likely to have their specific needs addressed. This chapter concludes with the first published paper, an opinion piece that defines the need for a change in the way end of life care is practiced in Australia. Chapter 3 provides a summary of the whole project based on the study protocol. It defines the necessary stages and the activity required to complete each stage with Chapter 4 a copy of the protocol paper submitted for publication. Chapter 5 is a record of the sub-studies undertaken to define some of the issues that confront dying patients with the overarching aim being to define existing gaps in care. A mixed methods approach was taken to collating this data with the results summarised in three papers namely an audit of usual care; a systematic review of the literature; and interviews with bereaved families. Combined, these papers highlight that although the self-identified needs of patients dying in acute care have been explored in the literature, at least in this part of NSW, routine care would not universally address dying patient’s needs. Chapter 6 has two sections. The first details the development of the care bundle with the contents of the bundle and supporting documentation included in Appendix C (Supporting information). The latter summarises the implementation of the bundle with the results of the implementation process detailed in an accepted paper. Briefly, over six months, the bundle was implemented in 74.5% of deaths with a significant improvement in dying patients’ symptoms and assessments of family distress. Chapter 7 is composed of three papers which describe separate sub studies undertaken to test the feasibility of using the bundle in terms of patient-centered, family- centered and staff-centered outcomes. The results of these studies were notable that while compliance with the bundle was good and objectively measured patient outcomes improved, no striking changes were noted in the degree of distress that families who agree to be interviewed described. Finally, Chapter 8 summarises the project to date, including the conclusion that even whole this project to date can only be considered a pilot project, and it has been conducted with sufficient quality and rigor to progress to a more definitive study. Indeed, this would not be possible without this initial project. As a result, this chapter also begins the discussion of further plans to more definitively test the benefits of integrating this care bundle more widely and ends with a personal reflection. In conclusion, for the majority of Australians, death will occur in an acute hospital. However, acute hospitals are places that focus in on the delivery of disease–modifying treatments delivered with the intent of prolonging life. When cure is not possible, such care becomes burdensome and unnecessarily costly, while failing to meet people’s needs. A real need exists to urgently address this situation. Projects such as this one, now summarised in this thesis provide evidence to support it is possible to implement and test changes to address this significant care gap.
- Subject
- care of the dying; acute hospitals; quality of care; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1321921
- Identifier
- uon:24481
- Rights
- Copyright 2016 Katherine Clark
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 11 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 11 MB | Adobe Acrobat PDF | View Details Download |