Palliative Care

The interview questions were informed by the theory of Organizational Readiness for Change (ORC) developed by Weiner [17 (link)]. ORC was also used as a framework to analyze the data by means of categorizing barriers and facilitators for implementing evidence-based palliative care in terms of the skills and knowledge addressed in the seminars.
ORC is conceptualized as a “shared team property” among organization members, but it can be assessed at both individual and supra-individual levels (e.g., team, department, or organization) [17: 5]. We used ORC to study the supra-individual level since the implementation of more substantial changes in health care usually requires collective and coordinated actions by many organization members [17 (link)]. ORC posits that organization members’ change commitment and change efficacy promote organizational readiness to implement change. The term “readiness” connotes a state of being both psychologically and behaviorally prepared to take action (i.e., willing and able). The theory also describes contextual factors as a determinant of organizational readiness to change because such factors can influence change commitment and change efficacy. The three overarching determinants of ORC are [17 (link)] as follows:

Change efficacy: organization members’ beliefs in their capabilities to execute the planned actions involved in the change. Can they implement this change effectively given the situation they currently face?

Change commitment: organization members’ resolve to pursue the courses of action involved in change implementation. To what extent do organization members value the specific impending change?

Context: resources, structure, and culture that influence the organization members’ preparedness to implement the change. How does the context affect the organizational members’ willingness or ability to take action?

interRAI Fellows from 12 countries (Australia, Canada, Czech Republic, France, Iceland, Italy, Japan, South Korea, Netherlands, Norway, Spain, and United States) volunteered to test one or more of five instruments available by 2005 for long-term care facilities, home care, palliative care, post-acute care, and mental health. Individual researchers selected instruments based on the availability of pilot sites in their countries, which was often dependent on patterns of use of the earlier versions of the instruments. For each instrument, interRAI created a detailed item by item instruction manual, with item definitions, process instructions, and examples. Field staff members were trained to do the assessments following this instructional set. These trained clinicians then completed dual assessments for 783 individuals. As shown in Table 1, the most widely tested instrument was the LTCF (8 countries, 31% of assessments) and the least common was MH (1 country, 11% of assessments). The largest number of assessments came from Canada (147 pairs), the United States (141 pairs), and Iceland (80 pairs), and the fewest were obtained from Spain (29 pairs) and Japan (28 pairs).

This study utilised a qualitative, exploratory design [30 ] to examine healthcare professionals’ perspectives on the impact/s of natural disasters on end-of-life care. Participants were recruited through social media, Facebook, and Linkedin, emails to end-of-life care services listed on the Palliative Care Australia website, and through snowball sampling. For inclusion in the study, participants needed to be aged 18 years and over and have had recent experience in the provision of end-of-life care during a natural disaster, COVID-19, bushfire, or flood. In-depth semi-structured interviews were undertaken by MK, an experienced qualitative researcher and counsellor, between February 2021 and June 2021. Sampling ceased when no new information was being generated in the interviews with regards to the themes identified here. Interviews ranged from 51 to 94 min, averaged 69 min, and were conducted in person (n = 2), online via Zoom (n = 5), or by telephone (n = 3) according to participants’ preference and capacity within the COVID-19 pandemic. Participants read and signed an informed consent form prior to the interview and received an AU$20 online gift card in recognition of their time.
The interview schedule was prepared during a series of discussions between the project team consisting of doctors, psychologists, and end-of-life care researchers. The questions were pilot tested, and the interview guide was refined to include emerging themes. Refer to Supplementary file 1 for the interview guide. No concerns arose during the pilot interview, so it was included in the final analysis. Open ended interview questions included ‘Tell me about your experience with a recent disaster’, and ‘Tell me how the disaster impacts on your role, your clients and the services you provide’. Follow-up questions were used as prompts during the interviews to explore the experiences of end-of-life service providers. The study was approved by the Australian National University Human Research Ethics Committee (2020/378). The reporting of this study is in accordance with the Standards for Reporting Qualitative Research (SRQR) checklist [31 ].

We administered the survey between September and December 2019. The questionnaire included the following items: facility background, evaluation tools used at the institution, whether PROMs or non-PROM evaluation tools were used, whether evaluation tools were used routinely, whether evaluation tools were used for screening, patient and provider opinions on PROs, if the facility had discontinued the use of PROMs, and the reasons for discontinuing the use of PROMs if so. We sent one reminder only to the institutions that did not respond to our initial contact (i.e., mailing the study questionnaire and relevant information). The questionnaire was developed through discussion by researchers who were experts in palliative care based on previous studies.

This study administered questionnaires and conducted online or telephone interviews. The questionnaires were sent to all institutions providing specialized palliative care in Japan and that were willing to participate in this portion of the study. The questionnaire surveyed respondents (healthcare providers) about their routine use of PROMs and their opinions on PROs. The interviews were conducted with informants who were healthcare providers. The interview asked healthcare providers for specific examples in regard to the usefulness of PROs as well as the barriers to their use; the interview also queried healthcare providers about effective methods used for collecting PROs. Respondents were to be representatives reporting on the institutional reality, not on their personal experience. Although we did not apply for ethical approval for this study, we conducted the study in accordance with Japanese research guidelines, including anonymity and respect for the respondents’ right to free will to participate in the study. For this study, the return of the questionnaire was regarded as the provision of consent for participation in the survey, and consent for participation in the interviews was obtained by e-mail or telephone. Participation in the survey was voluntary. All the survey results were statistically processed and the names of the hospitals were not disclosed to ensure ethical consideration for the respondents.