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Relational use of an electronic quality of life and practice support system in hospital palliative consult care: A pilot study

Published online by Cambridge University Press:  08 March 2018

Marian Krawczyk Open the ORCID record for Marian Krawczyk [Opens in a new window]  and
Richard Sawatzky
Marian Krawczyk
Affiliation:
School of Nursing, Trinity Western University, Langley, B.C., Canada & Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, Canada
Richard Sawatzky*
Affiliation:
School of Nursing, Trinity Western University, Langley, B.C., Canada & Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, Canada
*
Author for correspondence: Richard Sawatzky, School of Nursing, Trinity Western University, Langley, B.C., Canada & Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, Canada. E-mail: [email protected]
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Abstract

Objectives

This study is part of an overarching research initiative on the development and integration of an electronic Quality of Life and Practice Support System (QPSS) that uses patient-reported outcome and experience measures in clinical practice. The current study focused on palliative nurse consultants trialing the QPSS with older hospitalized adults receiving acute care. The primary aim of the study was to better understand consultants’ and patients’ experiences and perspectives of use.

Method

The project involved two nurse specialists within a larger palliative outreach consult team (POCT) and consenting older adult patients (age 55+) in a large tertiary acute care hospital in western Canada. User-centered design of the QPSS was informed by three focus groups with the entire POCT team, and implementation was evaluated by direct observation as well as interviews with the POCT nurses and three patients. Thematic analysis of interviews and field notes was informed by theoretical perspectives from social sciences.

Result

Over 9 weeks, the POCT nurses used the QPSS at least once with 20 patients, for a total of 47 administrations. The nurses most often assisted patients in using the QPSS. Participants referenced three primary benefits of relational use: enhanced communication, strengthened therapeutic relations, and cocreation of new insights about quality of life and care experiences. The nurses also reported increased visibility of quality of life concerns and positive development as relational care providers.

Significance of results

Participants expressed that QPSS use positively influenced relations of care and enhanced practices consistent with person-centered care. Results also indicate that electronic assessment systems may, in some instances, function as actor-objects enabling new knowledge and relations of care rather than merely as a neutral technological platform. This is the first study to examine hospital palliative consult clinicians’ use of a tablet-based system for routine collection of patient-reported outcome and experience measures.

Keywords

Relational carepalliative consult carequality of life assessmentperson-centered careboundary objects
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 2 , April 2019 , pp. 208 - 213
Copyright
Copyright © Cambridge University Press 2018 

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References

Antunes, B, Harding, R, and Higginson, IJ (2014) Implementing patient-reported outcome measures in palliative care clinical practice: a systematic review of facilitators and barriers. Palliative Medicine 28(2), 158–175.Google Scholar
Bausewein, C, Daveson, BA, Currow, DC, et al. (2016) EAPC White Paper on outcome measurement in palliative care: Improving practice, attaining outcomes and delivering quality services—Recommendations from the European Association for Palliative Care (EAPC) Task Force on Outcome Measurement. Palliative Medicine 30(1), 6–22.Google Scholar
Bausewein, C, Simon, ST, Benalia, H, et al. (2011) Implementing patient reported outcome measures (PROMs) in palliative care-users' cry for help. Health and Quality of Life Outcomes 9(1), 27.Google Scholar
Ben-Arye, E, Karkabi, S, Shapira, C, et al. (2012) Complementary medicine in the primary care setting: Results of a survey of gender and cultural patterns in Israel. Gender Medicine 6(2), 384–397.Google Scholar
Bruce, A and Boston, P (2008) The changing landscape of palliative care: Emotional challenges for hospice palliative care professionals. Journal of Hospice & Palliative Nursing 10(1), 49–55.Google Scholar
Catania, G, Beccaro, M, Costantini, M, et al. (2016) What are the components of interventions focused on quality-of-life assessment in palliative care practice? A systematic review. Journal of Hospice & Palliative Nursing 18(4), 310–316.Google Scholar
Catania, G, Beccaro, M, Costantini, M, et al. (2015) Effectiveness of complex interventions focused on quality-of-life assessment to improve palliative care patients’ outcomes: A systematic review. Palliative Medicine 29(1), 5–21.Google Scholar
Cohen, S, Sawatzky, R, Russell, L, et al. (2017) Measuring the quality of life of people at the end of life: The McGill Quality of Life Questionnaire–Revised. Palliative Medicine 31(2), 120–129.Google Scholar
Donaldson, MS (2008) Taking PROs and patient-centered care seriously: Incremental and disruptive ideas for incorporating PROs in oncology practice. Quality of Life Research, 17(10), 1323–1330.Google Scholar
Etkind, SN, Daveson, BA, Kwok, W, et al. (2014) Capture, transfer, and feedback of patient-centered outcomes data in palliative care populations: does it make a difference? A systematic review. Journal of Pain and Symptom Management 49(3), 611–624.Google Scholar
Fischer, S, David, D, Crotty, B, et al. (2013) Acceptance and use of health information technology by community-dwelling elders. International Journal of Medical Informatics 83(9), 623–635.Google Scholar
Fitzsimons, D, Mullan, D, Wilson, JS, et al. (2007) The challenge of patients' unmet palliative care needs in the final stages of chronic illness. Palliative Medicine 21(4), 313–322.Google Scholar
Fox, NJ (2011) Boundary objects, social meanings and the success of new technologies. Sociology, 45(1), 70–85.Google Scholar
Floriani, CA and Schramm, FR (2012) Routinization and medicalization of palliative care: Losses, gains and challenges. Palliative & Supportive Care 10(4), 295–303.Google Scholar
Fleischmann, KR (2006) Boundary objects with agency: A method for studying the design–use interface. The Information Society 22(2), 77–87.Google Scholar
Gliklich, R, Dreyer, N, and Leavy, M (2014) Registries for evaluating patient outcomes: A user's guide, 3rd ed. Rockville, MD: Agency for Healthcare Research and Quality. Available from https://www.ncbi.nlm.nih.gov/books/NBK208628/Google Scholar
Greenhalgh, J (2009) The applications of PROs in clinical practice: What are they, do they work, and why? Quality of Life Research 18(1) 115–123.Google Scholar
Greenhalgh, J, Long, AF, and Flynn, R (2005) The use of patient reported outcome measures in routine clinical practice: Lack of impact or lack of theory? Social Science & Medicine 60(4), 833–843.Google Scholar
Guest, G, MacQueen, KM, and Namey, EE (2011) Applied thematic analysis. Thousand Oaks, California: Sage.Google Scholar
Heyland, DK, Jiang, X, Day, AG, et al. , and Canadian Researchers at the End of Life Network (CARENET). (2013) The development and validation of a shorter version of the Canadian Health Care Evaluation Project Questionnaire (CANHELP Lite): A novel tool to measure patient and family satisfaction with end-of-life care. Journal of Pain and Symptom Management 46(2), 289–297.Google Scholar
Hughes, R, Aspinal, F, Addington-Hall, J, et al. (2003) Professionals' views and experiences of using outcome measures in palliative care. International Journal of Palliative Nursing 9(6), 234–238.Google Scholar
Humphreys, J and Harman, S (2014) Late referral to palliative care consultation service: Length of stay and in-hospital mortality outcomes. The Journal of Community and Supportive Oncology 12(4), 129–136.Google Scholar
Jensen, RE, Snyder, CF, Abernethy, AP, et al. (2013) Review of electronic patient-reported outcomes systems used in cancer clinical care. Journal of Oncology Practice 10(4), e215–e222.Google Scholar
Johns Hopkins University (2017) Users’ guide to integrating patient-reported outcomes in electronic health records. Available from https://www.pcori.org/sites/default/files/PCORI-JHU-Users-Guide-To-Integrating-Patient-Reported-Outcomes-in-Electronic-Health-Records.pdf.Google Scholar
Keshet, Y, Ben-Arye, E, and Schiff, E (2013) The use of boundary objects to enhance interprofessional collaboration: Integrating complementary medicine in a hospital setting. Sociology of Health & Illness 35(5), 666–681.Google Scholar
Nicolini, D (2010) Medical innovation as a process of translation: A case from the field of telemedicine. British Journal of Management 21(4), 1011–1026.Google Scholar
Peters, L and Sellick, K (2006) Quality of life of cancer patients receiving inpatient and home-based palliative care. Journal of Advanced Nursing 53(5), 524–533.Google Scholar
Tavares, AP, Paparelli, C, Kishimoto, CS, et al. (2017) Implementing a patient-centred outcome measure in daily routine in a specialist palliative care inpatient hospital unit: An observational study. Palliative Medicine 31(3), 275–282.Google Scholar
Reville, B, Miller, MN, Toner, RW, et al. (2010) End-of-life care for hospitalized patients with lung cancer: Utilization of a palliative care service. Journal of Palliative Medicine 13(10), 1261–1266.Google Scholar
Simon, ST, Higginson, IJ, Harding, R, et al. (2012) Enhancing patient-reported outcome measurement in research and practice of palliative and end-of-life care. Supportive Care in Cancer 20(7), 1573–1578.Google Scholar
Star, SL and Griesemer, JR (1989) Institutional ecology, translations' and boundary objects: Amateurs and professionals in Berkeley's Museum of Vertebrate Zoology, 1907–39. Social Studies of Science 19(3), 387–420.Google Scholar
Watanabe, S, Nekolaichuk, C, Beaumont, C, et al. (2011) A multi-centre comparison of two numerical versions of the Edmonton Symptom Assessment System in palliative care patients. Journal of Pain Symptom Management 41, 456–468.Google Scholar
Zhou, X, Ackerman, M, and Zheng, K (2011, May) CPOE workarounds, boundary objects, and assemblages. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (pp. 3353–3362). ACM.Google Scholar