Evaluating the Use of A Co-Designed Palliative and End-of-Life Care Education Program in Long-Term Care Homes

Individuals with life-limiting illnesses residing in long-term care homes (LTCHs) require access to timely and appropriate palliative and end-of-life care. The Western York Region Ontario Health Team (WYR OHT) in Ontario, Canada, has implemented a pilot palliative and end-of-life education program across 10 LTCHs to improve knowledge and strategies related to palliative care. The palliative and end-of-life education program was developed using a co-design approach by the nurse practitioner-led outreach team (NLOT) and over 15 stakeholders (e.g., partnering hospitals, hospices, long-term care homes, and retirement homes) from our Palliative Care working group. This led to the creation of a palliative and end-of-life education program with four modules; 1) Philosophy of Palliative Care Approach, 2) Identification of Residents for Palliative and End-of-Life Care, 3) Difficult Conversations, and 4) End-of-Life Care Assessment and Management. Collaboratively, the team developed, implemented, and evaluated the education program. To assess and ensure the quality of the pilot education program as well as adapt it iteratively, a quality improvement evaluation was developed with a plan to scale-and-spread the initiative. The evaluation collected data using a mixed method approach, including quantitative data using 5-point Likert scale surveys and qualitative data from focus group sessions. This strengthened palliative care capacity in LTCHs at the organizational level by providing education, resources, and supporting policy development and at the resident, family, and caregiver level. To strengthen and build capacity within LTCHs, project coordinators assembled a core collective to implement and evaluate the training program, which also built trust with community partners and established a mutually beneficial communication channel. Overall, the program provided significant changes in participants' knowledge and understanding of delivering palliative and end-of-life care within the LTCHs. The focus group sessions highlighted clear gaps and next steps for future education modules, such as 1) additional training, 2) consistency of training among staff, 3) staffing, 4) palliative care awareness, and 5) education delivery. The pilot palliative and end-of-life education program can be used as a model for creating co-designed program’s within LTCHs and understanding the effectiveness of implemented palliative and end-of-life care within LTCHs to improve patient and caregiver outcomes. This deeper understanding of the needs of those involved with the palliative care program and its delivery will be used to support future educational offerings as well as support the implementation of current training models within LTCHs.