Domain
Minimum standard
Score
1. Organisational motivation.
A strong case for greater economic investment in palliative and end-of-life care has been made across multiple sectors (Palliative Care Australia, 2020), particularly in regard to healthcare clinician education.
Met
The health service recognise the need to advance priorities of this group with the formation of the End of Life care committee. Majority of deaths still occur in hospital settings and current data supports this. Minimal attention to palliative or end of life care is provided in available education.
2. Intervention Rationale
54% of Australian occupational therapists’ report having no specific training in palliative care (Talbot-Coulombe & Guay, 2020).
Met
Current OT service provision within the health service identified that OT assessment and intervention was primarily focussed on rehabilitation and equipment provision and was not inclusive of occupational participation for palliative and end of life care clientele.
3. Intervention Description
OT for palliative or end-of-life care is a common clinical experience, yet rarely the subject of targeted professional education. Talbot-Coulombe & Guay (2020) estimate that 95% of OT clinicians will work with a dying patient.
Met
Development of an evidence informed education package aimed to enable OT clinicians to provide the best possible quality of care and promote occupational justice for clients receiving palliative or end-of-life care.
4. Organisational characteristics
Local state frameworks for palliative and end-of-life care, which emphasise advocating for person centred care and respecting client choices (Victorian State Government, 2021). Hammell (2015) asserts all individuals have the occupational right to participate in activities of their choice at any point in their life trajectory.
Met
This quality improvement project transpired in a large tertiary health service that caters to 900,000 people in a major Australian city. It has the three largest growth corridors in the city within its boundaries, and the highest number of people coming from culturally and linguistically diverse backgrounds in the Australian state of Victoria catering to more than 110 language groups.
5. Implementation
Without relevant, evidence-based and discipline specific education, Martin & Herkt (2018) warned that the needs for OT in palliative care may not be recognised, leading to less access to specialist occupational assessment and intervention and increased occupational injustice for these clients.
Met
The need for development of a targeted education package was identified from consultation with key stakeholders to discuss gaps in the current skills, knowledge and confidence of OT clinicians when working with this patient group. Further evidence to support this approach was gained from a literature review and benchmarking similar health services.
6. Study design
54% of Australian occupational therapists’ report having no specific training in palliative care (Talbot-Coulombe & Guay, 2020).
Met
An obsolete educational package previously developed for oncology clients included minimal information related to palliative care and adopted an inequitable focus on rehabilitation.
7. Comparator
Without relevant, evidence-based and discipline specific education, Martin & Herkt (2018) warned that the needs for OT in palliative care may not be recognised, leading to less access to specialist occupational assessment and intervention and increased occupational injustice for these clients.
Met
A skills audit questionnaire previously undertaken within the OT department did not include a specific evaluation of capabilities related to palliative or end-of-life care. The absence of palliative and end of life questions from the audit indicated a lack of recognition of the requirements specific to this area of practice.
8. Data Source
Data reviewed represented a higher number of clients from culturally and linguistically diverse backgrounds and greater overall demand experienced across all service areas compared to general Victorian population (Australian Bureau of Statistics, 2019; Australian Institute of Health and Welfare, 2021).
Met
A review of professional and grey literature was completed to establish evidence available, and benchmarking with a limited number of similar organisations provided a wider perspective on current Australian practice.
9. Timing
Following implementation of the face to face session, feedback gained will assist in evaluating content. Plans to transfer into an e-learning package and implement as mandatory for all new OT clinical staff. This stage of the PDSA cycle is expected to take place over the next 12 months.
Met
Pre-implementation data, review of baseline practice, literature review, bench marking and resource evaluation occurred over a period of 5 months from February to June 2021. The face to face session is anticipated to be provided within the following six month period.
10. Adherence /Fidelity
To enable a safe learning environment with opportunities for reflection, the overall package is multimodal (Breen et al., 2013; Koh et al., 2019; Talbot-Coulombe & Guay, 2020). The education package includes case scenarios and practice examples to assist clinicians make the link between theory, evidence and their own practice (Keesing & Rosenwax, 2013).
Met
Future plans to transfer this education to an e-learning platform where evaluation will be built into the package to allow continuous improvement.
11. Health outcomes
Acceptance, improved quality of life, increased occupational participation, wellness and occupational justice are all potential gains if an occupational perspective is maintained (Pickens et al., 2016).
Met
Disempowerment for clients and their caregivers throughout their palliative and end-of-life care journey is commonly experienced.
12. Organisational readiness
1.6% of the Australian OT workforce is employed in explicitly palliative or end-of-life services, in reality though, many clients are never admitted to these services due to access barriers and availability shortages (Keesing & Rosenwax, 2013).
Met
Development of an evidence informed education package aims to enable all OT clinicians across all areas of the health service to provide the best possible quality of care and promote occupational justice for clients receiving palliative or end-of-life care.
13. Penetration /Reach
Eva & Morgan (2018) noted the importance of promoting the palliative and end-of-life role of OT more broadly to generalist services and multidisciplinary team members.
Met
Initial design was undertaken within a specific health service, however recognises the variability of working areas, identifying a potential for the package to be utilised elsewhere for occupational therapists within the Australian health care context.
14. Sustainability
Eva & Morgan (2018) noted the importance of promoting the palliative and end-of-life role of OT more broadly to generalist services and multidisciplinary team members but identified concerns that demand would outstrip supply as an important barrier.
Met
Formulation of structure and content of a face-to-face clinical education session is completed Plans to transfer this to an e-learning platform with ongoing evaluation to allow continuous improvement.
15. Spread
To enable a safe learning environment with opportunities for reflection, the overall package is multimodal (Breen et al., 2013; Koh et al., 2019; Talbot-Coulombe & Guay, 2020).
Met
Once the face to face session is held, feedback gained will assist in fine tuning the e-learning content which can be implemented as a mandatory training package for all new OT clinical staff.
16. Limitations
Supervised exposure to death can be an effective strategy, but is ethically challenging to deliver (Breen et al., 2013; Talbot-Coulombe & Guay, 2020). Simulation approaches were also proposed as an appropriate medium by Vemuri et al. (2020), but potentially raise difficult issues around vulnerability, privacy and/or consent.
Met
OT specific educational initiatives are limited to undergraduate and postgraduate studies. Following graduation, the majority of professional education occurs in the workforce which utilises different pedagogical approaches to higher education. Benchmarking highlighted the variability in education between sites and services.
Development of an evidence-informed education package for occupational therapists for palliative and end of life care: promoting occupational justice