Conference Agenda

Background: There was unprecedented growth of telehealth in response to the COVID-19 pandemic. However, there has been concern from health professionals about the possible disruption to developing rapport when using telehealth, particularly in palliative care, where rapport is considered essential to patient and family care.

Objective: This study was designed to explore patient, family, and palliative care professional’s perspectives of rapport in telehealth encounters in the community.

Design: An Interpretive Description methodology was utilised, with the Theory of Human Relatedness providing the theoretical framework.

Methods: Data was gathered in two phases:

1. Semi-structured interviews with patients and family members who had received telehealth calls
2. Focus groups and individual interviews with health professionals working in palliative care using telehealth.

Data was analysed using Reflexive Thematic Analysis.

Results: The key finding from patients and families included relaxed interactions with rapport and uncomfortable interactions without rapport; all of which were related to the presence and skill of health professionals. From the health professionals the key findings identified the complexity of telehealth calls and the interpersonal skills needed to develop rapport.

The key outcomes of the study include the development of a conceptual definition of rapport for clinical interactions based on the patients and family findings. Along with an adapted “Model of rapport and relatedness” which highlights participants experiences of interactions characterised as Connectedness, Disconnectedness, and Pseudo-rapport.

This study adds important new knowledge about what constitutes rapport and how it is experienced during telehealth calls. This knowledge is useful for communicating to connect with patients and families.

Conclusion: Rapport via telehealth is a vital interpersonal skill that helps makes connections with patients and families at home. It requires health professionals to be present and reflexive. The implications for practice include that rapport via telehealth is achievable and teachable. Focus on reflective practice, and rapport specific telehealth education and training are recommended.

Background:

With the availability of palliative care services across 80% of its districts, Uganda is a leader in palliative care in Africa with specialist services provided since 1993 however there was lack of harmonized nationwide data collection and management. During the 2012 Health Management Information System (HMIS) review, the Ministry of Health included the data element “pain requiring palliative care” in the Outpatient and Inpatient Department registers. The indicator was included in the District Health Information System (DHIS 2) under the HMIS FORM 105: Health Unit Outpatient Monthly Report. This indicator was insufficient to measure the state of Palliative Care services in Uganda.

In 2020, Uganda initiated a pioneering endeavour to integrate palliative care data into the national HMIS.

Objectives

To harmonize national palliative care data collection and management within the HMIS.

Design

The initiative followed a multidisciplinary and collaborative design, incorporating key stakeholders in palliative care, public health, and health informatics in private and government institutions.

A technical working group was formed, periodic meetings were held, and tool drafting was done followed by pretesting, and approval by the Ministry of Health.

Methods

In May 2015,a pilot M-health (Mobile Health) palliative care surveillance project was initiated in four hospitals in Uganda. The palliative care providers were trained to use smartphones to collect several data elements on palliative care monthly. By 2019, 20 government and private not-for-profit hospitals were collecting palliative care data. The information obtained from the project provided evidence and a baseline for the HMIS Palliative Care tool.

Results

Palliative care tools were developed and added into the HMIS:

i). HMIS OPD 008 Unit Palliative Care Register

ii). HMIS 105c Health Unit Palliative Care monthly report.

Over 50% of facilities offering palliative care in Uganda are reporting through the system and this has provided a more comprehensive understanding of palliative care services at facility, regional and national levels.

Conclusion:

Uganda's journey signifies not only a successful integration of palliative care data into the National HMIS but a commitment to an enduring cycle of support, learning, and data refinement. By emphasizing the need for continuous support supervision and data quality assessments, Uganda continues to strengthen a sustainable model that can be emulated globally.

Background: Part of a public health approach is to operationalize early palliative care into the work of interprofessional primary care teams. Primary care providers can initiative an upstream, early palliative care approach due to their long-standing relationship with patients and families. However, evidence of the effectiveness of virtual education programs that offer practical strategies are limited.

Objectives: CAPACITI is a virtual training program for health care professionals that teaches practical tips to provide a palliative approach to care. The program consists of twelve 1-hour sessions, divided across three modules: (1) Identify and Assess; (2) Enhance Communication Skills; (3) Enhance Skills for Ongoing Care. We will report findings from the three modules.

Methods: A randomized controlled trial evaluating two modes of CAPACITI program delivery: 1) self-directed learning (only online materials); and 2) facilitated learning (live webinars and discussion). Outcomes included: 1) Percent of patients identified as requiring palliative care (past 3 months), 2) Timing of reported initiation of palliative care, and 2) Self-reported palliative care competency (End-of-Life Professional Caregiver Survey [EPCS] / CAPACITI Competency Survey). Analyses consisted of differences between intervention groups in pre/post paired comparisons and examination of covariates.

Results: Of the 566 participants across Canada that enrolled in CAPACITI, 380 (67%) completed Module 1 and 230 (41%) completed the full program (Modules 1-3). Participants represented diverse interprofessional backgrounds. At baseline, 295 providers (paired pre/post) reported identifying 4009 patients requiring palliative care, compared to 5358 patients following the intervention, an increase of 1349 patients (7.2 percentage points on average). Although there was a significant increase in patients identified overall (Paired Sample T-Test, p<0.001), no difference was found between the self-directed and facilitated groups, post intervention (GLM, p=0.3). Providers’ EPCS competencies improved overall (Paired T, p<0.001), with no significant difference between the groups (Cochran–Armitage trend test, p=0.27).

Conclusions: CAPACITI improved self-assessed palliative care identification and provider confidence in key competencies, regardless of whether the education delivery was self-directed or facilitated.

Background: To maximize the potential of advance care planning (ACP) to improve quality of care, scholars and practitioners advocate for interdisciplinary collaboration including medical legal partnerships (MLPs). We implement our framework for health-legal collaboration, which aims to overcome professional silos, align legal practice to clinical reality and improve support for individuals.

Objective: To develop a CLE curriculum to: cultivate understanding of practice contexts and cultures; identify gaps in policy and practice; jointly develop and disseminate best practices; and recruit volunteers for public education.

Design: Program development and delivery.

Methods: Data and feedback from a survey of lawyers, joint education, engagement events (n=13), stakeholder interviews, and literature provided understanding on: local delivery of CLE; learning preferences; barriers, knowledge gaps and needs; complaints to public guardian; MLPs; and similar curricula. A curriculum of ACP elements, case studies, context from legal, health and government sectors, and best practices was developed and found acceptable by experts. The local non-profit CLE provider (“the Provider”) agreed to host a course (faculty: palliative care physician, wills and estates lawyer, clinical ethicist and Office of the Public Guardian and Trustee subject matter expert). The recording and materials will be accessible to the bar and students (n=10,500) through the Provider’s library.

Results: As the primary source of CLE programs and resources in the jurisdiction, the Provider leads evaluation of suitable courses for the profession; their agreement to host recognizes it is prima facie acceptable. Results from a pilot test with the bar association (elder law group) were positive. The course was well subscribed (n=13), attendees asked substantive questions, and responded to polls on resources’ usefulness. The chairperson of the group rated the course as very satisfactory, and said it increased their interest in raising awareness of ACP and volunteering on project activities.

Conclusion: The course will be offered to the legal profession in April 2024 and evaluated by attendees. The curriculum is being submitted for inclusion in law schools’ wills and estates and health law courses, and as the foundation for joint education with health and financial sectors.

Funding was provided by the Government of Alberta. Opinions expressed do not necessarily reflect the Alberta government's policy or position.

Introduction:

Population aging, technological advancements, and an increasing emphasis on patient empowerment imply that individuals are increasingly confronted with intricate end-of-life decisions. Personal end-of-life health literacy skills may help empower individuals to participate more actively in their own end-of-life decisions, including engagement in advance care planning (ACP). This study thus investigates the associations between individuals’ end-of-life health literacy and their knowledge and behaviors toward ACP among a population-based sample of adults aged 58+ in Switzerland.

Method:

We used data from 1,319 respondents from Wave 8 (2019/2020) of the Survey on Health, Ageing, and Retirement in Europe. Subjective end-of-life health literacy was measured using the S-EOL-HLS scale. Respondents’ end-of-life knowledge was assessed using test-based questions about 11 end-of-life medical situations. Behaviors toward ACP were measured by whether respondents have discussed their end-of-life wishes, completed advance directives (AD), and appointed a potential surrogate for medical decisions in case of incapacity. Associations were estimated using separate ordinary least square and probit regressions, controlling for social, health, and regional characteristics.

Results:

Respondents with higher end-of-life health literacy tended to have better end-of-life knowledge and were more likely to have discussed their end-of-life wishes, to have completed AD, and to have appointed a surrogate for medical decisions in case of incapacity. Upon regressing the outcomes on the three end-of-life health literacy dimensions, interactive health literacy positively correlated with end-of-life knowledge and the three behaviors toward ACP, while critical health literacy was only associated with having an AD and appointing a surrogate for medical decisions.

Conclusions:

Our findings suggest that end-of-life health literacy may play a significant role in individuals' level of end-of-life knowledge and their behavior toward ACP. Thus, developing public health policies aimed at strengthening their end-of-life health literacy skills may increase individuals’ engagement in the ACP process and make ACP more effective.