Evaluation of palliative care needs rounds in residential aged care homes in South Australia: a qualitative study.

Abstract

Background: Palliative care needs rounds have been introduced to improve palliative and end-of-life care in residential aged care homes. As part of the Australian Government initiative 'Comprehensive Palliative Care in Aged Care Measure', needs rounds have been trialled in seven metropolitan and fifteen regional/rural aged care homes in South Australia. This qualitative study examined stakeholders' perspectives about potential values and factors that facilitate or hinder the implementation and sustainability of needs rounds.

Methods: A qualitative approach was employed by using individual interviews and focus groups. Semi-structured interviews (n = 13) were conducted with executives, project team members and staff from both sites. Additionally, four focus groups were facilitated in regional/rural sites (n = 10) to further unpack specific elements of needs rounds' model that were tailored based on their needs. The interview and focus group data were recorded and transcribed verbatim. The transcripts were transferred into the qualitative data management software NVivo (version 14) for coding and analysis. Guided by a coding framework, thematic analysis was undertaken.

Results: Participants found palliative care needs rounds valuable in providing a structured approach to improving palliative care planning and enhancing workforce knowledge and confidence in identifying and managing care towards the end of life. Access to telehealth facilitated needs rounds participation, especially in regional/rural areas. Comparing the nurse practitioner with the medical consultant led needs rounds revealed that there is no 'one size fits all' approach with advantages and disadvantages for each model. Successful implementation of such a model depends on the context within which needs rounds are implemented such as organisational needs, capacity and infrastructure, geography, and resources. Organisational commitment to palliative care, preparedness for change, strong leadership and financial support, and access to online platforms were noted as key factors enabling successful implementation of needs rounds.

Conclusions: Palliative care needs rounds can contribute to improving organisational culture and workforce knowledge in palliative and end-of-life care. Policy commitment and financial support to adopt and tailor palliative care needs rounds that meet local needs are highly recommended.