title: Care planning needs of palliative home care clients: Development of the interRAI palliative care assessment clinical assessment protocols (CAPs).
abstract: BACKGROUND
  The interRAI Palliative Care (interRAI PC) assessment instrument provides a standardized, comprehensive means to identify person-specific need and supports clinicians to address important factors such as aspects of function, health, and social support. The interRAI Clinical Assessment Protocols (CAPs) inform clinicians of priority issues requiring further investigation where specific intervention may be warranted and equip clinicians with evidence to better inform development of a person-specific plan of care. This is the first study to describe the interRAI PC CAP development process and provide an overview of distributional properties of the eight interRAI PC CAPs among community dwelling adults receiving palliative home care services.
  
  
  METHODS
  Secondary data analysis used interRAI PC assessments (N = 6,769) collected as part of regular clinical practice at baseline (N = 6,769) and follow-up (N = 1,000). Clients across six regional jurisdictions in Ontario, Canada, assessed to receive palliative homecare services between 2006 and 2011 were included (mean age 70.0 years; ±13.4 years). Descriptive analyses focused on the eight interRAI PC CAPs: Fatigue, Sleep Disturbance, Nutrition, Pressure Ulcers, Pain, Dyspnea, Mood Disturbance and Delirium.
  
  
  RESULTS
  The majority of clients triggered at least one CAP while two thirds triggered two or more. Triggering rates ranged from 74% for the Fatigue CAP to less than 15% for the Delirium and Pressure Ulcers CAPs. The hierarchical CAP triggering structure suggested Fatigue and Dyspnea CAPs were persistent issues prevalent among the majority of clients while Delirium and Pressure Ulcers CAPs rarely trigger in isolation and most often trigger later in the illness trajectory.
  
  
  CONCLUSIONS
  When any of the eight interRAI PC CAPs are triggered, clinicians should take notice. CAPs triggered at high rates such as fatigue, dyspnea, and pain warrant increased attention for the majority of clients. Consideration of triggered CAPs provide evidence to inform a collaborative decision making process on whether or not issues raised by the CAPs should be addressed in the plan of care. Integrating evidence from the interRAI PC CAPs into the clinical decision making process support care planning to address client strengths, preferences and needs with greater acuity.
authors.affiliation: School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia V2N 4Z9 Canada.
authors.forename: Shannon
authors.initials: S
authors.lastname: Freeman
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, ON N2L 6P4 Canada.
authors.forename: John P
authors.initials: JP
authors.lastname: Hirdes
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, ON N2L 6P4 Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Stolee
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, ON N2L 6P4 Canada.
authors.forename: John
authors.initials: J
authors.lastname: Garcia
authors.affiliation: Department of Sociology, Nipissing University, North Bay, Ontario Canada.
authors.forename: Trevor Frise
authors.initials: TF
authors.lastname: Smith
authors.affiliation: Retired Chief Emeritus of Geriatrics, Hackensack University Medical Center, 20 Prospect Ave, Hackensack, NJ 07601 USA.
authors.forename: Knight
authors.initials: K
authors.lastname: Steel
authors.affiliation: Hebrew Senior Life, 1200 Centre Street, Boston, MA 02131 USA.
authors.forename: John N
authors.initials: JN
authors.lastname: Morris