title: Normalising and planning for death in residential care: findings from a qualitative focus group study of a specialist palliative care intervention.
abstract: BACKGROUND
  Improving access to palliative care for older adults living in residential care is recognised internationally as a pressing clinical need. The integration of specialist palliative care in residential care for older adults is not yet standard practice.
  
  
  OBJECTIVE
  This study aimed to understand the experience and impact of integrating a specialist palliative care model on residents, relatives and staff.
  
  
  METHODS
  Focus groups were held with staff (n=40) and relatives (n=17). Thematic analysis was applied to the data.
  
  
  RESULTS
  Three major themes were identified. The intervention led to (1) normalising death and dying in these settings, (2) timely access to a palliative care specialist who was able to prescribe anticipatory medications aiding symptom management and unnecessary hospitalisations and (3) better decision-making and planned care for residents, which meant that staff and relatives were better informed about, and prepared for, the resident's likely trajectory.
  
  
  CONCLUSIONS
  The intervention normalised death and dying and also underlined the important role that specialists play in providing staff education, timely access to medicines and advance care planning. The findings from our study, and the growing wealth of evidence integrating specialist palliative care in residential care for older adults, indicate a number of priorities for care providers, academics and policymakers. Further work on determining the role of primary and specialist palliative care services in residential care settings is needed to inform service delivery models.
authors.affiliation: Clare Holland House, Calvary Health Care ACT, Canberra, Australian Capital Territory, Australia.
authors.forename: Nikki
authors.initials: N
authors.lastname: Johnston
authors.affiliation: Clare Holland House, Calvary Health Care ACT, Canberra, Australian Capital Territory, Australia.
authors.forename: Clare
authors.initials: C
authors.lastname: Lovell
authors.affiliation: Research School of Finance, Actuarial Studies & Statistics, Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Wai-Man
authors.initials: WM
authors.lastname: Liu
authors.affiliation: Clare Holland House, Calvary Health Care ACT, Canberra, Australian Capital Territory, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Chapman
authors.affiliation: Calvary Centre for Palliative Care Research, Calvary Health Care Bruce and the Australian Catholic University, Canberra, Australian Capital Territory, Australia.
authors.forename: Liz
authors.identifier: http://orcid.org/0000-0002-7218-5775
authors.initials: L
authors.lastname: Forbat
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D017144:Focus Groups; D064946:Hospice and Palliative Care Nursing / Q000379:methods*; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods*; D036301:Qualitative Research; D012112:Residential Facilities; D012297:Right to Die
keywords: Hospital care; Nurse Practitioner; Nursing Home care; anticipatory care plan; implementation; residential care