Mary J Foley

Palliative care for Parkinson’s disease: Patient and carer’s perspectives explored through qualitative interview

Background: Palliative care is recommended for non-malignant illnesses, including Parkinson’s disease. However, past research with healthcare workers highlights unmet palliative needs in this population and referral rates to Specialist Palliative Care are low. Some healthcare workers perceive a ‘fear’ in their patients about introducing palliative care. However, less is known about the views of people with Parkinson’s disease and their carers about palliative care. Aim: (1) To explore the palliative care and related issues most affecting people with Parkinson’s disease and their families and (2) to examine perceptions about/understanding of palliative care. Design: This was a qualitative study; semi-structured interviews were conducted, transcribed and analysed using thematic analysis. Setting/participants: A total of 31 people participated, both people with Parkinson’s disease (n = 19) and carers (n = 12), across three Movement Disorder Clinics in the Republic of Ireland. Results: People with Parkinson’s disease and their carers were unfamiliar with the term palliative care. When informed of the role of palliative care, most felt that they would benefit from this input. People with Parkinson’s disease and carers experienced a high illness burden and wanted extra support. Crises requiring Specialist Palliative Care involvement may occur at diagnosis and later, with advancing illness. Participants wanted more information about palliative care and especially further supports to address their psychosocial needs. Conclusion: A holistic palliative care approach could address the complex physical and psychosocial symptoms experienced by people with Parkinson’s disease and their carers, and people with Parkinson’s disease and their carers are open to palliative care. Further research needs to explore how palliative care can be introduced into the routine care for people with Parkinson’s disease.

Healthcare Professionals’ and Patients’ Views of Discussing Sexual Well-being Poststroke

PURPOSE Stroke can cause physical and emotional problems affecting sexual well-being; healthcare professionals (HCPs) are often uncomfortable discussing this topic with patients. We explored the perspectives of HCPs and stroke survivors about barriers to discussing sexual well-being poststroke. DESIGN A mixed methodology was employed. METHODS A postal survey of stroke survivors (n = 50), a focus group with HCPs on a stroke unit (n = 6), and a focus group with community-living stroke survivors (n = 6) were used in this study. Focus group data were analyzed thematically. FINDINGS No patient surveyed (60% response rate) had discussed sexual well-being with an HCP. Focus groups revealed barriers on multiple levels: structural, HCP, patient, and professional-patient interface. CONCLUSIONS Healthcare professionals were poorly trained, adopted a passive role, and addressed sexual activity based on individual beliefs rather than having an agreed team approach. CLINICAL RELEVANCE Relatively simple steps like inclusion in policy, training to empower HCPs, and the provision of written information for patients could help to improve practice.

154Healthcare Professionals’ Attitudes, Practice and Influencing Factors with Regard to Considering Older Persons’ Spirituality during Rehabilitation: A Mixed-Methods Study

Background: Healthcare has grown from a narrow, disease perspective to a wider notion of well-being. Interest in ageing and spirituality has increased due to research evidence supporting the health benefits of religious participation and spirituality; spirituality is linked to positive psychological functioning in older adults and higher life-satisfaction. However, older adults’ spiritual and religious needs are often overlooked. Healthcare professionals (HCPs) must be able to respond effectively to clients’ spiritual and religious commitments and beliefs to enrich the therapeutic experience and provide quality care. Methods: 50 surveys were distributed to a purposive sample of HCPs working with older adults in Cork city. Questions examined HCPs’ own spirituality using the Spirituality Index of Well-Being (SIWB), and their behaviours and attitudes regarding spirituality in clinical practice. A small focus-group was held to further explore survey topics. Results: Survey response rate was 82%, representing HCPs from seven disciplines. All HCPs scored high in the SIWB. The majority (97.3%) believe it is appropriate to discuss religious/spiritual issues when a patient brings them up, however only (16.2%) say they often or always encourage patients’ own spiritual beliefs and practices. HCPs are unsure about when it’s appropriate to inquire regarding spiritualty (73% believe it’s usually or always appropriate), talk about their own religious beliefs or experiences (45.9% say never, 13.5% rarely), and pray with patients (57.6% say never, 29.7% rarely). HCPs who identify themselves as spiritual, or who reported training in spirituality, are more likely to integrate spirituality in the clinical encounter. Conclusions: Overall, the HCPs were highly spiritual. Differences in spiritual and religious characteristics were associated with different behaviours and attitudes regarding integrating spirituality in the clinical encounter. Consideration should be given to specific training in spirituality in undergraduate and post-graduate curricula to enable a more uniform and informed approach to spirituality in clinical practice.

175A Novel Pathway to Improve Dementia Care in Acute Hospitals may Require Specialist Nurse Support to Achieve Practice Change

Background: Almost 30% of older people admitted to acute hospitals in Ireland have dementia. We introduced a novel dementia pathway in an acute hospital as follows: all older people (≥70 years) screened for cognitive vulnerability (delirium, dementia, or delirium on dementia) in ED; patients with dementia received daily delirium screening and a dementia care bundle; enhanced communication with community at time of discharge. The pathway was supported by an extensive pan-hospital education drive and a new dementia nurse specialist (DNS) post. We aimed to assess the compliance with the pathway and explore the effects of the pathway on practice. Methods: Three “spot” audits were performed at intervals on wards that had implemented the pathway. Twenty case-notes for a person with dementia (any type, any age) discharged between Jan 9th and Feb 20th 2017 were reviewed using the Irish National Audit of Dementia chart review tool; data was compared to 2012 (INAD) and 2014 (baseline) data. Results: Compliance with the pathway was excellent; daily delirium screening and using a patient passport proved most challenging to staff. Practice significantly improved across most INAD parameters. Delirium screening increased from 16% to >90%; recording collateral history of the dementia course increased from 50% to >90%. Assessments for mood, pain, malnutrition all improved. The documentation of dementia stage and delirium occurrence at the time of discharge also dramatically improved. However, much of the improved performance was due to the DNS performing the relevant assessments rather than other staff. Improvements also occurred in wards without the new pathway, again suggesting that the improved care is not solely due to the pathway. Conclusion: A novel pathway for dementia care, supported by a dementia nurse specialist, improves the care of a person with dementia in hospital, but both elements may be necessary for successful practice change.

Screening Cognitive Impairment in a Movement Disorder Clinic: Comparison of the Montreal Cognitive Assessment to the SMMSE

AIM To identify predictors of negative in-patient outcomes (prolonged hospital stay and death) in nursing home (NH) residents admitted to the hospital as medical emergencies. METHODS This was a retrospective patient series set at St Jamess Hospital (Dublin, Ireland). The participants were all NH patients requiring acute medical admission under the on-call medical team between 1 January 2002 and 31 December 2010. Patient characteristics on admission, such as demographics, comorbidity level, major diagnostic categories, vital signs and laboratory profile, were measured. The outcomes of the study were prolonged hospital stay (≥ 30 days) and in-hospital mortality. The characteristics of NH patients were compared with those of non-NH patients aged ≥ 65 years. Multivariate analyses were based on generalized estimating equations and classification trees. RESULTS There were 55,763 acute medical admissions over the period, of which 1938 (3.5%) were from NH. As compared with non-NH patients aged ≥ 65 years, NH patients had greater acute illness severity. NH patients had a median length of stay of 7 days, and 17% had a prolonged admission. Their overall mortality rate was 23%. However, the classification analysis showed substantial patient heterogeneity; the subgroup with the highest mortality (54%, n = 100) had positive serum troponin and a respiratory major diagnosis. The lowest mortality rate (4%) was seen in those without positive troponin, urea of 12 mmol/L or less, and albumin of more than 37 mg/L (n = 226). CONCLUSIONS Simple serum markers, such as troponin, urea and albumin, might predict mortality in medically admitted NH patients. This might help health-care practitioners to anticipate their clinical course at an early stage.