Guidelines for a Palliative Approach in Residential Aged Care

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APPENDIX D An evaluation tool for qualitative studies APRAC GUIDELINES: EVIDENCE EVALUATION Qualitative Study Article No. Yes = 1 No = 0 Aim of the study: Is the aim clear? ....................... Paradigm: Is the paradigm appropriate for the aim: ....................... Quality of evidence: Methodology: Is the methodology appropriate for the paradigm? ....................... Methods: Are the methods used appropriate for the methodology? ....................... Checking methods: Did checking methods establish rigor? ....................... Sample: Did the sampling strategy address the aim? ....................... Data Analysis: Was the data analysis appropriately rigorous? ....................... Findings: Are the findings clearly stated and relevant to the aim? ....................... Strength of evidence: ________________ 4 very high 3 high 2 low 1 very low Relevance to APRAC project: ________________ Evaluator/s: 4 very relevant 3 relevant 2 of some relevance 1 of little or no relevance Guidelines for a Palliative Approach in Residential Aged Care 233
APRAC GUIDELINES: EVIDENCE EVALUATION Inclusion criteria: Qualitative Study • Published in a peer-review journal, book chapters, government and non-government reports, therapeutic guidelines, standards of care and other guidelines • Published between January 1990 and September 2004 • Published in English language • Originating in country with comparative health system to Australia • Originating in country with social or cultural similarities to Australia • Originating in a country where the residential care facilities fit with those in Australia Exclusion criteria: • Articles not meeting the inclusion criteria above • Articles relating to community based programs rather than residential, aged or long-term care situations Scoring: The article will be rated regarding the quality of the evidence as it relates to the particular study cited — it will be given a score out of 8. The article will have a strength and relevance (to the APRAC project) rating score, each of which will be out of 4. References: Butler, T. (2002) personal communication, July. Clare, J. (2002) personal communication, August. Critical Appraisal Skills Program: 10 questions to help you make sense of Qualitative Research, www.public-health.org.uk/casp/qualitative.html National Health and Medical Research Council (2000) How to use the evidence: assessment and application of scientific evidence, Biotext, Canberra, Australia. The General Practice Section & Program Evaluation Unit (2000) The relative effectiveness of population health interventions in the general practice setting: Appendix C: Literature Review Summary Appraisal, Department of General Practice & Public Health, University of Melbourne, Victoria, Australia. 234 Guidelines for a Palliative Approach in Residential Aged Care
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Guidelines for a Palliative Approac
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NHMRC APPROVAL These guidelines wer
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4 ADVANCE CARE PLANNING 55 4.1 Impl
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16 MANAGEMENT’S ROLE IN IMPLEMENT
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17 Ann and Mr Wells’ family Helpi
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IMPORTANT NOTICE On 8 December 2005
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achieved for these guidelines from
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facets of a palliative approach are
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Additional levels of evidence The N
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Guidelines Ref No. Evidence level A
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Guidelines Ref No. Evidence Cachexi
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Guidelines Ref No. Evidence Anxiety
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Guidelines Ref No. Evidence 70. Und
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1.1.1 Aims The aims of the systemat
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Table 1: Search terms Terms Aborigi
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1.1.5 Exclusion Criteria Although t
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in the methodology that may invalid
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To ensure the reliability of the re
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1.2.2 Methodology When the first re
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1.4.2 Method When feedback was requ
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Several Working Party members conve
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or disagreed with each stakeholder
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All the feedback received was colla
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CHAPTER 2 A PALLIATIVE APPROACH A s
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• Profound weakness • Trouble s
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• Has the resident had a recent d
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in the RACF rather than transferrin
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palliative care teams is more appro
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or ageing progression (see Table 4)
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Table 7: A practical model of socia
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Vignette 2: Robert’s story Robert
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CHAPTER 4 ADVANCE CARE PLANNING Car
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efore discussing the advance care p
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• A change in their health status
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CHAPTER 5 ADVANCED DEMENTIA Advance
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A study was conducted to investigat
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5.3.2 Acute illness One study found
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Vignette 5: Anna’s story Anna was
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(see Fainsinger, Miller and Bruera
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Dame Cicely Saunders first describe
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Table 8: Common myths about pain ma
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6.2.4 Breakthrough pain The term
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Pain can lead to behavioural change
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Vignette 7: Mrs Harris’ story Mrs
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examined the addition of paracetamo
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provision and storage of drugs, whe
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successfully tested predominantly w
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The reasons for malnutrition in old
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The diets of residents should also
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To assist in such a discussion, a d
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appear until dehydration is far adv
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Guideline: Hydration 24. Recommenda
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6.7 NAUSEA AND VOMITING Nausea is t
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• Do you have any problem control
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6.9.1 Assessment A thorough oral as
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6.10 SKIN INTEGRITY The major skin
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Wounds can occur in residents for a
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Brocklehurst and colleagues (1999)
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medication treatment along with non
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• CAM therapies may be culturally
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word games, the present day, and fa
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CHAPTER 7 PSYCHOLOGICAL SUPPORT A r
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7.1.1 Death statements and depressi
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the factor structure of the CSDD. I
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7.2.2 Management Non-pharmacologica
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Table 17: Distinguishing delirium f
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is recognised that in many rural an
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important [305] (Level QE). Familie
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8.4 FAMILY INVOLVEMENT The role of
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CHAPTER 9 SOCIAL SUPPORT, INTIMACY
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Rather than denying the existence o
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9.2.2 Management Imaginative progra
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Guideline: Social Support Social Su
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include lack of information about t
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CHAPTER 11 CULTURAL ISSUES Australi
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11.2 Assessment The best approach t
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CHAPTER 12 SPIRITUAL SUPPORT Dein a
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Vignette 13: Jack’s story Jack wa
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Guideline: Spiritual Support 68. A
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interpersonal and leadership skills
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CHAPTER 14 END-OF-LIFE (TERMINAL) C
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mood (61%), constipation (59%) and
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e relevant, and may even worsen sym
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Treatment involves changes in posit
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14.5 PREPARING FOR IMMINENT DEATH
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education of the aged care team and
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Table 21: Grief, loss and bereaveme
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• excessively avoiding tasks remi
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Vignette 18: Reflections When provi
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may have been able to contribute to
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Page 198 and 199: REFERENCES 1. World Health Organiza
Page 200 and 201: 31. Hanson, L. C., Danis, M. & Garr
Page 202 and 203: 60. World Health Organization Quali
Page 204 and 205: 89. McCarthy, M., Addington-Hall, J
Page 206 and 207: 121. Saunders, C. M. (1998). Forewo
Page 208 and 209: 150. Sindrup, S. H. & Jensen, T. S.
Page 210 and 211: 177. Berry, E. M. & Marcus, E.-L. (
Page 212 and 213: 208. Robinson, S. B. & Rosher, R. B
Page 214 and 215: 237. Brocklehurst, J., Dickinson, E
Page 216 and 217: 265. Barraclough, J. (1997). ABC of
Page 218 and 219: 295. Brown, T. M. & Boyle, M. F. (2
Page 220 and 221: 328. Kristjanson, L. J., Leis, A.,
Page 222 and 223: 360. McGrath, P., Vun, M. & McLeod,
Page 224 and 225: 392. Saunders, C. M. & Baines, M. J
Page 226 and 227: 424. Rawlings, D. & Glynn, T. (2002
Page 228 and 229: Glossary acetaminophen Acetaminophe
Page 230 and 231: coordinator of volunteers coping A
Page 232 and 233: geropsychologist A geropsychologist
Page 234 and 235: opioids Opioid is a specific term u
Page 236: specialised palliative team A speci
Page 239 and 240: Ms Wendy Shiels Dr Jane Sims Dr Chr
Page 242: APPENDIX B The Australian Governmen
Page 245: APRAC GUIDELINES: EVIDENCE EVALUATI
Page 250 and 251: APPENDIX F: Summary of the frequenc
Page 252: APPENDIX G: An example of how the g
Page 256 and 257: APPENDIX I: Resource list PALLIATIV
Page 258 and 259: Psychological Challenge Depression
Page 260 and 261: APPENDIX J: Examples of advance dir
Page 262 and 263: Schedule 1 MEDICAL POWER OF ATTORNE
Page 264: APPENDIX K An example of a Genogram
Page 268 and 269: INDEX Abbey Pain Scale 64, 71, 78 A
Page 270 and 271: evidence levels 5, 6, 20, 21, 22 ev
Page 272: andomized controlled trials 5, 21 R
Page 275 and 276: Palliative Care Australia PO Box 24
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