Optimizing End-of-Life Care on Medical Clinical Teaching Units Using the CANHELP Questionnaire and a Nurse Facilitator: A Feasibility Study

Abstract

The purpose of this study was to pilot-test and evaluate the impact and feas ibility of a nurse facilitator-led quality-improvement intervention using the Canadian Health Evaluation Project (CANHELP) questionnaire to improve end-of-life (EoL) care on medical teaching units. Of 123 patients approached, 67 consented to participate. The majority had cancer. The questionnaire was completed by patients with end-stage diseases and their family caregivers. The researchers identified care issues showing the widest gap between satisfaction and importance and targeted these in order to optimize EoL care. In a second cohort, they also screened for symptoms using the Edmonton Symptom Assessment Scale (ESAS). In both cohorts, they evaluated outcomes 2 weeks post-discharge. The average satisfaction of priority items improved. Also, caregiver satisfaction improved significantly and ESAS scores improved. Using CANHELP, the nurse facilitator was able to identify opportunities for improving EoL care in patients on medical units and for making small improvements in satisfaction with care.