Baycrest

MEDICAL SERVICES SUPPORT KL-CARE Annual Report 2016-2017 Page 12 PALLIATIVE CARE Two studies examining palliative care practices in a Palliative Care Unit (PCU) End-Stage Liver Disease (ESLD) and End-of-Life Care (Study 1) Over the past year, KL-CARE supported several research projects on the PCU at Baycrest. One project examined the knowledge level and attitudes of PCU nurses about pain management in patients with ESLD. KL-CARE surveyed nursing staff and evaluated their baseline knowledge of pain management in ESLD at the end of life, which helped identify PCU nurses' educational needs. By identifying and meeting these needs, nurses will be in a better position to provide optimal, patient- centred, end-of-life pain management for ESLD patients, improving patients' quality of life. The impact of this work can help determine educational programs and quality- improvement initiatives in pain management for patients with ESLD, and it could further enhance knowledge among PCU nurses. Dementia Prevalence in a Geriatric PCU (Study 2) A second study helped inform admission practices for patients with dementia in a geriatric PCU. Patients with dementia at end of life often experience a high incidence of behavioural and psychological symptoms. These individuals may be admitted to PCUs later in their disease course, possibly resulting in negative end-of-life experiences and increased caregiver burden. In collaboration with PCU clinicians, KL-CARE helped examine whether there were any differences in the medical status and length of stay of individuals with and without dementia in the PCU, as this information could help improve admission practices. The project showed that on admission, PCU patients with a diagnosis of advanced dementia had lower overall function when compared to patients without dementia. Further, patients with advanced dementia had a similar length of stay in the PCU compared to those without dementia. These findings demonstrate that patients with advanced dementia should be considered for admission to PCUs requiring a length of stay of three months or less, as this may enhance their end-of-life care. This research has implications for patients with dementia at the end of life, particularly given the limited availability of long-term care beds and the impact on caregiver burden. Specifically, these findings may increase admissions to PCUs for patients with dementia at end of life, and they may also help to inform policy on PCU admission practices.

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