Abstract
BackgroundPain assessment and management in advanced and end-stage dementia are challenging; patients are at risk of under-diagnosis, under-assessment and under-treatment. Previous research has highlighted the importance of needs-driven training and development in this area for physicians, nurses and healthcare assistants (HCAs) across specialties, disciplines and care settings. This study used teleconferencing technology to connect healthcare professionals across multiple settings and disciplines in real-time clinics, based on the Project ECHO© model. This paper reports the evaluation of the clinics by physicians, nurses and HCAs, including their knowledge and self-efficacy in pain assessment and management for patients with advanced and end-stage dementia.MethodsA mixed method evaluation comprising quantitative survey of self-reported knowledge and self-efficacy pre- and post-ECHO clinic participation, and qualitative exploration of experiences of the clinics using focus group interviews. A census approach to sampling was undertaken. Pre- and post-ECHO evaluations were administered electronically using Survey Monkey software. Mann-Whitney U tests were used to explore differences in knowledge and self-efficacy scores pre- and post-ECHO clinic participation. Statistical significance was set a-priori at p = 0.05. Focus groups were video- and audio-recorded, transcribed verbatim and analysed using Braun & Clarke’s model of thematic analysis.ResultsEighteen healthcare professionals [HCPs] (physicians [n = 7], nurses [n = 10], HCA [n = 1]) and twenty HCPs (physicians [n = 10], nurses [n = 10]) completed pre- and post-ECHO evaluations respectively, reporting improvements in knowledge and self-efficacy on participation in ECHO clinics and perceived utility of the clinics. Seven HCPs (physicians [n = 2], nurses [n = 5]) participated in two focus groups. Four themes emerged: knowledge and skills development and dissemination; protected time; areas for improvement; and the future of ECHO.ConclusionsTelementoring clinics for HCP education and training in pain assessment and management in advanced and end-stage dementia demonstrate a positive impact on knowledge and self-efficacy of HCPs and highlight the value of a cross-specialty network of practice which spans across disciplines/HCP types, care settings and geographical areas. Further development of ECHO services in this and in other clinical areas, shows significant potential to support delivery of high-quality care to complex patient populations.
Highlights
Pain assessment and management in advanced and end-stage dementia are challenging; patients are at risk of under-diagnosis, under-assessment and under-treatment
Pain recognition and assessment in this patient population is widely recognised to be challenging; extensive cognitive decline in the advanced and terminal stages of dementia often significantly impair or remove the possibility of patient selfreport, increasing the risk of under-assessment and under-treatment of pain [14,15,16,17,18]. It was in this context that a programme of research into assessing and managing pain in people with advanced dementia nearing the end of life was undertaken to determine the issues in assessment and management of pain in this patient population, considering the perspectives of healthcare professionals (HCPs: physicians, nurses and healthcare assistants [Healthcare assistant (HCA)] practising in primary, secondary and hospice care) and carers in order to develop a model of practice to optimise detection and treatment of pain as patients with dementia approach the end of life
The findings from the qualitative interview phase of this research programme have been presented in a number of peer-reviewed articles [19,20,21], and indicated the need for training and ongoing professional development for these HCPs across specialties, disciplines and care settings
Summary
Pain assessment and management in advanced and end-stage dementia are challenging; patients are at risk of under-diagnosis, under-assessment and under-treatment. Pain recognition and assessment in this patient population is widely recognised to be challenging; extensive cognitive decline in the advanced and terminal stages of dementia often significantly impair or remove the possibility of patient selfreport, increasing the risk of under-assessment and under-treatment of pain [14,15,16,17,18] It was in this context that a programme of research into assessing and managing pain in people with advanced dementia nearing the end of life was undertaken to determine the issues in assessment and management of pain in this patient population, considering the perspectives of healthcare professionals (HCPs: physicians, nurses and healthcare assistants [HCAs] practising in primary, secondary and hospice care) and carers in order to develop a model of practice to optimise detection and treatment of pain as patients with dementia approach the end of life. Learning by experience, sharing disciplinary knowledge, and opportunities to co-manage complex patient cases were seen to be key elements of a highly dynamic and relevant form of clinical training capable of cultivating sustained practice change
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