Paramedical staffs' perception of their role during the continuum of care from detection to treatment in nursing homes: Results of the ONCOPAD-Pre survey.

Abstract

e13768 Background: Prevalence of cancer in nursing homes (NH) increases. ONCOPAD is a 4-step program dedicated to identifying and acting on educational needs, cultural and ethical barriers associated with cancer treatment in NH. The program included a scoping review (step 1), semi-directive interviews with care providers (step 2) designed to identify the major topics to be included in a tailored intervention and evaluated before and after it. Here we report the results of the survey before the intervention. Methods: Questions were mainly presented as 7-point Likert scales and classified into 6 sections: interviewee’s description, detection phase, treatment phase, relations and communication at work, ethical questioning, continuing education. Statistical analyses included descriptive statistics, exploratory factorial analyses, testing of model sphericity and sampling adequation. Results: From 06/2022 to 03/2023, 65 participants (median age 41 years; females: 84.6%) completed the questionnaire; 40.0% were nurses, 35.4% nurse assistants; 87.7% were full-time employees, and 73.8% were post holder. Interviewees considered their role as important at the detection stage (mean 4.82), to inform the physician (5.58) and their colleagues (5.45), their role during the decisional process (4.40) and to inform the patient on his diagnosis (4.05) were perceived as less important; organizational problems (lack of staff, time, facilities) could impede this stage. Factors perceived important for treatment decision were related to the patient (physical performance, cognition, age), his opinion (4.49), the opinion of his family (4.38), of his physician (5.17) and less to the paramedical team (4.02). The decision to pursue was mainly focused on care: pain relief (5.48), detection of clinical and psychological signs (5.18); the organizational barriers were perceived as major as well. Relations and communication at work, both internal and external to the institutions, were perceived as poor quality; 8 (12.3%) of the interviewees even skipped this section. The ethical questioning was permanent and homogeneous. Considering education, the interviewees felt insufficiently trained and the preferred model for training was short sequences integrated into daily work schedules; coordinating physicians appear as good mediators for such training courses. Conclusions: In this survey, paramedical staffs perceived their role as important during both detection and treatment of cancers, focusing more on care than cure; however, organizational constraints and poor quality of internal and external relations, and communication appear as major barriers in the completion of their role. Educational intervention should be tailored, favoring short sequences integrated into daily work schedules, coordinating physicians appear as good mediators for improvement in the future.