Assessing and addressing research-practice gaps in practitioners' provision of decision support for terminally-ill cancer patients considering the place of their end-of-life care: Design and evaluation of a multi-faceted educational intervention
Bibliographic record
Abstract
Background. A paradox exists between preferred place of end-of-life cars (home/hospice) and actual place of care (hospital). Patients often need help with decision making yet practitioners generally lack skills in providing quality decision support. Purpose. To evaluate an intervention designed to address barriers to providing decision support for place of end-of-life care. Objectives were to: (1) describe nurses' perceptions of factors that affect their provision of decision support; and (2) design and evaluate the efficacy of an educational intervention for strengthening the quality of practitioners' decision support. Design and methods. (1) Systematic review: Synthesis of primary research studies investigating factors influencing place-of-care. (2) Needs assessment: Semi-structured interviews with 22 nurses. (3) Randomized trial: Comparison of intervention and control groups on the quality of decision support provided to simulated patients considering place of care before and after training. Setting of the Needs Assessment and Randomized Trial. Ontario palliative and oncology practice settings. Results (1) Systematic Review: Of 735 papers identified, 39 papers (33 studies) met inclusion criteria. Factors related to the illness, the individual and the care and social environment influence place of end-of-life care for cancer patients. Commonly identified factors were patient preference, social supports and health care resources. Stated preference, care-giver presence and contact patterns with health care services influence place of end-of-life cancer care. (2) Needs assessment: Nurses held favourable attitudes towards providing decision support for place-of-care at end-of-life. Nurses considered decision support an important part of patient-centred care yet identified a lack of skills, confidence and tools as barriers. (3) Randomized control trial: The before-after changes in the quality of decision support were greater (p<0.0001) in the intervention group (mean change 3.75, 95%Cl: 2.46, 5.03) compared to the control group (mean change -0.667, 95% Cl: -1.57, 0.24). Conclusions. Numerous determinants influence terminal cancer patients' decision making about place of care. Nurses believe they have a role in providing decision support, but lack skills, confidence and tools. These barriers can be addressed with an educational program and a patient decision aid. Broad implementation of the intervention may improve end-of-life care planning. Full implementation of the intervention requires examination of broad system perspectives. Trial registration: NCT00614003
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.092 | 0.122 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.003 | 0.006 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".