Health Care Provider Perspectives during COVID-19 on Nutrition at End-of-Life in Long-Term Care
Bibliographic record
Abstract
Introduction: Older adults are admitted to long-term care (LTC) homes with advanced disease progression, complexity and acuity. There is a need for starting end-of-life (EOL) conversations earlier. Poor communication surrounding anticipated decline may result in unwanted interventions for residents and leave substitute decision makers (SDMs) feeling unsupported during the dying process. COVID-19 increases the need for earlier conversations. Objectives: (1) Examine current end-of-life nutrition related practices/standardized conversations in Canadian LTC homes with health care providers (HCPs) (2) Determine the acceptability of current EOL practices and timing of these practices in LTC homes among staff in Canada (3) Examine starting points for initiating informal EOL discussions between residents, substitute decision makers, and HCPs in LTC (4) Determine the impact of COVID-19 on EOL discussions. Methods: An online survey was sent to LTC HCPs across Canada from April 21 to July 30, 2021. Participant demographics, facility characteristics, information on current EOL policy and practice, and changes during COVID-19 was collected. Seventy completed surveys were analyzed using descriptive statistics (100% Female; 40.8 years ±11.54), Chi-Square and Fisher’s Exact Tests. Results: Participants included registered dietitians (82.6%), nurses (10.1%), administrators (2.9%), speech language pathologists, social workers, and occupational therapists (4.2%). Most represented provinces included British Columbia (31.4%), New Brunswick (22.9%), and Manitoba (20.0%). Seventy-Two percent of respondents indicated their LTC home had no policy outlining who is responsible for initiating EOL conversations or when EOL conversations should occur (73.6%). HCPs ranked their preferred times to initiate EOL conversations as on admission, as requested by the SDM, or as identified by the HCP. Respondents indicated they were comfortable/confident with nutrition at EOL conversations with residents (77.4%) and SDMs (87.1%). A total of 19 variables were examined as contributing to HCP comfort/confidence. None were statistically significant (alpha 0.05). HCPs found nutrition at EOL conversations more stressful during COVID 19. Conclusion: HCPs indicate they are comfortable/confident with nutrition at EOL conversations. However, HCPs feel timing of informal EOL conversations could start as early as on admission. During COVID-19, HCPs had feelings of increased stress with EOL discussions. This stress may be due to the government restrictions that were implemented resulting in understaffing, and increased workloads.
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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 | 0.006 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.006 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".