HOPE - HOME CARE OUTREACH FOR PALLIATIVE CARE EDUCATION

PURPOSE: The goal of this project was to develop and test an education al program to extend the principles of palliative care into homecare a gencies. The specific aims were: 1) to assess current practices within select home-care agencies regarding care of the dying; 2) to design t he educational program, the HOPE (Home Care Outreach for Palliative Ca re Education) curriculum, to include relevant content for realistic im plementation in home-care agencies; 3) to implement the HOPE project i n two home-care agencies; and 4) to assess outcomes of the project and plan for future dissemination to home-care agencies and organizations . DESCRIPTION or PROGRAM: A pilot project developed and tested five tr aining modules including overview of end-of-life care, pain management , symptom management, communicating with patients and families, and th e death event. A needs assessment survey completed by 134 home-care ag encies provided input for the training course development. The five-pa rt curriculum was developed by an interdisciplinary team of investigat ors and consultants and implemented in two agencies with 52 staff memb ers participating. Two agencies then were selected to participate in p ilot testing the curriculum. Precourse and postcourse surveys provided evaluation of the program content. RESULTS: Results from die home-car e agency survey demonstrated the need for improving end-of-life care. Only 32% of nonhospice agencies reporting the availability of speciall y trained nurses for care of the terminally ill, and only 16% of die a gencies reported providing such training. Pilot testing of the HOPE cu rriculum suggested that it was well received by staff members. Assessm ent of both self-effectiveness and agency effectiveness revealed great er comfort with content such as communication and other symptom manage ment followed by the areas of pain management, managing the death at h ome, and cultural issues in end-of-life care. The overall rating of en d-of-life care increased from a mean rating of 5.97 to 7.42 for self-a ssessment and from 6.59 to 7.94 for agency assessment (on a scale of 0 to 10, with 0 = not at all effective to 10 = very effective). This pr oject identified areas of education needed to improve care at the end of life. The HOPE curriculum will be refined and extended to reach oth er home-care agencies to benefit their staffs: and the patients they s erve. CLINICAL IMPLICATIONS: Home care agencies provide extensive cafe to patients and families facing many physical and psychosocial demand s at the end of life. Palliative care education is important to suppor t home-care professionals across all disciplines in optimum end-of-lif e care. This education should focus on aspects of physical care, such as treatment of pain, dyspnea, confusion, and fatigue, and also to add ress decisions about physical care, such as hydration/nutrition at the end of life. Psychosocial dimensions of care at home can be improved by attention to issues such as communication with dying patients and f amilies, cultural considerations, and the special care required at the time of the actual death at home.