Document Type

Thesis

Degree Name

Master of Science (MSc)

Department

Health Science

Faculty/School

Faculty of Science

First Advisor

Dawn M. Guthrie

Advisor Role

Supervisor

Second Advisor

Margaret Schneider

Advisor Role

Advisor

Third Advisor

Todd Coleman

Advisor Role

Advisor

Abstract

Introduction: The timely reassessment of clients receiving palliative home care (HC) is critical for supporting clinicians with care planning and service delivery. However, there is little information on the frequency of reassessments and factors driving reassessment in palliative HC clients.

Objectives: The objectives of this study were to: (i) determine the proportion of palliative HC clients reassessed with the interRAI Palliative Care (interRAI PC) instrument, (ii) calculate the average interRAI PC reassessment interval, (iii) identify the key factors driving interRAI PC reassessment at various intervals, and (iv) explore the factors that influence palliative HC clinicians to reassess their clients in general.

Methods: This sequential mixed methods study was comprised of three phases: a quantitative phase (i.e., Phase I), a qualitative phase (i.e., Phase II), and a supplementary quantitative phase (i.e., Phase III). Phase I was a retrospective cohort study using secondary interRAI PC assessment data for palliative HC clients assessed in Ontario from 2011 to 2022 (n = 128,740). Clinically meaningful differences between clients who were not reassessed and those reassessed at four intervals (i.e., within 90 days, 91-180 days, 181-365 days, and beyond 365 days) were identified using absolute standardized differences. A standardized difference of 0.2 or greater represented at least a small effect size and was considered to denote a significant difference. Phase II followed a collective exploratory case approach with palliative HC clinicians (i.e., nurses and nurse practitioners) being recruited from two provinces in Canada (n = 3). Clinicians were recruited through a snowball convenience sampling approach. Background surveys and semi-structured interviews were conducted to gain a deeper understanding of the factors that influence their decision to complete reassessments. The interviews were transcribed verbatim and analyzed using a cross-case synthesis and Braun & Clarke’s steps for reflexive thematic analysis. Phase III followed the same design as the first phase of the study and was used to address additional predictors of interRAI PC reassessment based on the results of Phase II.

Results: In Phase I, only 30.5% of the sample had a recorded reassessment, with the average reassessment interval being 198 days (standard deviation = 156). Across all comparisons, clients were significantly more likely to be reassessed if they had a prognosis of 6 months or longer, no/moderate health instability, no/mild levels of functional impairment, and/or a low/mild risk of developing a pressure ulcer. In Phase II, the researcher generated two main themes through her analysis: individualized care plans and a connected care team. In Phase III, clients with independent locomotion (i.e., walking or wheeling) were more likely to receive a reassessment at any interval.

Conclusion: The timely reassessment of palliative HC clients is critical to ensure their changing care needs are identified and they are receiving the proper supports and resources. While this work identified several factors influencing reassessment, further research needs to be conducted to gain a deeper understanding of how the different predictors interact with one another.

Convocation Year

2025

Convocation Season

Fall

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