Doris Barwich - Academia.edu (original) (raw)

Papers by Doris Barwich

Research paper thumbnail of OP05 A conversation card game motivates british columbians to engage in advance care planning

Research paper thumbnail of “Now I get what’s important” - Shifting philosophies of hospice society staff and trained volunteers involved in peer-facilitated Advance Care Planning workshops for the public

Patient Education and Counseling, Oct 1, 2023

Research paper thumbnail of Building Palliative Care Capacity for Generalist Providers in the Community: Results From the Capaciti Pilot Education Program

American Journal of Hospice and Palliative Medicine, Oct 21, 2022

Objective: Primary care providers play an important role in providing early palliative care, howe... more Objective: Primary care providers play an important role in providing early palliative care, however they often lack practical supports to operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to help primary care providers offer an early palliative approach to care. The CAPACITI pilot program consisted of 10 facilitated, monthly training sessions, covering identification and assessment, communication, and engaging caregivers and specialists. We present the findings of an evaluation of the pilot program. Method: We conducted a single cohort study of primary care providers who participated in CAPACITI. Study outcomes were the change in the percentage of caseload reported as requiring palliative care and improved confidence in competencies measured on a 20-item, study-created survey. Pre and post survey data were analyzed using paired t-tests. Results: Twenty-two teams representing 127 care providers (including 36 physicians and 28 Nurse Practitioners) completed CAPACITI. Paired comparisons showed a moderate improvement in confidence across the competencies covered (.6 to 1.3 mean improvement across items using seven-point scales, all P < .05). Pre-CAPACITI, clinician prescribers ( N = 32) identified a mean of 1.2% of their caseload requiring a palliative approach to care, which increased to 1.6% post-program ( P = .02). Said differently, the total group of paired clinician prescribers identified 338 patients as requiring palliative care in their caseloads at baseline vs 482 patients following the intervention, for an overall increase of 144 patients in their collective caseloads. Conclusion: CAPACITI improved self-assessed palliative care identification and provider confidence in core competencies. The program demonstrated potential for building palliative care capacity in primary care teams.

Research paper thumbnail of OP06 Primary care clinicians’ confidence, willingness and participation in advance care planning discussions: a multi-site survey

Research paper thumbnail of OP29 ‘While my thinking is clear’: outcomes from a feasibility pilot of a multidisciplinary, step-wise pathway for ACP in family medicine

Research paper thumbnail of Telehealth partnership in hospice palliative care: Achieving the goal of 24/7 access

Research paper thumbnail of Primary care clinicians’ confidence, willingness participation and perceptions of roles in advance care planning discussions with patients: a multi-site survey

Family Practice, Sep 19, 2019

Research paper thumbnail of Passion, persistence and pennies

BMJ supportive & palliative care, Jun 1, 2011

Research paper thumbnail of Designing advance care (incapacity) planning and advance directives legislation in British Columbia

BMJ supportive & palliative care, Jun 1, 2012

Research paper thumbnail of A Knowledge Translation Project on Best Practices in End-of-life Care

PubMed, 2015

This is a knowledge translation project to promote the uptake of best practices in end-of-life (E... more This is a knowledge translation project to promote the uptake of best practices in end-of-life (EOL) care within the primary care setting in British Columbia (BC) through the use of tools embedded into electronic medical records (EMRs). The knowledge-to-action model is used to engage primary care providers in co-designing, adopting and evaluating the EOL care toolkit built for 3 EMRs. The toolkit has a set of EMR-specific data entry templates, query/report functions and access to additional downloadable resources. It is based on the EOL learning module designed and offered by the BC General Practice Services Committee's Practice Support Program to improve EOL care by primary care providers in the province. Our web-based distribution method allows providers to download and install the toolkit then take part to evaluate its use and impact. Initial feedback from phases 1-3 (of 4) has been favorable and has led to iterative improvements.

Research paper thumbnail of Community-led, peer-facilitated Advance Care Planning workshops prompt increased Advance Care Planning behaviors among public attendees

Research paper thumbnail of Advance care planning in Canada

Oxford Scholarship Online, 2018

This chapter describes how advance care planning (ACP) is being implemented in Canada. It highlig... more This chapter describes how advance care planning (ACP) is being implemented in Canada. It highlights the use of an organizing National Framework for Advance Care Planning and a recent conceptual framework of end-of-life communication and decision making. A feature of the Canadian landscape are networks of collaboration and partnerships including research and non-governmental organizations, and examples of regional and national initiatives are presented in the boxes. A summary is provided of barriers, facilitators, the cultural milieu, and future opportunities for ACP in Canada. Implementation of ACP in Canada has followed a multi-faceted approach, with significant national leadership, key stakeholder participation and consumer engagement strategies, with important outcomes demonstrated.

Research paper thumbnail of Part of the solution: A survey of community organisation perspectives on barriers and facilitating actions to Advance Care Planning in British Columbia, Canada

Health Expectations, 2021

Research paper thumbnail of Additional file 1: of Recognizing difficult trade-offs: values and treatment preferences for end-of-life care in a multi-site survey of adult patients in family practices

Questionnaire asking patients about engagement in advance care planning. (DOCX 37Â kb)

Research paper thumbnail of Public health palliative care

Palliative Medicine: A Case-Based Manual, 2021

The increasing professionalization and specialization of palliative care over the last 40 years h... more The increasing professionalization and specialization of palliative care over the last 40 years has had enormous impact and benefit for millions, especially with respect to symptom management. However, it may have also inadvertently created an expectation that all palliative care needs can and should be met through improving access to health services. Given the inherently social nature of dying, there is an urgent need to embrace palliative care as a public health issue and adopt models and approaches that allow communities, service delivery organizations, and policymakers to work together to improve well-being and quality of care, not just at end of life, but throughout the serious illness journey.

Research paper thumbnail of Implementing Advance Care Planning Tools in Practice: A Modified World Café to Elicit Barriers and Recommendations from Potential Adopters

Healthcare quarterly, 2021

This paper reports findings from a modified World Café conducted at a palliative care professiona... more This paper reports findings from a modified World Café conducted at a palliative care professional conference in 2019, where input on tools to support advance care planning (ACP) was solicited from healthcare practitioners, managers and family members of patients. Barriers to ACP tool use included insufficient structures and resources in healthcare, death-avoidance culture and inadequate patient and family member engagement. Recommendations for tool use included clarification of roles and processes, training, mandates and monitoring, leadership support, greater reflection of diversity in tools and methods for public engagement. This paper illuminates factors to consider when implementing ACP tools in healthcare.

Research paper thumbnail of Guidelines and Protocols Working Group: Palliative Care

Research paper thumbnail of The development and validation of a questionnaire to audit advance care planning (ACP)

BMJ Supportive & Palliative Care, 2012

ACP is an established standard of care in many settings. However, no validated tool exists to eva... more ACP is an established standard of care in many settings. However, no validated tool exists to evaluate patients' and their families' perspectives on ACP. The purpose of this study was to develop and validate a novel questionnaire to evaluate the quantity and quality of ACP from the perspective of a patient and their family member. To develop the questionnaire, items were generated from focus groups with health care professionals and face to face interviews with hospitalised patients. This questionnaire was then piloted and evaluated by a sample of hospitalised patients who had advanced illnesses and their family members. The questionnaire was divided into 2 parts, the first part covering ACP activities before hospital admission (6 questions) and the second part relating to' goals of care' discussions that occurred during hospitalisation (8 questions). 27 patients and 24 family members participated in the pilot. All respondents rated the language, clarity, fit, accept...

Research paper thumbnail of Barriers to and enablers of advance care planning with patients in primary care: Survey of health care providers

Canadian family physician Medecin de famille canadien, 2018

OBJECTIVE To identify barriers to and enablers of advance care planning (ACP) perceived by physic... more OBJECTIVE To identify barriers to and enablers of advance care planning (ACP) perceived by physicians and other health professionals in primary care. DESIGN Cross-sectional, self-administered survey. SETTING Ontario, Alberta, and British Columbia. PARTICIPANTS Family physicians (n = 117) and other health professionals (n = 64) in primary care. MAIN OUTCOME MEASURES Perceived barriers relating to the clinician, characteristics of patients, and system factors, rated on a 7-point scale from 0 (not at all) to 6 (an extreme amount), and enablers reported using an open-ended question. RESULTS Between November 2014 and June 2015, questionnaires were returned by 72.2% (117 of 162) of family physicians and 68.8% (64 of 93) of the other health professionals. Physicians rated insufficient time, inability to electronically transfer the advance care plan across care settings, decreased interaction with patients near the end of life owing to transfer of care, and patients' difficulty understa...

Research paper thumbnail of Older patient engagement in advance care planning in Canadian primary care practices: Results of a multisite survey

OBJECTIVE To assess primary care patients' engagement in advance care planning (ACP) and pred... more OBJECTIVE To assess primary care patients' engagement in advance care planning (ACP) and predictors of engagement. DESIGN Cross-sectional survey using a revised version of a validated questionnaire. SETTING Alberta, Ontario, and British Columbia. PARTICIPANTS Convenience sample of 20 family practices that provided a consecutive sample of 810 patients aged 50 years and older. MAIN OUTCOME MEASURES Engagement in ACP activities, and sociodemographic and health-related predictors of having engaged in ACP activities. RESULTS Patients had a mean age of 66 years (55.6% women). Two-thirds of patients (68.5%; 555) had thought about the kinds of medical treatments they would want or not want if they were sick and in hospital, 52.8% (n = 428) had talked with someone about what they would want, 32.0% (n = 259) had written down their wishes, 50.4% (n = 408) had named someone to be their substitute decision maker, and 23.0% (n = 186) had engaged in all 4 key ACP activities. Of those patients ...

Research paper thumbnail of OP05 A conversation card game motivates british columbians to engage in advance care planning

Research paper thumbnail of “Now I get what’s important” - Shifting philosophies of hospice society staff and trained volunteers involved in peer-facilitated Advance Care Planning workshops for the public

Patient Education and Counseling, Oct 1, 2023

Research paper thumbnail of Building Palliative Care Capacity for Generalist Providers in the Community: Results From the Capaciti Pilot Education Program

American Journal of Hospice and Palliative Medicine, Oct 21, 2022

Objective: Primary care providers play an important role in providing early palliative care, howe... more Objective: Primary care providers play an important role in providing early palliative care, however they often lack practical supports to operationalize this approach in practice. CAPACITI is a virtual training program aimed at providing practical tips, strategies, and action plans to help primary care providers offer an early palliative approach to care. The CAPACITI pilot program consisted of 10 facilitated, monthly training sessions, covering identification and assessment, communication, and engaging caregivers and specialists. We present the findings of an evaluation of the pilot program. Method: We conducted a single cohort study of primary care providers who participated in CAPACITI. Study outcomes were the change in the percentage of caseload reported as requiring palliative care and improved confidence in competencies measured on a 20-item, study-created survey. Pre and post survey data were analyzed using paired t-tests. Results: Twenty-two teams representing 127 care providers (including 36 physicians and 28 Nurse Practitioners) completed CAPACITI. Paired comparisons showed a moderate improvement in confidence across the competencies covered (.6 to 1.3 mean improvement across items using seven-point scales, all P < .05). Pre-CAPACITI, clinician prescribers ( N = 32) identified a mean of 1.2% of their caseload requiring a palliative approach to care, which increased to 1.6% post-program ( P = .02). Said differently, the total group of paired clinician prescribers identified 338 patients as requiring palliative care in their caseloads at baseline vs 482 patients following the intervention, for an overall increase of 144 patients in their collective caseloads. Conclusion: CAPACITI improved self-assessed palliative care identification and provider confidence in core competencies. The program demonstrated potential for building palliative care capacity in primary care teams.

Research paper thumbnail of OP06 Primary care clinicians’ confidence, willingness and participation in advance care planning discussions: a multi-site survey

Research paper thumbnail of OP29 ‘While my thinking is clear’: outcomes from a feasibility pilot of a multidisciplinary, step-wise pathway for ACP in family medicine

Research paper thumbnail of Telehealth partnership in hospice palliative care: Achieving the goal of 24/7 access

Research paper thumbnail of Primary care clinicians’ confidence, willingness participation and perceptions of roles in advance care planning discussions with patients: a multi-site survey

Family Practice, Sep 19, 2019

Research paper thumbnail of Passion, persistence and pennies

BMJ supportive & palliative care, Jun 1, 2011

Research paper thumbnail of Designing advance care (incapacity) planning and advance directives legislation in British Columbia

BMJ supportive & palliative care, Jun 1, 2012

Research paper thumbnail of A Knowledge Translation Project on Best Practices in End-of-life Care

PubMed, 2015

This is a knowledge translation project to promote the uptake of best practices in end-of-life (E... more This is a knowledge translation project to promote the uptake of best practices in end-of-life (EOL) care within the primary care setting in British Columbia (BC) through the use of tools embedded into electronic medical records (EMRs). The knowledge-to-action model is used to engage primary care providers in co-designing, adopting and evaluating the EOL care toolkit built for 3 EMRs. The toolkit has a set of EMR-specific data entry templates, query/report functions and access to additional downloadable resources. It is based on the EOL learning module designed and offered by the BC General Practice Services Committee's Practice Support Program to improve EOL care by primary care providers in the province. Our web-based distribution method allows providers to download and install the toolkit then take part to evaluate its use and impact. Initial feedback from phases 1-3 (of 4) has been favorable and has led to iterative improvements.

Research paper thumbnail of Community-led, peer-facilitated Advance Care Planning workshops prompt increased Advance Care Planning behaviors among public attendees

Research paper thumbnail of Advance care planning in Canada

Oxford Scholarship Online, 2018

This chapter describes how advance care planning (ACP) is being implemented in Canada. It highlig... more This chapter describes how advance care planning (ACP) is being implemented in Canada. It highlights the use of an organizing National Framework for Advance Care Planning and a recent conceptual framework of end-of-life communication and decision making. A feature of the Canadian landscape are networks of collaboration and partnerships including research and non-governmental organizations, and examples of regional and national initiatives are presented in the boxes. A summary is provided of barriers, facilitators, the cultural milieu, and future opportunities for ACP in Canada. Implementation of ACP in Canada has followed a multi-faceted approach, with significant national leadership, key stakeholder participation and consumer engagement strategies, with important outcomes demonstrated.

Research paper thumbnail of Part of the solution: A survey of community organisation perspectives on barriers and facilitating actions to Advance Care Planning in British Columbia, Canada

Health Expectations, 2021

Research paper thumbnail of Additional file 1: of Recognizing difficult trade-offs: values and treatment preferences for end-of-life care in a multi-site survey of adult patients in family practices

Questionnaire asking patients about engagement in advance care planning. (DOCX 37Â kb)

Research paper thumbnail of Public health palliative care

Palliative Medicine: A Case-Based Manual, 2021

The increasing professionalization and specialization of palliative care over the last 40 years h... more The increasing professionalization and specialization of palliative care over the last 40 years has had enormous impact and benefit for millions, especially with respect to symptom management. However, it may have also inadvertently created an expectation that all palliative care needs can and should be met through improving access to health services. Given the inherently social nature of dying, there is an urgent need to embrace palliative care as a public health issue and adopt models and approaches that allow communities, service delivery organizations, and policymakers to work together to improve well-being and quality of care, not just at end of life, but throughout the serious illness journey.

Research paper thumbnail of Implementing Advance Care Planning Tools in Practice: A Modified World Café to Elicit Barriers and Recommendations from Potential Adopters

Healthcare quarterly, 2021

This paper reports findings from a modified World Café conducted at a palliative care professiona... more This paper reports findings from a modified World Café conducted at a palliative care professional conference in 2019, where input on tools to support advance care planning (ACP) was solicited from healthcare practitioners, managers and family members of patients. Barriers to ACP tool use included insufficient structures and resources in healthcare, death-avoidance culture and inadequate patient and family member engagement. Recommendations for tool use included clarification of roles and processes, training, mandates and monitoring, leadership support, greater reflection of diversity in tools and methods for public engagement. This paper illuminates factors to consider when implementing ACP tools in healthcare.

Research paper thumbnail of Guidelines and Protocols Working Group: Palliative Care

Research paper thumbnail of The development and validation of a questionnaire to audit advance care planning (ACP)

BMJ Supportive & Palliative Care, 2012

ACP is an established standard of care in many settings. However, no validated tool exists to eva... more ACP is an established standard of care in many settings. However, no validated tool exists to evaluate patients' and their families' perspectives on ACP. The purpose of this study was to develop and validate a novel questionnaire to evaluate the quantity and quality of ACP from the perspective of a patient and their family member. To develop the questionnaire, items were generated from focus groups with health care professionals and face to face interviews with hospitalised patients. This questionnaire was then piloted and evaluated by a sample of hospitalised patients who had advanced illnesses and their family members. The questionnaire was divided into 2 parts, the first part covering ACP activities before hospital admission (6 questions) and the second part relating to' goals of care' discussions that occurred during hospitalisation (8 questions). 27 patients and 24 family members participated in the pilot. All respondents rated the language, clarity, fit, accept...

Research paper thumbnail of Barriers to and enablers of advance care planning with patients in primary care: Survey of health care providers

Canadian family physician Medecin de famille canadien, 2018

OBJECTIVE To identify barriers to and enablers of advance care planning (ACP) perceived by physic... more OBJECTIVE To identify barriers to and enablers of advance care planning (ACP) perceived by physicians and other health professionals in primary care. DESIGN Cross-sectional, self-administered survey. SETTING Ontario, Alberta, and British Columbia. PARTICIPANTS Family physicians (n = 117) and other health professionals (n = 64) in primary care. MAIN OUTCOME MEASURES Perceived barriers relating to the clinician, characteristics of patients, and system factors, rated on a 7-point scale from 0 (not at all) to 6 (an extreme amount), and enablers reported using an open-ended question. RESULTS Between November 2014 and June 2015, questionnaires were returned by 72.2% (117 of 162) of family physicians and 68.8% (64 of 93) of the other health professionals. Physicians rated insufficient time, inability to electronically transfer the advance care plan across care settings, decreased interaction with patients near the end of life owing to transfer of care, and patients' difficulty understa...

Research paper thumbnail of Older patient engagement in advance care planning in Canadian primary care practices: Results of a multisite survey

OBJECTIVE To assess primary care patients' engagement in advance care planning (ACP) and pred... more OBJECTIVE To assess primary care patients' engagement in advance care planning (ACP) and predictors of engagement. DESIGN Cross-sectional survey using a revised version of a validated questionnaire. SETTING Alberta, Ontario, and British Columbia. PARTICIPANTS Convenience sample of 20 family practices that provided a consecutive sample of 810 patients aged 50 years and older. MAIN OUTCOME MEASURES Engagement in ACP activities, and sociodemographic and health-related predictors of having engaged in ACP activities. RESULTS Patients had a mean age of 66 years (55.6% women). Two-thirds of patients (68.5%; 555) had thought about the kinds of medical treatments they would want or not want if they were sick and in hospital, 52.8% (n = 428) had talked with someone about what they would want, 32.0% (n = 259) had written down their wishes, 50.4% (n = 408) had named someone to be their substitute decision maker, and 23.0% (n = 186) had engaged in all 4 key ACP activities. Of those patients ...