Psychosocial support needs matched to PPS at end-of-life
Following a student placement at Bethell Hospice in 2017, I worked with MSW supervisor Linda Hochstetler to analyze 72 clinical interactions with residents and their families.
Using grounded theory tools, I was able to identify the themes in the content of conversations we had with residents and their friends and family, and how that content correlated with residents’ scores on Victoria Hospice’s Palliative Performance Scale (PPS).
From there, we were able to find patterns in the content, and identify thematically how psychosocial needs shifted from arrival at the hospice, to the end of life.
The following are slides excerpted from a presentation delivered to Hospice Palliative Care Ontario’s annual conference in 2018. I have found these paradigms to be useful in my ongoing work, and hope they might be useful to you too.
Please contact me directly for more information or clarification.
When we combed through the data, and grouped the conversations thematically, we began to see a pattern.
From there, we posited a theory for how psychosocial needs change between arrival and death. This theory would require further testing, but how does it compare to your experiences working with people at end of life? Note that initial conversations were clearly as much with the resident as the family members. That shifts toward the end as the resident becomes less talkative.
Here you can see how we grouped the kinds of conversations and teased out the themes to arrive at the proposed theory.
This is the schematic I now keep in my mind when visiting with residents. It helps prepare me for what might come up in the room. Anecdotally, nurses have told me they found this helpful to check in with to prepare themselves before entering a resident’s room. You’ll note that all these conversations resulted from open-ended questions such as “How are you today?” “How are we looking after you?” “Just checking in to see how you are?” or “Are there any questions I can help you with today?”