Abstract
Background: Approximately 235,000 people experience homelessness or structural vulnerability in Canada in any given year, and many would benefit from hospice palliative care (HPC) due to their complex health and social care needs. Sustaining and growing integrated HPC for all, including people experiencing homelessness, hinges on staff and volunteer workforce capacity to deliver high-quality specialized HPC.Our program of research focuses on skill-building, training, and supportive working conditions for providers and volunteers to promote integrated HPC for structurally vulnerable clients through two studies: ) An evaluation of a co-designed Palliative Approach to Care (PA2Care) training program for social care providers to build capacity in delivering HPC within shelters, and 2) a planning project convening leaders, staff, and volunteers across three Canadian Hospice for Homeless (H4H) organizations to co-design and evaluate mindfulness-informed practices to prevent and/or mitigate work-related stressors within these organizations.
Approach: A Participatory Research to Action approach guides both mixed-method studies. Experts-by-experience were authentically engaged in co-designing the three-part PA2Care training (i.e., online module, workshop, online resource repository) from conception to delivery; endorsing key values (e.g., trauma-informed, relationship-driven) embedded in the training, and validating the training prototype. A convergent parallel mixed methods design was used to evaluate the training with semi-structured interviews and surveys with qualitative and quantitative components. Qualitative methods elucidated learners perceptions of the training and quantitative methods tracked changes in self-reported knowledge and confidence over time.Preliminary work for the planning project entails a mixed-methods survey designed in collaboration with H4H leaders to explore H4H staff members and volunteers experiences of work-related satisfaction, stress, and well-being. The survey includes closed-ended demographic questions, the compassion satisfaction subscale from the Professional Quality of Life scale, and open-ended questions informed by narrative inquiry including requests for metaphors symbolizing staff and volunteers experience of stress.
Results: Social care providers participated in 24 PA2Care training workshops across three Canadian cities between February and November 209. Survey responses were received from 243 learners and most indicated an increase in their confidence and knowledge in most training categories (e.g., navigating the healthcare system, legal and financial resources, dealing with grief and bereavement). Further, the use of a case study to deliver the training aligned with learnersvalues, made the content more relatable and engaging and helped participants learn the material better. At the three-month follow-up, survey data indicate learners found the training useful (93.5%) and applicable to practice (80.6%).Fifty-one survey responses were received from staff and volunteers at an H4H organization. Preliminary findings indicate most respondents (75%) have a high level of compassion satisfaction with a quarter (25%) having an average level of compassion satisfaction, indicating considerable work satisfaction. Thirty-eight metaphors depicting stress, coping, and well-being were provided and include stuck behind a glass window and kindness in an unkind world. Complete survey findings and recommendations will be presented at the conference.
Implications: Both studies integrate scientifically rigorous authentic engagement with experts-by-experience. At a micro-level, the PA2Care training supports skill-building of the social care workforce to provide high quality HPC to structurally vulnerable clients, while the planning project may protect H4H providers capacity by integrating meaningful supports on-site. There is potential for human-level transformation for collective impact at a meso-level through the mobilization of PA2Care training and planning project survey results to respectively support the delivery of HPC across community settings, and foster working conditions that better support provider well-being across organizations and sectors. At a macro-level, combined learnings from our research program may support future funding, program development and policy-decisions to support integrated HPC for all through targeted resources that build workforce stability and capacity to deliver high quality integrated HPC.