TY - JOUR
T1 - Improved Quality of Death and Dying in Care Homes
T2 - A Palliative Care Stepped Wedge Randomized Control Trial in Australia
AU - Liu, Wai Man
AU - Koerner, Jane
AU - Lam, Lawrence
AU - Johnston, Nikki
AU - Samara, Juliane
AU - Chapman, Michael
AU - Forbat, Liz
N1 - Funding Information:
We thank and acknowledge the staff at all 12 care homes who facilitated access to the data and who engaged in Needs Rounds. We also acknowledge Karemah François's role in data collection, Clare Lovell's role as a study clinician for part of the trial, and Professors Meera Agar and Deb Parker for their input in early discussions about the study's design. Conflict of Interest: The authors have declared no conflicts of interest for this article. Author Contributors: Liz Forbat designed the methodology and was the chief investigator for the study. Liz Forbat and Jane Koerner were responsible for study administration and management, and all authors were involved in ongoing implementation. Analyzed the data : Liu and Lam. Interpreted the data : Lam, Liu, Forbat, and Koerner. Wrote the first draft of the manuscript: Forbat. Revised the manuscript critically for important intellectual content : Forbat, Liu, Koerner, Johnston, Samara, and Chapman. Read and approved the final manuscript : All authors. Sponsor's Role: This study was funded by the Australian Capital Territory Health Department that played no further role in the study. Data Sharing: Individual‐level data collected for this study is subject to ethical and privacy restrictions. The conditions of ethical approval do not allow us to distribute or make available these data directly to other parties. Applications for data access should be made by contacting the chief investigator, from researchers who have their study protocol approved by an appropriate research ethics review board.
Publisher Copyright:
© 2019 The American Geriatrics Society
PY - 2020/2/1
Y1 - 2020/2/1
N2 - OBJECTIVES: Mortality in care homes is high, but care of dying residents is often suboptimal, and many services do not have easy access to specialist palliative care. This study examined the impact of providing specialist palliative care on residents' quality of death and dying. DESIGN: Using a stepped wedge randomized control trial, care homes were randomly assigned to crossover from control to intervention using a random number generator. Analysis used a generalized linear and latent mixed model. The trial was registered with ANZCTR: ACTRN12617000080325. SETTING: Twelve Australian care homes in Canberra, Australia. PARTICIPANTS: A total of 1700 non-respite residents were reviewed from the 12 participating care homes. Of these residents, 537 died and 471 had complete data for analysis. The trial ran between February 2017 and June 2018. INTERVENTION: Palliative Care Needs Rounds (hereafter Needs Rounds) are monthly hour-long staff-only triage meetings to discuss residents at risk of dying without a plan in place. They are chaired by a specialist palliative care clinician and attended by care home staff. A checklist is followed to guide discussions and outcomes, focused on anticipatory planning. MEASUREMENTS: This article reports secondary outcomes of staff perceptions of residents' quality of death and dying, care home staff confidence, and completion of advance care planning documentation. We assessed (1) quality of death and dying, and (2) staff capability of adopting a palliative approach, completion of advance care plans, and medical power of attorney. RESULTS: Needs Rounds are associated with staff perceptions that residents had a better quality of death and dying (P <.01; 95% confidence interval [CI] = 1.83-12.21), particularly in the 10 facilities that complied with the intervention protocol (P <.01; 95% CI = 6.37-13.32). Staff self-reported perceptions of capability increased (P <.01; 95% CI = 2.73-6.72). CONCLUSION: The data offer evidence for monthly triage meetings to transform the lives, deaths, and care of older people residing in care homes. J Am Geriatr Soc 68:305–312, 2020.
AB - OBJECTIVES: Mortality in care homes is high, but care of dying residents is often suboptimal, and many services do not have easy access to specialist palliative care. This study examined the impact of providing specialist palliative care on residents' quality of death and dying. DESIGN: Using a stepped wedge randomized control trial, care homes were randomly assigned to crossover from control to intervention using a random number generator. Analysis used a generalized linear and latent mixed model. The trial was registered with ANZCTR: ACTRN12617000080325. SETTING: Twelve Australian care homes in Canberra, Australia. PARTICIPANTS: A total of 1700 non-respite residents were reviewed from the 12 participating care homes. Of these residents, 537 died and 471 had complete data for analysis. The trial ran between February 2017 and June 2018. INTERVENTION: Palliative Care Needs Rounds (hereafter Needs Rounds) are monthly hour-long staff-only triage meetings to discuss residents at risk of dying without a plan in place. They are chaired by a specialist palliative care clinician and attended by care home staff. A checklist is followed to guide discussions and outcomes, focused on anticipatory planning. MEASUREMENTS: This article reports secondary outcomes of staff perceptions of residents' quality of death and dying, care home staff confidence, and completion of advance care planning documentation. We assessed (1) quality of death and dying, and (2) staff capability of adopting a palliative approach, completion of advance care plans, and medical power of attorney. RESULTS: Needs Rounds are associated with staff perceptions that residents had a better quality of death and dying (P <.01; 95% confidence interval [CI] = 1.83-12.21), particularly in the 10 facilities that complied with the intervention protocol (P <.01; 95% CI = 6.37-13.32). Staff self-reported perceptions of capability increased (P <.01; 95% CI = 2.73-6.72). CONCLUSION: The data offer evidence for monthly triage meetings to transform the lives, deaths, and care of older people residing in care homes. J Am Geriatr Soc 68:305–312, 2020.
KW - advance care planning
KW - death
KW - nursing home
KW - older persons
KW - palliative care
UR - http://www.scopus.com/inward/record.url?scp=85074760682&partnerID=8YFLogxK
U2 - 10.1111/jgs.16192
DO - 10.1111/jgs.16192
M3 - Article
C2 - 31681981
AN - SCOPUS:85074760682
SN - 0002-8614
VL - 68
SP - 305
EP - 312
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 2
ER -