Improved quality of death and dying in care homes : A palliative care stepped wedge randomized control trial in Australia

Journal article

Liu, Wai-Man, Koerner, Jane, Lam, Lawrence, Johnston, Nikki, Samara, Juliane, Chapman, Michael and Forbat, Liz. (2020). Improved quality of death and dying in care homes : A palliative care stepped wedge randomized control trial in Australia. Journal of the American Geriatrics Society. 68(2), pp. 305-312. https://doi.org/10.1111/jgs.16192
AuthorsLiu, Wai-Man, Koerner, Jane, Lam, Lawrence, Johnston, Nikki, Samara, Juliane, Chapman, Michael and Forbat, Liz
Abstract

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.

Keywordspalliative care; death; nursing home; advance care planning; older persons
Year2020
JournalJournal of the American Geriatrics Society
Journal citation68 (2), pp. 305-312
PublisherWiley Blackwell Publishing
ISSN0002-8614
Digital Object Identifier (DOI)https://doi.org/10.1111/jgs.16192
Scopus EID2-s2.0-85074760682
Open accessPublished as green open access
Page range305-312
Author's accepted manuscript
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All rights reserved
File Access Level
Open
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online04 Nov 2019
Publication process dates
Accepted27 Aug 2019
Deposited09 Aug 2021
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