The Effectiveness of the Care Programme for the Last Days of Life
- Conditions
- Older Patients Dying in Acute Geriatric Hospital Wards
- Interventions
- Other: Care Programme for the Last Days of Life
- Registration Number
- NCT01890239
- Lead Sponsor
- End-of-Life Research Group
- Brief Summary
BACKGROUND Demographic trends coupled with a rise in chronic diseases mean that the population of patients requiring palliative and end-of-life care is ageing. Due to the ageing population palliative care for older people has been identified as one of the worldwide public health priorities. A majority of elderly patients die in hospital. Studies from the United Kingdom and other countries have shown that many older persons dying in hospital experience suboptimal care. The Care Programme for the Last Days of Life has been developed to improve the quality of end-of-life care in acute geriatric hospital wards. The programme is based on existing end-of-life care programmes but modeled to the acute geriatric care setting. There is a lack of evidence of the effectiveness of end-of-life care programmes and the effects that may be achieved in patients dying in an acute geriatric hospital setting are unknown. The aim of this study is to evaluate the effectiveness of the Care Programme for the Last Days of Life in improving the quality of care and quality of life during the last 48 hours of life of patients dying in acute geriatric hospital wards in Flanders as compared to usual care.
METHODS In order to contribute substantially to the increase of evidence for the effect of the Care Programme for the Last Days of Life in patients dying in acute geriatric hospital wards, a cluster randomized controlled trial will be conducted. Ten hospitals with one or more acute geriatric wards will conduct a one-year baseline assessment during which care will be provided as usual. For each patient dying in the ward, a questionnaire will be filled in by a nurse, a physician and a family carer. At the end of the baseline assessment hospitals will be randomized to receive intervention (implementation of the Care Programme) or no intervention. Subsequently, the Care Programme will be implemented in the intervention hospitals over a six-month period. A one-year post-intervention assessment will be performed immediately after the baseline assessment in the control hospitals and after the implementation period in the intervention hospitals. Primary outcomes are symptom frequency and symptom burden of patients in the last 48 hours of life.
DISCUSSION This will be the first cluster randomized controlled trial to evaluate the effect of the Care Programme for the Last Days of Life for the acute geriatric hospital setting. The results will enable us to evaluate whether implementation of the Care Programme has positive effects on end-of-life care during the last days of life in this patient population and which components of the Care Programme contribute to improving the quality of end-of-life care.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 600
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Care Programme for the Last Days of Life Care Programme for the Last Days of Life The Care Programme for the Last Days of Life will be implemented in the acute geriatric hospital wards randomized to the experimental group. Subsequently, older patients hospitalized in one of these experimental wards and for who the multidisciplinary team has decided that he or she has entered the dying phase, will benefit from this Care Programme.
- Primary Outcome Measures
Name Time Method The effect of implementation of the Care Programme for the Last Days of Life on the quality of dying in acute geriatric hospital wards: the patient's symptom frequency and symptom burden evaluated by the SM-EOLD and CAD-EOLD within 3 months after a patient's death Using a cluster randomized controlled trail with randomized assignment to the intervention or control group, the effect of the Care Programme on the quality of dying is evaluated with the SM-EOLD and CAD-EOLD
- Secondary Outcome Measures
Name Time Method The communication among clinical staff, i.e. informing the family physician about the impending death within 3 months after a patient's death The quality of care during the last three days of life as perceived by nurses, i.e. physical symptoms, emotional, psychological and spiritual/existential needs and provision of information and support measured using the POS within 3 months after a patient's death The quality of care during the last 48 hours of life as perceived by family carers, i.e. satisfaction with the care provided to the patient during the last 48 hours of life measured using the EOLD-SWC within 3 months after a patient's death The content of care during the last 48 hours of life, i.e. the goal of treatment, medical and nursing interventions, medication policy within 3 months after a patient's death The communication between clinical staff and patients and/or family carers, i.e. the perception of communication with the physician during the dying phase by family carers measured using the FPPFC within 3 months after a patient's death The level of bereavement of family carers after the death of the patient measured using the PGD scale within 3 months after a patient's death
Trial Locations
- Locations (9)
St Jan Brugge
🇧🇪Brugge, Belgium
St Lucas Brugge
🇧🇪Brugge, Belgium
AZ Sint Blasius
🇧🇪Dendermonde, Belgium
Jessa Ziekenhuis Hasselt
🇧🇪Hasselt, Belgium
Sint Jozefskliniek Izegem
🇧🇪Izegem, Belgium
AZ Lokeren
🇧🇪Lokeren, Belgium
H. Hartziekenhuis Menen
🇧🇪Menen, Belgium
Sin Rembertziekenhuis Torhout
🇧🇪Torhout, Belgium
Sint Augustinuskliniek Veurne
🇧🇪Veurne, Belgium
St Jan Brugge🇧🇪Brugge, Belgium