Implementation of Knowledge-Based Palliative Care

Not Applicable

Completed

Conditions: Ageing

Interventions: Behavioral: Educational Intervention

Registration Number: NCT02708498

Lead Sponsor: Lund University

Brief Summary: The research on ageing during the last couple of decades has increasingly focused on questions regarding the quality of life and life satisfaction of the old people. Yet the research indicates that when it comes to the final stage of life, the end includes unnecessary suffering and the quality of life drops. Palliative care has traditionally been provided successfully to younger persons dying from incurable illnesses while older people dying of multiple morbidities or "old age" has received far less of this type of care. However, sixty percent of all people who died in Sweden in 2010 were at least 80 years old and it is well known that dying among older people often is a prolonged period of suffering. One reason might be that it is more difficult to identify when the final stages of life begins for older persons.

The purpose of this project is to implement and evaluate how a knowledge-based model for palliative care in nursing homes affects the quality of life and the participation in the care process for older persons in nursing homes and their next of kin. A second aim is to explore the staff's implementation process of palliative care and the role of the leadership. The final aim is to investigate which factors (barriers and facilitators) that affect the implementation process of this model.

Detailed Description: The project was planned to be conducted using a cross-over design in two counties in south of Sweden based on a feasibility/pilot study that was conducted during fall 2014 co-created palliative care educational intervention through seminars for professionals in nursing homes. Due to a more significant amount of drop-outs compared with expected (and for not receiving the total amount of applied foundation), the plan needed to be revised. The knowledge-based palliative care intervention was conducted as a non-blinded control trial, implemented over a six-month period in 30 nursing homes in two different counties in the south of Sweden (County A and County B). The data collection was made in two sequential periods in each county. First, the intervention was implemented in ten nursing homes in County A (Kronoberg County from April 2015), while ten nursing homes in County B served as a control group. Then, County B implemented the intervention (Skåne county from April 2016), and ten new nursing homes in County A, which had not received the intervention, were chosen as a control group. After the two sequential time periods were data from one intervention and one control group analysed. The selection through voluntary participation resulted in a mixture of both larger and smaller nursing homes in the two counties, as well as both from urban and rural areas.

Every seminar group met once a month and included different professions (unit manager, district nurse, assistant nurse, and other staff i.e. occupational therapist and physiotherapist). There were 5 meetings in each nursing home during a period of 6 months.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 1151

Inclusion Criteria

Older persons living in the participating nursing homes
Next of kin to older persons living in the participating nursing homes
Staff working at the participating nursing homes
Managers working at the participating nursing homes
The participating nursing homes must be located in either Kronoberg County or Skåne County in Sweden

Exclusion Criteria

Not being cognitive able to participate in interviews or answering the questionnaires

Study & Design

Study Type: INTERVENTIONAL

Study Design: SEQUENTIAL

Arm && Interventions

Group	Intervention	Description
Kronoberg Educational Intervention	Educational Intervention	The educational intervention is provided to ten nursing homes.
Skåne Educational Intervention	Educational Intervention	The educational intervention is provided to ten nursing homes.

Primary Outcome Measures

Name	Time	Method
World Health Organization Quality of Life-BREF (WHOQOL-BREF)	9 months	World Health Organization Quality of Life-BREF (WHOQOL-BREF) measure quality of life for older persons' at the end of life living in nursing homes. Five-point Likert-scale. Higher values mean better outcomes. Total score Min 26. Max 130. The range for the sub scale Overall Quality of Life; Min 1 Max 5 The range for the sub scale General health; Min 1 Max 5 The range for the sub scale Physical Health; Min 7 Max 35 The range for the sub scale Psychological; Min 6 Max 30 The range for the sub scale Social relationships; Min 3 Max 15 The range for the sub scale Environment; Min 8 Max 40
World Health Organization Quality of Life-OLD (WHOQOL-OLD)	9 months	World Health Organization Quality of Life-OLD (WHOQOL-OLD) measure quality of life for older persons living in nursing homes. Five point Likert-scale. Higher value means better outcome. Min 24. Max. 120. The range for the all the sub scales are; Min 1 Max 20
Person-Centred Climate Questionnaire (PCQ Patient Version)	9 months	Person-Centred Climate Questionnaire (PCQ patient version) measure person-centred care for older persons living in nursing homes. Six point Likert-scale. Higher score means better outcome. Min 17. Max. 102. The range for the sub scale Safety; Min 10 Max 60 The range for the sub scale Everydayness; Min 4 Max 24 The range for the sub scale Hospitality; Min 3 Max 18
Person-centred Care Assessment Tool (P-CAT)(Patient Version)	9 months	Person-centred Care Assessment Tool (P-CAT) (patient version) measure person-centred care for older persons living in nursing homes. Five point Likert-scale. Higher score means better outcomes. Min 13. Max. 65. The range for the sub scale Extent of personalizing care; Min 8 Max 40 The range for the sub scale Amount of organizational and environmental support; Min 5 Max 25
World Health Organization Quality of Life-BREF (WHOQOL-BREF) for Next of Kin	9 months	World Health Organization Quality of Life-BREF (WHOQOL-BREF) measure quality of life for next of kin to older persons in nursing homes. Five-point Likert-scale. Higher values mean better outcomes. Min 26. Max 130. he range for the sub scale Overall Quality of Life; Min 1 Max 5 The range for the sub scale General health; Min 1 Max 5 The range for the sub scale Physical Health; Min 7 Max 35 The range for the sub scale Psychological; Min 6 Max 30 The range for the sub scale Social relationships; Min 3 Max 15 The range for the sub scale Environment; Min 8 Max 40
Next-of-Kin Participation in Care (NoK-PiC); Psychometric Evaluation	9 months	Next-of-Kin Participation in Care (NoK-PiC) measure participation for next of kin to older persons in nursing homes. The study includes both intervention and control groups. The two scales are 1) Communication and Trust (CaT); and 2) Collaboration in Care (CiC). The scales contains nine items each and items are scored from 0 to 4 (agree not at all (=0); agree to a low degree (=1); agree partly (=2); agree to a high degree (=3); and agree totally (=4). The possible score range from 0 to 36 in each of the two scales, and from 0-72 in the total scale. Higher score means better outcomes. This results are based upon a recently published psychometric evaluation by Westergren et al (2020).

Secondary Outcome Measures

Name	Time	Method
Person-Centred Climate Questionnaire (PCQ-S)	6 months	Person-Centred Climate Questionnaire (PCQ-S) measure person-centred care for staff working in nursing homes. Six-point Likert-scale. Higher values mean better outcomes. Min 14. Max 84. The range for the sub scale Safety; Min 5 Max 30 The range for the sub scale Everydayness; Min 5 Max 30 The range for the sub scale Community; Min 4 Max 24
Person-centred Care Assessment Tool (P-CAT) (Staff Version)	6 months	Person-centred Care Assessment Tool (P-CAT)(staff version) measure person-centred care for staff working in nursing homes. Five-point Likert-scale. Higher values mean better outcomes. Min 13. Max 65. The range for the sub scale Extent of personalizing care; Min 8 Max 40 The range for the sub scale Amount of organizational and environmental support; Min 5 Max 25

Trial Locations

Locations (30): Skogsgläntan
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Höör, Skåne, Sweden
Holmagården
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Svedala, Skåne, Sweden
Åsgården
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Kågeröd, Skåne, Sweden
Mårtenslund
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Lund, Skåne, Sweden
Brunnslyckan
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Lund, Skåne, Sweden
Asken
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Grimslöv, Kronoberg, Sweden
Solgården
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Svalöv, Skåne, Sweden
Ängslyckan
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Teckomatorp, Skåne, Sweden
Norrdala
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Lund, Skåne, Sweden
Fästan
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Södra Sandby, Skåne, Sweden
Rönnebacken
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Osby, Skåne, Sweden
Bryggaren
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Alvesta, Kronoberg, Sweden
Högåsen
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Alvesta, Kronoberg, Sweden
Kvarngården
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Ingelstad, Kronoberg, Sweden
Åbrinken
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Lagan, Kronoberg, Sweden
Konga Allhus
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Konga, Kronoberg, Sweden
Ljungberga
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Ljungby, Kronoberg, Sweden
Ljungsätra
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Ljungby, Kronoberg, Sweden
Brunnsgården
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Ljungby, Kronoberg, Sweden
Torsgården
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Lönashult, Kronoberg, Sweden
Furuliden
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Moheda, Kronoberg, Sweden
Solängen
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Ryd, Kronoberg, Sweden
Örnen
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Tingsryd, Kronoberg, Sweden
Äppelgården
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Urshult, Kronoberg, Sweden
Solhaga
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Väckelsång, Kronoberg, Sweden
Björkliden
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Vislanda, Kronoberg, Sweden
Birkagården
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Växjö, Kronoberg, Sweden
Hovslund
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Växjö, Kronoberg, Sweden
Evelid
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Växjö, Kronoberg, Sweden
Älmegården
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Älmeboda, Kronoberg, Sweden