Educating Nursing Home Staff About the Progression of Dementia and the Comfort Care Option: Impact on Family Satisfaction with End-of-Life Care

Arcand, Marcel; Monette, Johanne; Monette, Michèle; Sourial, Nadia; Fournier, Lynn; Gore, Brian; Bergman, Howard

doi:10.1016/j.jamda.2008.07.008

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Volume 10, Issue 1 , Pages 50-55, January 2009

Educating Nursing Home Staff About the Progression of Dementia and the Comfort Care Option: Impact on Family Satisfaction with End-of-Life Care

Marcel Arcand, MD, MSc
- Department of Family Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
- Address correspondence to Marcel Arcand, MD, MSc, Department of Family Medicine, University of Sherbrooke, 1036 Belvedere sud, Sherbrooke, Quebec, J1H 4C4 Canada
Johanne Monette, MD, MSc
- Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- Solidage-McGill University/Université de Montréal research group on integrated services for older persons, Centre for Clinical Epidemiology and Community studies, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- Maimonides Geriatric Centre, McGill University, Montreal, Quebec, Canada
Michèle Monette, MSc
- Solidage-McGill University/Université de Montréal research group on integrated services for older persons, Centre for Clinical Epidemiology and Community studies, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- Maimonides Geriatric Centre, McGill University, Montreal, Quebec, Canada
Nadia Sourial, MSc
- Solidage-McGill University/Université de Montréal research group on integrated services for older persons, Centre for Clinical Epidemiology and Community studies, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
Lynn Fournier, N MSc
- Maimonides Geriatric Centre, McGill University, Montreal, Quebec, Canada
Brian Gore, MD
- Maimonides Geriatric Centre, McGill University, Montreal, Quebec, Canada
Howard Bergman, MD
- Division of Geriatric Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- Solidage-McGill University/Université de Montréal research group on integrated services for older persons, Centre for Clinical Epidemiology and Community studies, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- Maimonides Geriatric Centre, McGill University, Montreal, Quebec, Canada

published online 11 December 2008.

Objective

There is a growing consensus on the relevance of a palliative care approach in end-stage dementia. The objective of this study was to assess the impact, in terms of family satisfaction with end-of-life care, of a nursing home (NH) pilot educational program for nursing staff and physicians on comfort care and advanced dementia.

Methods

The intervention, implemented in one voluntary NH, consisted of an educational program that included providing an information booklet to all NH staff, and optionally to families. Satisfaction with care was compared using a validated instrument, the “After death bereaved family member interview” pre- and post-intervention. Pre and post groups were composed of close relatives of residents who died in the context of advanced dementia.

Results

Twenty-seven contact persons were interviewed pre-intervention and 21 post-intervention (participation rate of 60% for both groups). Descriptive statistics showed better scores on satisfaction with pain control, emotional support, treating patient with respect, and information on what to expect while patient was dying, in the post-intervention group. Comparison of overall scale scores revealed no statistical differences between the 2 groups, although the post-intervention group expressed greater satisfaction in the area of communication with the health care team (8.0 versus 6.6, P = .109) and greater global satisfaction with care (8.3 versus 7.3, P = .087).

Discussion

Although not significant, results as to the effectiveness of such an intervention to improve family satisfaction with end-of-life care are encouraging.

Conclusion

The booklet, as support tool, and the educational program may have facilitated communication within the team, and between the team and family members. Replication of this intervention in a multicenter NH population is needed to adequately assess its effectiveness.

Keywords: Dementia, nursing home, end-of-life care, interdisciplinary educational program, palliative care