Abstract
Objectives
PACE Steps to Success is a 1-year train-the-trainer program aiming to integrate nonspecialist
palliative care into nursing homes via staff education and organizational support.
In this study, we aimed to explore whether this program resulted in changes in residents'
hospital use and place of death.
Design
Secondary analysis of the PACE cluster randomized controlled trial (ISRCTN14741671).
Data were collected on deaths over the previous 4 months via questionnaires at baseline
and postintervention.
Setting and Participants
Questionnaires were completed by the nurse/care-assistant most involved from 78 nursing
homes in 7 European Union countries.
Measures
We measured number of emergency department visits, hospital admissions, length of
hospital stay, and place of death. Baseline and postintervention scores between intervention
and control groups were compared, and we conducted exploratory mixed-model analyses.
We collected 551 out of 610 questionnaires at baseline and 984 out of 1178 at postintervention
in 37 intervention and 36 control homes.
Results
We found no statistical significant effects of the program on emergency department
visits [odds ratio (OR) = 1.38, P = .32], hospital admissions (OR = 0.98, P = .93), length of hospital stay (geometric mean difference = 0.85, P = .44), or place of death (OR = 1.08, P = .80).
Conclusions and Implications
We found no effect of the PACE program on either hospital use in the last month of
life or place of death. Although this may be related to implementation problems in
some homes, the program might also require a more specific focus on managing acute
end-of-life situations and a closer involvement of general practitioners or specialist
palliative care services to influence hospital use or place of death.
Keywords
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References
- PACE Steps to Success Programme: Information Pack.(Available at:)https://www.eapcnet.eu/research/european-union-funded-projects/paceDate: 2018Date accessed: October 1, 2019
- Integrating palliative care in long-term care facilities across Europe (PACE): Protocol of a cluster randomized controlled trial of the “PACE Steps to Success” intervention in seven countries.BMC Palliat Care. 2018; 17: 47
- Evaluation of a palliative care program for nursing homes in 7 countries: The PACE cluster-randomized clinical trial.JAMA Intern Med. 2019; 180: 1-10
- Measuring the quality of dying in long-term care.J Am Geriatr Soc. 2007; 55: 1371-1379
- Evaluating the implementation of the PACE Steps to Success Programme in long-term care facilities in seven countries according to the RE-AIM framework.Implement Sci. 2019; 14: 107
- Place of death in the population dying from diseases indicative of palliative care need: A cross-national population-level study in 14 countries.J Epidemiol Community Health. 2016; 70: 17-24
- Implementing the care programme for the last days of life in an acute geriatric hospital ward: A phase 2 mixed method study.BMC Palliat Care. 2016; 15: 27
- Hospitalisations at the end of life in four European countries: A population-based study via epidemiological surveillance networks.J Epidemiol Community Health. 2016; 70: 430-436
- Final transitions to place of death: Patients and families wishes.J Public Health. 2017; 39: e302-e311
- A framework for cross-cultural development and implementation of complex interventions to improve palliative care in nursing homes: The PACE steps to success programme.BMC Health Serv Res. 2019; 19: 745
- An evaluation of the impact of the Gold Standards Framework on collaboration in end-of-life care in nursing homes. A qualitative and quantitative evaluation.Int J Nurs Stud. 2012; 49: 586-595
- The RAI-PC: An assessment instrument for palliative care in all settings.Am J Hosp Palliat Care. 2003; 20: 211-219
- EORTC Quality of Life Group translation procedure.(Available at:)https://abdn.pure.elsevier.com/en/publications/eortc-quality-of-life-group-translation-procedureDate: 2009Date accessed: February 4, 2019
- RStudio: Integrated Development for R.RStudio Inc, Boston, MA2015
- A systematic review of interventions to change staff care practices in order to improve resident outcomes in nursing homes.PLoS One. 2015; 10: e0140711
- Reducing hospital admissions from nursing homes: A systematic review.BMC Health Serv Res. 2014; 14: 36
- Emergency admissions to hospital from care homes: How often and what for? The Health Foundation.(Available at:)https://www.health.org.uk/publications/reports/emergency-admissions-to-hospital-from-care-homesDate: 2019Date accessed: October 1, 2019
- Issues surrounding end-of-life decision-making.Patient Prefer Adherence. 2013; 7: 771-775
- Impact of nursing home palliative care teams on end-of-life outcomes: A randomized controlled trial.Med Care. 2018; 56: 11-18
- Avoiding hospitalizations from nursing homes for potentially burdensome care: What helps facilities succeed?.JAMA Intern Med. 2017; 177: 137-139
- What justifies a hospital admission at the end of life? A focus group study on perspectives of family physicians and nurses.Palliat Med. 2014; 28: 941-948
- Family communication at the end of life.Behav Sci. 2017; 7: 45
Article info
Publication history
Published online: July 06, 2020
Footnotes
This work was supported by the European Union’s Seventh Framework Program (FP7/ 2007e2013) under grant agreement 603111 (PACE project Palliative Care for Older People). This work has been co-funded by Polish Ministry of Science and Higher Education in the years 2014‒2019 based on the decision no 3202/7PR/2014/2 dated on November 25, 2014. The funders had no role in study design, collection, analysis or interpretation of the data, nor in writing and the decision to submit this article for publication.
The authors declare no conflicts of interest.
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