Abstract
Objectives
The aim was to review evidence from all randomized controlled trials (RCTs) using
palliative care education or staff training as an intervention to improve nursing
home residents' quality of life (QOL) or quality of dying (QOD) or to reduce burdensome
hospitalizations.
Design
A systematic review with a narrative summary.
Setting and Participants
Residents in nursing homes and other long-term care facilities.
Methods
We searched MEDLINE, CINAHL, PsycINFO, the Cochrane Library, Scopus, and Google Scholar,
references of known articles, previous reviews, and recent volumes of key journals.
RCTs were included in the review. Methodologic quality was assessed.
Results
The search yielded 932 articles after removing the duplicates. Of them, 16 cluster
RCTs fulfilled inclusion criteria for analysis. There was a great variety in the interventions
with respect to learning methods, intensity, complexity, and length of staff training.
Most interventions featured other elements besides staff training. In the 6 high-quality
trials, only 1 showed a reduction in hospitalizations, whereas among 6 moderate-quality
trials 2 suggested a reduction in hospitalizations. None of the high-quality trials
showed effects on residents' QOL or QOD. Staff reported an improved QOD in 1 moderate-quality
trial.
Conclusions and Implications
Irrespective of the means of staff training, there were surprisingly few effects of
education on residents' QOL, QOD, or burdensome hospitalizations. Further studies
are needed to explore the reasons behind these findings.
Keywords
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Article info
Publication history
Published online: October 26, 2020
Footnotes
Funding: This study was supported by Helsinki University Hospital and with scholarships from the Uulo Arhio Foundation, the Finnish Medical Foundation, and the Foundation of General Practitioners in Finland. The funding sources had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review, and approval of the manuscript.
The authors declare no conflicts of interest.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
