Abstract
Objectives
This trial examines the effects of end-of-life training on long-term care facility
(LTCF) residents' health-related quality of life (HRQoL) and use and costs of hospital
services.
Design
A single-blind, cluster randomized (at facility level) controlled trial (RCT). Our
training intervention included 4 small-group 4-hour educational sessions on the principles
of palliative and end-of-life care (advance care planning, adverse effects of hospitalizations,
symptom management, communication, supporting proxies, challenging situations). Training
was provided to all members of staff. Education was based on constructive learning
methods and included resident cases, role-plays, and small-group discussions.
Setting and participants
We recruited 324 residents with possible need for end-of-life care due to advanced
illness from 20 LTCF wards in Helsinki.
Methods
Primary outcome measures were HRQoL and hospital inpatient days per person-year during
a 2-year follow-up. Secondary outcomes were number of emergency department visits
and cost of all hospital services.
Results
HRQoL according to the 15-Dimensional Health-Related Quality-of-Life Instrument declined
in both groups, and no difference was present in the changes between the groups (P for group .75, adjusted for age, sex, do-not-resuscitate orders, need for help, and
clustering). Neither the number of hospital inpatient days (1.87 vs 0.81 per person-year)
nor the number of emergency department visits differed significantly between intervention
and control groups (P for group .41). The total hospital costs were similar in the intervention and control
groups.
Conclusions and Implications
Our rigorous RCT on end-of-life care training intervention demonstrated no effects
on residents’ HRQoL or their use of hospitals. Unsupported training interventions
alone might be insufficient to produce meaningful care quality improvements.
Keywords
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Article info
Publication history
Published online: June 13, 2021
Footnotes
This study was supported by Helsinki University Hospital and the City of Helsinki and received 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 or execution of the study; in the collection, analysis, or interpretation of data; or in the preparation, review, or approval of the manuscript.
The authors declare no conflicts of interest.
Identification
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© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
