AI Article Synopsis
- Palliative care for nursing home residents with advanced dementia is often lacking; this study assessed whether facilitated case conferencing (FCC) improves end-of-life care compared to usual care (UC).
- Conducted in 20 nursing homes in Australia, the study involved 286 residents and their families, with one group receiving FCC led by Palliative Care Planning Coordinators for 18 months.
- Although the primary outcome did not show significant differences between groups, FCC resulted in better pharmacological and non-pharmacological management in the final month of life, indicating the need for future trials to focus on decision-making processes.
Article Abstract
Background: Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing (FCC) with usual care (UC) on end-of-life care.
Methods: A two arm parallel cluster randomised controlled trial was conducted. The sample included people with advanced dementia from 20 Australian nursing homes and their families and professional caregivers. In each intervention nursing home (n = 10), Palliative Care Planning Coordinators (PCPCs) facilitated family case conferences and trained staff in person-centred palliative care for 16 hours per week over 18 months. The primary outcome was family-rated quality of end-of-life care (End-of-Life Dementia [EOLD] Scales). Secondary outcomes included nurse-rated EOLD scales, resident quality of life (Quality of Life in Late-stage Dementia [QUALID]) and quality of care over the last month of life (pharmacological/non-pharmacological palliative strategies, hospitalization or inappropriate interventions).
Results: Two-hundred-eighty-six people with advanced dementia took part but only 131 died (64 in UC and 67 in FCC which was fewer than anticipated), rendering the primary analysis under-powered with no group effect seen in EOLD scales. Significant differences in pharmacological (P < 0.01) and non-pharmacological (P < 0.05) palliative management in last month of life were seen. Intercurrent illness was associated with lower family-rated EOLD Satisfaction with Care (coefficient 2.97, P < 0.05) and lower staff-rated EOLD Comfort Assessment with Dying (coefficient 4.37, P < 0.01). Per protocol analyses showed positive relationships between EOLD and staff hours to bed ratios, proportion of residents with dementia and staff attitudes.
Conclusion: FCC facilitates a palliative approach to care. Future trials of case conferencing should consider outcomes and processes regarding decision making and planning for anticipated events and acute illness.
Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12612001164886.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546584 | PMC |
| http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181020 | PLOS |
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