No difference in effects of ‘PACE steps to success’ palliative care program for nursing home residents with and without dementia: a pre-planned subgroup analysis of the seven-country PACE trial

BMC Palliative Care

Liesbeth Van Humbeeck¹  Nele Van Den Noortgate¹  Giovanni Gambassi²  Jenny T. van der Steen³  Sophie Pautex⁴  Sheila Payne⁵  Katarzyna Szczerbińska⁶  Marika Kylänen⁷  Rose Miranda⁸  Lieve Van den Block⁸  Tinne Smets⁸  Luc Deliens⁹ 

[1] Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium;Department of Internal Medicine, Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy;Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands;Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC-VU University Medical Center, Amsterdam, The Netherlands;Hôpitaux Universitaires de Genève, University of Geneva, Geneva, Switzerland;International Observatory on End-of-Life Care, Lancaster University, Lancaster, UK;Laboratory for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland;National Institute for Health and Welfare, Helsinki, Finland;Vrije Universiteit Brussel & Ghent University, End-of-Life Care Research Group, Laarbeeklaan 103, 1090, Brussels, Belgium;Vrije Universiteit Brussel, Department of Family Medicine and Chronic Care, Brussels, Belgium;Vrije Universiteit Brussel & Ghent University, End-of-Life Care Research Group, Laarbeeklaan 103, 1090, Brussels, Belgium;Vrije Universiteit Brussel, Department of Family Medicine and Chronic Care, Brussels, Belgium;Department of Public Health and Primary Care, Ghent University, Ghent, Belgium;

关键词: Nursing home care;    End of life care;    Bereavement;    Pain;    Communication;    Neurological conditions;   

DOI  :  10.1186/s12904-021-00734-1

来源: Springer

【 摘 要 】

Background‘PACE Steps to Success’ is a multicomponent training program aiming to integrate generalist and non-disease-specific palliative care in nursing homes. This program did not improve residents’ comfort in the last week of life, but it appeared to improve quality of care and dying in their last month of life. Because this program included only three dementia-specific elements, its effects might differ depending on the presence or stage of dementia. We aimed to investigate whether the program effects differ between residents with advanced, non-advanced, and no dementia.MethodsPre-planned subgroup analysis of the PACE cluster-randomized controlled trial in 78 nursing homes in seven European countries. Participants included residents who died in the previous 4 months. The nursing home staff or general practitioner assessed the presence of dementia; severity was determined using two highly-discriminatory staff-reported instruments. Using after-death questionnaires, staff assessed comfort in the last week of life (Comfort Assessment in Dying–End-of-Life in Dementia-scale; primary outcome) and quality of care and dying in the last month of life (Quality of Dying in Long-Term Care scale; secondary outcome).ResultsAt baseline, we included 177 residents with advanced dementia, 126 with non-advanced dementia and 156 without dementia. Post-intervention, respectively in the control and the intervention group, we included 136 and 104 residents with advanced dementia, 167 and 110 with non-advanced dementia and 157 and 137 without dementia. We found no subgroup differences on comfort in the last week of life, comparing advanced versus without dementia (baseline-adjusted mean sub-group difference 2.1; p-value = 0.177), non-advanced versus without dementia (2.7; p = 0.092), and advanced versus non-advanced dementia (− 0.6; p = 0.698); or on quality of care and dying in the last month of life, comparing advanced and without dementia (− 0.6; p = 0.741), non-advanced and without dementia (− 1.5; p = 0.428), and advanced and non-advanced dementia (0.9; p = 0.632).ConclusionsThe lack of subgroup difference suggests that while the program did not improve comfort in dying residents with or without dementia, it appeared to equally improve quality of care and dying in the last month of life for residents with dementia (regardless of the stage) and those without dementia. A generalist and non-disease-specific palliative care program, such as PACE Steps to Success, is a useful starting point for future palliative care improvement in nursing homes, but to effectively improve residents’ comfort, this program needs further development.Trial registrationISRCTN, ISRCTN14741671. Registered 8 July 2015 – Retrospectively registered.

【 授权许可】

CC BY