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 Palliative Care

on behalf of the PACE trial group¹  Catherine Bassal²  Lara Pivodic³  Tinne Smets³  Luc Deliens³  Rose Miranda³  Lieve Van den Block³  Hein van Hout⁴  Nele Van Den Noortgate⁵  Ruth Piers⁵  Marc Tanghe⁵  Roeline H. R. W. Pasman⁶  Mariska Oosterveld-Vlug⁶  Bregje B. D. Onwuteaka-Philipsen⁶  Sophie Pautex⁷  Yvonne Engels⁸  Anne B. Wichmann⁸  Myrra Vernooij-Dassen⁸  Jo Hockley⁹  Katherine Froggatt⁹  Sheila Payne⁹  Marika Kylänen^1,10  Suvi Leppäaho^1,10  Ilona Barańska^1,11  Katarzyna Szczerbińska^1,11  Giovanni Gambassi^1,12 

[1] ;Center for the Interdisciplinary Study of Gerontology and Vulnerability (CIGEV), University of Geneva;Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University;Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center;Department of Geriatric Medicine, Ghent University Hospital;EMGO Institute for Health and Care research, Expertise Center for Palliative Care, VU University Medical Center;Hôpitaux Universitaires de Genève, University of Geneva;IQ healthcare, Radboud University Medical Center;International Observatory on End-of-Life Care, Lancaster University;National Institute for Health and Welfare;Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College;Università Cattolica del Sacro Cuoro;

关键词: Nursing home;    Care home;    Palliative care;    End-of-life care;    Quality improvement;   

DOI  :  10.1186/s12904-018-0297-1

来源: DOAJ

【 摘 要 】

Abstract Background Several studies have highlighted the need for improvement in palliative care delivered to older people long-term care facilities. However, the available evidence on how to improve palliative care in these settings is weak, especially in Europe. We describe the protocol of the PACE trial aimed to 1) evaluate the effectiveness and cost-effectiveness of the ‘PACE Steps to Success’ palliative care intervention for older people in long-term care facilities, and 2) assess the implementation process and identify facilitators and barriers for implementation in different countries. Methods We will conduct a multi-facility cluster randomised controlled trial in Belgium, Finland, Italy, the Netherlands, Poland, Switzerland and England. In total, 72 facilities will be randomized to receive the ‘Pace Steps to Success intervention’ or to ‘care as usual’. Primary outcome at resident level: quality of dying (CAD-EOLD); and at staff level: staff knowledge of palliative care (Palliative Care Survey). Secondary outcomes: resident’s quality of end-of-life care, staff self-efficacy, self-perceived educational needs, and opinions on palliative care. Economic outcomes: direct costs and quality-adjusted life years (QALYs). Measurements are performed at baseline and after the intervention. For the resident-level outcomes, facilities report all deaths of residents in and outside the facilities over a previous four-month period and structured questionnaires are sent to (1) the administrator, (2) staff member most involved in care (3) treating general practitioner, and (4) a relative. For the staff-level outcomes, all staff who are working in the facilities are asked to complete a structured questionnaire. A process evaluation will run alongside the effectiveness evaluation in the intervention group using the RE-AIM framework. Discussion The lack of high quality trials in palliative care has been recognized throughout the field of palliative care research. This cross-national cluster RCT designed to evaluate the impact of the palliative care intervention for long-term care facilities ‘PACE Steps to Success’ in seven countries, will provide important evidence concerning the effectiveness as well as the preconditions for optimal implementation of palliative care in nursing homes, and this within different health care systems. Trial registration The study is registered at www.isrctn.com – ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) Registration date: July 30, 2015.

【 授权许可】

Unknown