Pragmatic cluster randomised controlled trial of facilitated family case conferencing compared with usual care for improving end of life care and outcomes in nursing home residents with advanced dementia and their families: the IDEAL study protocol

BMC Palliative Care

Study Protocol

Jane Phillips¹  Stephen Goodall²  Elizabeth Beattie³  Meera Agar⁴  Lynnette Chenoweth⁵  Geoffrey Mitchell⁶  Dimity Pond⁷  Patricia M. Davidson⁸  Georgina Luscombe⁹  Tim Luckett^1,10 

[1] Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia;Centre for health Economics Research and Evaluation (CHERE), University of Technology Sydney, Sydney, Australia;Dementia Collaborative Research Centre, Queensland University of Technology, Brisbane, Australia;School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia;Discipline of Palliative and Supportive Services, Flinders University, Adelaide, Australia;South West Sydney Clinical School, and Improving Palliative Care through Clinical trials (ImPACCT), University of New South Wales, Sydney, Australia;Department of Palliative Care, Braeside Hospital, HammondCare, Sydney, Australia;Ingham Institute of Applied Medical Research, Sydney, Australia;Faculty of Health, University of Technology Sydney, Sydney, Australia;Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia;Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Australia;School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, Australia;School of Nursing, Johns Hopkins University, Baltimore, USA;School of Rural Health, Faculty of Medicine, The University of Sydney, Sydney, Australia;South West Sydney Clinical School, and Improving Palliative Care through Clinical trials (ImPACCT), University of New South Wales, Sydney, Australia;Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia;University of Technology Sydney (UTS) Faculty of Health, Building 10, Level 7, 235-253 Jones St, NSW 2007, Ultimo, Australia;

关键词: End of life care;    Palliative care;    Dementia;    Nursing homes;    Person-centred care;    Case conferencing;    Advance care planning;    Communication;    Implementation;    Cost effectiveness;   

DOI  :  10.1186/s12904-015-0061-8

 received in 2015-10-11, accepted in 2015-11-10,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundCare for people with advanced dementia requires a palliative approach targeted to the illness trajectory and tailored to individual needs. However, care in nursing homes is often compromised by poor communication and limited staff expertise. This paper reports the protocol for the IDEAL Project, which aims to: 1) compare the efficacy of a facilitated approach to family case conferencing with usual care; 2) provide insights into nursing home- and staff-related processes influencing the implementation and sustainability of case conferencing; and 3) evaluate cost-effectiveness.Design/MethodsA pragmatic parallel cluster randomised controlled trial design will be used. Twenty Australian nursing homes will be randomised to receive either facilitated family case conferencing or usual care.In the intervention arm, we will train registered nurses at each nursing home to work as Palliative Care Planning Coordinators (PCPCs) 16 h per week over 18 months. The PCPCs’ role will be to: 1) use evidence-based ‘triggers’ to identify optimal time-points for case conferencing; 2) organise, facilitate and document case conferences with optimal involvement from family, multi-disciplinary nursing home staff and community health professionals; 3) develop and oversee implementation of palliative care plans; and 4) train other staff in person-centred palliative care.The primary endpoint will be symptom management, comfort and satisfaction with care at the end of life as rated by bereaved family members on the End of Life in Dementia (EOLD) Scales. Secondary outcomes will include resident quality of life (Quality of Life in Late-stage Dementia [QUALID]), whether a palliative approach is taken (e.g. hospitalisations, non-palliative medical treatments), staff attitudes and knowledge (Palliative Care for Advanced Dementia [qPAD]), and cost effectiveness. Processes and factors influencing implementation, outcomes and sustainability will be explored statistically via analysis of intervention ‘dose’ and qualitatively via semi-structured interviews. The pragmatic design and complex nature of the intervention will limit blinding and internal validity but support external validity.DiscussionThe IDEAL Project will make an important contribution to the evidence base for dementia-specific case conferencing in nursing homes by considering processes and contextual factors as well as overall efficacy. Its strengths and weaknesses will both lie in its pragmatic design.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612001164886. Registered 02/11/2012.

【 授权许可】

CC BY   
© Agar et al. 2015