Improving Palliative Care Through Teamwork

NCT ID: NCT01990742

Last Updated: 2018-09-17

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 31 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2013-09-27
• Study Completion Date: 2017-04-01

Brief Summary

One in three Americans dies in a nursing home (NH) or in a hospital, shortly following transfer from a long-term care facility. The proportion of deaths occurring in NHs is projected to increase to 40% by 2020. Excellence in palliative and end-of-life (EOL) care must become a priority for these long-term care institutions. However, findings from NHs point to high incidence of pain and poor management of other symptoms and excessive reliance on hospitalizations, indicating inadequate EOL care quality. Expert opinion and research have suggested that poor EOL quality in NHs may be due to lack of palliative care training among staff and absence of EOL care protocols or guidelines, but research demonstrating that attention to these factors improves outcomes is absent. While dedicated care teams have been shown to improve outcomes for NH residents in need of specialized care, the impact of palliative care teams in improving resident outcomes has remained largely unstudied and untested. This will be the first randomized controlled trial to evaluate the impact of palliative care teams (PCTeam) on resident and staff outcomes, and care processes, in NHs.

Our objective is to demonstrate, using a randomized controlled trial design and a difference in difference analytic approach, that nursing home-based palliative care practice guidelines implemented through PCTeams will improve quality of care processes and outcomes for residents at the end of life.

We will adapt existing palliative care guidelines for EOL care, endorsed by the National Quality Forum (NQF), to the NH environment, deploy the adapted practice guidelines through a PCTeam model, and evaluate the effectiveness of this intervention on resident EOL outcomes and staff care processes and outcomes. The specific aims (SA) will address the following questions:

SA 1: Is PCTeam intervention effective in improving NH residents' EOL outcomes?

SA 2: Is PCTeam intervention effective in improving NH staff EOL care processes and outcomes?

In the context of these specific aims we will test the following hypotheses:

H1: Residents in NHs in the intervention arm, compared to the control, will achieve better EOL risk-adjusted outcomes and care processes with regard to:

• Pain
• Dyspnea
• Depression
• In-hospital deaths
• Hospitalizations
• Advance directives

H2: Direct care staff in NHs in the intervention arm, compared to the control, will achieve better EOL processes and outcomes measured by:

• Assessment of EOL symptoms
• Delivery of EOL care
• Communication/coordination among providers
• Communication with residents/families
• Teamwork effectiveness
• Staff satisfaction

H3: Family caregivers of decedent residents in the intervention NHs, compared to the control, will report receiving more patient and family centered care as measured by higher levels of satisfaction with:

• Shared decision making between providers, the patient and the family
• Care that is respectful of the patient wishes and dignity
• Attention to the emotional and spiritual needs of the family.

31 NHs in upstate New York have been recruited for the study (letters of support). Stakeholders include residents, family members, staff, policy makers, and others. The intervention will deploy theTeamSTEPPS, a team development model created by the Department of Defense and the Agency for Healthcare Research and Quality.

Conditions

Palliative Care

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

Palliative Care Team (PCTeam)

Palliative care teams will be established and will round with residents in the intervention homes.

Group Type: EXPERIMENTAL

Palliative Care Team (PCTeam)

Intervention Type: BEHAVIORAL

Palliative care teams will be established and will round with residents in the intervention nursing homes.

Standard care

Usual care will be provided to residents in the control homes.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Palliative Care Team (PCTeam)

Palliative care teams will be established and will round with residents in the intervention nursing homes.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• long-stay nursing home residents (>90 days)

Exclusion Criteria

• rehabilitative, post-acute residents (<90 days)

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of California, Irvine

OTHER

Sponsor Role: collaborator

University of Rochester

OTHER

Sponsor Role: lead

Responsible Party

Helena Temkin-Greener

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Helena Temkin-Greener, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Rochester

Locations

University of Rochester School of Medicine and Dentistry

Rochester, New York, United States

Countries

United States

References

Ryan RE, Connolly M, Bradford NK, Henderson S, Herbert A, Schonfeld L, Young J, Bothroyd JI, Henderson A. Interventions for interpersonal communication about end of life care between health practitioners and affected people. Cochrane Database Syst Rev. 2022 Jul 8;7(7):CD013116. doi: 10.1002/14651858.CD013116.pub2.

Reference Type: DERIVED

PMID: 35802350 (View on PubMed)

Other Identifiers

PCORI-641

Identifier Type: -

Identifier Source: org_study_id