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Implementation of Knowledge-Based Palliative Care

NCT ID: NCT02708498

Last Updated: 2020-10-28

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1151 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-04-09

Study Completion Date

2017-10-15

Brief Summary

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The research on ageing during the last couple of decades has increasingly focused on questions regarding the quality of life and life satisfaction of the old people. Yet the research indicates that when it comes to the final stage of life, the end includes unnecessary suffering and the quality of life drops. Palliative care has traditionally been provided successfully to younger persons dying from incurable illnesses while older people dying of multiple morbidities or "old age" has received far less of this type of care. However, sixty percent of all people who died in Sweden in 2010 were at least 80 years old and it is well known that dying among older people often is a prolonged period of suffering. One reason might be that it is more difficult to identify when the final stages of life begins for older persons.

The purpose of this project is to implement and evaluate how a knowledge-based model for palliative care in nursing homes affects the quality of life and the participation in the care process for older persons in nursing homes and their next of kin. A second aim is to explore the staff's implementation process of palliative care and the role of the leadership. The final aim is to investigate which factors (barriers and facilitators) that affect the implementation process of this model.

Detailed Description

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The project was planned to be conducted using a cross-over design in two counties in south of Sweden based on a feasibility/pilot study that was conducted during fall 2014 co-created palliative care educational intervention through seminars for professionals in nursing homes. Due to a more significant amount of drop-outs compared with expected (and for not receiving the total amount of applied foundation), the plan needed to be revised. The knowledge-based palliative care intervention was conducted as a non-blinded control trial, implemented over a six-month period in 30 nursing homes in two different counties in the south of Sweden (County A and County B). The data collection was made in two sequential periods in each county. First, the intervention was implemented in ten nursing homes in County A (Kronoberg County from April 2015), while ten nursing homes in County B served as a control group. Then, County B implemented the intervention (Skåne county from April 2016), and ten new nursing homes in County A, which had not received the intervention, were chosen as a control group. After the two sequential time periods were data from one intervention and one control group analysed. The selection through voluntary participation resulted in a mixture of both larger and smaller nursing homes in the two counties, as well as both from urban and rural areas.

Every seminar group met once a month and included different professions (unit manager, district nurse, assistant nurse, and other staff i.e. occupational therapist and physiotherapist). There were 5 meetings in each nursing home during a period of 6 months.

Conditions

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Ageing

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SEQUENTIAL

The knowledge-based palliative care intervention was conducted as a non-randomized control trial.
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Kronoberg Educational Intervention

The educational intervention is provided to ten nursing homes.

Group Type EXPERIMENTAL

Educational Intervention

Intervention Type BEHAVIORAL

The seminar groups will be led by two experienced clinical nurses and researchers from the field of palliative care and geriatric care. The educational material consist of six themes; values in palliative care, symptom relief, dignity and a dignified death, collaborative co-creating care, support to next of kin and dialogue with older persons and next of kin about death and dying. The content of the different themes will have a common core for each nursing home but will be adjusted based on the expressed needs of each nursing home. New themes can be created related to the needs of the unique nursing home. The participants in the seminar groups will reflect together over the content of the developed binder of educational material and will relate it to their own work in order to identify areas suitable for changes and/or development.

Skåne Control

The control group consists of an equal number of nursing homes. This group receives no intervention.

Group Type NO_INTERVENTION

No interventions assigned to this group

Skåne Educational Intervention

The educational intervention is provided to ten nursing homes.

Group Type EXPERIMENTAL

Educational Intervention

Intervention Type BEHAVIORAL

The seminar groups will be led by two experienced clinical nurses and researchers from the field of palliative care and geriatric care. The educational material consist of six themes; values in palliative care, symptom relief, dignity and a dignified death, collaborative co-creating care, support to next of kin and dialogue with older persons and next of kin about death and dying. The content of the different themes will have a common core for each nursing home but will be adjusted based on the expressed needs of each nursing home. New themes can be created related to the needs of the unique nursing home. The participants in the seminar groups will reflect together over the content of the developed binder of educational material and will relate it to their own work in order to identify areas suitable for changes and/or development.

Kronoberg Control

The control group consists of an equal number of nursing homes. This group receives no intervention.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Educational Intervention

The seminar groups will be led by two experienced clinical nurses and researchers from the field of palliative care and geriatric care. The educational material consist of six themes; values in palliative care, symptom relief, dignity and a dignified death, collaborative co-creating care, support to next of kin and dialogue with older persons and next of kin about death and dying. The content of the different themes will have a common core for each nursing home but will be adjusted based on the expressed needs of each nursing home. New themes can be created related to the needs of the unique nursing home. The participants in the seminar groups will reflect together over the content of the developed binder of educational material and will relate it to their own work in order to identify areas suitable for changes and/or development.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Older persons living in the participating nursing homes
* Next of kin to older persons living in the participating nursing homes
* Staff working at the participating nursing homes
* Managers working at the participating nursing homes
* The participating nursing homes must be located in either Kronoberg County or Skåne County in Sweden

Exclusion Criteria

* Not being cognitive able to participate in interviews or answering the questionnaires
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Linnaeus University

OTHER

Sponsor Role collaborator

The Swedish Research Council

OTHER_GOV

Sponsor Role collaborator

Lund University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Gerd Ahlström, PhD

Role: PRINCIPAL_INVESTIGATOR

Department of Health Sciences, Lund University

Locations

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Bryggaren

Alvesta, Kronoberg County, Sweden

Site Status

Högåsen

Alvesta, Kronoberg County, Sweden

Site Status

Älmegården

Älmeboda, Kronoberg County, Sweden

Site Status

Asken

Grimslöv, Kronoberg County, Sweden

Site Status

Kvarngården

Ingelstad, Kronoberg County, Sweden

Site Status

Konga Allhus

Konga, Kronoberg County, Sweden

Site Status

Åbrinken

Lagan, Kronoberg County, Sweden

Site Status

Ljungberga

Ljungby, Kronoberg County, Sweden

Site Status

Ljungsätra

Ljungby, Kronoberg County, Sweden

Site Status

Brunnsgården

Ljungby, Kronoberg County, Sweden

Site Status

Torsgården

Lönashult, Kronoberg County, Sweden

Site Status

Furuliden

Moheda, Kronoberg County, Sweden

Site Status

Solängen

Ryd, Kronoberg County, Sweden

Site Status

Örnen

Tingsryd, Kronoberg County, Sweden

Site Status

Äppelgården

Urshult, Kronoberg County, Sweden

Site Status

Birkagården

Vaxjo, Kronoberg County, Sweden

Site Status

Hovslund

Vaxjo, Kronoberg County, Sweden

Site Status

Evelid

Vaxjo, Kronoberg County, Sweden

Site Status

Solhaga

Väckelsång, Kronoberg County, Sweden

Site Status

Björkliden

Vislanda, Kronoberg County, Sweden

Site Status

Skogsgläntan

Höör, Skåne County, Sweden

Site Status

Åsgården

Kågeröd, Skåne County, Sweden

Site Status

Mårtenslund

Lund, Skåne County, Sweden

Site Status

Brunnslyckan

Lund, Skåne County, Sweden

Site Status

Norrdala

Lund, Skåne County, Sweden

Site Status

Rönnebacken

Osby, Skåne County, Sweden

Site Status

Fästan

Södra Sandby, Skåne County, Sweden

Site Status

Solgården

Svalöv, Skåne County, Sweden

Site Status

Holmagården

Svedala, Skåne County, Sweden

Site Status

Ängslyckan

Teckomatorp, Skåne County, Sweden

Site Status

Countries

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Sweden

References

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Persson HA, Ahlstrom G, Ekwall A. Professionals readiness for change to knowledge-based palliative care at nursing homes: a qualitative follow-up study after an educational intervention. BMC Palliat Care. 2022 Jul 20;21(1):132. doi: 10.1186/s12904-022-01018-y.

Reference Type DERIVED
PMID: 35854375 (View on PubMed)

Ahlstrom G, Rosen H, Persson EI. Quality of Life among Next of Kin of Frail Older People in Nursing Homes: An Interview Study after an Educational Intervention concerning Palliative Care. Int J Environ Res Public Health. 2022 Feb 24;19(5):2648. doi: 10.3390/ijerph19052648.

Reference Type DERIVED
PMID: 35270339 (View on PubMed)

Bokberg C, Sandberg J. Until death do us part Adult children's perspective of their parents' transition from living at home to moving into a nursing home and the time after death. BMC Geriatr. 2021 Nov 27;21(1):666. doi: 10.1186/s12877-021-02633-9.

Reference Type DERIVED
PMID: 34837994 (View on PubMed)

Sandgren A, Arnoldsson L, Lagerholm A, Bokberg C. Quality of life among frail older persons (65+ years) in nursing homes: A cross-sectional study. Nurs Open. 2021 May;8(3):1232-1242. doi: 10.1002/nop2.739. Epub 2020 Dec 13.

Reference Type DERIVED
PMID: 34482652 (View on PubMed)

Westergren A, Ahlstrom G, Persson M, Behm L. Next of kin participation in the care of older persons in nursing homes: A pre-post non-randomised educational evaluation, using within-group and individual person-level comparisons. PLoS One. 2021 Jan 25;16(1):e0244600. doi: 10.1371/journal.pone.0244600. eCollection 2021.

Reference Type DERIVED
PMID: 33493153 (View on PubMed)

Tjernberg J, Bokberg C. Older persons' thoughts about death and dying and their experiences of care in end-of-life: a qualitative study. BMC Nurs. 2020 Dec 16;19(1):123. doi: 10.1186/s12912-020-00514-x.

Reference Type DERIVED
PMID: 33327960 (View on PubMed)

Rosen H, Ahlstrom G, Lexen A. Psychometric properties of the WHOQOL-BREF among next of kin to older persons in nursing homes. Health Qual Life Outcomes. 2020 Apr 19;18(1):103. doi: 10.1186/s12955-020-01345-9.

Reference Type DERIVED
PMID: 32306965 (View on PubMed)

Westergren A, Behm L, Lindhardt T, Persson M, Ahlstrom G. Measuring next of kin's experience of participation in the care of older people in nursing homes. PLoS One. 2020 Jan 31;15(1):e0228379. doi: 10.1371/journal.pone.0228379. eCollection 2020.

Reference Type DERIVED
PMID: 32004352 (View on PubMed)

Rosen H, Behm L, Wallerstedt B, Ahlstrom G. Being the next of kin of an older person living in a nursing home: an interview study about quality of life. BMC Geriatr. 2019 Nov 21;19(1):324. doi: 10.1186/s12877-019-1343-4.

Reference Type DERIVED
PMID: 31752709 (View on PubMed)

Bokberg C, Behm L, Ahlstrom G. Next of kin's quality of life before and after implementation of a knowledge-based palliative care intervention in nursing homes. Qual Life Res. 2019 Dec;28(12):3293-3301. doi: 10.1007/s11136-019-02268-9. Epub 2019 Aug 14.

Reference Type DERIVED
PMID: 31414348 (View on PubMed)

Bokberg C, Behm L, Wallerstedt B, Ahlstrom G. Evaluation of person-centeredness in nursing homes after a palliative care intervention: pre- and post-test experimental design. BMC Palliat Care. 2019 May 31;18(1):44. doi: 10.1186/s12904-019-0431-8.

Reference Type DERIVED
PMID: 31151438 (View on PubMed)

Ahlstrom G, Nilsen P, Benzein E, Behm L, Wallerstedt B, Persson M, Sandgren A. Implementation of knowledge-based palliative care in nursing homes and pre-post post evaluation by cross-over design: a study protocol. BMC Palliat Care. 2018 Mar 22;17(1):52. doi: 10.1186/s12904-018-0308-2.

Reference Type DERIVED
PMID: 29566688 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Related Links

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https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/2013-6-4.pdf

The Swedish national knowledge support document for good palliative care

Other Identifiers

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2014-0071

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

2014-2759

Identifier Type: -

Identifier Source: org_study_id