Effects of facilitated family case conferencing for advanced dementia: A cluster randomised clinical trial

Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing (FCC) with usual care (UC) on end-of-life care. A two arm parallel cluster randomised controlled trial was conducted. The sample included peopl...

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Published inPloS one Vol. 12; no. 8; p. e0181020
Main Authors Agar, Meera, Luckett, Tim, Luscombe, Georgina, Phillips, Jane, Beattie, Elizabeth, Pond, Dimity, Mitchell, Geoffrey, Davidson, Patricia M, Cook, Janet, Brooks, Deborah, Houltram, Jennifer, Goodall, Stephen, Chenoweth, Lynnette
Format Journal Article
LanguageEnglish
Published United States Public Library of Science 07.08.2017
Public Library of Science (PLoS)
Subjects
Aged
Aged, 80 and over
Analysis
Australia
Care and treatment
Caregivers
Clinical decision making
Clinical trials
Comfort
Decision making
Dementia
Dementia - therapy
Dementia disorders
Family
Female
Health Personnel
Humans
Intervention
Linear Models
Male
Management
Medical research
Medicine and Health Sciences
Middle Aged
Nurses
Nursing
Nursing Homes
Nursing schools
Palliative care
Palliative Care - methods
People and Places
Pharmacology
Physicians
Quality of Health Care
Quality of Life
Research and Analysis Methods
Single-Blind Method
Terminal Care - methods
Treatment Outcome
Australia
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Abstract Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing (FCC) with usual care (UC) on end-of-life care. A two arm parallel cluster randomised controlled trial was conducted. The sample included people with advanced dementia from 20 Australian nursing homes and their families and professional caregivers. In each intervention nursing home (n = 10), Palliative Care Planning Coordinators (PCPCs) facilitated family case conferences and trained staff in person-centred palliative care for 16 hours per week over 18 months. The primary outcome was family-rated quality of end-of-life care (End-of-Life Dementia [EOLD] Scales). Secondary outcomes included nurse-rated EOLD scales, resident quality of life (Quality of Life in Late-stage Dementia [QUALID]) and quality of care over the last month of life (pharmacological/non-pharmacological palliative strategies, hospitalization or inappropriate interventions). Two-hundred-eighty-six people with advanced dementia took part but only 131 died (64 in UC and 67 in FCC which was fewer than anticipated), rendering the primary analysis under-powered with no group effect seen in EOLD scales. Significant differences in pharmacological (P < 0.01) and non-pharmacological (P < 0.05) palliative management in last month of life were seen. Intercurrent illness was associated with lower family-rated EOLD Satisfaction with Care (coefficient 2.97, P < 0.05) and lower staff-rated EOLD Comfort Assessment with Dying (coefficient 4.37, P < 0.01). Per protocol analyses showed positive relationships between EOLD and staff hours to bed ratios, proportion of residents with dementia and staff attitudes. FCC facilitates a palliative approach to care. Future trials of case conferencing should consider outcomes and processes regarding decision making and planning for anticipated events and acute illness. Australian New Zealand Clinical Trial Registry ACTRN12612001164886.
AbstractList Background Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing (FCC) with usual care (UC) on end-of-life care. Methods A two arm parallel cluster randomised controlled trial was conducted. The sample included people with advanced dementia from 20 Australian nursing homes and their families and professional caregivers. In each intervention nursing home (n = 10), Palliative Care Planning Coordinators (PCPCs) facilitated family case conferences and trained staff in person-centred palliative care for 16 hours per week over 18 months. The primary outcome was family-rated quality of end-of-life care (End-of-Life Dementia [EOLD] Scales). Secondary outcomes included nurse-rated EOLD scales, resident quality of life (Quality of Life in Late-stage Dementia [QUALID]) and quality of care over the last month of life (pharmacological/non-pharmacological palliative strategies, hospitalization or inappropriate interventions). Results Two-hundred-eighty-six people with advanced dementia took part but only 131 died (64 in UC and 67 in FCC which was fewer than anticipated), rendering the primary analysis under-powered with no group effect seen in EOLD scales. Significant differences in pharmacological (P < 0.01) and non-pharmacological (P < 0.05) palliative management in last month of life were seen. Intercurrent illness was associated with lower family-rated EOLD Satisfaction with Care (coefficient 2.97, P < 0.05) and lower staff-rated EOLD Comfort Assessment with Dying (coefficient 4.37, P < 0.01). Per protocol analyses showed positive relationships between EOLD and staff hours to bed ratios, proportion of residents with dementia and staff attitudes. Conclusion FCC facilitates a palliative approach to care. Future trials of case conferencing should consider outcomes and processes regarding decision making and planning for anticipated events and acute illness. Trial registration Australian New Zealand Clinical Trial Registry ACTRN12612001164886
BACKGROUNDPalliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing (FCC) with usual care (UC) on end-of-life care.METHODSA two arm parallel cluster randomised controlled trial was conducted. The sample included people with advanced dementia from 20 Australian nursing homes and their families and professional caregivers. In each intervention nursing home (n = 10), Palliative Care Planning Coordinators (PCPCs) facilitated family case conferences and trained staff in person-centred palliative care for 16 hours per week over 18 months. The primary outcome was family-rated quality of end-of-life care (End-of-Life Dementia [EOLD] Scales). Secondary outcomes included nurse-rated EOLD scales, resident quality of life (Quality of Life in Late-stage Dementia [QUALID]) and quality of care over the last month of life (pharmacological/non-pharmacological palliative strategies, hospitalization or inappropriate interventions).RESULTSTwo-hundred-eighty-six people with advanced dementia took part but only 131 died (64 in UC and 67 in FCC which was fewer than anticipated), rendering the primary analysis under-powered with no group effect seen in EOLD scales. Significant differences in pharmacological (P < 0.01) and non-pharmacological (P < 0.05) palliative management in last month of life were seen. Intercurrent illness was associated with lower family-rated EOLD Satisfaction with Care (coefficient 2.97, P < 0.05) and lower staff-rated EOLD Comfort Assessment with Dying (coefficient 4.37, P < 0.01). Per protocol analyses showed positive relationships between EOLD and staff hours to bed ratios, proportion of residents with dementia and staff attitudes.CONCLUSIONFCC facilitates a palliative approach to care. Future trials of case conferencing should consider outcomes and processes regarding decision making and planning for anticipated events and acute illness.TRIAL REGISTRATIONAustralian New Zealand Clinical Trial Registry ACTRN12612001164886.
Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing (FCC) with usual care (UC) on end-of-life care. A two arm parallel cluster randomised controlled trial was conducted. The sample included people with advanced dementia from 20 Australian nursing homes and their families and professional caregivers. In each intervention nursing home (n = 10), Palliative Care Planning Coordinators (PCPCs) facilitated family case conferences and trained staff in person-centred palliative care for 16 hours per week over 18 months. The primary outcome was family-rated quality of end-of-life care (End-of-Life Dementia [EOLD] Scales). Secondary outcomes included nurse-rated EOLD scales, resident quality of life (Quality of Life in Late-stage Dementia [QUALID]) and quality of care over the last month of life (pharmacological/non-pharmacological palliative strategies, hospitalization or inappropriate interventions). Two-hundred-eighty-six people with advanced dementia took part but only 131 died (64 in UC and 67 in FCC which was fewer than anticipated), rendering the primary analysis under-powered with no group effect seen in EOLD scales. Significant differences in pharmacological (P < 0.01) and non-pharmacological (P < 0.05) palliative management in last month of life were seen. Intercurrent illness was associated with lower family-rated EOLD Satisfaction with Care (coefficient 2.97, P < 0.05) and lower staff-rated EOLD Comfort Assessment with Dying (coefficient 4.37, P < 0.01). Per protocol analyses showed positive relationships between EOLD and staff hours to bed ratios, proportion of residents with dementia and staff attitudes. FCC facilitates a palliative approach to care. Future trials of case conferencing should consider outcomes and processes regarding decision making and planning for anticipated events and acute illness.
Background Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing (FCC) with usual care (UC) on end-of-life care. Methods A two arm parallel cluster randomised controlled trial was conducted. The sample included people with advanced dementia from 20 Australian nursing homes and their families and professional caregivers. In each intervention nursing home (n = 10), Palliative Care Planning Coordinators (PCPCs) facilitated family case conferences and trained staff in person-centred palliative care for 16 hours per week over 18 months. The primary outcome was family-rated quality of end-of-life care (End-of-Life Dementia [EOLD] Scales). Secondary outcomes included nurse-rated EOLD scales, resident quality of life (Quality of Life in Late-stage Dementia [QUALID]) and quality of care over the last month of life (pharmacological/non-pharmacological palliative strategies, hospitalization or inappropriate interventions). Results Two-hundred-eighty-six people with advanced dementia took part but only 131 died (64 in UC and 67 in FCC which was fewer than anticipated), rendering the primary analysis under-powered with no group effect seen in EOLD scales. Significant differences in pharmacological (P < 0.01) and non-pharmacological (P < 0.05) palliative management in last month of life were seen. Intercurrent illness was associated with lower family-rated EOLD Satisfaction with Care (coefficient 2.97, P < 0.05) and lower staff-rated EOLD Comfort Assessment with Dying (coefficient 4.37, P < 0.01). Per protocol analyses showed positive relationships between EOLD and staff hours to bed ratios, proportion of residents with dementia and staff attitudes. Conclusion FCC facilitates a palliative approach to care. Future trials of case conferencing should consider outcomes and processes regarding decision making and planning for anticipated events and acute illness. Trial registration Australian New Zealand Clinical Trial Registry ACTRN12612001164886
Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing (FCC) with usual care (UC) on end-of-life care. A two arm parallel cluster randomised controlled trial was conducted. The sample included people with advanced dementia from 20 Australian nursing homes and their families and professional caregivers. In each intervention nursing home (n = 10), Palliative Care Planning Coordinators (PCPCs) facilitated family case conferences and trained staff in person-centred palliative care for 16 hours per week over 18 months. The primary outcome was family-rated quality of end-of-life care (End-of-Life Dementia [EOLD] Scales). Secondary outcomes included nurse-rated EOLD scales, resident quality of life (Quality of Life in Late-stage Dementia [QUALID]) and quality of care over the last month of life (pharmacological/non-pharmacological palliative strategies, hospitalization or inappropriate interventions). Two-hundred-eighty-six people with advanced dementia took part but only 131 died (64 in UC and 67 in FCC which was fewer than anticipated), rendering the primary analysis under-powered with no group effect seen in EOLD scales. Significant differences in pharmacological (P < 0.01) and non-pharmacological (P < 0.05) palliative management in last month of life were seen. Intercurrent illness was associated with lower family-rated EOLD Satisfaction with Care (coefficient 2.97, P < 0.05) and lower staff-rated EOLD Comfort Assessment with Dying (coefficient 4.37, P < 0.01). Per protocol analyses showed positive relationships between EOLD and staff hours to bed ratios, proportion of residents with dementia and staff attitudes. FCC facilitates a palliative approach to care. Future trials of case conferencing should consider outcomes and processes regarding decision making and planning for anticipated events and acute illness. Australian New Zealand Clinical Trial Registry ACTRN12612001164886.
Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing (FCC) with usual care (UC) on end-of-life care.A two arm parallel cluster randomised controlled trial was conducted. The sample included people with advanced dementia from 20 Australian nursing homes and their families and professional caregivers. In each intervention nursing home (n = 10), Palliative Care Planning Coordinators (PCPCs) facilitated family case conferences and trained staff in person-centred palliative care for 16 hours per week over 18 months. The primary outcome was family-rated quality of end-of-life care (End-of-Life Dementia [EOLD] Scales). Secondary outcomes included nurse-rated EOLD scales, resident quality of life (Quality of Life in Late-stage Dementia [QUALID]) and quality of care over the last month of life (pharmacological/non-pharmacological palliative strategies, hospitalization or inappropriate interventions).Two-hundred-eighty-six people with advanced dementia took part but only 131 died (64 in UC and 67 in FCC which was fewer than anticipated), rendering the primary analysis under-powered with no group effect seen in EOLD scales. Significant differences in pharmacological (P < 0.01) and non-pharmacological (P < 0.05) palliative management in last month of life were seen. Intercurrent illness was associated with lower family-rated EOLD Satisfaction with Care (coefficient 2.97, P < 0.05) and lower staff-rated EOLD Comfort Assessment with Dying (coefficient 4.37, P < 0.01). Per protocol analyses showed positive relationships between EOLD and staff hours to bed ratios, proportion of residents with dementia and staff attitudes.FCC facilitates a palliative approach to care. Future trials of case conferencing should consider outcomes and processes regarding decision making and planning for anticipated events and acute illness.Australian New Zealand Clinical Trial Registry ACTRN12612001164886.
Audience Academic
Author Cook, Janet
Houltram, Jennifer
Phillips, Jane
Beattie, Elizabeth
Chenoweth, Lynnette
Luckett, Tim
Mitchell, Geoffrey
Goodall, Stephen
Davidson, Patricia M
Pond, Dimity
Agar, Meera
Brooks, Deborah
Luscombe, Georgina
AuthorAffiliation 6 School of Nursing, Queensland University of Technology, Herston, Queensland (QLD), Australia
1 Faculty of Health, University of Technology Sydney, Ultimo, New South Wales (NSW), Australia
7 School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
5 Sydney Medical School, The University of Sydney, Ultimo, NSW, Australia
8 Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
University of Glasgow, UNITED KINGDOM
11 Centre for Healthy Brain Ageing, University of New South Wales, Randwick, NSW, Australia
9 School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
2 South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia
4 Improving Palliative Care through Clinical Trials (ImPaCCT), Sydney, NSW, Australia
3 Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
10 Centre for Health Research and Evaluation (CHERE), Faculty of Business, UTS, Haymarket, NS
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– name: University of Glasgow, UNITED KINGDOM
– name: 6 School of Nursing, Queensland University of Technology, Herston, Queensland (QLD), Australia
– name: 9 School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
– name: 10 Centre for Health Research and Evaluation (CHERE), Faculty of Business, UTS, Haymarket, NSW, Australia
– name: 7 School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
– name: 4 Improving Palliative Care through Clinical Trials (ImPaCCT), Sydney, NSW, Australia
– name: 3 Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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  organization: Sydney Medical School, The University of Sydney, Ultimo, NSW, Australia
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  surname: Phillips
  fullname: Phillips, Jane
  organization: Faculty of Health, University of Technology Sydney, Ultimo, New South Wales (NSW), Australia
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  organization: School of Nursing, Queensland University of Technology, Herston, Queensland (QLD), Australia
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  organization: School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
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  fullname: Mitchell, Geoffrey
  organization: Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
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  surname: Chenoweth
  fullname: Chenoweth, Lynnette
  organization: Centre for Healthy Brain Ageing, University of New South Wales, Randwick, NSW, Australia
BackLink https://www.ncbi.nlm.nih.gov/pubmed/28786995$$D View this record in MEDLINE/PubMed
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2017 Agar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
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– notice: 2017 Agar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
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Snippet Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing...
Background Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case...
BACKGROUNDPalliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case...
Background Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case...
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StartPage e0181020
SubjectTerms Aged
Aged, 80 and over
Analysis
Australia
Care and treatment
Caregivers
Clinical decision making
Clinical trials
Comfort
Decision making
Dementia
Dementia - therapy
Dementia disorders
Family
Female
Health Personnel
Humans
Intervention
Linear Models
Male
Management
Medical research
Medicine and Health Sciences
Middle Aged
Nurses
Nursing
Nursing Homes
Nursing schools
Palliative care
Palliative Care - methods
People and Places
Pharmacology
Physicians
Quality of Health Care
Quality of Life
Research and Analysis Methods
Single-Blind Method
Terminal Care - methods
Treatment Outcome
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Title Effects of facilitated family case conferencing for advanced dementia: A cluster randomised clinical trial
URI https://www.ncbi.nlm.nih.gov/pubmed/28786995
https://www.proquest.com/docview/1926897311
https://search.proquest.com/docview/1927306720
https://pubmed.ncbi.nlm.nih.gov/PMC5546584
https://doaj.org/article/9b3d7530bd3e4cf484845d2ad21a0fe4
http://dx.doi.org/10.1371/journal.pone.0181020
Volume 12
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