From: UK quality statements on end of life care in dementia: a systematic review of research evidence
Study and country | Design | Population | Intervention content, data collection, analysis and number with palliative care assessment | Resultsa: Impact on care outcomes of assessment in the community to identify, and plan palliative care needs | ||||
---|---|---|---|---|---|---|---|---|
Arcand et al. 2009 [36] Canada | Pre and post intervention study. | Relatives of residents who died with advanced dementia, and where dementia was the main physician recorded diagnosis. pre intervention Mean age 91 years and 90 % female and post intervention. 87 years and 71 % female. | Intervention educational Delivered by geriatric nurse specialist for all care home staff and physicians. Topics included symptom control & palliative care in advanced dementia, advance care planning & medical guidelines for considering prognosis. Information booklet for use by staff and to give to family members. | Mean difference in scores and confidence intervals pre and post interventiona | ||||
One 387 bed nursing home (NH). | 48 deceased residents, 27 pre-intervention, and 21 post-intervention. | Data collection 4–16 months post bereavement. Family satisfaction with care using validated scale “After death bereaved family member interview/ NH version”. | Communication | 1.40 [−3.04, 0.24] | ||||
Unit of analysis NH | Analysis t-tests statistics | Care according to | ||||||
Patient’s wishes | −0.10 [−1.18, 0.98] | |||||||
Symptom control | −0.80 [−1.96, 0.36] | |||||||
Dying with dignity | 0.10 [−1.22, 1.42] | |||||||
Family emotional | ||||||||
Support | 1.00 [−2.85, 0.85] | |||||||
Satisfaction | −1.00 [−2.05, 0.05] | |||||||
ausing “After death bereaved family member interview/ Nursing Home version”. | ||||||||
None of the mean differences were signficiant. | ||||||||
Hanson et al. 2005 [37] US | Pre and post intervention study, 7 NH with another 2 NH acting as a control. This was to gauge temporal trends. | All residents, 43 % had dementia diagnosis and 76 % cognitive impairment. | Intervention educational Plan-do-study-act design. NH identified staff members to form interdisciplinary palliative care team who attended one day conference; education on hospice enrolment and services, pain management, advance care plans and communication. Then monthly in house education and support (x6 sessions) available to all clinical staff; help with designing procedures & protocols and the use of assessment tools. | Results in numbers: | ||||
Pre (%) | Post (%) | |||||||
N = 345 | n = 346 | |||||||
Unit of analysis NH | Mean age 82 years, 74 % white, 81 % female. | Data collection from medical records and after death interview at least three months after the death. | Hospice care | 4.0 | 6.8* | |||
345 residents pre intervention and 346 post intervention | Analysis chi-squared statistics | Pain assessed | 18 | 60* | ||||
113 residents in 2 control NHs No significant differences between intervention and control NHs at baseline | Receiving pain | |||||||
Medication | 77 | 81 | ||||||
Receiving non-drug | ||||||||
Treatment for pain | 15 | 34* | ||||||
DNR order | 58 | 65* | ||||||
DNR flagged in chart | 45 | 60* | ||||||
Documented discussion on preferences | 4 | 17* | ||||||
*Statistically significant, P value equal or less than 0.05, chi-squared test | ||||||||
Livingston, 2013 et al. [38] UK | Pre and post intervention study, | Residents with dementia of any severity (most advanced dementia MMSE mean = 5) | Educational interventional 10 session training program for all staff covering structured listening, empathy communication skills, advance care planning and preferred place of care. | Pre | Post | X2 | P value | |
One 120 bed NH. | Residents with dementia of any severity (most advanced dementia MMSE mean = 5) | Data collection from medical records & after-death bereaved family member interview | EOL talk | 04/30 | 13/28 | 15.2 | 0.001 | |
Unit of an analysis the NH | 59 deaths, 30 1 year pre-study, 29 1 year post study. | Analysis before and after intervention using t-tests and Mann Whitney for means or medians according to data distribution | DNR orders | 04/28 | 16/22 | 17.4 | 0.001 | |
EOL talk + | ||||||||
DNR order | 01/04 | 12/16 | 5.3 | 0.06 | ||||
Deaths in care home | 14/30 | 22/29 | 5.3 | 0.02 | ||||
Intervention | ||||||||
In line with wishes | 05/07 | 13/13 | 4.1 | 0.04 | ||||
Days in hospital | ||||||||
Last 3 months | 4 | 1.25 | 29.0a | 0.22 | ||||
Care | ||||||||
satisfaction | 7.5 (1.3) | 9.1 (2.4) | 17.6a | 0.06 | ||||
at test or Mann–Whitney |