Implementation of knowledge-based palliative care in nursing homes and pre-post post evaluation by cross-over design: a study protocol

Abstract

BackgroundThe demography of the world is changing as the population is ageing. Because of this change to a higher proportion of older people, the WHO has called for improved palliative care for older persons. A large number of all deaths in the industrialised world occur while older people are living in nursing homes and therefore a key question becomes how the principles of palliative care can be implemented in that context. The aims of this study are: a) to describe a model of an educational intervention with the goal of implementing knowledge-based palliative care in nursing homes, and b) to describe the design of the evaluation of the effectiveness regarding the implementation of knowledge-based palliative care.Methods/designA complex intervention is evaluated by means of a cross-over design. An educational intervention concerning palliative care consisting of five seminars during 6 months for staff and managers has been developed and conducted in 20 nursing homes in two counties. Before the intervention started, the feasibility was tested in a pilot study conducted in nursing homes not included in the main study. The intervention is evaluated through a non-randomized experimental design with intervention and control groups and pre- and post-assessments. The evaluation includes older persons living in nursing homes, next-of-kin, staff and managers. Data collection consists of quantitative methods such as questionnaires and register data and qualitative methods in the form of individual interviews, focus-group interviews and participant observations.DiscussionThe research will contribute to new knowledge about how to implement knowledge-based palliative care in a nursing home setting. A strength of this project is that the Medical Research Council framework of complex intervention is applied. The four recommended stages, Development, Feasibility and piloting, Evaluation and Implementation, are combined for the educational intervention, which functions as a strategy to achieve knowledge-based palliative care in the nursing homes. Implementation is always a question of change and a good theoretical understanding is needed for drawing valid conclusions about the causal mechanisms of change. The topic is highly relevant considering the world’s ageing population. The data collection is completed and the analysis is ongoing.Trial registrationNCT02708498.

Evaluating person‐centredness for frail older persons in nursing homes before and after implementing a palliative care intervention

“…This study is part of the project Knowledge‐based Palliative Care [in Swedish: KUnskapsbaserad PAlliativ vård”], abbreviated the KUPA project (Ahlström et al, ). Based on questionnaires and narrative descriptions collected by interviews with the older persons’ assessments, this study uses a mixed‐method design, suggested as a proper method for evaluating complex interventions (Creswell & Creswell, ; Farquhar, Ewing, & Booth, ).…”

“…The evaluation of the KUPA project addresses several different outcomes reported in previous papers (Alftberg et al, ; Bökberg Behm, & Ahlström, , ; Bökberg, Behm, Wallerstedt, & Ahlström, ; Bökberg et al, ) and will be further reported in future papers. The intervention was implemented during a 6‐month period with different staff and front leaders (8–12 in each nursing home) in 20 nursing homes in two different counties in southern Sweden (Ahlström et al, ). Trial registration: NCT02708498.…”

“…The content of the different themes had a common core, but space was left for discussions and questions connected to each of the themes. The seminar groups were led by experienced Registered Nurses and researchers from the field of palliative and geriatric care (Ahlström et al, ).…”

“…The selection of nursing homes was made through voluntary participation and resulted in larger and smaller nursing homes, from both urban and rural areas (Ahlström et al, ). The older persons were recruited consecutively in equal numbers from the implementation and the control nursing homes.…”

“…Since a convergent mixed‐method (Creswell & Creswell, ) was chosen, quantitative as well as qualitative data were collected with the same participants simultaneously within the same interview. Data were collected before the intervention started (baseline) and followed up three months after the intervention was completed (Ahlström et al, ). The included nursing homes were asked to designate a contact person who informed older persons, fulfilling the inclusion criteria, about the study.…”