Improving end-of-life care in acute geriatric hospital wards using the Care Programme for the Last Days of Life: study protocol for a phase 3 cluster randomized controlled trial

Verhofstede, Rebecca; Smets, Tinne; Cohen, Joachim; Costantini, Massimo; Noortgate, Nele Van Den; Deliens, Luc

doi:10.1186/s12877-015-0010-7

Cited by 8 publications

(7 citation statements)

References 39 publications

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“…However, this should not be a reason to abandon any efforts to structure and further improve end-of-life care in health care settings. Rather, it pinpoints the need to properly develop, evaluate and implement ameliorated end-of-life care improvement programmes taking into account the context in which it will be implemented as well as the concerns raised in the UK, such as improper implementation leading to cases of inadequate end-of-life care [ 16 ]. With respect to the raised concerns in the UK the terminology was changed from ‘Pathway’ to ‘Care Guide’ and an implemention guide was developed.…”

Section: Discussionmentioning

confidence: 99%

“…With respect to the raised concerns in the UK the terminology was changed from ‘Pathway’ to ‘Care Guide’ and an implemention guide was developed. This implementation guide incorporates nine components to be performed and includes a detailed and elaborated training package to help health care staff in educating and supporting their colleagues in using the Care Guide in a correct and compassionate way [ 16 ]. Additionally, a quantitative process evaluation tool was developed in order to assess and monitor the quality of implementation.…”

Section: Discussionmentioning

confidence: 99%

“…To improve the quality of end-of-life care for older patients dying in hospital, we developed the Care Programme for the Last Days of Life (hereinafter - Care Programme) for acute geriatric hospital wards [ 16 ]. This programme is based on the Liverpool Care Pathway (LCP) programme, taking into account the raised concerns in the UK regarding the LCP.…”

Section: Introductionmentioning

confidence: 99%

“…Raised concerns regarding the LCP arise mainly from inappropriate implementation and use and not the principles of the LCP itself [ 18 ]. The Care Programme in Belgium can be considered as being different from the original LCP programme in several ways [ 16 ]. It is for instance specifically adapted to the older hospital population and setting.…”

Section: Introductionmentioning

confidence: 99%

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Implementing the care programme for the last days of life in an acute geriatric hospital ward: a phase 2 mixed method study

et al. 2016

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BackgroundTo improve the quality of end-of-life care in geriatric hospital wards we developed the Care Programme for the Last Days of Life. It consists of 1) the Care Guide for the Last Days of Life, 2) supportive documentation and 3) an implementation guide. The aim of this study is (1) to determine the feasibility of implementing the Care Programme for the Last Days of Life in the acute geriatric hospital setting and (2) to explore the health care professionals’ perceptions of the effects of the Care Programme on end-of-life care.MethodsA phase 2 mixed methods study according with the MRC framework was performed in the acute geriatric ward of Ghent University Hospital between 1 April and 30 September 2013. During the implementation process a mixed methods approach was used including observation, interviews and the use of a quantitative process evaluation tool. This tool measured the success of implementation using several indicators, such as whether a steering group was formed, whether and how much of the health care staff was informed and trained and how many patients were cared for according to the Care Guide for the Last Days of Life.ResultsThe process evaluation tool showed that implementing the Care Programme for the Last Days of Life in the geriatric ward was successful and thus feasible; a steering group was formed consisting of two facilitators, health care staff of the geriatric ward were trained in using the Care Guide for the Last Days of Life which was subsequently introduced onto the ward and approximately 57 % of all dying patients were cared for according to the Care Guide for the Last Days of Life.With regard to health care professionals’ perceptions, nurses and physicians experienced the Care Guide for the Last Days of Life as improving the overall documentation of care, improving communication among health care staff and between health care staff and patient/family and improving the quality of end-of-life care. Barriers to implementing the Care Programme for the Last Days of Life successfully are, among others, difficulties with the content of the documents used within the Care Programme for the Last Days of Life and the low participation rate of physicians in the training sessions and audits.ConclusionsResults of this mixed methods study suggest that implementing the Care Programme for the Last Days of Life is feasible and that it has favorable effects on end-of-life care as reported by health care professionals. Based on the identified barriers during the implementation process, we were able to make recommendations for future implementation and further refine the Care Programme for the Last Days of Life before implementing it in a phase 3 cluster randomized controlled trial for the evaluation of its effectiveness.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implementing the care programme for the last days of life in an acute geriatric hospital ward: a phase 2 mixed method study

et al. 2016

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“…Measurement of outcomes by using the questionnaires filled out by clinical staff and the family carer should be included in further studies to enable a more comprehensive assessment on the quality of EOL care. 19 Thirdly, it was difficult to justify whether palliative medications on patients were "essential" in a retrospective review, as fair justification could not be made simply based on WHO recommended drug list. It should be considered with individual patient clinical context.…”

Section: Limitationsmentioning

confidence: 99%