Palliative Care Symptoms, Outcomes, and Interventions for Chronic Advanced Patients in Spanish Nursing Homes with and without Dementia

Puente‐Fernández, Daniel; Campos-Calderón, Concepción; Esteban-Burgos, Ana Alejandra; Hueso‐Montoro, César; Roldán-López, Concepción Beatriz; Montoya‐Juárez, Rafael

doi:10.3390/ijerph17051465

Cited by 7 publications

(12 citation statements)

References 34 publications

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“…Similarly, it was not possible to select the original cases randomly, but rather, these were chosen according to whether the patients died within the data collection period (consecutively). Although cases were not randomly selected, the characteristics of the sample coincide with those of other studies in the Spanish population [ 8 , 11 , 47 , 48 ]. Despite having been evaluated by the expert committee, it would be interesting to test the acceptability and practicability of the scale in nursing homes.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Dementia may be another key factor in care provision in these facilities, given that there is a high prevalence in this population [ 7 , 8 , 11 , 12 ]. Symptoms and treatments at the end of life are different depending on the presence or absence of dementia [ 11 ]. Many tools have been developed to assess the quality of dying and deaths [ 9 , 13 , 14 ], although none of them have been adapted and validated for the Spanish population and for use in nursing homes.…”

Section: Introductionmentioning

confidence: 99%

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Cultural Adaptation and Validation of the Quality of Dying in Long-Term Care Scale (QoD-LTC) for Spanish Nursing Homes

Puente‐Fernández

Jimeno-Ucles²,

Mota-Romero

et al. 2021

IJERPH

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Background: There is a need for instruments that can evaluate the psychosocial quality of dying in nursing homes. The aim of this study was to adapt and validate the Quality of Dying in Long-Term Care scale (QoD-LTC) to the Spanish context. Methods: Descriptive cross-sectional study. Fourteen nurses from 7 facilities in southern Spain assessed 153 residents who died in the centers; validity, reliability, and feasibility were evaluated. Results: The Spanish version consists of 11 items with acceptable reliability (α = 0.681). Three factors model was validated by principal components analysis. A mean of 180.62 (SD = 86.66) seconds is needed to fill it in. An inter-observer 0.753 (95% CI: 0.391–0.900, p< 0.001) and intra-observer 0.855 (95% CI: 0.568–0.951 p = 0.001) reliability were observed. Weak correlation was observed; positive with mono-item question (0.322) and negative with Eastern Cooperative Oncology Group (ECOG) with a value of (−0.321) and Integrated Palliative outcome scale (IPOS) with a value of (−0.252). Conclusions: The QoD-LTC scale presents an adequate factorial structure, internal consistency, and feasibility to evaluate psychosocial quality of dying in nursing homes. It can be used as a quality indicator.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cultural Adaptation and Validation of the Quality of Dying in Long-Term Care Scale (QoD-LTC) for Spanish Nursing Homes

Puente‐Fernández

Jimeno-Ucles²,

Mota-Romero

et al. 2021

IJERPH

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“…In Spain, cognitive impairment was detected in 56.4% of residents of Andalusian nursing homes (10). In general, nursing homes have only limited material, human, and training resources to meet the considerable demand for palliative care (39)(40)(41); nevertheless, speci c instruments may be required for residents with dementia, whose needs for palliative care may differ from those of residents without this condition (42).…”

Section: Introductionmentioning

confidence: 99%

The prognostic value of the NECPAL instrument, Palliative Prognostic Index, and PROFUND index in elderly residents of nursing homes with advanced chronic condition

Esteban-Burgos¹,

Hueso‐Montoro²,

Mota-Romero

et al. 2023

Preprint

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Background: It is essential to assess the need for palliative care and the life prognosis of elderly nursing home residents with an advanced chronic condition, and the NECPAL ICO-CCOMS©4.0 prognostic instrument may be adequate for both purposes. The objective of this study was to examine the predictive capacity of NECPAL, the Palliative Prognosis Index, and the PROFUND index in elderly residents with advanced chronic condition with and without dementia, comparing their results at different time points. Methods: This prospective observational study was undertaken in eight nursing homes, following the survival of 146 residents with advanced chronic condition (46.6% with dementia) at 3, 6, 12, and 24 months. The capacity of the three instruments to predict mortality was evaluated by calculating the area under the receiver operating characteristic curve (AUC), with 95% confidence interval, for the global population and separately for residents with and without dementia. Results: The mean age of residents was 84.63 years (±8.989 yrs); 67.8% were female. The highest predictive capacity was found for PROFUND at 3 months (95%CI: 0.526-0.756; p=0.016), for PROFUND and NECPAL at 12 months (non-significant; AUC >0.5), and NECPAL at 24 months (close-to-significant (AUC=0.624; 95% CI: 0.499-0.750; p=0.053). The highest capacity at 12 months was obtained using PROFUND in residents with dementia (AUC=0.698; 95%CI: 0.566-0.829; p=0.003) and NECPAL in residents without dementia (non-significant; AUC=0.649; 95%CI: 0.432-0.867; p=0.178). Significant differences in AUC values were observed between PROFUND at 12 (p=0.017) and 24 (p=0.028) months. Conclusions: PROFUND offers the most accurate prediction of survival in elderly care home residents with advanced chronic condition overall and in those with dementia, especially over the short term, whereas NECPAL ICO-CCOMS©4.0 appears to be the most useful to predict the long-term survival of residents without dementia. These results support early evaluation of the need for palliative care in elderly care home residents with advanced chronic condition.

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“…In Spain, as in other European countries, a high prevalence of palliative care needs and difficult-to-control symptoms have also been reported in nursing homes [ 20 – 22 ]. However, no palliative care programs specifically focused on this type of facility have been published to date [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

NUrsing Homes End of Life care Program (NUHELP): developing a complex intervention

et al. 2021

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Background Nursing homes are likely to become increasingly important as end-of-life care facilities. Previous studies indicate that individuals residing in these facilities have a high prevalence of end-of-life symptoms and a significant need for palliative care. The aim of this study was to develop an end-of-life care program for nursing homes in Spain based on previous models yet adapted to the specific context and the needs of staff in nursing homes in the country. Methods A descriptive study of a complex intervention procedure was developed. The study consisted of three phases. The first phase was a prospective study assessing self-efficacy in palliative care (using the SEPC scale) and attitudes towards end-of-life care (using the FATCOD-B scale) among nursing home staff before and after the completion of a basic palliative care training program. In the second phase, objectives were selected using the Delphi consensus technique, where nursing home and primary care professionals assessed the relevance, feasibility, and level of attainment of 42 quality standards. In phase 3, interventions were selected for these objectives through two focus group sessions involving nursing home, primary care, and palliative care professionals. Results As a result of the training, an improvement in self-efficacy and attitudes towards end-of-life care was observed. In phase 2, 14 standards were selected and grouped into 5 objectives: to conduct a comprehensive assessment and develop a personalized care plan adapted to the palliative needs detected; to provide information in a clear and accessible way; to request and record advance care directives; to provide early care with respect to loss and grief; to refer patients to a specialized palliative care unit if appropriate, depending on the complexity of the palliative care required. Based on these objectives, the participants in the focus group sessions designed the 22 interventions that make up the program. Conclusions The objectives and interventions of the NUHELP program constitute an end-of-life care program which can be implemented in nursing homes to improve the quality of end-of-life care in these facilities by modifying their clinical practice, organization, and relationship with the health system as well as serving as an example of an effective health intervention program.

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Palliative Care Symptoms, Outcomes, and Interventions for Chronic Advanced Patients in Spanish Nursing Homes with and without Dementia

Cited by 7 publications

References 34 publications

Cultural Adaptation and Validation of the Quality of Dying in Long-Term Care Scale (QoD-LTC) for Spanish Nursing Homes

Cultural Adaptation and Validation of the Quality of Dying in Long-Term Care Scale (QoD-LTC) for Spanish Nursing Homes

The prognostic value of the NECPAL instrument, Palliative Prognostic Index, and PROFUND index in elderly residents of nursing homes with advanced chronic condition

NUrsing Homes End of Life care Program (NUHELP): developing a complex intervention

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