Integrating palliative care in long-term care facilities across Europe (PACE): protocol of a cluster randomized controlled trial of the ‘PACE Steps to Success’ intervention in seven countries
Open Access
- 12 March 2018
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Palliative Care
- Vol. 17 (1), 1-11
- https://doi.org/10.1186/s12904-018-0297-1
Abstract
Several studies have highlighted the need for improvement in palliative care delivered to older people long-term care facilities. However, the available evidence on how to improve palliative care in these settings is weak, especially in Europe. We describe the protocol of the PACE trial aimed to 1) evaluate the effectiveness and cost-effectiveness of the ‘PACE Steps to Success’ palliative care intervention for older people in long-term care facilities, and 2) assess the implementation process and identify facilitators and barriers for implementation in different countries. We will conduct a multi-facility cluster randomised controlled trial in Belgium, Finland, Italy, the Netherlands, Poland, Switzerland and England. In total, 72 facilities will be randomized to receive the ‘Pace Steps to Success intervention’ or to ‘care as usual’. Primary outcome at resident level: quality of dying (CAD-EOLD); and at staff level: staff knowledge of palliative care (Palliative Care Survey). Secondary outcomes: resident’s quality of end-of-life care, staff self-efficacy, self-perceived educational needs, and opinions on palliative care. Economic outcomes: direct costs and quality-adjusted life years (QALYs). Measurements are performed at baseline and after the intervention. For the resident-level outcomes, facilities report all deaths of residents in and outside the facilities over a previous four-month period and structured questionnaires are sent to (1) the administrator, (2) staff member most involved in care (3) treating general practitioner, and (4) a relative. For the staff-level outcomes, all staff who are working in the facilities are asked to complete a structured questionnaire. A process evaluation will run alongside the effectiveness evaluation in the intervention group using the RE-AIM framework. The lack of high quality trials in palliative care has been recognized throughout the field of palliative care research. This cross-national cluster RCT designed to evaluate the impact of the palliative care intervention for long-term care facilities ‘PACE Steps to Success’ in seven countries, will provide important evidence concerning the effectiveness as well as the preconditions for optimal implementation of palliative care in nursing homes, and this within different health care systems. The study is registered at www.isrctn.com – ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) Registration date: July 30, 2015.Keywords
Funding Information
- European Union's Seventh Framework Programme (603111)
This publication has 23 references indexed in Scilit:
- What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of deathPalliative Medicine, 2017
- The Bedford Alzheimer Nursing-Severity Scale to Assess Dementia Severity in Advanced DementiaAmerican Journal of Alzheimer's Disease and Other Dementias®, 2013
- Validation of the rotterdam MOVE2PC questionnaire for assessment of nurses' knowledge and opinions on palliative careResearch in Nursing & Health, 2013
- Quality of dying of nursing home residents with dementia as judged by relativesInternational Psychogeriatrics, 2013
- Selecting the Best Instruments to Measure Quality of End-of-Life Care and Quality of Dying in Long Term CareJournal of the American Medical Directors Association, 2013
- Knowledge and perceived competence among nurses caring for the dying in long-term care homesInternational Journal of Palliative Nursing, 2012
- A system lifeworld perspective on dying in long term care settings for older people: Contested states in contested placesHealth & Place, 2011
- Measuring the Quality of Dying in Long‐Term CareJournal of the American Geriatrics Society, 2007
- Physician Communication with Family Caregivers of Long‐Term Care Residents at the End of LifeJournal of the American Geriatrics Society, 2007
- The Global Deterioration Scale for assessment of primary degenerative dementiaAmerican Journal of Psychiatry, 1982