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

Ahlström, Gerd LU ; Nilsen, Per; Benzein, Eva; Behm, Lina LU ; Wallerstedt, Birgitta; Persson, Magnus LU and Sandgren, Anna (2018) In BMC Palliative Care 17.
Abstract
Background
The 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... (More)
Background
The 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/design
A 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.

Discussion
The 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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Complex intervention, Cross-over design, Elderly care, Evaluation, Frail elderly, Implementation, Implementation theory, Palliative care, Quality improvement, Residential care home, Staff education
in
BMC Palliative Care
volume
17
publisher
BioMed Central
external identifiers
  • pmid:29566688
  • scopus:85044252204
ISSN
1472-684X
DOI
10.1186/s12904-018-0308-2
language
English
LU publication?
yes
id
a2a4b5da-108d-4970-88d2-ab2a9171d8b8
date added to LUP
2018-03-23 07:12:56
date last changed
2019-04-11 02:20:01
@article{a2a4b5da-108d-4970-88d2-ab2a9171d8b8,
  abstract     = {Background<br/>The 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.<br/><br/>Methods/design<br/>A 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.<br/><br/>Discussion<br/>The 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.},
  articleno    = {52},
  author       = {Ahlström, Gerd and Nilsen, Per and Benzein, Eva and Behm, Lina and Wallerstedt, Birgitta and Persson, Magnus and Sandgren, Anna},
  issn         = {1472-684X},
  keyword      = {Complex intervention,Cross-over design,Elderly care,Evaluation,Frail elderly,Implementation,Implementation theory,Palliative care,Quality improvement,Residential care home,Staff education},
  language     = {eng},
  month        = {03},
  publisher    = {BioMed Central},
  series       = {BMC Palliative Care},
  title        = {Implementation of knowledge-based palliative care in nursing homes and pre-post post evaluation by cross-over design: a study protocol},
  url          = {http://dx.doi.org/10.1186/s12904-018-0308-2},
  volume       = {17},
  year         = {2018},
}