Abstract
BackgroundPeople with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care to equip them with knowledge and skills to deliver high quality care.ObjectiveThe primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia.DesignCluster randomised controlled trial of nursing homes with process evaluation conducted alongside.Subjects & settingOne thousand three hundred four people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff.MethodsRandomisation was conducted at the level of the nursing home (cluster). The allocation sequence was generated by an independent statistician using a computer-generated allocation sequence.Staff from intervention nursing homes had access to the IMPETUS-D training intervention, and staff from control nursing homes had access to usual training opportunities. The predicted primary outcome measure was a 20% reduction in the proportion of people with dementia who had an unplanned transfer to hospital and/or death in hospital at 6-months follow-up in the intervention nursing homes compared to the control nursing homes.ResultsAt 6-months follow-up, 128 (21.1%) people with dementia from the intervention group had an unplanned transfer or death in hospital compared to 132 (19.0%) residents from the control group; odds ratio 1.14 (95% CI, 0.82-1.59). There were suboptimal levels of staff participation in the training intervention and several barriers to participation identified.ConclusionThis study of a dementia-specific palliative care staff training intervention found no difference in the proportion of residents with dementia who had an unplanned hospital transfer. Implementation of the intervention was challenging and likely did not achieve adequate staff coverage to improve staff practice or resident outcomes.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618002012257. Registered 14 December 2018.
Highlights
People with dementia have unique palliative and end-of-life needs
This study of a dementia-specific palliative care staff training intervention found no difference in the proportion of residents with dementia who had an unplanned hospital transfer
This study evaluated a training program IMproving Palliative care Education and Training Using Simulation in Dementia (IMPETUS-D) for nurses and personal care workers (PCWs), aimed at improving the quality of palliative care provision and outcomes for people with dementia living in nursing homes
Summary
People with dementia have unique palliative and end-of-life needs. access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. Training nursing home staff in dementia-specific palliative care is a recognised strategy to improve the quality of care provided, and has been recommended by the European Association for Palliative Care, the Worldwide Hospice Palliative Care Alliance, and more recently in Australia by the Royal Commission into Aged Care Quality and Safety [5, 9,10,11]. Despite this recommendation, there is a paucity of robust research and evidence to support the use of dementia palliative care training interventions. Among the few studies that have assessed dementia-specific palliative care training in nursing homes, two used simulation techniques but were single-site, non- randomised studies and of low methodological quality [15, 16]
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