Abstract
BackgroundAn increasing number of older people reach the end of life in care homes. The aim of this study is to explore the perceived benefits of, and barriers to, implementation of the Gold Standards Framework for Care Homes (GSFCH), a quality improvement programme in palliative care.MethodsNine care homes involved in the GSFCH took part. We conducted semi-structured interviews with nine care home managers, eight nurses, nine care assistants, eleven residents and seven of their family members. We used the Framework approach to qualitative analysis. The analysis was deductive based on the key tasks of the GSFCH, the 7Cs: communication, coordination, control of symptoms, continuity, continued learning, carer support, and care of the dying. This enabled us to consider benefits of, and barriers to, individual components of the programme, as well as of the programme as a whole.ResultsPerceived benefits of the GSFCH included: improved symptom control and team communication; finding helpful external support and expertise; increasing staff confidence; fostering residents' choice; and boosting the reputation of the home. Perceived barriers included: increased paperwork; lack of knowledge and understanding of end of life care; costs; and gaining the cooperation of GPs. Many of the tools and tasks in the GSFCH focus on improving communication. Participants described effective communication within the homes, and with external providers such as general practitioners and specialists in palliative care. However, many had experienced problems with general practitioners. Although staff described the benefits of supportive care registers, coding predicted stage of illness and advance care planning, which included improved communication, some felt the need for more experience of using these, and there were concerns about discussing death.ConclusionsMost of the barriers described by participants are relevant to other interventions to improve end of life care in care homes. There is a need to investigate the impact of quality improvement programmes in care homes, such as the GSFCH, on a wider range of outcomes for residents and their families, and to monitor the sustainability of any resulting improvements. It is also important to explore the impact of the different components of these complex interventions.
Highlights
An increasing number of older people reach the end of life in care homes
The aim of this study is to explore the views of care home staff, residents and their families on the benefits of and barriers to implementation of the Gold Standards Framework for Care Homes (GSFCH), to inform the development of palliative care interventions in care homes for older people
Barriers to implementing the programme reported by staff included: the amount of paperwork; lack of understanding of the palliative care terminology used in the GSFCH paperwork (Q2); time and money; and staff believing that palliative care was General views on the GSFCH
Summary
An increasing number of older people reach the end of life in care homes. The aim of this study is to explore the perceived benefits of, and barriers to, implementation of the Gold Standards Framework for Care Homes (GSFCH), a quality improvement programme in palliative care. There are, barriers to providing palliative care in care homes, for example: staff shortages and turnover; lack of time and knowledge of palliative care among staff; shortage of equipment; lack of support from primary care; and poor communication among staff, and between staff and residents and their families [6,7,8]. Some of these are likely to be encountered across different countries, since the systems of care and support for residents are different (e.g. residents’ access to medical and palliative care support), others may be more context specific
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