Improving end-of-life care in acute geriatric hospital wards using the Care Programme for the Last Days of Life: study protocol for a phase 3 cluster randomized controlled trial.

Rebecca Verhofstede,Joachim Cohen,Tinne Smets,Luc Deliens,Nele Van Den Noortgate,Massimo Costantini

doi:10.1186/s12877-015-0010-7

Rebecca Verhofstede, Joachim Cohen + Show 4 more

Open Access

https://doi.org/10.1186/s12877-015-0010-7

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Abstract

BackgroundThe Care Programme for the Last Days of Life has been developed to improve the quality of end-of-life care in acute geriatric hospital wards. The programme is based on existing end-of-life care programmes but modeled to the acute geriatric care setting. There is a lack of evidence of the effectiveness of end-of-life care programmes and the effects that may be achieved in patients dying in an acute geriatric hospital setting are unknown. The aim of this paper is to describe the research protocol of a cluster randomized controlled trial to evaluate the effects of the Care Programme for the Last Days of Life.Methods and designA cluster randomized controlled trial will be conducted. Ten hospitals with one or more acute geriatric wards will conduct a one-year baseline assessment during which care will be provided as usual. For each patient dying in the ward, a questionnaire will be filled in by a nurse, a physician and a family carer. At the end of the baseline assessment hospitals will be randomized to receive intervention (implementation of the Care Programme) or no intervention. Subsequently, the Care Programme will be implemented in the intervention hospitals over a six-month period. A one-year post-intervention assessment will be performed immediately after the baseline assessment in the control hospitals and after the implementation period in the intervention hospitals. Primary outcomes are symptom frequency and symptom burden of patients in the last 48 hours of life.DiscussionThis will be the first cluster randomized controlled trial to evaluate the effect of the Care Programme for the Last Days of Life for the acute geriatric hospital setting. The results will enable us to evaluate whether implementation of the Care Programme has positive effects on end-of-life care during the last days of life in this patient population and which components of the Care Programme contribute to improving the quality of end-of-life care.Trial registrationClinicalTrials.gov Identifier: NCT01890239. Registered June 24th, 2013.

Highlights

The Care Programme for the Last Days of Life has been developed to improve the quality of end-of-life care in acute geriatric hospital wards
To improve the quality of care at the end of life in the geriatric hospital population we developed and successfully piloted the Care Programme for the Last Days of Life (Verhofstede R, Smets T, Cohen J, Costantini M, Van Den Noortgate N, van der Heide A, Deliens L: Development of the care programme for the last days of life for older patients in acute geriatric hospital wards: a phase 0–1 study according to the Medical Research Council Framework, submitted; Verhofstede R, Smets T, Cohen J, Costantini M, Van Den Noortgate N, Deliens L: Feasibility and preliminary effects of the Care Programme for the Last Days of Life in an older acute hospital population: mixed-methods study of the success of implementation and staff perceptions, in preparation)
This programme is based on the Liverpool Care Pathway (LCP) programme, taking into account the concerns regarding the LCP raised in the UK and adapted to the geriatric hospital population and setting (Verhofstede R, Smets T, Cohen J, Costantini M, Van Den Noortgate N, van der Heide A, Deliens L: Development of the care programme for the last days of life for older patients in acute geriatric hospital wards: a phase 0–1 study according to the Medical Research Council Framework, submitted)

Summary

Introduction

The Care Programme for the Last Days of Life has been developed to improve the quality of end-of-life care in acute geriatric hospital wards. To improve the quality of care at the end of life in the geriatric hospital population we developed and successfully piloted the Care Programme for the Last Days of Life (Verhofstede R, Smets T, Cohen J, Costantini M, Van Den Noortgate N, van der Heide A, Deliens L: Development of the care programme for the last days of life for older patients in acute geriatric hospital wards: a phase 0–1 study according to the Medical Research Council Framework, submitted; Verhofstede R, Smets T, Cohen J, Costantini M, Van Den Noortgate N, Deliens L: Feasibility and preliminary effects of the Care Programme for the Last Days of Life in an older acute hospital population: mixed-methods study of the success of implementation and staff perceptions, in preparation). The Care Programme consists of the following documents: (1) the Care Guide for the Last Days of Life, (2) supportive documentation and (3) an implementation guide (Figure 1)

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