Abstract
BackgroundNursing homes are important locations for palliative care. Through comprehensive geriatric assessments (CGAs), evaluations can be made of palliative care needs of nursing home residents. The interRAI Palliative Care instrument (interRAI PC) is a CGA that evaluates diverse palliative care needs of adults in all healthcare settings. The evaluation results in Client Assessment Protocols (CAPs: indications of problems that need addressing) and Scales (e.g. Palliative Index for Mortality (PIM)) which can be used to design, evaluate and adjust care plans. This study aims to examine the effect of using the interRAI PC on the quality of palliative care in nursing homes. Additionally, it aims to evaluate the feasibility and validity of the interRAI PC.MethodsThis study covers phases 0, I and II of the Medical Research Council (MRC) framework for designing and evaluating complex interventions, with a longitudinal, quasi-experimental pretest-posttest design and with mixed methods of evaluation. In phase 0, a systematic literature search is conducted. In phase I, the interRAI PC is adapted for use in Belgium and implemented on the BelRAI-website and a practical training is developed. In phase II, the intervention is tested in fifteen nursing homes. Participating nursing homes fill out the interRAI PC during one year for all residents receiving palliative care. Using a pretest-posttest design with quasi-random assignment to the intervention or control group, the effect of the interRAI PC on the quality of palliative care is evaluated with the Palliative care Outcome Scale (POS). Psychometric analysis is conducted to evaluate the predictive validity of the PIM and the convergent validity of the CAP ‘Mood’ of the interRAI PC. Qualitative data regarding the usability and face validity of the instrument are collected through focus groups, interviews and field notes.DiscussionThis is the first study to evaluate the validity and effect of the interRAI PC in nursing homes, following a methodology based on the MRC framework. This approach improves the study design and implementation and will contribute to a higher generalizability of results. The final result will be a psychometrically evaluated CGA for nursing home residents receiving palliative care.Trial registrationClinicalTrials.gov NCT02281032. Registered October 30th, 2014.
Highlights
Introduction on the interRAIinterRAI palliative care instrument (PC) and the BelRAI webapplication in the organizationMain objective Identification of residents with palliative care needs, based on the surprise questionInformed consent signature requirementsStep 5 Login to the BelRAI webapplication Step 6 Definitions of roles and functionsStep 7 Completion of the interRAI PCStep 8 Interpretation of results Step 9 Use of resultsPreparatory phase Secondary objective 1
Phase 0: Preclinical or theoretical A systematic review was conducted to provide an overview of all existing comprehensive geriatric assessments (CGAs) that have been validated for nursing home residents with palliative care needs [19]
Based on this systematic review, we found that the interRAI PC is the most comprehensive geriatric assessment to evaluate the palliative care needs of nursing home residents
Summary
Introduction on the interRAIPC and the BelRAI webapplication in the organizationMain objective Identification of residents with palliative care needs, based on the surprise questionInformed consent signature requirementsStep 5 Login to the BelRAI webapplication Step 6 Definitions of roles and functionsStep 7 Completion of the interRAI PCStep 8 Interpretation of results Step 9 Use of resultsPreparatory phase Secondary objective 1. Main objective Identification of residents with palliative care needs, based on the surprise question. Filling out the interRAI PC for all nursing home residents with palliative care needs 2. Through comprehensive geriatric assessments (CGAs), evaluations can be made of palliative care needs of nursing home residents. This study aims to examine the effect of using the interRAI PC on the quality of palliative care in nursing homes. Optimal palliative care in long-term care facilities requires a comprehensive evaluation of the different care needs of nursing home residents [6,7]. The main objectives of a CGA are to improve diagnostic accuracy and treatment, optimize functioning and quality of life, extend community tenure, reduce use of unnecessary formal services and improve long-term care management [8,9]
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