Abstract
An increasingly frail population in nursing homes accentuates the need for high quality care at the end of life and better access to palliative care in this context. Implementation of palliative care and its outcomes can be monitored by using quality indicators. Therefore, we developed a quality indicator set for palliative care in nursing homes and a tailored measurement procedure while using a mixed-methods design. We developed the instrument in three phases: (1) literature search, (2) interviews with experts, and (3) indicator and measurement selection by expert consensus (RAND/UCLA). Second, we pilot tested and evaluated the instrument in nine nursing homes in Flanders, Belgium. After identifying 26 indicators in the literature and expert interviews, 19 of them were selected through expert consensus. Setting-specific themes were advance care planning, autonomy, and communication with family. The quantitative and qualitative analyses showed that the indicators were measurable, had good preliminary face validity and discriminative power, and were considered to be useful in terms of quality monitoring according to the caregivers. The quality indicators can be used in a large implementation study and process evaluation in order to achieve continuous monitoring of the access to palliative care for all of the residents in nursing homes.
Highlights
In the past decade, in many Western countries, an increasing number of elderly persons were admitted to nursing homes
In phase 1, we identified a comprehensive set of candidate quality indicators for palpalliative care in nursing homes
We combined both objective and subjective measures into four questionnaires for different perspectives in order to reach a comprehensive picture on quality of palliative care, end-of-life care and advance care planning in nursing homes
Summary
In many Western countries, an increasing number of elderly persons were admitted to nursing homes. Prediction studies indicate that the need for high quality care at the end of life will most likely double in the nursing home setting, because of an increasing prevalence of frailty and multimorbidity in the resident population [2,3], being linked to a strongly reduced average length of stay of residents in recent years [4]. In research, emphasis in the past decade has been placed on the quality of advance care planning, autonomy of residents, and the implementation of palliative care in nursing homes [7,8]. An urgent need arises for better access for all elderly persons to high quality palliative care provision in the nursing home context
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