Nursing Home Residents With Palliative Care Needs
Conditions
Keywords
Palliative Care, Nursing Homes, interRAI Palliative Care instrument, Older adults
Brief summary
BACKGROUND Nursing homes are important locations for palliative care. Through comprehensive geriatric assessments (CGAs), evaluations can be made of the 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. METHODS This 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 instrument 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. DISCUSSION This 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.
Interventions
OTHERinterRAI PC
PREPARATORY PHASE * Step 0: Introductory information * Step 1: Training on the interRAI PC and the BelRAI webapplication * Step 2: Introduction on the interRAI PC and the BelRAI webapplication in the organization IMPLEMENTATION PHASE * Step 3: Identification of residents with palliative care needs, based on the surprise question * Step 4: Informed consent signature requirements * Step 5: Login to the BelRAI webapplication * Step 6: Definitions of roles and functions * Step 7: Completion of the interRAI PC * Step 8: Interpretation of results * Step 9: Use of results
Sponsors
Amsterdam UMC, location VUmc
University Ghent
Vrije Universiteit Brussel
Agentschap voor Innovatie door Wetenschap en Technologie
KU Leuven
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 65+ * residing in a nursing home * having palliative care needs (based on the 'surprise question': 'would you be surprised if this person was to die within 6 to 12 months?') (Hubard G, 2011)
Exclusion criteria
* 65- * not residing in a nursing home * no palliative care needs
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The effect of using the interRAI PC instrument on the quality of palliative care in nursing homes evaluated by the Palliative care Outcome Scale (POS) | 1 year | 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) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The feasibility of the interRAI C for use in nursing homes assessed through focus groups, interviews and field notes | 1 year | Qualitative data regarding the feasibility of the instrument are collected through focus groups, interviews and field notes |
| The validity of the interRAI PC for use in nursing homes assessed by Psychometric analysis | 1 year | Psychometric analysis is conducted to evaluate the predictive validity of the Palliative Index for Mortality (PIM) of the interRAI PC and the convergent validity of the CAP 'Mood' of the interRAI PC. Qualitative data regarding the face validity of the instrument are collected through focus groups, interviews and field notes |
Countries
Belgium
Outcome results
None listed