eu pace project pace steps to success - vub
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6countrydescriptivestudyofdyinginLTCFs
7 countryclusterRCTPACEStepstoSuccesswithprocessevaluation
Complexpopulationswithunaddressedneeds
Complexsettings withlowereducatedpersonnelandinsufficientpalliativecarecompetences
2015322representativeLTCFs1701deceasedresidents2275staffmembers
median length of stay from 5 months (Poland) to 25 months (in Belgium)
between 58% (England) and 83% (Finland) of deceased residents had dementia and roughly half of these in an advanced stage
between 52% (England) and 90% (Finland) of deceased residentsexperienced pain in the last week of life
Palliative Care knowledge
0.640.58 0.61
0.47
0.62
0.410.49
0.250.18
0.29
00.10.20.30.40.50.60.70.80.91nu
rses
careassistants
nurses
careassistants
nurses
careassistants
nurses
nurses
careassistants
nurses
Belgium Netherlands England Finland Poland Italy
higher mean scores (0 to 1) = better knowledgePC
SEn
d-of-LifeCaresubscale
6countrydescriptivestudyofdyinginLTCFs
7 countryclusterRCTPACEStepstoSuccesswithprocessevaluation
Function
High
Low†
Time
Palliativecare
Old model of palliative care not suitable for population of LTCF residents
†Frailtyanddementiatrajectory
Function
High
Low
Time
New model of palliative care:Early integration, alongside life-prolonging treatmentsPreferred culture in LTCFs
Palliativecareapproach†
6 steps programme
External trainers
PACE coordinators in the facilities
One year implementation: 6 steps with tools
General palliative care in PACE Steps to success programme
1. Advancecareplanning
2. Mapping changesinphysicalconditiontoanticipatedyingbetter
Monthly mapping changes in condition chart
General palliative care in PACE Steps to success programme
1. Advancecareplanning
2. Mapping changesinphysicalconditiontoanticipatedyingbetter
3. Palliativecareregister tobeusedduringmonthlymultidisciplinarymeeting,involvingstaffandGPs
General palliative care in PACE Steps to success programme
1. Advancecareplanning
2. Mapping changesinphysicalconditiontoanticipatedyingbetter
3. Palliativecareregister tobeusedduringmonthlymultidisciplinarymeeting,involvingstaffandGPs
4. Screeningofpainanddepression(PAIN-AD,GeriatricDepressionScale,Cornellfordementia)
General palliative care in PACE Steps to success programme
1. Advancecareplanning
2. Mapping changesinphysicalconditiontoanticipatedyingbetter
3. Palliativecareregister tobeusedduringmonthlymultidisciplinarymeeting,involvingstaffandGPs
4. Screeningofpainanddepression(PAIN-AD,GeriatricDepressionScale,Cornellfordementia)
5. Checklistlastdaysoflife
6. Reflectivedebriefing afterdeath
Cluster RCT in 7 countries 2016-2017BE, NL, ENG, PL, FI, IT, Switzerland
80 facilities randomizedOutcome, process, cost evaluation
By implementing PACE Steps to Success:• is quality of dying and quality of end-
of-life care of residents improved? • is staff knowledge of palliative care
improved compared to a control group?
80facilitiesrecruited
38Interventiongroup 37Controlgroup
Baselinemeasurementmonth0:deceasedresidentsandstaff
Postinterventionmeasurementmonth13andmonth17:deceasedresidentsandstaff
5dropouts
Staff knowledge of end-of-life care slightly improved (PC survey subscale)
Resultsforthcoming
Quality of care in last month of life as judged by staff improved (QOD-LTC)
Resident outcomes judged by staff
Resultsforthcoming
Symptoms last week of life CAD-EOLD
Resultsforthcoming
Process evaluation
7 country implementation of PACE Steps to Success in 78 LTCFs was very challenging and highly variable
• Diaries• Attendancelists• Nursinghomefilesreview• Evaluationquestionnaires• Interviews
Mean % of staff present at the trainings
0
10
20
30
40
50
60
70
80
90
1 2 3 4 5 6 2 3 6 7 9 11 2 3 4 5 8 13 1 2 4 9 10 12 1 2 3 4 2 3 6 11 14 1 2 5 6
BE FI IT NL PL EN SW
n° of residents with ACP documents / n°of beds
0
20
40
60
80
100
120
1 2 3 4 5 6 2 3 6 7 9 11 2 3 4 5 8 13 1 2 4 9 1012 1 2 3 4 2 3 6 1114 1 2 5 6
BE FI IT NL PL EN SW
Key recommendations for PACE Steps to Success
Stepwise implementation with facilitation of experienced trainersSelection and training of key PACE coordinators within the facilityActive management supportContinuous training, evaluation & monitoringTailoring intervention to local context and flexibility to adapt (timing/content of) intervention to changes in contextSpecialist palliative care services accessible
English, Dutch, Polish, Finnish, Italianhttp://www.eapcnet.eu/
PACEStepstoSuccessProgramme
Stepstowardsachievinghighqualitypalliativecareinyourcarehome
InformationPack
ThisprojecthasreceivedfundingfromtheEuropeanUnion’sSeventhFrameworkProgrammeforresearch,technologicaldevelopmentanddemonstrationundergrantagreementno.603111.