TY - JOUR
T1 - Integrating palliative care in long-term care facilities across Europe (PACE): Protocol of a cluster randomized controlled trial of the 'PACE Steps to Success' intervention in seven countries
AU - Smets, Tinne
AU - Onwuteaka-Philipsen, Bregje B. D.
AU - Miranda, Rose
AU - Pivodic, Lara
AU - Tanghe, Marc
AU - van Hout, Hein
AU - Pasman, Roeline H. R. W.
AU - Oosterveld-Vlug, Mariska
AU - Piers, Ruth
AU - van den Noortgate, Nele
AU - Wichmann, Anne B.
AU - Engels, Yvonne
AU - Vernooij-Dassen, Myrra
AU - Hockley, Jo
AU - Froggatt, Katherine
AU - Payne, Sheila
AU - Szczerbińska, Katarzyna
AU - Kylänen, Marika
AU - Leppäaho, Suvi
AU - Barańska, Ilona
AU - Gambassi, Giovanni
AU - Pautex, Sophie
AU - Bassal, Catherine
AU - Deliens, Luc
AU - van den Block, Lieve
AU - Mammarella, Federica
AU - Mercuri, Martina
AU - Rossi, Paola
AU - Segat, Ivan
AU - Stodolska, Agata
AU - Adang, Eddy
AU - Andreasen, Paula
AU - Kuitunen-Kaija, Outi
AU - Moore, Danni Collingridge
AU - Pac, Agnieszka
AU - Kijowska, Violetta
AU - ten Koppel, Maud
AU - van der Steen, Jenny T.
AU - de Paula, Emilie Morgan
PY - 2018
Y1 - 2018
N2 - Background: Several studies have highlighted the need for improvement in palliative care delivered to older people long-term care facilities. However, the available evidence on how to improve palliative care in these settings is weak, especially in Europe. We describe the protocol of the PACE trial aimed to 1) evaluate the effectiveness and cost-effectiveness of the 'PACE Steps to Success' palliative care intervention for older people in long-term care facilities, and 2) assess the implementation process and identify facilitators and barriers for implementation in different countries. Methods: We will conduct a multi-facility cluster randomised controlled trial in Belgium, Finland, Italy, the Netherlands, Poland, Switzerland and England. In total, 72 facilities will be randomized to receive the 'Pace Steps to Success intervention' or to 'care as usual'. Primary outcome at resident level: quality of dying (CAD-EOLD); and at staff level: staff knowledge of palliative care (Palliative Care Survey). Secondary outcomes: resident's quality of end-of-life care, staff self-efficacy, self-perceived educational needs, and opinions on palliative care. Economic outcomes: direct costs and quality-adjusted life years (QALYs). Measurements are performed at baseline and after the intervention. For the resident-level outcomes, facilities report all deaths of residents in and outside the facilities over a previous four-month period and structured questionnaires are sent to (1) the administrator, (2) staff member most involved in care (3) treating general practitioner, and (4) a relative. For the staff-level outcomes, all staff who are working in the facilities are asked to complete a structured questionnaire. A process evaluation will run alongside the effectiveness evaluation in the intervention group using the RE-AIM framework. Discussion: The lack of high quality trials in palliative care has been recognized throughout the field of palliative care research. This cross-national cluster RCT designed to evaluate the impact of the palliative care intervention for long-term care facilities 'PACE Steps to Success' in seven countries, will provide important evidence concerning the effectiveness as well as the preconditions for optimal implementation of palliative care in nursing homes, and this within different health care systems. Trial registration: The study is registered at www.isrctn.com - ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) Registration date: July 30, 2015.
AB - Background: Several studies have highlighted the need for improvement in palliative care delivered to older people long-term care facilities. However, the available evidence on how to improve palliative care in these settings is weak, especially in Europe. We describe the protocol of the PACE trial aimed to 1) evaluate the effectiveness and cost-effectiveness of the 'PACE Steps to Success' palliative care intervention for older people in long-term care facilities, and 2) assess the implementation process and identify facilitators and barriers for implementation in different countries. Methods: We will conduct a multi-facility cluster randomised controlled trial in Belgium, Finland, Italy, the Netherlands, Poland, Switzerland and England. In total, 72 facilities will be randomized to receive the 'Pace Steps to Success intervention' or to 'care as usual'. Primary outcome at resident level: quality of dying (CAD-EOLD); and at staff level: staff knowledge of palliative care (Palliative Care Survey). Secondary outcomes: resident's quality of end-of-life care, staff self-efficacy, self-perceived educational needs, and opinions on palliative care. Economic outcomes: direct costs and quality-adjusted life years (QALYs). Measurements are performed at baseline and after the intervention. For the resident-level outcomes, facilities report all deaths of residents in and outside the facilities over a previous four-month period and structured questionnaires are sent to (1) the administrator, (2) staff member most involved in care (3) treating general practitioner, and (4) a relative. For the staff-level outcomes, all staff who are working in the facilities are asked to complete a structured questionnaire. A process evaluation will run alongside the effectiveness evaluation in the intervention group using the RE-AIM framework. Discussion: The lack of high quality trials in palliative care has been recognized throughout the field of palliative care research. This cross-national cluster RCT designed to evaluate the impact of the palliative care intervention for long-term care facilities 'PACE Steps to Success' in seven countries, will provide important evidence concerning the effectiveness as well as the preconditions for optimal implementation of palliative care in nursing homes, and this within different health care systems. Trial registration: The study is registered at www.isrctn.com - ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) Registration date: July 30, 2015.
KW - Care home
KW - End-of-life care
KW - Nursing home
KW - Palliative care
KW - Quality improvement
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85043579806&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29530091
U2 - 10.1186/s12904-018-0297-1
DO - 10.1186/s12904-018-0297-1
M3 - Article
C2 - 29530091
VL - 17
JO - BMC Palliative Care
JF - BMC Palliative Care
SN - 1472-684X
IS - 1
M1 - 47
ER -