TY - JOUR
T1 - No difference in effects of ‘PACE steps to success’ palliative care program for nursing home residents with and without dementia: a pre-planned subgroup analysis of the seven-country PACE trial
AU - Miranda, Rose
AU - Smets, Tinne
AU - van den Noortgate, Nele
AU - van der Steen, Jenny T.
AU - Deliens, Luc
AU - Payne, Sheila
AU - Szczerbińska, Katarzyna
AU - Pautex, Sophie
AU - van Humbeeck, Liesbeth
AU - Gambassi, Giovanni
AU - Kylänen, Marika
AU - van den Block, Lieve
AU - on behalf of PACE
AU - Gatsolaeva, Yuliana
AU - Pivodic, Lara
AU - Honinx, Elisabeth
AU - Tanghe, Marc
AU - van Hout, Hein
AU - Froggatt, Katherine
AU - Onwuteaka-Philipsen, Bregje
AU - Pasman, H. Roeline W.
AU - Piers, Ruth
AU - Baranska, Ilona
AU - Oosterveld-Vlug, Mariska
AU - Wichmann, Anne B.
AU - Engels, Yvonne
AU - Vernooij-Dassen, Myrra
AU - Hockley, Jo
AU - Leppäaho, Suvi
AU - Bassal, Catherine
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 - Hammar, Teija
AU - Heikkilä, Rauha
AU - Moore, Danni Collingridge
AU - Kijowska, Violetta
AU - ten Koppel, Maud
AU - de Paula, Emilie Morgan
N1 - Funding Information:
This work was supported by Marie Curie Innovative Training Network (ITN) action, H2020-MSCA-ITN-2015 [grant agreement number 676265] and the Wetenschappelijk Fonds Willy Gepts of the UZ Brussel. The PACE project was supported by the European Union’s Seventh Framework Program FP7/ 2007e2013 under [grant agreement 603111] (PACE project Palliative Care for Older People). It has been co-funded by Polish Ministry of Science and Higher Education in the years 2014 to 2019 based on the decision no 3202/7PR/2014/2 (November 25, 2014) and by the Swiss Academy of Medical Sciences in the years 2015 to 2017. The sponsors did not have any role in the study design, methods, subject recruitment, data collections, analysis and preparation of paper.
Publisher Copyright:
© 2021, The Author(s).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Background: ‘PACE Steps to Success’ is a multicomponent training program aiming to integrate generalist and non-disease-specific palliative care in nursing homes. This program did not improve residents’ comfort in the last week of life, but it appeared to improve quality of care and dying in their last month of life. Because this program included only three dementia-specific elements, its effects might differ depending on the presence or stage of dementia. We aimed to investigate whether the program effects differ between residents with advanced, non-advanced, and no dementia. Methods: Pre-planned subgroup analysis of the PACE cluster-randomized controlled trial in 78 nursing homes in seven European countries. Participants included residents who died in the previous 4 months. The nursing home staff or general practitioner assessed the presence of dementia; severity was determined using two highly-discriminatory staff-reported instruments. Using after-death questionnaires, staff assessed comfort in the last week of life (Comfort Assessment in Dying–End-of-Life in Dementia-scale; primary outcome) and quality of care and dying in the last month of life (Quality of Dying in Long-Term Care scale; secondary outcome). Results: At baseline, we included 177 residents with advanced dementia, 126 with non-advanced dementia and 156 without dementia. Post-intervention, respectively in the control and the intervention group, we included 136 and 104 residents with advanced dementia, 167 and 110 with non-advanced dementia and 157 and 137 without dementia. We found no subgroup differences on comfort in the last week of life, comparing advanced versus without dementia (baseline-adjusted mean sub-group difference 2.1; p-value = 0.177), non-advanced versus without dementia (2.7; p = 0.092), and advanced versus non-advanced dementia (− 0.6; p = 0.698); or on quality of care and dying in the last month of life, comparing advanced and without dementia (− 0.6; p = 0.741), non-advanced and without dementia (− 1.5; p = 0.428), and advanced and non-advanced dementia (0.9; p = 0.632). Conclusions: The lack of subgroup difference suggests that while the program did not improve comfort in dying residents with or without dementia, it appeared to equally improve quality of care and dying in the last month of life for residents with dementia (regardless of the stage) and those without dementia. A generalist and non-disease-specific palliative care program, such as PACE Steps to Success, is a useful starting point for future palliative care improvement in nursing homes, but to effectively improve residents’ comfort, this program needs further development. Trial registration: ISRCTN, ISRCTN14741671. Registered 8 July 2015 – Retrospectively registered.
AB - Background: ‘PACE Steps to Success’ is a multicomponent training program aiming to integrate generalist and non-disease-specific palliative care in nursing homes. This program did not improve residents’ comfort in the last week of life, but it appeared to improve quality of care and dying in their last month of life. Because this program included only three dementia-specific elements, its effects might differ depending on the presence or stage of dementia. We aimed to investigate whether the program effects differ between residents with advanced, non-advanced, and no dementia. Methods: Pre-planned subgroup analysis of the PACE cluster-randomized controlled trial in 78 nursing homes in seven European countries. Participants included residents who died in the previous 4 months. The nursing home staff or general practitioner assessed the presence of dementia; severity was determined using two highly-discriminatory staff-reported instruments. Using after-death questionnaires, staff assessed comfort in the last week of life (Comfort Assessment in Dying–End-of-Life in Dementia-scale; primary outcome) and quality of care and dying in the last month of life (Quality of Dying in Long-Term Care scale; secondary outcome). Results: At baseline, we included 177 residents with advanced dementia, 126 with non-advanced dementia and 156 without dementia. Post-intervention, respectively in the control and the intervention group, we included 136 and 104 residents with advanced dementia, 167 and 110 with non-advanced dementia and 157 and 137 without dementia. We found no subgroup differences on comfort in the last week of life, comparing advanced versus without dementia (baseline-adjusted mean sub-group difference 2.1; p-value = 0.177), non-advanced versus without dementia (2.7; p = 0.092), and advanced versus non-advanced dementia (− 0.6; p = 0.698); or on quality of care and dying in the last month of life, comparing advanced and without dementia (− 0.6; p = 0.741), non-advanced and without dementia (− 1.5; p = 0.428), and advanced and non-advanced dementia (0.9; p = 0.632). Conclusions: The lack of subgroup difference suggests that while the program did not improve comfort in dying residents with or without dementia, it appeared to equally improve quality of care and dying in the last month of life for residents with dementia (regardless of the stage) and those without dementia. A generalist and non-disease-specific palliative care program, such as PACE Steps to Success, is a useful starting point for future palliative care improvement in nursing homes, but to effectively improve residents’ comfort, this program needs further development. Trial registration: ISRCTN, ISRCTN14741671. Registered 8 July 2015 – Retrospectively registered.
KW - Bereavement
KW - Communication
KW - End of life care
KW - Neurological conditions
KW - Nursing home care
KW - Pain
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85102201977&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/33678179
U2 - 10.1186/s12904-021-00734-1
DO - 10.1186/s12904-021-00734-1
M3 - Article
C2 - 33678179
VL - 20
JO - BMC Palliative Care
JF - BMC Palliative Care
SN - 1472-684X
IS - 1
M1 - 39
ER -