Training nursing home staff to improve residents' end-of-life care: design and baseline findings from a randomized controlled trial

Key summary pointsAimWe present the design, intervention, baseline findings and feasibility of a randomized, controlled trial examining the effectiveness of staff training in palliative care on nursing home residents' hospitalizations and health-related quality-of-life.FindingsMost staff members participated in the training sessions and they gave good feedback. Our patient groups are fairly well balanced in their characteristics.MessageIf our further trial shows patient-related benefits, we will have a well-defined model for improving palliative care in nursing homes. AbstractPurposeWe aim to describe the design, educational intervention, baseline findings and feasibility of our training intervention. Our trial will aim to improve the residents' health-related quality of life (HRQOL) and to reduce unnecessary hospitalizations.MethodsWe recruited 340 residents from 20 nursing home wards in Helsinki, and they were randomized into intervention and control groups. At baseline, all the participants were assessed for demographics, medical history, medication, HRQOL, symptoms, hospitalizations, advance care plans, and proxies' satisfaction with care. The staff in the intervention wards were offered four 4-h educational sessions on the principles of palliative care (advance care planning, the adverse effects of hospitalizations, symptom management, communication, giving support to proxies and challenging situations). The sessions were based on constructive learning methods and patient cases.ResultsThe mean age of residents was 84years and 76% were women. The intervention and control groups did not differ with respect to demographics, terminal diseases, comorbidities, nutritional status, cognition or the use of palliative medication. However, the control residents were more likely to be bed-bound and to have a do-not-resuscitate order on their medical chart. Of about 180 staff members, 132 completed the educational intervention. The discussions in the training sessions were lively and the participants gave an overall rating of 4.6/5 for the education.ConclusionsWe have successfully randomized nursing home wards in this trial and completed staff training with very positive feedback. If our trial shows resident-related benefits, we will have a well-defined model for improving palliative care in nursing homes. The study was registered in the Australian New Zealand Clinical Trials Registry under the intervention code: ACTRN12617001040358.