Effects of facilitated family case conferencing for advanced dementia: A cluster randomised clinical trial

被引：52

作者：

Agar, Meera ^{[1
,2
,3
,4
]}

Luckett, Tim ^{[1
]}

Luscombe, Georgina ^{[5
]}

Phillips, Jane ^{[1
]}

Beattie, Elizabeth ^{[6
]}

Pond, Dimity ^{[7
]}

Mitchell, Geoffrey ^{[8
]}

Davidson, Patricia M. ^{[1
,9
]}

Cook, Janet ^{[1
]}

Brooks, Deborah ^{[6
]}

Houltram, Jennifer ^{[10
]}

Goodall, Stephen ^{[10
]}

Chenoweth, Lynnette ^{[11
]}

机构：

[1] Univ Technol Sydney, Fac Hlth, Ultimo, NSW, Australia

[2] Univ New South Wales, South Western Sydney Clin Sch, Liverpool, NSW, Australia

[3] Ingham Inst Appl Med Res, Liverpool, NSW, Australia

[4] Improving Palliat Care Clin Trials ImPaCCT, Sydney, NSW, Australia

[5] Univ Sydney, Sydney Med Sch, Ultimo, NSW, Australia

[6] Queensland Univ Technol, Sch Nursing, Herston, Qld, Australia

[7] Univ Newcastle, Sch Med & Publ Hlth, Newcastle, NSW, Australia

[8] Univ Queensland, Fac Med, St Lucia, Qld, Australia

[9] Johns Hopkins Univ, Sch Nursing, Baltimore, MD USA

[10] UTS, Fac Business, Ctr Hlth Res & Evaluat CHERE, Haymarket, NSW, Australia

[11] Univ New South Wales, Ctr Hlth Brain Ageing, Randwick, NSW, Australia

来源：

PLOS ONE | 2017年 / 12卷 / 08期

关键词：

OF-LIFE CARE; NURSING-HOME RESIDENTS; PALLIATIVE CARE; OLDER-PEOPLE; END; OUTCOMES; SCALES; CHALLENGES; DECISIONS; ATTITUDES;

D O I：

10.1371/journal.pone.0181020

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Background Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing (FCC) with usual care (UC) on end-of-life care. Methods A two arm parallel cluster randomised controlled trial was conducted. The sample included people with advanced dementia from 20 Australian nursing homes and their families and professional caregivers. In each intervention nursing home (n = 10), Palliative Care Planning Coordinators (PCPCs) facilitated family case conferences and trained staff in person-centred palliative care for 16 hours per week over 18 months. The primary outcome was familyrated quality of end-of-life care (End-of-Life Dementia [EOLD] Scales). Secondary outcomes included nurse-rated EOLD scales, resident quality of life (Quality of Life in Latestage Dementia [QUALID]) and quality of care over the last month of life (pharmacological/non-pharmacological palliative strategies, hospitalization or inappropriate interventions). Results Two-hundred-eighty-six people with advanced dementia took part but only 131 died (64 in UC and 67 in FCC which was fewer than anticipated), rendering the primary analysis under- powered with no group effect seen in EOLD scales. Significant differences in pharmacological (P < 0.01) and non-pharmacological (P < 0.05) palliative management in last month of life were seen. Intercurrent illness was associated with lower family-rated EOLD Satisfaction with Care (coefficient 2.97, P < 0.05) and lower staff-rated EOLD Comfort Assessment with Dying (coefficient 4.37, P < 0.01). Per protocol analyses showed positive relationships between EOLD and staff hours to bed ratios, proportion of residents with dementia and staff attitudes. Conclusion FCC facilitates a palliative approach to care. Future trials of case conferencing should consider outcomes and processes regarding decision making and planning for anticipated events and acute illness.

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