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Implementation of Knowledge-Based Palliative Care (KUPA)

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ClinicalTrials.gov Identifier: NCT02708498
Recruitment Status : Completed
First Posted : March 15, 2016
Last Update Posted : March 12, 2018
Sponsor:
Collaborators:
Linneaus University
The Swedish Research Council
Information provided by (Responsible Party):
Lund University

Brief Summary:

The research on ageing during the last couple of decades has increasingly focused on questions regarding the quality of life and life satisfaction of the old people. Yet the research indicates that when it comes to the final stage of life, the end includes unnecessary suffering and the quality of life drops. Palliative care has traditionally been provided successfully to younger persons dying from incurable illnesses while older people dying of multiple morbidities or "old age" has received far less of this type of care. However, sixty percent of all people who died in Sweden in 2010 were at least 80 years old and it is well known that dying among older people often is a prolonged period of suffering. One reason might be that it is more difficult to identify when the final stages of life begins for older persons.

The purpose of this project is to implement and evaluate how a knowledge-based model for palliative care in nursing homes affects the quality of life and the participation in the care process for older persons in nursing homes and their next of kin. A second aim is to explore the staff's implementation process of palliative care and the role of the leadership. The final aim is to investigate which factors (barriers and facilitators) that affect the implementation process of this model.


Condition or disease Intervention/treatment Phase
Ageing Behavioral: Educational Intervention Not Applicable

Detailed Description:

The project is conducted as a cross-over implementation project about evidence-based palliative care. It is an educational intervention with seminars for professionals in nursing homes. It takes place in two counties (Kronoberg and Skåne) in the south of Sweden. The strategy is based on two national knowledge documents concerning palliative care at the end of life and the Swedish Register of Palliative Care (SRPC). The main tailored intervention study is ongoing during 6 months. It is based on a pilot study conducted during fall 2014. The main intervention started in April 2015 in Alvesta and Ljungby municipalities, Kronoberg County. The educational intervention will be implemented in other municipal nursing homes than in the pilot/feasibility study. Implementation of the educational intervention is conducted in ten nursing homes in Kronoberg County (2015). An equal number of nursing homes in Skåne County will consist of the control group. The educational intervention will then be evaluated in the same way in the two counties through measurement before (baseline) and after the intervention. In the second phase (cross-over design) during 2016, the ten control nursing homes in Skåne will be chosen to implement the co-created palliative care educational intervention and ten new nursing homes in Kronoberg, which has not received the intervention, will be chosen as a control group in Tingsryd and Växjö municipalities.

Every seminar group meets once a month and includes different professions (unit manager, district nurse, assistant nurse, and other staff i.e. occupational therapist and physiotherapist). There will be 5 meetings with 8-10 participants in each group from each nursing home. The total intervention period is about 6 months.


Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1154 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: Implementation of Knowledge-Based Palliative Care for Frail Older Persons in Nursing Homes
Actual Study Start Date : April 9, 2015
Actual Primary Completion Date : June 20, 2017
Actual Study Completion Date : October 15, 2017

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Kronoberg Educational Intervention
The educational intervention is provided to staff at ten nursing homes.
Behavioral: Educational Intervention
The seminar groups will be led by two experienced clinical nurses and researchers from the field of palliative care and geriatric care. The educational material consist of six themes; values in palliative care, symptom relief, dignity and a dignified death, collaborative co-creating care, support to next of kin and dialogue with older persons and next of kin about death and dying. The content of the different themes will have a common core for each nursing home but will be adjusted based on the expressed needs of each nursing home. New themes can be created related to the needs of the unique nursing home. The participants in the seminar groups will reflect together over the content of the developed binder of educational material and will relate it to their own work in order to identify areas suitable for changes and/or development.

No Intervention: Skåne Control
The control group consists of an equal number of participants. This group receives no intervention.
Experimental: Skåne Educational Intervention
The educational intervention is provided to staff at ten nursing homes.
Behavioral: Educational Intervention
The seminar groups will be led by two experienced clinical nurses and researchers from the field of palliative care and geriatric care. The educational material consist of six themes; values in palliative care, symptom relief, dignity and a dignified death, collaborative co-creating care, support to next of kin and dialogue with older persons and next of kin about death and dying. The content of the different themes will have a common core for each nursing home but will be adjusted based on the expressed needs of each nursing home. New themes can be created related to the needs of the unique nursing home. The participants in the seminar groups will reflect together over the content of the developed binder of educational material and will relate it to their own work in order to identify areas suitable for changes and/or development.

No Intervention: Kronoberg Control
The control group consists of an equal number of participants. This group receives no intervention.



Primary Outcome Measures :
  1. World Health Organization Quality of Life-BREF (WHOQOL-BREF) [ Time Frame: 2,5 years ]
    Measure quality of life for older persons' at the end of life living in nursing homes

  2. World Health Organization Quality of Life-OLD (WHOQOL-OLD) [ Time Frame: 2,5 years ]
    Measure quality of life for older persons' at the end of life living in nursing homes

  3. Person-centred Care Assessment Tool (P-CAT)(patient version) [ Time Frame: 2,5 years ]
    Measure person-centred care for older persons' at the end of life living in nursing homes

  4. Person-Centred Climate Questionnaire (PCQ patient version) [ Time Frame: 2,5 years ]
    Measure person-centred care for older persons' at the end of life living in nursing homes

  5. The participation of next of kin in care in nursing homes questionnaire [ Time Frame: 2,5 years ]
    Measure participation for next of kin to older persons in nursing homes

  6. World Health Organization Quality of Life-OLD (WHOQOL-OLD) for next of kin [ Time Frame: 2,5 years ]
    Measure quality of life for next of kin to older persons in nursing homes

  7. World Health Organization Quality of Life-BREF (WHOQOL-BREF) for next of kin [ Time Frame: 2,5 years ]
    Measure quality of life for next of kin to older persons in nursing homes

  8. Swedish Register of Palliative Care (SRPC) [ Time Frame: One year before the intervention and one year after the intervention ]
    Measure quality of palliative care at the end of life


Secondary Outcome Measures :
  1. Your experience of palliative care questionnaire [ Time Frame: 2,5 years ]
    Measure knowledge about palliative care among the staff

  2. Focus group interviews before and after the intervention [ Time Frame: 2,5 years ]
    The staff's experiences of the educational intervention about palliative care

  3. Ethnographic observation method [ Time Frame: One year ]
    Observations of staff preforming their daily work at nursing homes and interviews with staff.

  4. Interviews with nursing home managers during and six months after the intervention [ Time Frame: Two years ]
    The nursing home's readiness to implement changes

  5. Person-centred Care Assessment Tool (P-CAT)(staff version) [ Time Frame: 2,5 years ]
    Measure person-centred care for staff working in nursing homes

  6. Person-Centred Climate Questionnaire (PCQ-S) [ Time Frame: 2,5 years ]
    Measure person-centred care for staff working in nursing homes



Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Older persons living in the participating nursing homes
  • Next of kin to older persons living in the participating nursing homes
  • Staff working at the participating nursing homes
  • Managers working at the participating nursing homes
  • The participating nursing homes must be located in either Kronoberg County or Skåne County in Sweden

Exclusion Criteria:

  • Not being cognitive able to participate in interviews or answering the questionnaires

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02708498


Locations
Sweden
Bryggaren
Alvesta, Kronoberg, Sweden, 34230
Högåsen
Alvesta, Kronoberg, Sweden, 34235
Asken
Grimslöv, Kronoberg, Sweden, 34032
Kvarngården
Ingelstad, Kronoberg, Sweden, 360 44
Konga Allhus
Konga, Kronoberg, Sweden, 362 40
Åbrinken
Lagan, Kronoberg, Sweden, 34014
Ljungberga
Ljungby, Kronoberg, Sweden, 34135
Ljungsätra
Ljungby, Kronoberg, Sweden, 34138
Brunnsgården
Ljungby, Kronoberg, Sweden, 34183
Torsgården
Lönashult, Kronoberg, Sweden, 34253
Furuliden
Moheda, Kronoberg, Sweden, 34260
Solängen
Ryd, Kronoberg, Sweden, 360 10
Örnen
Tingsryd, Kronoberg, Sweden, 362 30
Äppelgården
Urshult, Kronoberg, Sweden, 360 13
Björkliden
Vislanda, Kronoberg, Sweden, 34250
Solhaga
Väckelsång, Kronoberg, Sweden, 362 51
Birkagården
Växjö, Kronoberg, Sweden, 352 41
Hovslund
Växjö, Kronoberg, Sweden, 352 44
Evelid
Växjö, Kronoberg, Sweden, 352 64
Älmegården
Älmeboda, Kronoberg, Sweden, 360 23
Skogsgläntan
Höör, Skåne, Sweden, 24395
Åsgården
Kågeröd, Skåne, Sweden, 28677
Mårtenslund
Lund, Skåne, Sweden, 224 60
Brunnslyckan
Lund, Skåne, Sweden, 22460
Norrdala
Lund, Skåne, Sweden, 22466
Rönnebacken
Osby, Skåne, Sweden, 283 42
Solgården
Svalöv, Skåne, Sweden, 26834
Holmagården
Svedala, Skåne, Sweden, 23338
Fästan
Södra Sandby, Skåne, Sweden, 24731
Ängslyckan
Teckomatorp, Skåne, Sweden, 26872
Sponsors and Collaborators
Lund University
Linneaus University
The Swedish Research Council
Investigators
Principal Investigator: Gerd Ahlström, PhD. Department of Health Sciences, Lund University

Additional Information:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Lund University
ClinicalTrials.gov Identifier: NCT02708498     History of Changes
Other Study ID Numbers: 2014-2759
2014-0071 ( Other Grant/Funding Number: The Vardal Foundation )
First Posted: March 15, 2016    Key Record Dates
Last Update Posted: March 12, 2018
Last Verified: March 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Keywords provided by Lund University:
Palliative care
Frail elderly
Comorbidity
Staff Development
Nursing Homes