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Quality End-of-Life Care in Nursing Homes

This study has been completed.
National Institutes of Health (NIH)
Information provided by:
University of Nebraska Identifier:
First received: February 4, 2008
Last updated: December 1, 2014
Last verified: February 2008
The purpose of this study is to examine key organizational structures and processes (leadership, teamwork, communication, palliative care) and their impact on the quality of end-of-life care for dying residents and their family members.

Quality of End-of-life Care in Nursing Homes

Study Type: Observational
Study Design: Observational Model: Case-Only
Time Perspective: Cross-Sectional
Official Title: The Impact of Quality End-of-Life Care in Nursing Homes

Resource links provided by NLM:

Further study details as provided by University of Nebraska:

Primary Outcome Measures:
  • The influence on palliative care of communication, leadership, and teamwork. [ Time Frame: Nursing home staff: at beginning and end of study; family members: following the death of nursing home resident ]

Secondary Outcome Measures:
  • Associations among structure (staffing), non-clinical (communication, leadership, teamwork) and clinical (palliative care) care processes and quality of end-of-life care. [ Time Frame: Nursing home staff: at beginning and end of study; family members: following the death of nursing home resident ]
  • Unruh and Wan's expanded structure, process, and outcomes model in the context of nursing home palliative care. [ Time Frame: Nursing home staff: at beginning and end of study; family members: following the death of nursing home resident ]

Estimated Enrollment: 8500
Study Start Date: January 2007
Study Completion Date: January 2011
Primary Completion Date: January 2011 (Final data collection date for primary outcome measure)
1 Nursing Home Staff
Direct care staff
2 Family Members
Family members/Significant other of nursing home resident.

Detailed Description:

As the American population ages, nursing homes are rapidly becoming a dominant site for death. Currently, 25% of all deaths occur in nursing homes and 35% of all elders over the age of 85 die in nursing homes. By 2020, 40% of those over 65 will die in nursing homes. Nursing home residents die in pain with undue psychosocial suffering. For all permanently placed residents, death is inevitable. Nonetheless, how residents die, is not.

There have been long standing concerns about the quality of care and quality of life in nursing homes. Although there is some evidence that the quality of care for nursing home residents has improved, serious problems continue in areas that potentially affect end-of-life such as dehydration, pressure ulcers, and pain. Efforts to improve care have rarely considered the dynamic nature of nursing home structure and process factors, such as staffing levels, leadership of the director of nursing, or communication and teamwork among staff that facilitate or impede the organization's ability to improve care processes. Findings from our preliminary studies in nursing homes indicate that organizational structure and process factors make a difference in end-of-life care for residents and their family members. More specifically, staff education, staffing levels, leadership of the DON and administrator, teamwork and communication among direct care staff, and incorporating palliative care clinical practices into day-to-day care had a profound impact on outcomes such as the honoring of end-of-life preferences, symptom management, and satisfaction with care. A more generalizable understanding of key structure and process factors and their relationship to resident care and outcomes at the end-of-life will provide a foundation for future intervention studies aimed at improving care.


Ages Eligible for Study:   19 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Nursing Homes in Nebraska and the Western half of Iowa, nursing home staff, and family members/significant other of nursing home residents

Inclusion Criteria (Nursing Homes):

  • 60 beds or greater

Exclusion Criteria (Nursing Homes):

  • less than 60 beds

Inclusion Criteria (Nursing Home Staff):

  • 19 years of age or older
  • trained to provide resident care

Exclusion Criteria (Nursing Homes):

  • less than 19 years of age
  • staff on units exclusively Medicare or average length of stay less than 30 days

Inclusion Criteria (Family Member/Significant Other):

  • 19 years of age or older
  • somewhat to very involved in resident's care and decision-making

Exclusion Criteria (Family Member/Significant Other):

  • not involved in resident's care and decision-making
  • resident was in the nursing home less than 31 days
  • resident was less than 65 years old
  Contacts and Locations
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Please refer to this study by its identifier: NCT00616473

United States, Nebraska
University of Nebraska Medical Center
Omaha, Nebraska, United States, 68198
Sponsors and Collaborators
University of Nebraska
National Institutes of Health (NIH)
Principal Investigator: Sarah A Thompson, RN, PhD University of Nebraska
Principal Investigator: Virginia Tilden, RN, DNSC University of Nebraska
  More Information

Additional Information:
Responsible Party: Sarah A Thompson, RN, PhD, University of Nebraska Medical Center Identifier: NCT00616473     History of Changes
Other Study ID Numbers: 433-06
7R01NR009547-02 ( US NIH Grant/Contract Award Number )
Study First Received: February 4, 2008
Last Updated: December 1, 2014 processed this record on May 25, 2017