Older Patients Dying in Acute Geriatric Hospital Wards Clinical Trial
Official title:
Improving End-of-life Care in Acute Geriatric Hospital Wards Using the Care Programme for the Last Days of Life: a Cluster Randomized Controlled Trial
BACKGROUND Demographic trends coupled with a rise in chronic diseases mean that the
population of patients requiring palliative and end-of-life care is ageing. Due to the ageing
population palliative care for older people has been identified as one of the worldwide
public health priorities. A majority of elderly patients die in hospital. Studies from the
United Kingdom and other countries have shown that many older persons dying in hospital
experience suboptimal care. The Care Programme for the Last Days of Life has been developed
to improve the quality of end-of-life care in acute geriatric hospital wards. The programme
is based on existing end-of-life care programmes but modeled to the acute geriatric care
setting. There is a lack of evidence of the effectiveness of end-of-life care programmes and
the effects that may be achieved in patients dying in an acute geriatric hospital setting are
unknown. The aim of this study is to evaluate the effectiveness of the Care Programme for the
Last Days of Life in improving the quality of care and quality of life during the last 48
hours of life of patients dying in acute geriatric hospital wards in Flanders as compared to
usual care.
METHODS In order to contribute substantially to the increase of evidence for the effect of
the Care Programme for the Last Days of Life in patients dying in acute geriatric hospital
wards, a cluster randomized controlled trial will be conducted. Ten hospitals with one or
more acute geriatric wards will conduct a one-year baseline assessment during which care will
be provided as usual. For each patient dying in the ward, a questionnaire will be filled in
by a nurse, a physician and a family carer. At the end of the baseline assessment hospitals
will be randomized to receive intervention (implementation of the Care Programme) or no
intervention. Subsequently, the Care Programme will be implemented in the intervention
hospitals over a six-month period. A one-year post-intervention assessment will be performed
immediately after the baseline assessment in the control hospitals and after the
implementation period in the intervention hospitals. Primary outcomes are symptom frequency
and symptom burden of patients in the last 48 hours of life.
DISCUSSION This will be the first cluster randomized controlled trial to evaluate the effect
of the Care Programme for the Last Days of Life for the acute geriatric hospital setting. The
results will enable us to evaluate whether implementation of the Care Programme has positive
effects on end-of-life care during the last days of life in this patient population and which
components of the Care Programme contribute to improving the quality of end-of-life care.
n/a