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J Am Med Dir Assoc. 2017 Jun 1;18(6):550.e7-550.e14. doi: 10.1016/j.jamda.2017.02.016. Epub 2017 Apr 12.

Palliative Care Development in European Care Homes and Nursing Homes: Application of a Typology of Implementation.

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International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom. Electronic address:
International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom.
Division of Health Research, Lancaster University, Lancaster, United Kingdom.
National Institute for Health and Welfare, Helsinki, Finland.
Università Cattolica del Sacro Cuoro, Rome, Italy.
Amsterdam Public Health Research Institute, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.
Unit for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.



The provision of institutional long-term care for older people varies across Europe reflecting different models of health care delivery. Care for dying residents requires integration of palliative care into current care work, but little is known internationally of the different ways in which palliative care is being implemented in the care home setting.


To identify and classify, using a new typology, the variety of different strategic, operational, and organizational activities related to palliative care implementation in care homes across Europe.


We undertook a mapping exercise in 29 European countries, using 2 methods of data collection: (1) a survey of country informants, and (2) a review of data from publically available secondary data sources and published research. Through a descriptive and thematic analysis of the survey data, we identified factors that contribute to the development and implementation of palliative care into care homes at different structural levels. From these data, a typology of palliative care implementation for the care home sector was developed and applied to the countries surveyed.


We identified 3 levels of palliative care implementation in care homes: macro (national/regional policy, legislation, financial and regulatory drivers), meso (implementation activities, such as education, tools/frameworks, service models, and research), and micro (palliative care service delivery). This typology was applied to data collected from 29 European countries and demonstrates the diversity of palliative care implementation activity across Europe with respect to the scope, type of development, and means of provision. We found that macro and meso factors at 2 levels shape palliative care implementation and provision in care homes at the micro organizational level.


Implementation at the meso and micro levels is supported by macro-level engagement, but can happen with limited macro strategic drivers. Ensuring the delivery of consistent and high-quality palliative care in care homes is supported by implementation activity at these 3 levels. Understanding where each country is in terms of activity at these 3 levels (macro, meso, and micro) will allow strategic focus on future implementation work in each country.


Europe; Palliative care; care homes; education; implementation; nursing homes

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