Format

Send to

Choose Destination
Palliat Med. 2018 Mar;32(3):613-621. doi: 10.1177/0269216317719588. Epub 2017 Jul 21.

Quasi-experimental evaluation of a multifaceted intervention to improve quality of end-of-life care and quality of dying for patients with advanced dementia in long-term care institutions.

Author information

1
1 Faculty of Medicine, Laval University, Quebec City, QC, Canada.
2
2 Quebec Centre of Excellence on Aging, Quebec City, QC, Canada.
3
3 Faculty of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada.
4
4 Veterans Affairs Canada, Montreal, QC, Canada.
5
5 Centre on Aging and Health, University of Regina, Regina, SK, Canada.
6
6 Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

Abstract

BACKGROUND:

Improvement in the quality of end-of-life care for advanced dementia is increasingly recognized as a priority in palliative care.

AIM:

To evaluate the impact of a multidimensional intervention to improve quality of care and quality of dying in advanced dementia in long-term care facilities.

DESIGN:

Quasi-experimental study with the intervention taking place in two long-term care facilities versus usual care in two others over a 1-year period. The intervention had five components: (1) training program to physicians and nursing staff, (2) clinical monitoring of pain using an observational pain scale, (3) implementation of a regular mouth care routine, (4) early and systematic communication with families about end-of-life care issues with provision of an information booklet, and (5) involvement of a nurse facilitator to implement and monitor the intervention. Quality of care was assessed with the Family Perception of Care Scale. The Symptom Management for End-of-Life Care in Dementia and the Comfort Assessment in Dying scales were used to assess the quality of dying.

PARTICIPANTS:

A total of 193 residents with advanced dementia and their close family members were included (97 in the intervention group and 96 in the usual care group).

RESULTS:

The Family Perception of Care score was significantly higher in the intervention group than in the usual care group (157.3 vs 149.1; p = 0.04). The Comfort Assessment and Symptom Management scores were also significantly higher in the intervention group.

CONCLUSIONS:

Our multidimensional intervention in long-term care facilities for patients with terminal dementia resulted in improved quality of care and quality of dying when compared to usual care.

KEYWORDS:

Long-term care; dementia; end-of-life care; palliative care

PMID:
28731379
DOI:
10.1177/0269216317719588
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center