Improving Quality of Care for the Dying Patient in Hospice: A Quasi Experimental Trial in Liguria Region

This is a before-after phase II study, according to the Medical Research Council framework, investigating the feasibility of introducing the Liverpool Care Pathway for the dying patient (LCP) in 5 Ligurian hospices.

Study Overview

• Status: Completed
• Conditions: End-of-Life
• Intervention / Treatment: Other: LCP Program

• Study Type: Interventional
• Enrollment (Actual): 282
• Phase: Phase 2

Contacts and Locations

Study Locations

• Italy
  • Genova, Italy, 16000
    • Hospice Gigi Ghirotti "Albaro"
  • Genova, Italy, 16000
    • Hospice Gigi Ghirotti "Bolzaneto"
  • Imperia, Italy, 18014
    • Hospice ASL1 Liguria
  • Savona, Italy, 171000
    • CENTRO MISERICORDIA" SANTA M.G.ROSSELLO. Ist.Figlie Ns Signora Misericordia
  • Genova
    • Chiavari, Genova, Italy, 16000
      • Hospice ASL 4

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• All patients deceased in the hospice during the evaluation period
• Approval of ethics committee

Exclusion Criteria:

• Prior use of LCP in the hospice
• Deceased was a relative of a hospice member of staff

Study Plan

How is the study designed?

Design Details

• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: LCP Program; The LCP Program is continuous quality improvement program of end-of-life care implemented in hospice	Other: LCP Program; The LCP Program is continuous quality improvement program of end-of-life care implemented in hospice

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
feasibility of LCP implementation	measured as proportion of hospices that complete the experimental phase of introducing the LCP Program and maintain the program in the 6 months subsequent the process of experimental LCP implementation	6 months after the end of LCP implementation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
quality of information provided to patients and to family	measured with the scale 1 (Informing and promoting shared decision making) from the Toolkit After-death bereaved family member interview (Teno 2001). The Toolkit will be administered to non-professional caregivers 2-4 months after the patient's death	2-4 months after the patient's death
Level of advanced care planning among patients	measured with the scale 2 (Encouraging advance care planning) from the Toolkit After-death bereaved family member interview (Teno 2001). The Toolkit will be administered to non-professional caregivers 2-4 months after the patient's death	2 - 4 months after the patient's death
Provision of care focusing on patient's individual needs.	measured with the scale 3 (Focus on individual) from the Toolkit After-death bereaved family member interview (Teno 2001). The Toolkit will be administered to non-professional caregivers 2-4 months after the patient's death	2 - 4 months after the patient's death
Quality of emotional support to family members before an after the patient's death	measured with the scale 4 (Attending to the emotional and spiritual needs of the family) from the Toolkit After-death bereaved family member interview (Teno 2001). The Toolkit will be administered to non-professional caregivers 2-4 months after the patient's death	2 - 4 months after the patient's death
Level of care coordination	measured with the scale 5 (Providing coordination of care) from the Toolkit After-death bereaved family member interview (Teno 2001). The Toolkit will be administered to non-professional caregivers 2-4 months after the patient's death	2 - 4 months after the patient's death
Family support levels	measured with the scale 6 (Supporting the self-efficacy of the family) from the Toolkit After-death bereaved family member interview (Teno 2001). The Toolkit will be administered to non-professional caregivers 2-4 months after the patient's death	2 - 4 months after the death of the patient
Appropriateness of therapeutic and diagnostic procedures	measured with a specific tool in which all diagnostic and therapeutic procedures and drugs administered to the patient during the last 3 days of life are reported	the last 3 days of life
Overall quality of care experience for patients and family	measured with the scale 7 (Overall quality of care provided to patients and family) from the Toolkit After-death bereaved family member interview (Teno 2001). The Toolkit will be administered to non-professional caregivers 2-4 months after the patient's death	2 - 4 months after the death of the patient
Quality of communication between General Practitioner and hospice	measured with a telephonic interview	an expected average of 2 months after the patient's death

Collaborators and Investigators

• Sponsor: Regional Palliative Care Network
• Investigators: Study Chair: Massimo Costantini, IRCCS AOU San Martino- IST

Study record dates

Study Major Dates

• Study Start: September 1, 2010
• Primary Completion (Actual): March 1, 2012
• Study Completion (Actual): March 1, 2012

Study Registration Dates

• First Submitted: October 21, 2011
• First Submitted That Met QC Criteria: November 9, 2011
• First Posted (Estimate): November 11, 2011

Study Record Updates

• Last Update Posted (Estimate): January 14, 2013
• Last Update Submitted That Met QC Criteria: January 11, 2013
• Last Verified: January 1, 2013

More Information

Terms related to this study

• Keywords: Patients; Hospice; Dying; Liverpool Care Pathways
• Additional Relevant MeSH Terms: Pathologic Processes; Death
• Other Study ID Numbers: LCP-I LIG