Increasing the Number of Patients Receiving Information About Transition to End-of-life Care

Increasing the Number of Patients Receiving Information About Transition to End-of-life Care: the Effect of a Half-day Physician and Nurse Training

Introduction: Honest prognostication and information for patients are important parts of end-of-life care. This study examined whether an educational intervention could increase the proportion of patients who received information about the transition to end-of-life care (ITEOL).

Method: Two municipalities (in charge of nursing homes) and two hospitals were randomized to receive an interactive half-day course about ITEOL for physicians and nurses. The proportion of patients who received ITEOL was measured with data from the Swedish Register of Palliative Care (SRPC). Patients were only included if they died an expected death and maintained their ability to express their will until days or hours before their death. Four hospitals and four municipalities were assigned controls, matched by hospital size, population, and proportion of patients receiving ITEOL at baseline.

Study Overview

• Status: Completed
• Conditions: Palliative Care; Disclosure
• Intervention / Treatment: Other: Educative intervention

• Study Type: Interventional
• Enrollment (Actual): 1431
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Sweden
  • Umeå, Sweden, SE-901 87
    • Umeå University, Dept of radiation sciences

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Hospitals and municipalities: Participation in the Swedish Register of Palliative Care.
• Patients: Reported from an included hospital or municipality during six months before to six months after intervention.

Exclusion Criteria:

• Hospitals and municipalities: Exclusion criteria were more than 40% patients receiving ITEOL at start of study, too large for an intervention due to practical reasons (university hospitals or municipalities with over 100 000 inhabitants), and hospitals not containing both internal medicine and surgery departments.
• Patients were excluded when death was unexpected, when a forensic post mortem examination was performed, or when the patients had lost their ability to express their will and take part in decisions concerning the content of medical care one week or more before death.

Study Plan

How is the study designed?

Design Details

• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: No intervention; No intervention.
Other: Educative intervention; Two municipalities (in charge of nursing homes) and two hospitals were randomized to receive an interactive half-day course about ITEOL for physicians and nurses.	Other: Educative intervention; Two municipalities (in charge of nursing homes) and two hospitals were randomized to receive an interactive half-day course about ITEOL for physicians and nurses.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The proportion of patients who received ITEOL	The proportion of patients who received ITEOL was measured with data from the Swedish Register of Palliative Care (SRPC). Six months after the intervention data were collected from the SRPC for all patients who had died at the included hospitals and municipalities. Data were collected from six months before the intervention to six months after the intervention. The outcome was compared before and after the intervention.	Six months after intervention

Collaborators and Investigators

• Sponsor: Umeå University
• Investigators: Principal Investigator: Bertil Axelsson, MD PhD, Umeå University

Study record dates

Study Major Dates

• Study Start: August 1, 2011
• Primary Completion (Actual): October 1, 2012
• Study Completion (Actual): October 1, 2012

Study Registration Dates

• First Submitted: March 13, 2014
• First Submitted That Met QC Criteria: March 17, 2014
• First Posted (Estimate): March 19, 2014

Study Record Updates

• Last Update Posted (Estimate): March 19, 2014
• Last Update Submitted That Met QC Criteria: March 17, 2014
• Last Verified: March 1, 2014

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Death
• Other Study ID Numbers: Intervention-sv-pall