Informed palliative care in nursing homes through the interRAI Palliative Care instrument: a study protocol based on the Medical Research Council framework

Kirsten Hermans, Nele Spruytte, Joachim Cohen, Chantal Van Audenhove, Anja Declercq, Kirsten Hermans, Nele Spruytte, Joachim Cohen, Chantal Van Audenhove, Anja Declercq

Abstract

Background: Nursing homes are important locations for palliative care. Through comprehensive geriatric assessments (CGAs), evaluations can be made of palliative care needs of nursing home residents. The interRAI Palliative Care instrument (interRAI PC) is a CGA that evaluates diverse palliative care needs of adults in all healthcare settings. The evaluation results in Client Assessment Protocols (CAPs: indications of problems that need addressing) and Scales (e.g. Palliative Index for Mortality (PIM)) which can be used to design, evaluate and adjust care plans. This study aims to examine the effect of using the interRAI PC on the quality of palliative care in nursing homes. Additionally, it aims to evaluate the feasibility and validity of the interRAI PC.

Methods: This study covers phases 0, I and II of the Medical Research Council (MRC) framework for designing and evaluating complex interventions, with a longitudinal, quasi-experimental pretest-posttest design and with mixed methods of evaluation. In phase 0, a systematic literature search is conducted. In phase I, the interRAI PC is adapted for use in Belgium and implemented on the BelRAI-website and a practical training is developed. In phase II, the intervention is tested in fifteen nursing homes. Participating nursing homes fill out the interRAI PC during one year for all residents receiving palliative care. Using a pretest-posttest design with quasi-random assignment to the intervention or control group, the effect of the interRAI PC on the quality of palliative care is evaluated with the Palliative care Outcome Scale (POS). Psychometric analysis is conducted to evaluate the predictive validity of the PIM and the convergent validity of the CAP 'Mood' of the interRAI PC. Qualitative data regarding the usability and face validity of the instrument are collected through focus groups, interviews and field notes.

Discussion: This is the first study to evaluate the validity and effect of the interRAI PC in nursing homes, following a methodology based on the MRC framework. This approach improves the study design and implementation and will contribute to a higher generalizability of results. The final result will be a psychometrically evaluated CGA for nursing home residents receiving palliative care.

Trial registration: ClinicalTrials.gov NCT02281032. Registered October 30th, 2014.

Figures

Figure 1
Figure 1
Study model based on the MRC Framework for designing and evaluating complex interventions.

References

    1. Wowchuk SM, McClement S, Bond J. The challenge of providing palliative care in the nursing home part II: internal factors. Int J of Palliat Nurs. 2007;13(7):345–350. doi: 10.12968/ijpn.2007.13.7.24346.
    1. Froggatt K, Payne S. A survey of end-of-life care in care in care homes: issues of definition and practice. Health Soc Care Community. 2006;14(4):341–348. doi: 10.1111/j.1365-2524.2006.00628.x.
    1. Houttekier D, Cohen J, Surkyn J, Deliens L. Study of recent and future trends in place of death in Belgium using death certificate data: a shift from hospitals to care homes. BMC Public Health. 2011;11(1):228. doi: 10.1186/1471-2458-11-228.
    1. Happ MB, Capetzuti E, Strumpf N, Wagner L, Cunningham S, Evans L, Maislin G. Advance care planning and end-of-life care for nursing home residents. The Gerontologist. 1999;39(Special Issue I):60.
    1. Christopher M. Benchmarks to improve end-of-life care. Midwest Bioethics Center: Kansas City, Missouri; 2000.
    1. National Consensus Project for Quality Palliative Care . Clinical Practice Guidelines for Quality Palliative Care. 2. Pittsburgh, PA: National Consensus Project for Quality Palliative Care; 2009.
    1. Jerant AF, Azari RS, Nesbitt TS, Meyers FJ. The TLC model of palliative care in the elderly: preliminary application in the assisted living setting. Ann Fam Med. 2004;2:54–60. doi: 10.1370/afm.29.
    1. Rubenstein LZ. An overview of comprehensive geriatric assessment: rationale, history, program models, basic components. In: Rubenstein LZ, Wieland D, Bernabei R, editors. Geriatric Assessment Technology: The State of the Art. New York, NY: Springer; 1995.
    1. Wieland D, Hirth V. Comprehensive geriatric assessment. Cancer Control. 2003;10(6):454–462.
    1. InterRAI.
    1. Gray LC, Berg K, Fries BE, Henrard JC, Hirdes JP, Steel K, Morris JN. Sharing clinical information across care settings: the birth of an integrated assessment system. BMC Health Serv Res. 2009;9:71. doi: 10.1186/1472-6963-9-71.
    1. Gray LC, Bernabei R, Berg K, Finne-Soveri H, Fries BE, Hirdes JP, Jònsson PV, Morris JN, Steel K, Ariño-Blasco S. Standardizing assessment of elderly people in acute care: the interRAI acute care instrument. J Am Geriatr Society. 2008;56(3):536–541. doi: 10.1111/j.1532-5415.2007.01590.x.
    1. Declercq A, Gosset C, Paepen B, Mello J, Vanneste D, Detroyer E, Milisen K, Moons P, Berden J, Collard J, Londot A, Schumacher I, Demul N, Piette N, Joiris T, Gillain N, Van Audenhove C. Actieproject BelRAI II: Haalbaarheid van de Rai-Methode in België. Eindrapport in opdracht van het Ministerie van Volksgezondheid, Veiligheid van de Voedselketen en Leefmilieu. België: Brussel; 2008.
    1. Declercq A, Gosset C, Paepen B, De Almeida Mello J, Vanneste D, Detroyer E, Spruytte N, De Vliegher K, Berden J, Degey S, Philippet C, Tancredi A, Lepère C, Renard F, Gillain N, Van Audenhove C. Actieproject BelRAI III: Haalbaarheid van de RAI-methode in België. Eindrapport in opdracht van het Ministerie van Volksgezondheid, Veiligheid van de Voedselketen en Leefmilieu. België: Brussel; 2009.
    1. Bernabei R, Landi F, Onder G, Liperoti R, Gambassi G. Second and third generation assessment instruments: the birth of standardization in geriatric. J Gerontol A Biol Sci Med Sci. 2008;63:308–313. doi: 10.1093/gerona/63.3.308.
    1. Hirdes JP, Ljunggren G, Morris JN, Frijters DH, Finne-Soveri H, Björkgren M, Gilgen R. Reliability of the interRAI suite of instruments: a 12-country study of an integrated health information system. BMC Health Serv Res. 2008;8:277. doi: 10.1186/1472-6963-8-277.
    1. Ljunggren SG, Topinkova E, Morris JN, Vitale C, Parzuchowski J, Nonemaker S, Frijters DH, Rabinowitz T, Murphy M, Ribbe MW, Fries BE. The RAI-PC: an assessment instrument for palliative care in all settings. Am J Hosp Palliat Care. 2003;20:211. doi: 10.1177/104990910302000311.
    1. Smith TF, Steel K, Fries BE, Morris JN, Belleville-Taylor P, Curtin-Telegdi N, Frijters D, Hirdes JP, Ljunggren G, Murphy KM, Nonemaker S, Rabinowitz T, Ribbe M, Topinková E, Berg K, Björkgren M, Declercq A, Finne-Soveri H, Gilgen R, Gray L, Hawes C, Henrard J-C, Szczerbińska K. interRAI Palliative Care (PC) Assessment Form and User’s Manual. Washington, DC: interRAI; 2010.
    1. Hermans K, De Almeida MJ, Spruytte N, Cohen J, Van Audenhove C, Declercq A. A comparative analysis of comprehensive geriatric assessments for nursing home residents receiving palliative care: a systematic review. J Am Med Dir Assoc. 2014;15(7):467–476. doi: 10.1016/j.jamda.2014.01.002.
    1. Porock D, Parker-Oliver D, Petroski GF, Rantz M. The MDS mortality risk index: the evolution of a method for predicting 6-month mortality in nursing home residents. BMC Res Notes. 2010;3:200. doi: 10.1186/1756-0500-3-200.
    1. Wiki – Client Assessment Protocols (CAPs).
    1. Campbell NC, Murray E, Darbyshire J, Emery J, Farmer A, Griffiths F, Guthrie B, Lester H, Wilson P, Kinmonth AL. Designing and evaluating complex interventions to improve health care. BMJ. 2007;334:455–459. doi: 10.1136/.
    1. Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, Tyrer P. Framework for design and evaluation of complex interventions to improve health. BMJ. 2000;321:694–696. doi: 10.1136/bmj.321.7262.694.
    1. Guidelines for a Palliative Approach in Residential Care: A Systematic Review of the Literature.
    1. Moss AH, Ganjoo J, Sharma S, Gansor J, Senft S, Weaner B, Dalton C, MacKay K, Pellegrino B, Anantharaman P, Schmidt R. Utility of the "surprise" question to identify dialysis patients with high mortality. Clin J Am Soc Nephrol. 2008;3:1379–1384. doi: 10.2215/CJN.00940208.
    1. Cohen LM, Ruthazer R, Moss AH, Germain MJ. Predicting six-month mortality for patients who are on maintenance hemodialysis. Clin J Am Soc Nephrol. 2010;5:72–79. doi: 10.2215/CJN.03860609.
    1. Vlaams Agentschap Zorg en Gezondheid: cijfers over sterfte.
    1. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41:1149–1160. doi: 10.3758/BRM.41.4.1149.
    1. Bamberger M. Institutionalizing Impact Evaluation Within the Framework of a Monitoring and Evaluation System. Washington DC: World Bank’s Independent Evaluation Group; 2009.
    1. Bausewein C, Le Grice C, Simon S, Higginson I. The use of two common palliative outcome measures in clinical care and research: A systematic review of POS and STAS. Palliat Med. 2011;25(4):304–313. doi: 10.1177/0269216310395984.
    1. Brandt BE, Deliens L, Steen JT, Ooms ME, Ribbe MW, Wal G. The last days of life of nursing home patients with and without dementia assessed with the Palliative care Outcome Scale. Palliat Med. 2005;19:334–342. doi: 10.1191/0269216305pm1018oa.
    1. Siegert RJ, Gao W, Walkey FH, Higginson IJ. Psychological well-being and quality of care: a factor-analytic examination of the palliative care outcome scale. J Pain Symptom Manage. 2010;40(1):67–74. doi: 10.1016/j.jpainsymman.2009.11.326.
    1. Dimiter MD, Rumrill PD. Pretest-posttest designs and measurement of change. Work: A Journal of Prevention, Assessment and Rehabilitation. 2003;20(2):159–165.
    1. Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, Bakken S, Kaplan CP, Squiers L, Fabrizio C, Fernandez M. How we design feasibility studies. Am J Prev Med. 2009;36(5):452–457. doi: 10.1016/j.amepre.2009.02.002.
    1. Houghton Mifflin . The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company. Boston, New York: Houghton Mifflin Company; 2009.
    1. Research Methods Knowledge Base.
    1. Cronbach LJ, Meehl PE. Construct validity for psychological tests. Psychol Bull. 1955;52:281–302. doi: 10.1037/h0040957.
    1. Clark TG, Bradburn MJ, Altman DG. Survival analysis part I: basic concepts and first analyses. Br J Cancer. 2003;89(2):232–238. doi: 10.1038/sj.bjc.6601118.
    1. Bradburn MJ, Clark TG, Love SB, Altman DG. Survival analysis part II: multivariate data analysis – an introduction to concepts and methods. Br J Cancer. 2003;89(3):431–436. doi: 10.1038/sj.bjc.6601119.
    1. Bugnard F, Ducrot C, Calavas D. Advantages and inconveniences of the Cox model compared with the logistic model: application to a study of risk factors of nursing cow infertility. Vet Res. 1994;25(2–3):134–139.
    1. Campell DT, Fiske DW. Convergent and discriminant validation by the multitrait-multimethod matrix. Psychol Bull. 1959;56:81–105. doi: 10.1037/h0046016.
    1. Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell scale for depression in dementia. Biol Psychiatry. 1988;23:271–284. doi: 10.1016/0006-3223(88)90038-8.
    1. Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Use of the cornell scale in non-demented people. J Am Geriatr Soc. 1988;36(3):230–235.
    1. Kørner A, Lauritzen L, Abelskov K, Gulmann N, Marie Brodersen A, Wedervang-Jensen T, Marie Kjeldgaard K. The geriatric depression scale and the Cornell scale for depression in dementia: a validity study. Nord J Psychiatry. 2006;60(5):360–364. doi: 10.1080/08039480600937066.
    1. Debruyne H, Van Buggenhout M, Le Bastard N, Aries M, Audenaert K, De Deyn PP, Engelborghs S. Is the geriatric depression scale a reliable screening tool for depressive symptoms in elderly patients with cognitive impairment? Int J Geriatr Psychiatry. 2009;24(6):556–562. doi: 10.1002/gps.2154.
    1. Elsawy B, Higgins KE. The geriatric assessment. Am Fam Physician. 2011;83(1):48–56.
    1. Hirdes JP. Addressing the health needs of frail elderly people: Ontario’s experience with an integrated health information system. Age Ageing. 2006;35(4):329–331. doi: 10.1093/ageing/afl036.
    1. Shepperd S, Lewin S, Straus S, Clarke M, Eccles MP, Fitzpatrick R, Wong G, Sheikh A. Can we systematically review studies that evaluate complex interventions? PLoS Med. 2009;6(8):e1000086. doi: 10.1371/journal.pmed.1000086.
Pre-publication history
    1. The pre-publication history for this paper can be accessed here:

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren