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Implementation of Knowledge-Based Palliative Care (KUPA)

6 octobre 2020 mis à jour par: Lund University

Implementation of Knowledge-Based Palliative Care for Frail Older Persons in Nursing Homes

The research on ageing during the last couple of decades has increasingly focused on questions regarding the quality of life and life satisfaction of the old people. Yet the research indicates that when it comes to the final stage of life, the end includes unnecessary suffering and the quality of life drops. Palliative care has traditionally been provided successfully to younger persons dying from incurable illnesses while older people dying of multiple morbidities or "old age" has received far less of this type of care. However, sixty percent of all people who died in Sweden in 2010 were at least 80 years old and it is well known that dying among older people often is a prolonged period of suffering. One reason might be that it is more difficult to identify when the final stages of life begins for older persons.

The purpose of this project is to implement and evaluate how a knowledge-based model for palliative care in nursing homes affects the quality of life and the participation in the care process for older persons in nursing homes and their next of kin. A second aim is to explore the staff's implementation process of palliative care and the role of the leadership. The final aim is to investigate which factors (barriers and facilitators) that affect the implementation process of this model.

Aperçu de l'étude

Statut

Complété

Les conditions

Intervention / Traitement

Description détaillée

The project was planned to be conducted using a cross-over design in two counties in south of Sweden based on a feasibility/pilot study that was conducted during fall 2014 co-created palliative care educational intervention through seminars for professionals in nursing homes. Due to a more significant amount of drop-outs compared with expected (and for not receiving the total amount of applied foundation), the plan needed to be revised. The knowledge-based palliative care intervention was conducted as a non-blinded control trial, implemented over a six-month period in 30 nursing homes in two different counties in the south of Sweden (County A and County B). The data collection was made in two sequential periods in each county. First, the intervention was implemented in ten nursing homes in County A (Kronoberg County from April 2015), while ten nursing homes in County B served as a control group. Then, County B implemented the intervention (Skåne county from April 2016), and ten new nursing homes in County A, which had not received the intervention, were chosen as a control group. After the two sequential time periods were data from one intervention and one control group analysed. The selection through voluntary participation resulted in a mixture of both larger and smaller nursing homes in the two counties, as well as both from urban and rural areas.

Every seminar group met once a month and included different professions (unit manager, district nurse, assistant nurse, and other staff i.e. occupational therapist and physiotherapist). There were 5 meetings in each nursing home during a period of 6 months.

Type d'étude

Interventionnel

Inscription (Réel)

1151

Phase

  • N'est pas applicable

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Lieux d'étude

  • Suède
    • Kronoberg
      • Alvesta, Kronoberg, Suède, 34230
        • Bryggaren
      • Alvesta, Kronoberg, Suède, 34235
        • Högåsen
      • Grimslöv, Kronoberg, Suède, 34032
        • Asken
      • Ingelstad, Kronoberg, Suède, 360 44
        • Kvarngården
      • Konga, Kronoberg, Suède, 362 40
        • Konga Allhus
      • Lagan, Kronoberg, Suède, 34014
        • Åbrinken
      • Ljungby, Kronoberg, Suède, 34135
        • Ljungberga
      • Ljungby, Kronoberg, Suède, 34138
        • Ljungsätra
      • Ljungby, Kronoberg, Suède, 34183
        • Brunnsgården
      • Lönashult, Kronoberg, Suède, 34253
        • Torsgården
      • Moheda, Kronoberg, Suède, 34260
        • Furuliden
      • Ryd, Kronoberg, Suède, 360 10
        • Solängen
      • Tingsryd, Kronoberg, Suède, 362 30
        • Örnen
      • Urshult, Kronoberg, Suède, 360 13
        • Äppelgården
      • Vislanda, Kronoberg, Suède, 34250
        • Björkliden
      • Väckelsång, Kronoberg, Suède, 362 51
        • Solhaga
      • Växjö, Kronoberg, Suède, 352 41
        • Birkagården
      • Växjö, Kronoberg, Suède, 352 44
        • Hovslund
      • Växjö, Kronoberg, Suède, 352 64
        • Evelid
      • Älmeboda, Kronoberg, Suède, 360 23
        • Älmegården
    • Skåne
      • Höör, Skåne, Suède, 24395
        • Skogsgläntan
      • Kågeröd, Skåne, Suède, 28677
        • Åsgården
      • Lund, Skåne, Suède, 224 60
        • Mårtenslund
      • Lund, Skåne, Suède, 22460
        • Brunnslyckan
      • Lund, Skåne, Suède, 22466
        • Norrdala
      • Osby, Skåne, Suède, 283 42
        • Rönnebacken
      • Svalöv, Skåne, Suède, 26834
        • Solgården
      • Svedala, Skåne, Suède, 23338
        • Holmagården
      • Södra Sandby, Skåne, Suède, 24731
        • Fästan
      • Teckomatorp, Skåne, Suède, 26872
        • Ängslyckan

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

  • Enfant
  • Adulte
  • Adulte plus âgé

Accepte les volontaires sains

Non

Sexes éligibles pour l'étude

Tout

La description

Inclusion Criteria:

  • Older persons living in the participating nursing homes
  • Next of kin to older persons living in the participating nursing homes
  • Staff working at the participating nursing homes
  • Managers working at the participating nursing homes
  • The participating nursing homes must be located in either Kronoberg County or Skåne County in Sweden

Exclusion Criteria:

  • Not being cognitive able to participate in interviews or answering the questionnaires

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: Soins de soutien
  • Répartition: Non randomisé
  • Modèle interventionnel: Affectation séquentielle
  • Masquage: Aucun (étiquette ouverte)

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Expérimental: Kronoberg Educational Intervention
The educational intervention is provided to ten nursing homes.
Comportemental: Educational Intervention
The seminar groups will be led by two experienced clinical nurses and researchers from the field of palliative care and geriatric care. The educational material consist of six themes; values in palliative care, symptom relief, dignity and a dignified death, collaborative co-creating care, support to next of kin and dialogue with older persons and next of kin about death and dying. The content of the different themes will have a common core for each nursing home but will be adjusted based on the expressed needs of each nursing home. New themes can be created related to the needs of the unique nursing home. The participants in the seminar groups will reflect together over the content of the developed binder of educational material and will relate it to their own work in order to identify areas suitable for changes and/or development.
Aucune intervention: Skåne Control
The control group consists of an equal number of nursing homes. This group receives no intervention.
Expérimental: Skåne Educational Intervention
The educational intervention is provided to ten nursing homes.
Comportemental: Educational Intervention
The seminar groups will be led by two experienced clinical nurses and researchers from the field of palliative care and geriatric care. The educational material consist of six themes; values in palliative care, symptom relief, dignity and a dignified death, collaborative co-creating care, support to next of kin and dialogue with older persons and next of kin about death and dying. The content of the different themes will have a common core for each nursing home but will be adjusted based on the expressed needs of each nursing home. New themes can be created related to the needs of the unique nursing home. The participants in the seminar groups will reflect together over the content of the developed binder of educational material and will relate it to their own work in order to identify areas suitable for changes and/or development.
Aucune intervention: Kronoberg Control
The control group consists of an equal number of nursing homes. This group receives no intervention.

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
World Health Organization Quality of Life-BREF (WHOQOL-BREF)
Délai: 9 months

World Health Organization Quality of Life-BREF (WHOQOL-BREF) measure quality of life for older persons' at the end of life living in nursing homes.

Five-point Likert-scale. Higher values mean better outcomes. Total score Min 26. Max 130.

The range for the sub scale Overall Quality of Life; Min 1 Max 5 The range for the sub scale General health; Min 1 Max 5 The range for the sub scale Physical Health; Min 7 Max 35 The range for the sub scale Psychological; Min 6 Max 30 The range for the sub scale Social relationships; Min 3 Max 15 The range for the sub scale Environment; Min 8 Max 40
9 months
World Health Organization Quality of Life-OLD (WHOQOL-OLD)
Délai: 9 months

World Health Organization Quality of Life-OLD (WHOQOL-OLD) measure quality of life for older persons living in nursing homes.

Five point Likert-scale. Higher value means better outcome. Min 24. Max. 120. The range for the all the sub scales are; Min 1 Max 20
9 months
Person-centred Care Assessment Tool (P-CAT)(Patient Version)
Délai: 9 months

Person-centred Care Assessment Tool (P-CAT) (patient version) measure person-centred care for older persons living in nursing homes. Five point Likert-scale. Higher score means better outcomes. Min 13. Max. 65.

The range for the sub scale Extent of personalizing care; Min 8 Max 40 The range for the sub scale Amount of organizational and environmental support; Min 5 Max 25
9 months
Person-Centred Climate Questionnaire (PCQ Patient Version)
Délai: 9 months

Person-Centred Climate Questionnaire (PCQ patient version) measure person-centred care for older persons living in nursing homes. Six point Likert-scale. Higher score means better outcome. Min 17. Max. 102.

The range for the sub scale Safety; Min 10 Max 60 The range for the sub scale Everydayness; Min 4 Max 24 The range for the sub scale Hospitality; Min 3 Max 18
9 months
Next-of-Kin Participation in Care (NoK-PiC); Psychometric Evaluation
Délai: 9 months

Next-of-Kin Participation in Care (NoK-PiC) measure participation for next of kin to older persons in nursing homes. The study includes both intervention and control groups. The two scales are 1) Communication and Trust (CaT); and 2) Collaboration in Care (CiC).

The scales contains nine items each and items are scored from 0 to 4 (agree not at all (=0); agree to a low degree (=1); agree partly (=2); agree to a high degree (=3); and agree totally (=4). The possible score range from 0 to 36 in each of the two scales, and from 0-72 in the total scale. Higher score means better outcomes. This results are based upon a recently published psychometric evaluation by Westergren et al (2020).
9 months
World Health Organization Quality of Life-BREF (WHOQOL-BREF) for Next of Kin
Délai: 9 months

World Health Organization Quality of Life-BREF (WHOQOL-BREF) measure quality of life for next of kin to older persons in nursing homes. Five-point Likert-scale. Higher values mean better outcomes. Min 26. Max 130.

he range for the sub scale Overall Quality of Life; Min 1 Max 5 The range for the sub scale General health; Min 1 Max 5 The range for the sub scale Physical Health; Min 7 Max 35 The range for the sub scale Psychological; Min 6 Max 30 The range for the sub scale Social relationships; Min 3 Max 15 The range for the sub scale Environment; Min 8 Max 40
9 months

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Person-centred Care Assessment Tool (P-CAT) (Staff Version)
Délai: 6 months

Person-centred Care Assessment Tool (P-CAT)(staff version) measure person-centred care for staff working in nursing homes. Five-point Likert-scale. Higher values mean better outcomes. Min 13. Max 65.

The range for the sub scale Extent of personalizing care; Min 8 Max 40 The range for the sub scale Amount of organizational and environmental support; Min 5 Max 25
6 months
Person-Centred Climate Questionnaire (PCQ-S)
Délai: 6 months

Person-Centred Climate Questionnaire (PCQ-S) measure person-centred care for staff working in nursing homes. Six-point Likert-scale. Higher values mean better outcomes. Min 14. Max 84.

The range for the sub scale Safety; Min 5 Max 30 The range for the sub scale Everydayness; Min 5 Max 30 The range for the sub scale Community; Min 4 Max 24
6 months

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Parrainer

Lund University

Collaborateurs

The Swedish Research Council
Linnaeus University

Les enquêteurs

  • Chercheur principal: Gerd Ahlström, PhD, Department of Health Sciences, Lund University

Publications et liens utiles

La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.

Publications générales

Liens utiles

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude (Réel)

9 avril 2015

Achèvement primaire (Réel)

20 juin 2017

Achèvement de l'étude (Réel)

15 octobre 2017

Dates d'inscription aux études

Première soumission

26 février 2016

Première soumission répondant aux critères de contrôle qualité

9 mars 2016

Première publication (Estimation)

15 mars 2016

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

28 octobre 2020

Dernière mise à jour soumise répondant aux critères de contrôle qualité

6 octobre 2020

Dernière vérification

1 octobre 2020

Plus d'information

Termes liés à cette étude

Mots clés

Autres numéros d'identification d'étude

  • 2014-2759
  • 2014-0071 (Autre subvention/numéro de financement: The Vardal Foundation)

Plan pour les données individuelles des participants (IPD)

Prévoyez-vous de partager les données individuelles des participants (DPI) ?

NON

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .

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