Improving caring quality for people with dementia in nursing homes using IPOS-Dem: A stepped-wedge cluster randomized controlled trial protocol

Internal consistency and structural validity of the Swiss easy-read Integrated Palliative Care Outcome Scale for People with dementia: a secondary exploratory factor analysis

BACKGROUND

The Integrated Palliative Care Outcome Scale for People with Dementia (IPOS-Dem) was developed as a promising person-centred proxy measure of symptoms and concerns. We used the Swiss-German easy-read version, a measure designed to be completed individually by family members and frontline staff caring for people with dementia. In this secondary data analysis of multicentre trial data, we investigate the IPOS-Dem's structural validity and internal consistency of the version.

METHODS

A total of 257 people with dementia were assessed by frontline staff, while family members assessed 118 people residing in one of 23 participating Swiss-German long-term care facilities. Each IPOS-Dem version, corresponding to the two rater populations (family members and frontline staff), underwent exploratory factor analysis separately, using data from one assessment per person with dementia. A minimum residual solution with varimax rotation was calculated to determine the factor structure. Item reduction decisions were based on factor loadings and indices for internal consistency.

RESULTS

The construct validity of the Swiss-German easy-read IPOS-Dem for frontline staff is demonstrated by two factors: Dementia Interaction and Physical Impact (Cronbach's α = 0.83) and Dementia Emotional and Behavioural Impact (Cronbach's α = 0.81). Four factors, with Cronbach's α ranging from 0.77 to 0.86, were computed for the family member version: Dementia Interaction Impact, Easy-to-Assess Dementia Physical Impact, Hard-to-Assess Dementia Physical Impact and Dementia Emotional and Behavioural Impact.

CONCLUSIONS

Like other reduced patient-related outcome measures, palliative care measures and their parent instrument IPOS we identified subscales in the easy-read IPOS-Dem that describe a psychosocial impact and a physical impact. Differences in the internal structure of the family and staff versions of the IPOS-Dem likely stem from variations in observation intervals, roles and perspectives, with family members often focusing on loss and past experiences whereas staff may equate quality of life with quality of care leading to differing ratings. However, the identified internal consistency indices between 0.77 and 0.86 indicate acceptable internal consistency for the subscales and the IPOS-Dem should be taken forward for further psychometric evaluation.

TRIAL REGISTRATION

The overarching trial has been approved by the Swiss Regional Ethics Committee of the Canton of Zürich as the leading ethics committee for the involved regions, with clearance certification number BASEC2019-01847 (12/11/2019). The main study and secondary analysis are registered with the German Clinical Trials Register (DRKS00022339, 05/10/2020). Full registration is available online at http://www.drks.de/DRKS00022339 .

Person Profile Dementia Intervention in Long-Term Care: A Stepped-Wedge Cluster-Randomized Trial

OBJECTIVES

We aimed to assess the efficacy of a person-centered care intervention in improving quality of life (QoL) for people with dementia in long-term care facilities.

DESIGN

This study was a stepped-wedge cluster-randomized clinical trial of monthly person-centered outcome measurements, followed by collaborative nurse-led person profile interventions involving nursing staff and family members, compared with monthly person-centered outcome measurements alone.

SETTING AND PARTICIPANTS

We included people with a medical diagnosis of Alzheimer's disease or vascular dementia or with clinical symptoms of dementia from 23 long-term care facilities in the German-speaking part of Switzerland.

METHODS

The primary outcome was QoL, as assessed using the QUALIDEM. Secondary outcomes were the QUALIDEM subscales and the Integrated Palliative Care Outcome Scale for People with Dementia subscales. The study duration was 15 months, and linear mixed-effect models were used for the analysis.

RESULTS

We recruited 240 people with dementia from 23 long-term care facilities. Modeling 1143 observations, we found a statistically significant positive intervention effect of 2.6 points according to the QUALIDEM (95% CI, 1.34-3.86; P < .001; total QUALIDEM intervention: 67; 95% CI, 64.8-69.1 vs 64.4; 95% CI, 62.3-66.4 for the control). We also found positive effects of the intervention on all secondary outcomes.

CONCLUSIONS AND IMPLICATIONS

Once-a-month person profile interventions based on person-centered outcome measurements provided a small but significant improvement in QoL. Thus, our findings suggest a potential benefit to the broader implementation of person profiles involving nursing staff and family members in long-term care facilities.

Palliative Care Interventions for Persons With Neurodegenerative Disease: A Scoping Review of Clinical Trial Study Design Features

Background: Within palliative care research, best practice guidelines to conduct scientifically rigorous clinical trials for neurodegenerative diseases are underexplored. This patient population experiences unique challenges, including fluctuations in cognitive capacity, care partner (CP) and proxy involvement, and high adverse events (AEs), that necessitate special consideration when designing clinical trials. Objective: The objective of this study was to describe and identify clinical trial design features that have been documented in studies involving a neuropalliative intervention for persons with neurodegenerative diseases, highlighting features that have been adapted for this unique patient population. Design: We conducted a scoping review of clinical trials with a neuropalliative intervention for persons with neurodegenerative disease. We searched Cochrane, Web of Science, EMBASE, Scopus, and PubMed (MEDLINE) databases for articles published in English between 1950 and 2023. Two reviewers screened, extracted, and synthesized data from the included articles. A third reviewer adjudicated instances of conflict. The data were analyzed using a thematic framework approach. Results: Of 1025 texts, 44 articles were included. Seven study design features were analyzed: (1) consent, (2) proxies and CPs, (3) recruitment strategies, (4) retention strategies, (5) choice of comparator, (6) AEs, and (7) internal validity. This scoping review found disparities in study design features around structured consent, proxies and CPs, comparators, and AEs. Conclusions: To date, neuropalliative care clinical trials have had varied study designs and the majority of research has focused on dementia. Research guideline development for high-quality neuropalliative care clinical trials is greatly needed across the range of neurodegenerative diseases. To increase the scientific rigor of clinical trials and neuropalliative care, we recommend a standardized capacity assessment for consent, defining conditions for the CP, proxy, and AEs, systematizing appropriate comparators, and outlining preemptive recruitment and retention strategies to address the broader unpredictable challenges of palliative care research.

Clinical Competence of Nurses and the Associated Factors in Public Hospitals of Gamo Zone, Southern Ethiopia: A Cross-Sectional Study

Introduction

Nursing competency is an essential component for improving the quality of care in the healthcare system. However, assessing competency solely on the dimensions of skills and knowledge does not provide complete picture of a nurse ability to provide quality patient care. This is because it lacks focus on the nurse's attitudes and values, which are also important determinants of clinical competence. Therefore, this study aimed to assess the comprehensive clinical competence of nurses and its associated factors in public hospitals of Gamo Zone, Southern Ethiopia.

Materials and Methods

A cross-sectional study was conducted using a census method to collect information from nurses through self-administered questionnaires. The data were entered into EpiData version 3.1 and exported to Stata version 15 for analysis. A linear regression model was used to identify factors associated with clinical competence.

Results

In this study, the average clinical competence of nurses was 177.32, with a standard deviation of 19.19, and 31.2% of the respondents had a high level of clinical competence. Associated factors identified with clinical competence include gender, age, marital status, qualification, position, work experience, unit, interest in their profession, critical thinking disposition, clinical self-efficacy, and emotional intelligence.

Conclusions

The overall level of clinical competence among nurses in this study was moderate. As such, nurses improve their clinical competence by receiving training and development opportunities that focus on critical thinking, clinical self-efficacy, and emotional intelligence; working in a supportive work environment that encourages them to take risks and learn from their mistakes; and being monitored and coached on a regular basis.

Primary care contacts, continuity, identification of palliative care needs, and hospital use: a population-based cohort study in people dying with dementia

BACKGROUND

Reducing hospital admissions among people dying with dementia is a policy priority.

AIM

To explore associations between primary care contacts, continuity of primary care, identification of palliative care needs, and unplanned hospital admissions among people dying with dementia.

DESIGN AND SETTING

This was a retrospective cohort study using the Clinical Practice Research Datalink linked with hospital records and Office for National Statistics data. Adults (>18 years) who died between 2009 and 2018 with a diagnosis of dementia were included in the study.

METHOD

The association between GP contacts, Herfindahl-Hirschman Index continuity of care score, palliative care needs identification before the last 90 days of life, and multiple unplanned hospital admissions in the last 90 days was evaluated using random-effects Poisson regression.

RESULTS

In total, 33 714 decedents with dementia were identified: 64.1% (n = 21 623) female, mean age 86.6 years (SD 8.1), mean comorbidities 2.2 (SD 1.6). Of these, 1894 (5.6%) had multiple hospital admissions in the last 90 days of life (increase from 4.9%, 95% confidence interval [CI] = 4.2 to 5.6 in 2009 to 7.1%, 95% CI = 5.7 to 8.4 in 2018). Participants with more GP contacts had higher risk of multiple hospital admissions (incidence risk ratio [IRR] 1.08, 95% CI = 1.05 to 1.11). Higher continuity of care scores (IRR 0.79, 95% CI = 0.68 to 0.92) and identification of palliative care needs (IRR 0.66, 95% CI = 0.56 to 0.78) were associated with lower frequency of these admissions.

CONCLUSION

Multiple hospital admissions among people dying with dementia are increasing. Higher continuity of care and identification of palliative care needs are associated with a lower risk of multiple hospital admissions in this population, and might help prevent these admissions at the end of life.