Barriers and facilitators to palliative care education in nursing and residential homes: a rapid review

The Effectiveness of Palliative Care Interventions in Long-Term Care Facilities: A Systematic Review

The increasing elderly population is driving higher utilization rates of long-term care facilities, where residents often have multiple chronic diseases, making them potential candidates for palliative care. Timely palliative care interventions can improve their quality of life and medical autonomy. This study systematically reviews the effectiveness of palliative care programs in long-term care facilities. Databases such as PubMed, EMBASE, Cochrane Library, and Airiti Library were searched up to 31 December 2023, using PICO criteria and the following keywords: 'care home', 'nursing home', 'residential aged care facility', and 'long-term care facility' for patients; and 'Gold Standard Framework in Care Homes', 'integrated care pathway', 'care home project', and 'palliative care program' for interventions. Seven articles were included. The results indicate that the Program of All-Inclusive Care for the Elderly (PACE) intervention did not significantly influence overall quality of life but did improve the quality of death. There were no statistical differences in comfort or quality of death between the dementia and non-dementia groups. However, PACE significantly reduced healthcare costs. The implementation of the Liverpool Care Pathway (LCP) notably enhanced the control of terminal symptoms, while the Gold Standard Framework in Care Homes (GSFCH) effectively improved end-of-life care rates, do-not-resuscitate (DNR) signing rates, advance care planning (ACP) completion rates, and reduced inappropriate readmission rates. While palliative care interventions are shown to improve the quality of end-of-life care, their practical application should be adapted to fit the implementation conditions and capabilities of domestic long-term care facilities.

Improving End-of-Life Care for Nursing Home Residents Using an Interprofessional Approach

Interprofessional collaboration enhances quality end-of-life care leading to a dignified death. Hospice care uses an interdisciplinary approach to optimize quality of life and mitigate impacts of serious illness. Interventions to improve hospice care delivery have been proven to be effective, but little is known about nursing home staff preparedness, implementation of hospice education, and interprofessional communication. Research is limited on how hospice care can be implemented into the nursing home setting. The purpose of this study was to determine if education combined with a communication tool improved nursing home staff knowledge and improved communication with the hospice team. The descriptive study invited participants to take a preseminar and postseminar survey to assess end-of-life preparedness in terms of willingness, capability, and resilience. A communication tool was implemented to measure collaboration with the hospice team over 3 months. The results from this study suggest education combined with interprofessional communication improves end-of-life care.

'Palliative care education in nursing homes: a qualitative evaluation of telementoring

There is an increasing need to support nursing homes in palliative care to reduce suffering and avoid unnecessary hospital admissions at the end of life. Providing education to nursing homes faces many barriers including structural systems and cultural issues. In order to overcome some of these barriers, education using Project Extension for Community Health Outcomes (ECHO) methodology has been delivered to nursing homes throughout a large city in England. This paper aims to explore participant experience in Project ECHO for nursing homes.

METHODOLOGY

Qualitative semistructured interviews with a purposive sample of nursing home staff. Interviews were conducted by one researcher and transcribed verbatim. Line-by-line coding and categorisation were used to form themes.

RESULTS

Eleven interviews were completed with data saturation reached by interview eight. The following themes were revealed: Barriers and facilitators to accessing Project ECHO, Community of Practice and Communication with nursing homes and data extraction.

CONCLUSION

Project ECHO is an accessible, acceptable and engaging way of delivering palliative care education to nursing homes combatting some of the traditional barriers that nursing homes face in accessing training.