Data relevant to understanding processes influencing implementation and evaluating cost-effectiveness will be reported in other papers. As such, it focuses on data relevant to evaluating quality of end of life (EOL) care for participants who died during the study period. This paper focuses on the study’s first aim, namely to compare the efficacy of a facilitated approach to family case conferencing with usual care. Human Research Ethics Committees of the University of NSW, University of Technology Sydney, Queensland University of Technology approved the trial. The parallel cluster RCT design is described in a published protocol (see also S1 File), and was conducted over a predefined study period of 18 months between February 2013 to December 2014. The current study compared the efficacy of facilitated case conferencing versus usual care in improving end of life (EOL) care for persons with advanced dementia living in nursing homes.Ī cluster RCT design was used because the intervention aimed to change the approach to dementia palliative care across nursing homes and randomizing individual residents or staff members would have resulted in contamination. Evidence from randomised controlled trials (RCTs) in the community palliative care setting is more compelling with better maintenance of physical and mental health and decreased hospitalization seen, provided the process is facilitated by appropriate training and organizational support.

Case conferencing shows promise for improving symptom management in people with dementia living in nursing homes but systematic reviews have highlighted methodological weaknesses in the evidence base. Ĭase conferencing brings together health professionals and other surrogate decision-makers to build consensus on goals of care and appropriate steps for current management and advance care planning. Surrogates should be involved in symptom management decisions and care planning, and provide the personal context. Decisions include whether hospital transfers and acute interventions such as intravenous antibiotics will offer net benefit versus detriment to QOL.

Communication between staff, health services and families (including surrogate decision-makers) addressing palliative care needs is often poor. Nursing home residents with advanced dementia often receive suboptimal palliation due to limited staff awareness and training. Care in advanced dementia requires a palliative approach focused on quality of life (QOL).

Learning German by Tim Luscombe