Original study
Educating Nursing Home Staff About the Progression of Dementia and the Comfort Care Option: Impact on Family Satisfaction with End-of-Life Care

https://doi.org/10.1016/j.jamda.2008.07.008Get rights and content

Objective

There is a growing consensus on the relevance of a palliative care approach in end-stage dementia. The objective of this study was to assess the impact, in terms of family satisfaction with end-of-life care, of a nursing home (NH) pilot educational program for nursing staff and physicians on comfort care and advanced dementia.

Methods

The intervention, implemented in one voluntary NH, consisted of an educational program that included providing an information booklet to all NH staff, and optionally to families. Satisfaction with care was compared using a validated instrument, the “After death bereaved family member interview” pre- and post-intervention. Pre and post groups were composed of close relatives of residents who died in the context of advanced dementia.

Results

Twenty-seven contact persons were interviewed pre-intervention and 21 post-intervention (participation rate of 60% for both groups). Descriptive statistics showed better scores on satisfaction with pain control, emotional support, treating patient with respect, and information on what to expect while patient was dying, in the post-intervention group. Comparison of overall scale scores revealed no statistical differences between the 2 groups, although the post-intervention group expressed greater satisfaction in the area of communication with the health care team (8.0 versus 6.6, P = .109) and greater global satisfaction with care (8.3 versus 7.3, P = .087).

Discussion

Although not significant, results as to the effectiveness of such an intervention to improve family satisfaction with end-of-life care are encouraging.

Conclusion

The booklet, as support tool, and the educational program may have facilitated communication within the team, and between the team and family members. Replication of this intervention in a multicenter NH population is needed to adequately assess its effectiveness.

Section snippets

Study Design

A pre-post study was conducted to compare levels of satisfaction pre- and post-intervention (Figure 1). The pre-intervention group was composed of close relatives of residents who died in the context of advanced dementia between January 1 and August 31, 2005. The post-intervention group was based on deaths occurring between January 1 and August 31, 2006. The intervention, composed of an educational program and a booklet for staff, was implemented between September and December 2005. In January

Results

The number of deaths that occurred in the context of advanced dementia at MGC was 71 in the pre-intervention group and 56 in the post-intervention group. Table 1 describes the selection process for contact persons. The number of persons that could be reached by phone among contacts of eligible decedents in the pre- and post-intervention was 45/61 and 35/52 respectively. The participation rate was 60% for both groups (27/45 and 21/35). The main reason expressed for refusal to participate was

Discussion

An educational program for nursing staff and physicians that focuses on the option of comfort care for advanced NH residents with dementia is an innovative intervention. Our pilot program is also a rare palliative care NH intervention where measurement with a validated instrument was used to assess an important clinical outcome. The educational program appears to have had an effect on family satisfaction with care in many aspects. The most notable improvement was in the area of communication

Conclusion

Despite the absence of statistically significant results, the results of this pilot study are encouraging in that we found indications that educational strategies for staff and families, including an information booklet on comfort care, may have improved family satisfaction with end-of-life care. The educational program and the content of the booklet were generally well accepted by the doctors and nursing staff. Our relatively simple intervention appears to have facilitated communication

Acknowledgments

The authors thank the Foundation Maimonides Geriatric Centre (MGC); Barbra Gold, MGC Executive Director; and Lucie Tremblay, Director of Nursing and Clinical Services, for their continuous support. Thanks also to Deborah Scipio for gathering information from medical records and to Eva Jeliazkova, MD, research assistant. Finally thanks to Jenny van der Steen, PhD for her suggestions to improve the manuscript. There is no conflict of interest to report for this project.

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  • Cited by (63)

    • Dementia prevention, intervention, and care

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      Citation Excerpt :

      Good person-centred care requires a whole-person approach and several multicomponent complex interventions and pathways have been developed. Training and educational programmes on end-of-life care for nursing home staff improve knowledge and increase bereaved family members' satisfaction with end-of-life care.587,588 Research has focused on specific interventions, such as pain management, or when not to treat—eg, with antibiotics—rather than active palliative interventions.589

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    This project was financially supported by Foundation Maimonides Geriatric Centre.

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