Life In The Slower Lane

Here is the structured PICO analysis for the sixty-ninth article you uploaded:

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Full Title (verbatim and exact):

“Acceptability and feasibility of end-of-life care pathways in Australian residential aged care facilities”

Horey D, Street AF, Sands AF

Medical Journal of Australia (2012); 197(2):106–109

DOI: 10.5694/mja11.11518

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Type of Article:

Mixed-method implementation study (multistage action research with audit, surveys, and interviews)

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PICO Analysis:

Population:

• Residents and staff of 14 residential aged care facilities (RACFs) in Victoria and South Australia
• Total of 1033 residential places
• Participants included:
  • RACF managers
  • Registered and enrolled nurses
  • Personal care assistants
  • GPs affiliated with the facilities 

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Intervention:

Implementation of a modified end-of-life (EOL) care pathway derived from the Liverpool Care Pathway, tailored for Australian RACFs through the “Good Death Project”. The pathway included:

1. Recognition of dying phase and initiation of EOL care
2. Advance care planning and medical orders
3. Daily comfort and symptom management charts
4. Multidisciplinary communication documentation
5. After-death care processes 

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Comparator:

• Pre-implementation practice as recorded in retrospective audits and manager-reported hospital transfers
• No randomised control group; pre/post comparisons used to assess feasibility outcomes 

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Outcome:

1. Person-centred outcomes (proxy):

• Improved documentation of anticipatory care and medications (98% of residents on a pathway had as-needed meds ordered)
• Discontinuation of non-essential treatments and observations in 76% and 60% of cases, respectively
• Staff and GP feedback suggested improved holistic care, timeliness, communication, and confidence in managing the dying process 

2. Process outcomes (acceptability):

• Pathway used in 36% of all deaths (63/175), or 43% excluding sudden deaths
• Uptake varied widely:
  • High uptake: 4 RACFs (68% of deaths)
  • Moderate uptake: 6 RACFs (34%)
  • Low uptake: 4 RACFs (10%)
• Pathways were mostly initiated by RNs (90%), with GP sign-off in about half the cases (49%)
• Verbal GP support was commonly reported even if not physically present 

3. Health system outcomes (feasibility):

• Reduction in transfers to hospital and return before death (from 5% to 1%, p = 0.002)
• Total hospital deaths remained stable (14–15%), but fewer unnecessary transfers for symptom managementwere noted
• Median length of time on the pathway: 5.5 days, suggesting proactive recognition of dying phase 

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Summary Conclusion:

This Australian study found that end-of-life care pathways are both acceptable and feasible in residential aged care when implemented with local leadership, staff education, and GP involvement. Higher uptake was associated with greater organisational commitment and policy integration. Staff reported improved quality and consistency of EOL care, while unnecessary hospital transfers were reduced. The study recommends national support structures, GP training, electronic integration, and embedding pathways into RACF accreditation and advance care planning as strategies to improve uptake and sustainability.

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