Here is the standardised PICO analysis for the twenty-seventh uploaded article:
Full Title
Australian residential aged care home staff experiences of implementing an intervention to improve palliative and end-of-life care for residents: A qualitative study
Authors: Srivalli Vilapakkam Nagarajan et al.
Journal: Health & Social Care in the Community, 2022; 30:e5588–e5601
DOI: 10.1111/hsc.13984
Type of Study
Qualitative evaluation study (semi-structured interviews, thematic analysis)
PICO Summary
Population (P)
- Healthcare professionals, careworkers, clinical educators, and managers working in two residential aged care homes (RACHs) in New South Wales, Australia
- Facilities included one rural and one metropolitan site
- Participants (n=15) were directly involved in palliative and end-of-life care (EoLC) delivery or implementation
Intervention (I)
Quality End-of-Life Care (QEoLC) Project, a multicomponent intervention including:
- Education and training (10-module palliative care resource manual)
- Palliative Care Needs Rounds (case identification using the SPICT tool)
- Palliative Care Outcomes Collaboration (PCOC) data collection and structured assessments
- Tele-mentoring by specialist palliative care nurse
- Program of Experience in the Palliative Approach (PEPA) – though not delivered due to COVID-19
Comparison (C)
- No formal control group
- Variation in uptake across the two RACHs and between components (e.g., higher participation in Needs Rounds, lower in tele-education sessions)
Outcomes (O)
Process outcomes:
- Improved staff confidence in:
- Identifying residents at risk of deterioration/death
- Initiating ACP conversations
- Recognising and managing symptoms (e.g. pain)
- Better communication among staff, and between staff and families
- Champions and local mentors were crucial facilitators
Resident outcomes (perceived):
- Reduced unnecessary hospitalisations
- Timely pain management
- Improved medication review and reduced polypharmacy
- Greater goal-concordant care and peaceful death in place
Barriers:
- Lack of executive buy-in and organisational leadership
- Staff shortages and high turnover, exacerbated by COVID-19
- Incompatible documentation systems and manual processes
- Poor GP engagement and knowledge of palliative care
- Low uptake of education sessions due to scheduling conflicts and digital delivery limitations
Findings Summary
The QEoLC intervention was viewed positively where implemented effectively, particularly the Needs Rounds and Symptom Assessment Scale. Staff reported gains in confidence and knowledge, and noted improvements in patient comfort and symptom management. However, barriers to sustainability included limited staff time, high turnover, lack of integration into electronic systems, and organisational resistance or disengagement. The study highlights the need for co-design, dedicated support roles, and executive sponsorship for future implementations.
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