Life In The Slower Lane

Here is the standardised PICO analysis for the ninth uploaded article:

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Full Title

Effects of Advance Care Planning on End-of-Life Indicators for Nursing Home Residents—An Experimental Study with a Retrospective Chart Review

Authors: Yu-Tai Lo et al.

Journal: Geriatrics, 2024; 9(2):42

DOI: 10.3390/geriatrics9020042

Type of Study

Experimental study with a retrospective chart review and a historical control group

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PICO Summary

Population (P)

• Residents of a 200-bed nursing home in Kaohsiung City, Taiwan
• Predominantly elderly (mean age ~85), with multiple comorbidities
• All participants had advanced dependency (Barthel Index indicating total to severe functional impairment)
• 37 residents in the intervention group (after ACP implementation), 33 in the control group (preceding year)

Intervention (I)

• Advance Care Planning (ACP) program tailored to local context
• Included:
  • Education sessions for nursing staff and families
  • Regular health assessments
  • Physician-led discussions about treatment preferences and end-of-life goals
  • AD (advance directive) signing opportunities at admission and during disease decline

Comparison (C)

• Historical control group of residents who died in the year prior to ACP implementation
• No structured ACP intervention provided

Outcomes (O)

Process/Clinical outcomes:

• Higher (but nonsignificant) rates of:
  • DNR orders (83.8% vs. 72.7%)
  • Hospice care usage (27.0% vs. 15.2%)
  • In-facility and hospice ward deaths
• Lower (but nonsignificant) rates of:
  • Hospitalizations during the last year of life (mean 1.9 vs. 2.5)
  • ICU and emergency department deaths
• Feeding tube usage was high in both groups (intervention 89.2% vs. control 81.8%) 

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Findings Summary

• The ACP program showed promising trends towards better end-of-life care quality, but statistical significance was not reached, likely due to small sample size
• The study highlights cultural and systemic barriers to ACP in Taiwan (e.g., death taboos, surrogate hesitancy, high dependence on family decisions)
• Suggests that ACP implementation during early stages of illness and in resource-supported facilities may improve outcomes
• Recommends further large-scale, prospective studies to validate ACP’s effectiveness in Asian long-term care settings 

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