Life In The Slower Lane

Here is the structured PICO analysis for the thirty-sixth article you uploaded:

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✅ 

Full Title (verbatim and exact):

“Evaluation of a Palliative Care Program for Nursing Homes in 7 Countries: The PACE Cluster-Randomized Clinical Trial”

Van den Block L, Honinx E, Pivodic L, et al.

JAMA Internal Medicine (2020); 180(2):233–242

DOI: https://doi.org/10.1001/jamainternmed.2019.5349

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📄 

Type of Article:

Multicentre cluster-randomised controlled trial

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🔍 

PICO Analysis:

Population:

• 78 nursing homes across 7 European countries (Belgium, England, Finland, Italy, Netherlands, Poland, Switzerland)
• Residents (n=1535 deceased over study period) and nursing home staff (n=5117 questionnaire responses)
• Mean age of residents: ~85 years; 65–70% were women; ~70% had dementia 

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Intervention:

PACE Steps to Success Program – a 12-month, multicomponent, train-the-trainer intervention to implement basic nonspecialist palliative care in nursing homes via:

1. Advance care planning with residents/families
2. Assessment and review of residents’ needs
3. Multidisciplinary review meetings
4. High-quality care for pain and depression
5. End-of-life care in final days
6. Care after death

Delivered via workshops and on-site coaching by trained PACE coordinators, with support from national trainers 

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Comparator:

• Usual care in control group facilities, which continued existing practices without the structured PACE intervention 

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Outcome:

1. Person-centred outcomes (Resident-level):

• Primary outcome:
  • Comfort in the last week of life (EOLD-CAD scale, range 14–42), assessed by staff after resident death
  • Result: No significant difference between intervention and control (adjusted mean difference: –0.55; 95% CI –1.71 to 0.61; P = .35) 
• Secondary outcomes:
  • Quality of care in the last month of life (QOD-LTC scale): significantly improved in intervention group (mean difference +3.40; 95% CI 2.01–4.80; P < .001), particularly in the “preparatory tasks” subscale 
  • Relatives’ ratings of care and communication: no significant differences between groups

2. Process outcomes (Staff-level):

• Primary outcome:
  • Staff knowledge of palliative care (Palliative Care Survey): small but statistically significant improvement (mean difference +0.04; 95% CI 0.02–0.05; P < .001), although deemed clinically negligible
• Secondary outcomes:
  • Self-efficacy, educational needs, and attitudes showed mixed results:
    • Small improvements in ethical/cultural values education needs
    • No significant change in self-efficacy in communication
    • Minor attitude shifts, e.g., more agreement that palliative care includes family support 

3. Health system outcomes:

• Not directly measured, but implied benefits include:
  • Increased ACP documentation and planning activities
  • Enhanced staff engagement in end-of-life care processes
• However, resource burden and implementation complexity may hinder feasibility and scalability without stronger outcome effects 

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Summary Conclusion:

The PACE Steps to Success Program, despite being a large-scale and well-supported intervention across 78 European nursing homes, did not improve residents’ comfort at end of life and only produced modest gains in staff knowledge. While quality of care in the last month of life improved, particularly around preparatory tasks, the primary outcome remained unchanged. The findings suggest that multicomponent palliative care programs may be too diffuse or slow to implement effectively in one year, and that future efforts may need more targeted, flexible, and context-adapted strategies to produce meaningful change in resident outcomes.

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