Life In The Slower Lane

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

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Full Title (verbatim and exact):

“Evaluation of an advance care planning education programme for nursing homes: A longitudinal study”

Baron K, Hodgson A, Walshe C

Nurse Education Today (2015); 35:689–695

DOI: 10.1016/j.nedt.2015.01.005

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Type of Article:

Longitudinal quasi-experimental study (pre-post evaluation of an education intervention)

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PICO Analysis:

Population:

• Staff and residents from nursing homes (n = 20) in Wigan, UK
• Staff included healthcare assistants, nurses, and managers
• Residents were predominantly older and living with frailty; hospital admission and death records were evaluated
• 16 homes participated: 12 had completed training; 4 were yet to receive training 

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Intervention:

Advance Care Planning (ACP) education programme, including:

• Four interactive workshops over 4–6 weeks:
  1. Introduction to ACP
  2. Legal and ethical issues
  3. Communication
  4. Documentation
• Training based on the Gold Standards Framework in Care Homes
• Delivered by an ACP facilitator using role-play and case discussions
• Follow-up data collected between 2–14 months post-training 

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Comparator:

• Pre-intervention data (baseline questionnaires, ACP documents, and hospital deaths)
• Untrained homes used as a comparison group in the post-intervention phase

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Outcome:

1. Person-centred outcomes:

• Not directly assessed, but proxy metrics included:
  • Reduction in hospital deaths (suggesting preference-concordant care)
  • Increased ACP documentation (linked to preferences for place of death)
• In training homes, hospital deaths decreased by 25% (from 79 to 59)
• In homes that had not yet received training, hospital deaths increased by 86%

2. Process outcomes:

• Knowledge of ACP:
  • Staff who underwent training scored highest (mean = 74%) on post-training knowledge assessments
  • Staff in the same homes but who did not attend training scored 63%
  • Staff in untrained homes scored lowest (mean = 59%)
  • Statistically significant difference in knowledge between groups (ANOVA, p < 0.001) 
• ACP practice uptake:
  • Mean number of ACP documents rose from 13 to 24 per home (+85%) in training homes
  • In untrained homes, ACP documents remained at or near zero
  • Data quality was variable; some homes showed unexpected reductions due to misunderstanding or poor documentation practices 

3. Health system outcomes:

• Hospital death rates:
  • Significant decline in intervention homes (25%)
  • Increase in all homes that had not yet received training (86%)
• Potential cost implications suggested, though not directly measured
  • Previous studies cited show hospital admissions near end of life are expensive and often not aligned with resident preferences 

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Summary Conclusion:

This longitudinal evaluation demonstrates that a structured ACP training programme for nursing home staffsignificantly improves ACP knowledge, increases documentation of advance care plans, and reduces hospital deaths. The results were sustained up to 14 months post-training and suggest that ACP education can meaningfully influence practice and outcomes. However, the study did not assess the quality of ACP conversations or whether care aligned with expressed preferences. Data limitations included inconsistent response rates, documentation quality, and lack of resident-level outcome verification. Nonetheless, the findings support the use of interactive, nurse-led ACP training as a valuable intervention to improve end-of-life care in residential aged care.

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