Here is the standardised PICO analysis for the eleventh uploaded article:
Full Title
Implementation of an Advance Care Planning Intervention in Nursing Homes: An International Multiple Case Study
Authors: Kevin Brazil et al. (mySupport Study Group)
Journal: The Gerontologist, 2024; 64(6), gnae007
Type of Study
International multiple-case qualitative implementation study of the Family Carer Decision Support (FCDS) Intervention
PICO Summary
Population (P)
- Nursing homes across six countries: Canada, Czech Republic, Italy, Netherlands, Republic of Ireland, and the United Kingdom
- Targeted residents with advanced dementia who lacked decision-making capacity
- Participants included family carers, internal and external facilitators, healthcare professionals, and nursing home staff
Intervention (I)
- Family Carer Decision Support (FCDS) Intervention, which included:
- Train-the-trainer model for internal staff with external facilitation
- Comfort Care Booklet and question prompt list tailored to local languages and contexts
- Structured family care conference to discuss goals of care, supported by the REMAP framework
Comparison (C)
- No formal control group; comparison was across cases in varied contexts, including both implementers and non-implementers
- Barriers and facilitators were explored between successful and less successful implementation contexts
Outcomes (O)
Person-centred outcomes (via family and staff feedback):
- Increased satisfaction and preparedness in decision-making reported in prior quantitative study (referenced)
- Family carers felt more supported and informed about end-of-life options
Process outcomes:
- Key themes supporting successful implementation:
- Trusting relationships between families and staff
- Committed and engaged nursing home leadership
- Value placed on staff training for end-of-life communication
- Flexibility to adapt intervention to local context
- Impact of external factors (e.g., COVID-19, staffing pressures)
Health system/organisational outcomes:
- Resource demands:
- Training delivery (online and in-person) required time and funding
- Some staff needed to use personal time or overtime to prepare and deliver conferences
- Integration into routine care (e.g. annual review meetings) seen as a route to sustainability
- Economic evaluation: Online training (£22/hour) was significantly less expensive than face-to-face (£89/hour)
Findings Summary
- 13 of 17 recruited homes implemented the intervention during the study period
- Implementation was most successful where leadership was committed, training was supported, and staff viewed it as part of core responsibilities
- COVID-19 posed significant barriers but also revealed potential for hybrid training models
- Facilitation (internal and external) was central to uptake and effectiveness of the intervention
- Authors call for continued integration of family-focused ACP tools and for policy frameworks to support implementation across varied national systems
Life In The Slower Lane 
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