Life In The Slower Lane

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

---

✅ 

Full Title (verbatim and exact):

“Improved Quality of Death and Dying in Care Homes: A Palliative Care Stepped Wedge Randomized Control Trial in Australia”

Liu WM, Koerner J, Lam L, et al.

Journal of the American Geriatrics Society (2020); 68(2):305–312

DOI: https://doi.org/10.1111/jgs.16192

---

📄 

Type of Article:

Stepped wedge cluster-randomised controlled trial

---

🔍 

PICO Analysis:

Population:

• 1700 non-respite residents of 12 care homes in Canberra, Australia
• Mean age: 85 years; 36% male
• 537 residents died during the trial; 471 had complete data included in the analysis
• Many residents had dementia, frailty, or other age-related comorbidities 

---

Intervention:

Palliative Care Needs Rounds – a structured monthly triage intervention:

• 60-minute staff-only meetings led by a specialist palliative care clinician
• Focused on residents at risk of dying without a plan
• Used a checklist to guide anticipatory planning (e.g. symptom burden, need for case conferences, advance care planning, medication review)
• Embedded staff education, review of biopsychosocial issues, and proactive care coordination
• Delivered face-to-face by a nurse practitioner or palliative care nurse consultant 

---

Comparator:

• Usual care: ad hoc specialist palliative care consultations when requested by facility staff or general practitioners
• Randomisation occurred at facility level using a stepped wedge design 

---

Outcome:

1. Person-centred outcomes:

• Primary outcome:
  • Quality of Death and Dying Inventory (QODD) – staff-rated, 0–100 scale
  • Intervention significantly improved scores:
    • Overall QODD increase: +8.1 (95% CI: 3.8 to 12.4; P < .01)
    • Subscale QODD-1 (general aspects): +9.0
    • Subscale QODD-2 (specific clinical scenarios): +6.2
  • Effect larger in high/moderate fidelity sites (e.g. QODD increase: +10.4) 
• Advance care planning (ACP):
  • ACP completion rose from 30% in control to 42% in intervention (P < .01)
  • Increase in medical power of attorney appointments 

2. Process outcomes:

• Staff capability (measured using CAPA scale):
  • Pre- to post-intervention improvement of +4.7 points (95% CI: 2.7 to 6.7; P < .01)
  • Indicates significant improvement in staff confidence and ability to deliver end-of-life care 

3. Health system outcomes:

• Primary outcome of hospital length of stay (reported separately)
• Qualitative evidence suggests reduced avoidable hospitalisations and greater anticipatory prescribing and planning activity
• No harms or adverse events reported; sites with high fidelity demonstrated strongest effects 

---

Summary Conclusion:

This stepped wedge RCT demonstrated that monthly specialist-led palliative care triage meetings (Needs Rounds)significantly improved the quality of death and dying for care home residents in Australia. The intervention was associated with increased ACP completion, improved staff capability, and enhanced anticipatory planning. Importantly, effects were strongest in sites that implemented the program with high fidelity. These findings suggest that Needs Rounds are a scalable, low-burden intervention with measurable benefits for end-of-life care in residential aged care settings.

---