Here is the standardised PICO analysis for the second uploaded article:
Full Title
Interventionen zur Verbesserung der Palliativversorgung älterer Menschen, die in Pflegeeinrichtungen leben
(Translated: Interventions to improve palliative care for older people living in nursing care homes)
Authors: Miriam Heupel-Reuter, Tania Zieschang, Falk Hoffmann, Jürgen Bauer, Sebastian Voigt-Radloff
Source: Zeitschrift für Gerontologie und Geriatrie, 2019; 52:758–760
DOI: 10.1007/s00391-019-01615-2
Based on Original Cochrane Review:
Hall S, Kolliakou A, Petkova H, Froggatt K, Higginson IJ. Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD007132
Type of Study
Systematic Review (Cochrane)
Including 2 RCTs and 1 Controlled-Before-and-After Study (Total n = 735)
PICO Summary
Population (P)
- Older people living in nursing care homes
- All studies were conducted in the USA
- Included residents with advanced dementia in some sub-analyses
- Total participants across studies: 735
Intervention (I)
- Multicomponent palliative care interventions in nursing homes
- Typical components included:
- Symptom assessment and management (physical, psychological, existential)
- Advance care planning (ACP)
- Training and process improvements for staff
- Intervention focused on the whole facility approach, not individual-level ACP alone
Comparison (C)
- Usual care (standard palliative or geriatric care without structured intervention)
Outcomes (O)
- Person-centred outcomes:
- Increased satisfaction with care (reported by residents or proxies)
- Reduced observed discomfort in residents with end-stage dementia
- Process outcomes:
- More referrals to hospice services in the intervention group
- Increases in documented ACP discussions and DNR orders
- Some reduction in hospital admissions and hospital days
- Health system outcomes:
- Hospitalisations reduced in one study
- No pooled meta-analysis due to heterogeneity of outcomes
Findings Summary
- Evidence is limited and all from the USA; promising but not definitive
- Review highlights the need for high-quality trials outside the USA, particularly in Europe
- Emphasises the potential of structured palliative care to improve satisfaction, reduce unnecessary hospital use, and promote goal-concordant care
Life In The Slower Lane 
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