Life In The Slower Lane

Here is the structured PICO analysis for the fifty-third article you uploaded:

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Full Title (verbatim and exact):

“Predicting hospital transfers among nursing home residents in the last months of life”

Krishnan P, Thompson G, McClement S

International Journal of Palliative Nursing (2017); 23(11):535–542

DOI: 10.12968/ijpn.2017.23.11.535

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Type of Article:

Secondary analysis of a retrospective observational study (quantitative survey data)

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PICO Analysis:

Population:

• 119 bereaved family members of nursing home residents who died within the previous year
• Participants were drawn from 21 nursing homes in Central Canada
• Residents included both with and without dementia; average age at death was 86.7 years
• Nursing homes included a mix of non-profit and for-profit organisations, with and without religious affiliations 

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Intervention (Exposure of Interest):

• Family and facility characteristics examined as potential predictors of terminal hospital transfers
• Hospital transfer defined as a transfer occurring in the last month of life

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Comparator:

• Residents who were not transferred to hospital in the last month of life
• The study compared residents who experienced terminal hospital transfers with those who did not

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Outcome:

1. Person-centred outcomes:

• Not directly measured, but the outcome (terminal hospitalisation) is a proxy for burdensome or potentially non-beneficial end-of-life care
• The goal is to identify risk factors to reduce unnecessary hospital transfers and improve quality of dying 

2. Process outcomes (Predictors of transfer):

• From logistic regression analysis, two variables were significantly associated with hospital transfer:
  • Having an adult child as the decision-maker (Odds Ratio [OR] = 5.03; 95% CI: 1.55–16.31; p = 0.007)
  • Family income below $59,000 CAD (OR = 2.93; 95% CI: 1.13–7.59; p = 0.027) 
• Variables not significantly associated:
  • Family member’s gender, education level, health status, visitation pattern, place of residence
  • Facility characteristics: number of beds, religious affiliation, or profit status

3. Health system outcomes:

• High prevalence of terminal hospital transfers: 70% of residents were transferred in the last month of life
• Findings suggest that family dynamics and socioeconomic factors may drive hospital transfers more than facility characteristics or clinical need
• Implications for targeted interventions to promote advance care planning and reduce unnecessary hospitalisation at end of life 

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Summary Conclusion:

This study found that family-related factors—specifically, having an adult child as the decision-maker and lower household income—were significantly associated with higher odds of terminal hospital transfers for nursing home residents. These findings indicate that family influence may override clinical or organisational efforts to prevent burdensome end-of-life hospitalisation. Advance care planning education targeting families (especially adult children and lower-income households) and improving staff-family communication may reduce unnecessary transfers and improve quality of death in residential aged care.

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