Life In The Slower Lane

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Here is the standardised PICO analysis for the twelfth uploaded article:

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Full Title

Desired dementia care towards end of life: Development and experiences of implementing a new approach to improve person-centred dementia care

Authors: Jesper M.A. Biesmans et al.

Journal: Journal of Advanced Nursing, 2024

DOI: 10.1111/jan.16285

Type of Study

Qualitative study using co-creation methodology and content analysis to develop and evaluate a new intervention (DEDICATED approach) for palliative dementia care

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PICO Summary

Population (P)

• Healthcare professionals (HCPs) (mostly nurses, dementia case managers) working in home care or nursing home settings in the Netherlands
• People with dementia towards end of life, and their family caregivers, were involved in earlier stages of needs assessment (but not in this evaluation)

Intervention (I)

• DEDICATED approach (Desired Dementia Care Towards End of Life):
  • A co-created toolkit with six themes, including:
    1. Awareness of palliative care needs
    2. Familiarisation with the person with dementia
    3. Communication about care preferences
    4. Interprofessional collaboration in advance care planning (ACP)
    5. Collaboration during care transitions
    6. Management of pain and responsive behaviours
  • Digital and physical tools: photo cards, dice for conversation starters, ACP guides, training modules, online resources
  • Implementation supported by trained “DEDICATED ambassadors” who introduced tools in practice settings

Comparison (C)

• No formal control group. Comparison is internal: first-wave (co-creators) vs. second-wave ambassadors (trained but not involved in development)

Outcomes (O)

Process outcomes:

• Ambassadors described increased awareness of when and how to initiate palliative care and ACP
• Tools were seen as usable, tangible, and useful for promoting person-centred care
• Co-creation led to greater ownership and implementation success among first-wave ambassadors
• Second-wave ambassadors faced more challenges, especially in home care settings and during COVID-19
• Long-term uptake was associated with managerial support and continued peer learning (e.g. reflective meetings)

Person-centred outcomes (indirect, inferred):

• Improved alignment with residents’ life stories and preferences
• Increased staff sensitivity to quality-of-life issues
• Enhanced team communication and structured case discussions

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Findings Summary

• The DEDICATED approach is a context-sensitive, co-created framework that helps healthcare professionals provide more person-centred palliative care to people with dementia
• Tangible tools and peer-supported training increase feasibility and relevance in practice
• Ownership, managerial support, and training delivery format (e.g., face-to-face vs. online) significantly affect implementation outcomes
• The approach appears scalable, but extramural care settings (e.g., home care) present specific barriers due to fragmented team structures and less frequent in-person contact 

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