Here is the standardised PICO analysis for the thirteenth uploaded article:
Full Title
The Effectiveness of Palliative Care Interventions in Long-Term Care Facilities: A Systematic Review
Authors: Xuan Liu, Yun-Chen Chang, Wen-Yu Hu
Journal: Journal of Personalized Medicine, 2024; 14(7):700
DOI: 10.3390/jpm14070700
Type of Study
Systematic Review of seven studies (RCTs, pre-post studies, and qualitative studies)
PICO Summary
Population (P)
- Residents of long-term care facilities (LTCFs), including nursing homes and residential aged care, predominantly aged 85+
- Included individuals with and without dementia
- Institutional staff including nurses, care assistants, and physicians were also indirectly involved
Intervention (I)
- Palliative care interventions, including:
- PACE (Program of All-Inclusive Care for the Elderly): comprehensive end-of-life care training and coordination across six domains
- Liverpool Care Pathway (LCP): structured end-of-life symptom management and care pathway (now evolved into Integrated Care Pathways)
- Gold Standard Framework in Care Homes (GSFCH): institution-wide education and process reorganisation for palliative care delivery over 6–18 months
Comparison (C)
- Standard care or non-intervention groups (e.g. observational or before–after comparison)
- In one study, comparison was between institutions with different levels of implementation support (e.g. “high facilitation” vs. standard GSFCH)
Outcomes (O)
Person-centred outcomes:
- Quality of death improved significantly with PACE (QOD-LTC score +3.19, p < 0.001)
- Symptom relief (notably dyspnoea and nausea) improved under LCP interventions
- No significant differences in comfort or quality of death between dementia and non-dementia subgroups
Process outcomes:
- DNR completion rates increased (e.g. from 15% to 72% in one GSFCH study)
- ACP completion rates improved (e.g. from 4% to 53%)
- LCP implementation rates increased from 3% to 31%
- Hospital readmission rates decreased (e.g. from 31% to 24% in the last two weeks of life)
- Proportion of in-facility deaths increased (e.g. from 68% to 77.6%)
System-level outcomes:
- Cost-effectiveness: PACE reduced hospital-related costs by ~€983 per person
- Barriers identified for implementation included:
- Lack of palliative care knowledge
- Inadequate interdisciplinary teamwork
- Hesitancy to discuss end-of-life care
- Institutional resistance to change
Findings Summary
This systematic review supports the conclusion that palliative care interventions in LTCFs improve end-of-life outcomes, including symptom control, care planning, and reduced unnecessary hospital use. Among the models, GSFCH and LCP were particularly effective for embedding palliative practices institution-wide, while PACEdemonstrated cost-effectiveness. Successful implementation depended on staff training, institutional support, and integrated teamwork. However, no major gains in comfort quality for residents with dementia were observed, highlighting an ongoing need to tailor palliative care to this population’s specific needs.
Life In The Slower Lane 
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