Life In The Slower Lane

Here is the PICO analysis for the second uploaded article:

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✅ PICO Analysis

Full Article Title:

Advance Care Planning in Nursing Homes – Improving the Communication Among Patient, Family, and Staff: Results From a Cluster Randomized Controlled Trial (COSMOS)

Type of Study:

Cluster Randomised Controlled Trial (RCT)

Journal and Year:

Frontiers in Psychology (2018); Volume 9, Article 2284

DOI: 10.3389/fpsyg.2018.02284

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P – Population

• Setting: 72 nursing home units across 8 municipalities in Southern Norway
• Participants:
  • Patients: Aged >65 years, both with and without dementia, minimum 2-week stay in NH, excluding those with life expectancy <6 months or schizophrenia
  • Nursing staff and physicians at participating units
  • Family members involved in communication and satisfaction assessments
• Sample Size:
  • 545 patients included: 297 in 36 intervention units, 248 in 31 control units
  • 43% of patients had severe cognitive impairment based on MMSE

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I – Intervention

• Name: ACP component of the COSMOS multicomponent intervention
• Description:
  • Focused on Advance Care Planning (ACP) through a 2-day education seminar for nursing staff and managers
  • Train-the-trainer model using COSMOS ambassadors to lead implementation
  • Components included role definition, staff-family-patient communication, monthly calls, quarterly meetings, and documentation of preferences
  • Education reinforced by flashcards with key questions and fortnightly support calls from researchers
  • Staff distress was also addressed by improving communication confidence and competence

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C – Comparison

• Comparison Group:
  • Usual care in control group NH units, with no structured ACP education or intervention
  • Some spontaneous ACP activity may have occurred, but without structured implementation or support

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O – Outcomes

Primary Outcomes:

1. Communication frequency among patient, family, and nursing home staff (via documentation of meetings, calls, and contact)
2. Satisfaction with communication (self-reported by nurses and families using Likert scales)
3. Staff distress levels (measured via the NPI-NH Distress scale, 0–60)

Outcome Classification:

• Person-centred outcomes: Communication satisfaction (staff and family)
• Process outcomes: Frequency of documented communication events, phone calls, nurse-patient-family meetings
• Staff-level well-being: Reduction in self-reported distress due to neuropsychiatric symptoms in patients

Key Findings:

• Improved communication with family and shared meetings with nurses (OR = 3.9 for shared conversations at 4 months)
• Increased family contact and satisfaction at 4 months
• Significant reduction in nursing staff distress (B = −1.8, 95% CI = −3.1 to −0.4, p = 0.012)
• Effect not sustained at 9-month follow-up, suggesting need for ongoing staff support 

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