Life In The Slower Lane

Here is the PICO analysis for the nineteenth uploaded article:

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✅ PICO Analysis

Full Article Title:

Developing Palliative Care Practice Guidelines and Standards for Nursing Home–Based Palliative Care Teams: A Delphi Study

Type of Study:

Delphi consensus study

Journal and Year:

Journal of the American Medical Directors Association (JAMDA), 2015; 16(2):86.e1–86.e7

DOI: 10.1016/j.jamda.2014.10.013

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P – Population

• Setting:
  • Nursing homes (NHs) in upstate New York, USA
• Participants:
  • 38 NH clinical and administrative leaders (nurses, social workers, directors of nursing, physicians) from 16 nursing homes
• Resident Focus:
  • Older adults receiving palliative or end-of-life care in long-term care settings 

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I – Intervention

• Nature of Intervention:
  • Development of consensus-based palliative care guidelines and operational standards tailored specifically for nursing home-based palliative care teams (PCTeams)
  • Used a two-round Delphi process to assess:
    1. Importance of existing national consensus guidelines
    2. Feasibility of implementation in the NH context
• Source Material:
  • Adapted from National Consensus Project (NCP) guidelines and National Quality Forum (NQF) preferred practices
  • Supplemented by resources such as:
    • AMDA Palliative Care Toolkit
    • Medical Orders for Life-Sustaining Treatment (MOLST)
    • ELNEC curriculum 

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C – Comparison

• Comparator:
  • No direct comparator; Delphi method used to select among existing palliative care guidelines
  • Implicit comparison between “national best practices” and what is “realistically feasible” within the nursing home environment 

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O – Outcomes

Primary Outcome:

• Identification of feasible and important guidelines for NH-based PCTeams
  • Of 22 guidelines evaluated:
    • 17 were accepted as both important and feasible
    • 5 were rejected (e.g., due to cost, staffing limitations, or infeasibility in NH context: interpreter access, ethics committees, bereavement services) 

Secondary Outcomes:

• Definition of core and extended team composition:
  • Core team: Nurse, nurse practitioner/physician assistant, physician, social worker, certified nursing assistant
  • Extended team: Chaplain, dietary staff, therapist 
• Feasibility of operational standards for PCTeams:
  • Screening at admission (78.4% feasible)
  • Quarterly reassessment (83.3%)
  • Weekly team rounding seen as more difficult (16.2% rated as “not feasible”)
  • Communication about prognosis with families and staff rated as highly feasible
  • Bereavement support for families and staff rated as least feasible 

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Outcome Classification

• Person-centred outcomes: Indirect—guidelines aim to enhance resident-centred decision-making, symptom relief, and psychosocial/spiritual support
• Process outcomes: Definition of practical, feasible operational standards for NH PCTeams; improved communication practices and interdisciplinary coordination
• Health system outcomes: Potential to reduce in-hospital deaths, standardise palliative care, improve NH staff capacity for end-of-life care

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Summary Conclusion

This Delphi study engaged a multidisciplinary panel of NH leaders to identify which national palliative care guidelines are both important and feasible for implementation in nursing homes. The panel agreed on 17 of 22 clinical guidelines and outlined a realistic structure and operational model for NH-based palliative care teams. The findings offer a practical framework for NHs to integrate palliative care into everyday practice, though barriers like limited staffing and bereavement resources remain. The guidelines are being used as part of a broader PCORI-funded intervention to evaluate their impact on resident outcomes and care quality .

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