Life In The Slower Lane

Here is the PICO analysis for the thirteenth uploaded article:

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✅ PICO Analysis

Full Article Title:

Education and training to enhance end-of-life care for nursing home staff: a systematic literature review

Type of Study:

Systematic literature review

Journal and Year:

BMJ Supportive & Palliative Care (2016); 6:353–361

DOI: 10.1136/bmjspcare-2015-000956

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P – Population

• Setting: Nursing homes and long-term care facilities
• Participants:
  • Care home staff (qualified nurses, unqualified support workers, social workers, and in some cases, GPs and managers)
  • Residents were not direct participants, but were the focus of the outcomes
• Geographic Spread: UK, USA, Canada, Scandinavia, Hong Kong 

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I – Intervention

• Nature of Intervention:
  • Educational and training interventions aimed at improving end-of-life (EOL) and palliative care in nursing homes
• Content of Interventions:
  • Mostly short and variable formats (e.g. 1-hour lectures, single-day workshops, or short study programmes)
  • Intended to improve staff knowledge, confidence, and attitudes around EOL care
  • Often lacked detailed descriptions of delivery or structure
  • No reports of e-learning, blended learning, or sustained training models 

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C – Comparison

• Study Designs Used:
  • Majority were uncontrolled before-and-after studies (UCBA)
  • Some controlled trials, one cluster RCT
  • Limited or no comparison to control groups in most studies
• Limitations Noted:
  • Lack of baseline equivalency between groups
  • Small sample sizes; inconsistent or non-standardised outcome measures
  • Absence of power calculations or theoretical underpinnings 

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O – Outcomes

1. Staff-Related Outcomes:

• Most commonly reported:
  • Self-reported increases in knowledge, confidence, and attitudes towards EOL care
  • Positive evaluations of training satisfaction
• Few used validated tools; outcome measures were often bespoke and unvalidated
• Some evidence of improved competencies (where organisational goals were linked to palliative care training) 

2. Resident and System-Level Outcomes (less common):

• Some studies included:
  • Audit of care documentation (e.g., advance care plans, do-not-resuscitate orders, hospital admissions)
  • Perceived improvements in patient care and reduced hospital transfers
  • Limited evidence of direct resident/family outcomes; one study included bereaved family interviews
• No studies assessed cost-effectiveness or conducted economic analysis 

3. Quality of Evidence and Sustainability:

• Generally poor methodological quality across studies
• Interventions lacked theoretical underpinning and long-term follow-up
• Findings were often based on brief, one-off educational events unlikely to result in sustainable change
• No alignment with international palliative care education guidelines in most cases 

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Outcome Classification

• Person-centred outcomes: Minimal direct measurement; resident outcomes mostly inferred through documentation audits
• Process outcomes: Moderate—evidence of improved staff self-perceptions, occasional improvements in ACP documentation
• Health system outcomes: Infrequent; limited evidence of reduced hospitalisations or improved EOL metrics; no cost data reported

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Summary Conclusion

This systematic review found that although education is frequently cited as the key to improving end-of-life care in nursing homes, current interventions are often insufficient. Most training was brief, poorly described, and evaluated through staff self-report rather than objective or resident-centred outcomes. There was no robust evidence linking education to better clinical practice or patient experience. Future educational strategies should be theoretically grounded, aligned with international palliative care guidelines, incorporate varied modalities (e.g., blended learning), and include rigorous evaluations of clinical, organisational, and economic outcomes .

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