Life In The Slower Lane

Here is the PICO analysis for the third uploaded article:

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✅ PICO Analysis

Full Article Title:

Normalising and planning for death in residential care: findings from a qualitative focus group study of a specialist palliative care intervention

Type of Study:

Qualitative focus group study (nested within a quasi-experimental design)

Journal and Year:

BMJ Supportive & Palliative Care (2019); 9:e12

DOI: 10.1136/bmjspcare-2016-001127

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P – Population

• Setting: Residential aged care facilities (nursing homes) in an Australian city
• Participants:
  • Staff: 40 participants including carers, registered nurses, team leaders, managers, and one geriatrician
  • Relatives: 17 participants (mainly adult children of deceased residents)
• Residents: Older adults receiving care in four facilities (360 total beds; 104 residents received the intervention)
• Residents were generally in the final stages of life; inclusion for family focus groups required the resident to have died at least 3 months prior

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I – Intervention

• Type: Specialist palliative care service delivered by a Palliative Care Nurse Practitioner (PCNP)
• Components:
  • Direct clinical care: symptom assessment, prescribing, case conferencing, family support
  • Indirect care: triage meetings, staff education, mentoring, needs rounds
  • Education included recognising dying, pain and symptom management, and communication strategies
  • Needs rounds (triage meetings) used to identify residents likely to die within 6 months and initiate planning
  • Total intervention time: ~2 days/week over 6 months

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C – Comparison

• No formal control group in this qualitative focus group study. However, this analysis was embedded in a wider quasi-experimental design where the facilities receiving the PCNP-led intervention were contrasted with usual care in other facilities (not analysed here).
• Historical comparison (prior care practices before intervention) is implied in the staff and relative comments

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O – Outcomes

Primary Outcomes (qualitatively derived):

1. Normalisation of death and dying
   • Staff became more confident discussing end-of-life issues
   • Death recognised as a routine part of residential aged care
   • Earlier conversations with families about end-of-life planning
2. Timely access to specialist palliative care
   • Improved symptom control and pain management
   • Faster and more appropriate prescribing through the nurse practitioner
   • Reduced reliance on GPs and improved interprofessional communication
   • Avoidance of unnecessary hospitalisations
3. Improved advance care planning and decision-making
   • Families felt more prepared for the dying process
   • Staff reported greater confidence in recognising deterioration and initiating palliative care earlier
   • Use of anticipatory prescribing and structured case review supported better end-of-life experiences

Outcome Classification:

• Person-centred outcomes: Family satisfaction, preparedness for death, comfort of residents
• Process outcomes: Staff education, earlier ACP conversations, timely symptom management
• Health system outcomes: Avoided hospitalisations, better coordination with GPs, reduced time to symptom relief

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