Life In The Slower Lane

Here is the standardised PICO analysis for the forty-seventh uploaded article:

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Full Title

Palliative and end-of-life care in care homes: Protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK

Authors: Aisha Macgregor, Alasdair Rutherford, Brendan McCormack, et al.

Journal: BMJ Open, 2021; 11:e049486

DOI: 10.1136/bmjopen-2021-049486

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Type of Study

Implementation science protocol (hybrid implementation-effectiveness study with qualitative and quantitative evaluation)

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PICO Summary

Population (P)

• Care home residents in the UK (particularly those at risk of dying without adequate planning)
• Care home staff, including registered nurses and assistants
• Specialist palliative care teams (6 services working with 4–6 care homes each)
• Family members of residents
• Estimated: 30 care homes, ~1500 residents, and ~300 relatives involved in Phase 2 

Intervention (I)

UK adaptation of “Palliative Care Needs Rounds” (Needs Rounds)

• Monthly one-hour triage and planning meetings chaired by a palliative care specialist
• Includes discussion of 8–10 residents most at risk of dying without a care plan
• Generates personalised actions (e.g., ACP, medication review, case conferencing, referrals)
• Emphasises proactive planning, education, and anticipatory prescribing 

Comparison (C)

• No formal control group; pre–post comparisons on hospitalisations and quality of death
• Baseline vs. 12-month implementation data collection

Outcomes (O)

Primary outcome:

• What works, for whom, in what circumstances—evaluated through realist-informed qualitative data and i-PARIHS framework

Secondary outcomes:

1. Hospitalisations (frequency, length of stay, associated costs)
2. Quality of death and dying (QODDI scores)
3. Staff capability to provide palliative care (CAPA tool)
4. Family perceptions of care (CANHELP Lite)
5. Cost-effectiveness (including NHS and social care savings from reduced hospitalisation)
6. Implementation process fidelity, feasibility, and sustainability 

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Findings Summary (Protocol)

This study aims to:

• Adapt and implement the Australian “Needs Rounds” model for the UK context
• Use i-PARIHS framework and realist methods to explore context, mechanisms, and outcomes
• Evaluate both process and impact, including staff capability, resident outcomes, and cost implications

Key design features:

• Mixed-methods: interviews, surveys, site documents, observational field notes
• Structured economic evaluation using NHS tariffs and care home costing data
• PPI involvement throughout design, data collection, and dissemination

The project is expected to yield a scalable UK model of Needs Rounds with a structured implementation toolkit for wider use in care homes .

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