Life In The Slower Lane

Here is the PICO analysis for the fifteenth uploaded article:

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✅ PICO Analysis

Full Article Title:

Pragmatic cluster randomised controlled trial of facilitated family case conferencing compared with usual care for improving end of life care and outcomes in nursing home residents with advanced dementia and their families: the IDEAL study protocol

Type of Study:

Study protocol for a pragmatic cluster randomised controlled trial

Journal and Year:

BMC Palliative Care (2015); 14:63

DOI: 10.1186/s12904-015-0061-8

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P – Population

• Setting: 20 nursing homes in metropolitan and regional areas of Australia
• Participants:
  • Residents with advanced dementia (Functional Assessment Staging Tool [FAST] ≥6a and AKPS ≤50)
  • Family members involved in care decision-making
  • Nursing staff and external health professionals (e.g., GPs) 

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I – Intervention

• Name: Facilitated family case conferencing
• Key Components:
  • Appointment and training of a Palliative Care Planning Coordinator (PCPC) at each intervention site
  • PCPC responsibilities:
    1. Use of “triggers” to identify appropriate timing for case conferences
    2. Organisation, facilitation, and documentation of family case conferences
    3. Implementation of palliative care plans
    4. Staff training in person-centred palliative dementia care
  • Ongoing support via biweekly teleconferences and expert site visits
  • Implementation over 18 months, with PCPCs employed 16 hours/week per site 

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C – Comparison

• Control Group:
  • Usual care (no structured support or training from the research team)
  • Standard practices for EOL decision-making, care planning, and staff education as already in place
  • Documentation of any concurrent external education or initiatives to control for confounding variables 

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O – Outcomes

Primary Outcomes (Family-rated):

• Symptom-related comfort during last 7 days of life (CAD-EOLD scale)
• Symptom management over last 90 days (SM-EOLD scale)
• Family satisfaction with care over last 90 days (SWC-EOLD scale) 

Secondary Outcomes:

• Resident-Level:
  • Nurse-rated EOL outcomes (CAD-EOLD, SM-EOLD)
  • Proxy-rated resident quality of life (QUALID, EQ-5D-5L)
  • Frequency of acute care episodes and potentially non-palliative interventions (e.g. PEG feeding, resuscitation, transfusion)
  • Place of death, and incidents such as falls or medication errors 
• Staff-Level:
  • Staff attitudes, knowledge, and confidence in dementia palliative care (qPAD questionnaire) 

Health Economic Outcomes:

• Quality-adjusted life years (QALYs) gained
• Program costs, avoided health service utilisation, and cost-effectiveness analysis from healthcare and societal perspectives 

Implementation Process Outcomes:

• ‘Dose’ of the intervention (e.g., number of case conferences, staff involvement)
• Qualitative data on facilitators, barriers, and sustainability through interviews with staff, families, and GPs 

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Outcome Classification

• Person-centred outcomes: Comfort in dying, symptom control, family satisfaction, place of death
• Process outcomes: Implementation fidelity, staff confidence, palliative planning integration
• Health system outcomes: Reduced hospitalisations, reduced inappropriate interventions, cost-effectiveness via QALYs

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Summary Conclusion

The IDEAL study protocol outlines a rigorously designed cluster RCT testing the effect of a nurse-led, facilitated family case conferencing model for improving palliative care for people with advanced dementia in Australian nursing homes. The multifaceted intervention targets timely EOL discussions, better symptom control, staff upskilling, and reduced hospitalisation. Its pragmatic design, integration into existing systems, and inclusion of economic and qualitative evaluation components make it highly relevant for informing policy and practice in aged care .

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