Here is the standardised PICO analysis for the forty-fourth uploaded article:
Full Title
Strengthening advance care planning in rural residential aged care through multidisciplinary educational case conferences: A hybrid implementation-effectiveness study
Authors: Suzanne Rainsford, Sally Hall Dykgraaf, Rosny Kasim, Christine Phillips, Nicholas Glasgow
Journal: Progress in Palliative Care, 2021; 29(4):199–208
DOI: 10.1080/09699260.2021.1872136
Type of Study
Hybrid implementation-effectiveness study using a convergent mixed-methods design
PICO Summary
Population (P)
- Residents of two rural residential aged care (RAC) facilities in Cooma, New South Wales, Australia
- Total of 112 beds across facilities; 23 residents died during the study period
- Targeted residents had no clear or up-to-date advance care plans (ACPs), especially following recent hospitalisations or acute medical events
Intervention (I)
- Implementation of Multidisciplinary Educational Case Conferences (MuDECCs):
- One-hour meetings including:
- Resident (where possible)
- Family or guardian
- General Practitioner (GP)
- Registered Nurse(s)
- Care assistants
- Community pharmacist
- Palliative care nurses and others
- Used to coordinate care, initiate ACP discussions, chart anticipatory medications, and provide interprofessional education
- Supported by a logic model (see Figure 1 on page 5) and facilitated documentation of outcomes
- One-hour meetings including:
Comparison (C)
- No formal control group; baseline comparison was drawn from decedent reviews and pre-existing ACP practices in the facilities
Outcomes (O)
Implementation Outcomes:
- 10 MuDECCs conducted
- 51 individuals participated (mean 9 per session)
- Implementation was found to be acceptable and valuable, but time-consuming
- Enablers: strong interpersonal networks in rural settings, committed leadership, active involvement of community pharmacist
- Barriers: staff shortages, high GP workload, logistical constraints (e.g. one facility lacked after-hours RNs), reliance on voluntary effort
Effectiveness Outcomes:
- Of 23 residents who died:
- 65% had a documented ACP
- 57% had anticipatory medications charted
- 39% died in hospital, despite none indicating hospital as preferred place of death
- Following MuDECCs:
- 6 new ACPs and 3 updates completed
- Anticipatory meds charted in 3 cases
- Surveys from families and staff showed high satisfaction and increased confidence, understanding, and clarity around roles and care goals
Findings Summary
MuDECCs were shown to:
- Facilitate timely and collaborative advance care planning
- Promote shared decision-making and reduction of hospital transfers
- Enhance staff and family confidence, understanding of care goals, and role clarity
- Serve as an educational tool, especially for rural healthcare workers with limited access to palliative training
However, sustainability is challenged by:
- Time burden on facilitators and participants
- Under-remuneration of key professionals (e.g. pharmacists, GPs)
- Difficulty integrating into routine workflows
Recommendations:
- Consider funding or formal recognition for staff roles
- Explore telehealth options and scalable models
- Evaluate impact on hospital transfers and ACP quality in future research
Life In The Slower Lane 
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