Life In The Slower Lane

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

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Full Title

Supporting Adoption of the Palliative Approach Toolkit in Residential Aged Care: An Exemplar of Organisational Facilitation for Sustainable Quality Improvement

Authors: Jenny Davis, Amee Morgans, Mairead Dunne

Journal: Contemporary Nurse, 2019; 55(4–5): 369–379

DOI: 10.1080/10376178.2019.1670708

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Type of Study

Organisational quality improvement study using a facilitation model and pre/post implementation design

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PICO Summary

Population (P)

• Residents and staff from 13 residential aged care facilities (RACFs) in Victoria, Australia (848 residents in total)
• Participants included 197 internal and external health professionals (facility managers, nurses, personal care workers, GPs, pharmacists, allied health) 

Intervention (I)

Implementation of the Palliative Approach Toolkit (PAT) using a Palliative Approach Facilitator (PAF) model over six months

• Included:
  • PAT-aligned education sessions on ACP, end-of-life care, symptom management, case conferencing, equipment use, and staff self-care
  • Provision of a standardised resource kit for each facility (materials, equipment, documentation tools)
  • On-site training, 1:1 coaching, team meetings, and consultative case support
  • Facilitation of Palliative Approach Working Groups to support sustainability 

Comparison (C)

• Pre-implementation status quo: decentralised PAT use, limited education uptake, and inconsistent ACP documentation
• Comparison focused on changes in practice and perceived confidence before and after intervention

Outcomes (O)

System-level outcomes:

• Reviewed Advance Care Plans for 484 clients
• Revised organisational policies and procedures to align with national PAT guidelines
• Facilitated site-wide standardisation of palliative care practices

Staff outcomes (based on feedback and observational data):

• Improved knowledge, confidence, and skill in ACP, symptom management, and end-of-life discussions
• Enhanced interdisciplinary collaboration including GP and allied health engagement
• Examples of practice change included:
  • Increased use of case conferencing
  • More consistent ACP documentation
  • Greater staff-led communication with families 

Illustrative outcomes (case examples):

• Successful completion of ACPs by junior staff with PAF support
• Reduced hospital transfers for end-of-life care following clear documentation of preferences
• Family satisfaction with involvement and transparency in care decisions 

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Findings Summary

The intervention demonstrated that a dedicated facilitator-led model:

• Built sustainable capacity for palliative and end-of-life care delivery
• Promoted consistent documentation and family involvement
• Was well received by staff across roles, with widespread uptake of training
• Enabled the standardisation of ACP and symptom management practices across multiple sites

Unlike traditional “train-the-trainer” models, the PAF model reduced reliance on single champions, mitigating the effects of staff turnover and allowing for broader cultural change. The intervention established infrastructure (kits, procedures, mentoring) to sustain change beyond the six-month implementation period .

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Conclusion

This study offers a scalable, facilitation-based alternative to traditional training models for embedding palliative care in aged care. By combining clinical education, practice support, resource provision, and leadership engagement, it demonstrates how organisational change in end-of-life care can be achieved and sustained.

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