Here is the standardised PICO analysis for the fifty-eighth uploaded article:
Full Title
Training Nursing Home Staff to Improve Residents’ End-of-Life Care: Design and Baseline Findings from a Randomized Controlled Trial
Authors: Pauli J. Lamppu, Jouko Laurila, Harriet Finne-Soveri, et al.
Journal: European Geriatric Medicine, 2019; 10:649–657
DOI: 10.1007/s41999-019-00200-5
Type of Study
Cluster randomised controlled trial (cRCT) with 2-year follow-up, focused on palliative care staff training in Finnish nursing homes
PICO Summary
Population (P)
- 340 residents from 20 nursing home and assisted living wards in Helsinki, Finland
- Inclusion criteria:
- Age 84 on average, 76% women
- Diagnoses indicating limited prognosis (severe dementia, cancer, heart failure, COPD, renal failure, etc.)
- Inclusion by self-consent or proxy consent for those with cognitive impairment
Intervention (I)
- Four-part staff training program in palliative care:
- Topics: ACP, symptom management, hospital transfer risks, end-of-life communication, supporting families
- Methods: Reflective learning, group discussions, case-based problem-solving, role-play, and educational materials
- Led by experienced geriatricians
Comparison (C)
- Control wards received usual care with no training during the study period
- Randomisation was stratified by case-mix using RAI-MDS data, and matched by facility type (nursing home vs assisted living)
Outcomes (O)
Primary outcomes:
- Change in health-related quality of life (HRQOL) measured by the 15D instrument
- Number of hospital days over 24 months
Secondary outcomes:
- Symptom burden (ESAS, PAINAD)
- Psychosocial well-being (PWB)
- Proxies’ satisfaction with end-of-life care (SWC-EOLD)
- Number of hospital admissions and care transitions
- Use of advance care plans and documentation of DNR orders
Process outcomes:
- 74% of staff completed the training, including all physicians
- Feedback score: 4.6/5 on training value and relevance
- Most valued themes: avoiding hospital transfers, improving ACP communication, symptom control
Findings Summary
- This trial demonstrates the feasibility of large-scale palliative care training in nursing homes
- Baseline results showed:
- High prevalence of frailty, dementia, multimorbidity
- Substantial symptom burden, with only ~28% on opioids despite moderate pain scores
- DNR orders were more frequent in control group (95%) than intervention group (70%), possibly reflecting past interventions
The intervention was well received, showing potential to shift staff attitudes and improve ACP and symptom management without extending care time. The use of constructive learning models, group reflection, and real-life case discussion contributed to high engagement .
Conclusion
This study provides a strong foundation for understanding the impact of targeted, reflective, multidisciplinary palliative care education. Pending long-term results, it offers a replicable model to reduce avoidable hospitalisation and enhance quality of end-of-life care in nursing home settings.
Life In The Slower Lane 
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