Life In The Slower Lane

Here is the PICO analysis for the thirty-fifth uploaded article:

---

✅ PICO Analysis

Full Article Title:

A residential aged care end-of-life care pathway (RAC EoLCP) for Australian aged care facilities

Type of Study:

Prospective, multisite implementation study with mixed-methods evaluation

Journal and Year:

Australian Health Review (2011); 35(3):350–356

DOI: 10.1071/AH10899

---

P – Population

• Setting:
  • Six residential aged care facilities (RACFs) in Brisbane, Australia
• Participants:
  • 693 high-care residents in six not-for-profit RACFs
  • RACF nursing and care staff
  • Bereaved relatives of deceased residents

---

I – Intervention

• Intervention Name:
  • Residential Aged Care End-of-Life Care Pathway (RAC EoLCP)
• Core Components:
  • Clinical pathway adapted from the Liverpool Care Pathway (LCP) to suit Australian RACF context
  • Integration with Medicare claiming, ACFI (Aged Care Funding Instrument), accreditation standards
  • Establishment of Link Nurses in each facility to champion the model
  • Support from specialist palliative care nurse practitioner and medical officer
  • Palliative Care Medication Imprest System to ensure timely access to symptom management medications
  • Targeted education workshops (n = 53) for over 500 generalist staff
  • Workshops for over 60 GPs; pathway-aligned with Palliative Care Australia standards 

---

C – Comparison

• Comparator:
  • Place of death and care quality indicators were compared for residents:
    • Pre-implementation (3 months)
    • During implementation (18 months)
  • Implementation-period residents were further stratified by those:
    • Commenced on the RAC EoLCP
    • Not commenced on the RAC EoLCP

---

O – Outcomes

1. 

Primary Outcome:

• Hospital transfer at end-of-life
  • Pre-implementation: 21.7% transferred to hospital
  • During implementation:
    • 12% transferred overall
    • 1.7% transferred if on the RAC EoLCP vs. 21.5% if not (P < 0.001)
  • 98.3% of those on the pathway died in place

2. 

Secondary Outcomes:

RACF Staff Perceptions:

• Surveys (n = 473) from 224 staff over four time points showed:
  • Significant improvements across 15 of 16 palliative care quality items
  • Ratings increased progressively (pre: mean = 5.6, 18 months: mean = 6.3 on 7-point scale)
  • Improvements noted in symptom control, family involvement, care coordination, and training access
  • Qualitative feedback supported education value and improved staff confidence 

Bereaved Relatives’ Perceptions:

• Surveys from 87 bereaved relatives (21 pre, 66 post):
  • High satisfaction pre- and post-implementation (mean = 6.0 vs. 5.9, no significant change)
  • No significant improvement post-implementation, possibly due to ceiling effect
  • Qualitative comments mostly positive; some concerns about staffing ratios 

Process Outcomes:

• Pathway uptake varied across RACFs (27.6% to 69.3%)
• Influenced by Link Nurse stability, GP support, and clinical diagnosis (e.g. higher uptake for cancer patients)

---

Outcome Classification

• Person-centred outcomes:
  • Fewer hospital transfers at end of life; higher likelihood of dying in place; maintained family satisfaction with care
• Process outcomes:
  • Improved staff capability, confidence, and consistency in delivering end-of-life care; expanded access to anticipatory medications
• Health system outcomes:
  • Reduced potentially avoidable hospitalisations; potential cost savings by avoiding inappropriate acute care use

---

Summary Conclusion

This pioneering Australian study provided the first national evidence that an end-of-life care pathway adapted for residential aged care (RAC EoLCP) can significantly improve outcomes for dying residents—specifically, by reducing unnecessary hospital transfers and enabling death in place. The model enhanced staff confidence, care coordination, and palliative care delivery, supported by education, medication access, and Link Nurse leadership. While bereaved relatives’ satisfaction remained unchanged (likely due to pre-existing high standards), the intervention was clearly impactful from both clinical and systemic perspectives .

---