Here is the PICO analysis for the article:
Full Article Title:
Pneumonia care and the nursing home: a qualitative descriptive study of resident and family member perspectives
Authors: Carusone SC, Loeb M, Lohfeld L
Journal: BMC Geriatrics (2006); 6:2
✅ PICO Analysis
Type of Study:
Qualitative descriptive study nested within a larger multicentre randomised controlled trial of pneumonia care pathways
P – Population
- Setting:Five nursing homes in Ontario, Canada (2 for-profit, 3 not-for-profit; 100–250 beds each)
- Participants:
- Residents (n = 6): Women aged 76–93, with varying levels of dependency (Barthel Index 0–17)
- Family members (n = 8): Primary decision-makers of residents (sons, daughters, spouses); residents they represented had low Barthel Index scores (0–12) and were aged 84–98
- Inclusion Criteria (from trial context):Residents with pneumonia confirmed through clinical criteria (e.g., cough, fever, new chest findings)Excluded if life expectancy <30 days, declined participation, or had advance directives precluding hospitalisation
I – Intervention (Exposure)
- Exposure:Treatment of nursing home-acquired pneumonia (NHAP) within the nursing home setting as per a trial clinical pathway (i.e. in situ care)
- Purpose of Study:To explore how residents and family members experienced pneumonia care, and their preferences for location of care (nursing home vs hospital), their perceptions of care quality, and their desired involvement in decision-making
C – Comparison
- No formal comparison groupQualitative thematic analysis comparing perspectives of residents vs family members on in situ vs hospital-based pneumonia care
O – Outcomes
Person-Centred Outcomes (Preferences and Experiences):
- Preferred Locus of Care:Both residents and family members generally preferred pneumonia to be treated in the nursing home, unless the condition was very seriousResidents often accepted provider-led decision-making; family members preferred to be consulted
- Perceived Benefits of In Situ Care:
- More personalised attention, comfort, familiar surroundings
- Greater continuity of care
- Less stress and disruption, especially for residents with dementia
- Perceived as the resident’s “home”
- Concerns About Nursing Home Care:
- Limited physician presence and staff availability
- Concerns about staff training and response time (expressed mainly by family members)
- Uncertainty about the facility’s capacity for acute care
- Decision-Making Preferences:
- Residents: Often deferred to doctors, hesitated to express preferences
- Family members: Wanted active involvement and shared decision-making
Summary Conclusion
This qualitative study found that both residents and family members generally preferred pneumonia care to occur within the nursing home, citing reasons of comfort, personal attention, and familiar surroundings. While residents tended to defer to staff in decision-making, family members wanted to be involved. These preferences support the acceptability of models of care that aim to manage NHAP without hospital transfer, particularly when pneumonia is detected early and resources are available. This study reinforces the importance of aligning care models with both resident and surrogate perspectives .
Life In The Slower Lane 
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