Effects of facilitated family case conferencing for advanced dementia

A cluster randomised clinical trial

Meera Agar, Tim Luckett, Georgina Luscombe, Jane Phillips, Elizabeth Beattie, Dimity Pond, Geoffrey Mitchell, Patricia M Davidson, Janet Cook, Deborah Brooks, Jennifer Houltram, Stephen Goodall, Lynnette Chenoweth

Research output: Contribution to journalArticle

Abstract

Background: Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing (FCC) with usual care (UC) on end-of-life care. Methods: A two arm parallel cluster randomised controlled trial was conducted. The sample included people with advanced dementia from 20 Australian nursing homes and their families and professional caregivers. In each intervention nursing home (n = 10), Palliative Care Planning Coordinators (PCPCs) facilitated family case conferences and trained staff in person-centred palliative care for 16 hours per week over 18 months. The primary outcome was family-rated quality of end-of-life care (End-of-Life Dementia [EOLD] Scales). Secondary outcomes included nurse-rated EOLD scales, resident quality of life (Quality of Life in Late-stage Dementia [QUALID]) and quality of care over the last month of life (pharmacological/ non-pharmacological palliative strategies, hospitalization or inappropriate interventions). Results: Two-hundred-eighty-six people with advanced dementia took part but only 131 died (64 in UC and 67 in FCC which was fewer than anticipated), rendering the primary analysis underpowered with no group effect seen in EOLD scales. Significant differences in pharmacological (P < 0.01) and non-pharmacological (P < 0.05) palliative management in last month of life were seen. Intercurrent illness was associated with lower family-rated EOLD Satisfaction with Care (coefficient 2.97, P < 0.05) and lower staff-rated EOLD Comfort Assessment with Dying (coefficient 4.37, P < 0.01). Per protocol analyses showed positive relationships between EOLD and staff hours to bed ratios, proportion of residents with dementia and staff attitudes. Conclusion: FCC facilitates a palliative approach to care. Future trials of case conferencing should consider outcomes and processes regarding decision making and planning for anticipated events and acute illness. Trial registration: Australian New Zealand Clinical Trial Registry ACTRN12612001164886.

Original languageEnglish (US)
Article numbere0181020
JournalPLoS One
Volume12
Issue number8
DOIs
StatePublished - Aug 1 2017

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randomized clinical trials
Nursing
dementia
Dementia
Randomized Controlled Trials
Planning
nursing homes
Nursing Homes
Quality of Life
Decision making
Terminal Care
planning
Palliative Care
quality of life
Hospice and Palliative Care Nursing
Pharmacology
Attitude of Health Personnel
group effect
Quality of Health Care
rendering

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Agar, M., Luckett, T., Luscombe, G., Phillips, J., Beattie, E., Pond, D., ... Chenoweth, L. (2017). Effects of facilitated family case conferencing for advanced dementia: A cluster randomised clinical trial. PLoS One, 12(8), [e0181020]. https://doi.org/10.1371/journal.pone.0181020

Effects of facilitated family case conferencing for advanced dementia : A cluster randomised clinical trial. / Agar, Meera; Luckett, Tim; Luscombe, Georgina; Phillips, Jane; Beattie, Elizabeth; Pond, Dimity; Mitchell, Geoffrey; Davidson, Patricia M; Cook, Janet; Brooks, Deborah; Houltram, Jennifer; Goodall, Stephen; Chenoweth, Lynnette.

In: PLoS One, Vol. 12, No. 8, e0181020, 01.08.2017.

Research output: Contribution to journalArticle

Agar, M, Luckett, T, Luscombe, G, Phillips, J, Beattie, E, Pond, D, Mitchell, G, Davidson, PM, Cook, J, Brooks, D, Houltram, J, Goodall, S & Chenoweth, L 2017, 'Effects of facilitated family case conferencing for advanced dementia: A cluster randomised clinical trial', PLoS One, vol. 12, no. 8, e0181020. https://doi.org/10.1371/journal.pone.0181020
Agar, Meera ; Luckett, Tim ; Luscombe, Georgina ; Phillips, Jane ; Beattie, Elizabeth ; Pond, Dimity ; Mitchell, Geoffrey ; Davidson, Patricia M ; Cook, Janet ; Brooks, Deborah ; Houltram, Jennifer ; Goodall, Stephen ; Chenoweth, Lynnette. / Effects of facilitated family case conferencing for advanced dementia : A cluster randomised clinical trial. In: PLoS One. 2017 ; Vol. 12, No. 8.
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abstract = "Background: Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing (FCC) with usual care (UC) on end-of-life care. Methods: A two arm parallel cluster randomised controlled trial was conducted. The sample included people with advanced dementia from 20 Australian nursing homes and their families and professional caregivers. In each intervention nursing home (n = 10), Palliative Care Planning Coordinators (PCPCs) facilitated family case conferences and trained staff in person-centred palliative care for 16 hours per week over 18 months. The primary outcome was family-rated quality of end-of-life care (End-of-Life Dementia [EOLD] Scales). Secondary outcomes included nurse-rated EOLD scales, resident quality of life (Quality of Life in Late-stage Dementia [QUALID]) and quality of care over the last month of life (pharmacological/ non-pharmacological palliative strategies, hospitalization or inappropriate interventions). Results: Two-hundred-eighty-six people with advanced dementia took part but only 131 died (64 in UC and 67 in FCC which was fewer than anticipated), rendering the primary analysis underpowered with no group effect seen in EOLD scales. Significant differences in pharmacological (P < 0.01) and non-pharmacological (P < 0.05) palliative management in last month of life were seen. Intercurrent illness was associated with lower family-rated EOLD Satisfaction with Care (coefficient 2.97, P < 0.05) and lower staff-rated EOLD Comfort Assessment with Dying (coefficient 4.37, P < 0.01). Per protocol analyses showed positive relationships between EOLD and staff hours to bed ratios, proportion of residents with dementia and staff attitudes. Conclusion: FCC facilitates a palliative approach to care. Future trials of case conferencing should consider outcomes and processes regarding decision making and planning for anticipated events and acute illness. Trial registration: Australian New Zealand Clinical Trial Registry ACTRN12612001164886.",
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