Quality End-of-Life Care in Nursing Homes

This study is enrolling participants by invitation only.
Sponsor:
Collaborator:
Information provided by:
University of Nebraska
ClinicalTrials.gov Identifier:
NCT00616473
First received: February 4, 2008
Last updated: NA
Last verified: February 2008
History: No changes posted
  Purpose

The purpose of this study is to examine key organizational structures and processes (leadership, teamwork, communication, palliative care) and their impact on the quality of end-of-life care for dying residents and their family members.


Condition
Quality of End-of-Life Care in Nursing Homes

Study Type: Observational
Study Design: Observational Model: Case-Only
Time Perspective: Cross-Sectional
Official Title: The Impact of Quality End-of-Life Care in Nursing Homes

Resource links provided by NLM:


Further study details as provided by University of Nebraska:

Primary Outcome Measures:
  • The influence on palliative care of communication, leadership, and teamwork. [ Time Frame: Nursing home staff: at beginning and end of study; family members: following the death of nursing home resident ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Associations among structure (staffing), non-clinical (communication, leadership, teamwork) and clinical (palliative care) care processes and quality of end-of-life care. [ Time Frame: Nursing home staff: at beginning and end of study; family members: following the death of nursing home resident ] [ Designated as safety issue: No ]
  • Unruh and Wan's expanded structure, process, and outcomes model in the context of nursing home palliative care. [ Time Frame: Nursing home staff: at beginning and end of study; family members: following the death of nursing home resident ] [ Designated as safety issue: No ]

Estimated Enrollment: 8500
Study Start Date: January 2007
Estimated Study Completion Date: November 2010
Estimated Primary Completion Date: January 2009 (Final data collection date for primary outcome measure)
Groups/Cohorts
1 Nursing Home Staff
Direct care staff
2 Family Members
Family members/Significant other of nursing home resident.

Detailed Description:

As the American population ages, nursing homes are rapidly becoming a dominant site for death. Currently, 25% of all deaths occur in nursing homes and 35% of all elders over the age of 85 die in nursing homes. By 2020, 40% of those over 65 will die in nursing homes. Nursing home residents die in pain with undue psychosocial suffering. For all permanently placed residents, death is inevitable. Nonetheless, how residents die, is not.

There have been long standing concerns about the quality of care and quality of life in nursing homes. Although there is some evidence that the quality of care for nursing home residents has improved, serious problems continue in areas that potentially affect end-of-life such as dehydration, pressure ulcers, and pain. Efforts to improve care have rarely considered the dynamic nature of nursing home structure and process factors, such as staffing levels, leadership of the director of nursing, or communication and teamwork among staff that facilitate or impede the organization's ability to improve care processes. Findings from our preliminary studies in nursing homes indicate that organizational structure and process factors make a difference in end-of-life care for residents and their family members. More specifically, staff education, staffing levels, leadership of the DON and administrator, teamwork and communication among direct care staff, and incorporating palliative care clinical practices into day-to-day care had a profound impact on outcomes such as the honoring of end-of-life preferences, symptom management, and satisfaction with care. A more generalizable understanding of key structure and process factors and their relationship to resident care and outcomes at the end-of-life will provide a foundation for future intervention studies aimed at improving care.

  Eligibility

Ages Eligible for Study:   19 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

Nursing Homes in Nebraska and the Western half of Iowa, nursing home staff, and family members/significant other of nursing home residents

Criteria

Inclusion Criteria (Nursing Homes):

  • 60 beds or greater

Exclusion Criteria (Nursing Homes):

  • less than 60 beds

Inclusion Criteria (Nursing Home Staff):

  • 19 years of age or older
  • trained to provide resident care

Exclusion Criteria (Nursing Homes):

  • less than 19 years of age
  • staff on units exclusively Medicare or average length of stay less than 30 days

Inclusion Criteria (Family Member/Significant Other):

  • 19 years of age or older
  • somewhat to very involved in resident's care and decision-making

Exclusion Criteria (Family Member/Significant Other):

  • not involved in resident's care and decision-making
  • resident was in the nursing home less than 31 days
  • resident was less than 65 years old
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00616473

Locations
United States, Nebraska
University of Nebraska Medical Center
Omaha, Nebraska, United States, 68198
Sponsors and Collaborators
University of Nebraska
Investigators
Principal Investigator: Sarah A Thompson, RN, PhD University of Nebraska
Principal Investigator: Virginia Tilden, RN, DNSC University of Nebraska
  More Information

Additional Information:
No publications provided

Responsible Party: Sarah A Thompson, RN, PhD, University of Nebraska Medical Center
ClinicalTrials.gov Identifier: NCT00616473     History of Changes
Other Study ID Numbers: 433-06, 7 R01 NR009547-02
Study First Received: February 4, 2008
Last Updated: February 4, 2008
Health Authority: United States: Institutional Review Board

ClinicalTrials.gov processed this record on October 29, 2014