EU PACE project Pace Steps to Success - VUB

prof Lieve Van den Block

EU PACE project

Pace Steps to Success

lvdblock@vub.bewww.eupace.eu

6countrydescriptivestudyofdyinginLTCFs

7 countryclusterRCTPACEStepstoSuccesswithprocessevaluation

Complexpopulationswithunaddressedneeds

Complexsettings withlowereducatedpersonnelandinsufficientpalliativecarecompetences

2015322representativeLTCFs1701deceasedresidents2275staffmembers

median length of stay from 5 months (Poland) to 25 months (in Belgium)

between 58% (England) and 83% (Finland) of deceased residents had dementia and roughly half of these in an advanced stage

between 52% (England) and 90% (Finland) of deceased residentsexperienced pain in the last week of life

Palliative Care knowledge

0.640.58 0.61

0.47

0.62

0.410.49

0.250.18

0.29

00.10.20.30.40.50.60.70.80.91nu

rses

careassistants

nurses

careassistants

nurses

careassistants

nurses

nurses

careassistants

nurses

Belgium Netherlands England Finland Poland Italy

higher mean scores (0 to 1) = better knowledgePC

SEn

d-of-LifeCaresubscale

6countrydescriptivestudyofdyinginLTCFs

7 countryclusterRCTPACEStepstoSuccesswithprocessevaluation

Function

High

Low†

Time

Palliativecare

Old model of palliative care not suitable for population of LTCF residents

†Frailtyanddementiatrajectory

Function

High

Low

Time

New model of palliative care:Early integration, alongside life-prolonging treatmentsPreferred culture in LTCFs

Palliativecareapproach†

6 steps programme

External trainers

PACE coordinators in the facilities

One year implementation: 6 steps with tools

General palliative care in PACE Steps to success programme

1. Advancecareplanning

2. Mapping changesinphysicalconditiontoanticipatedyingbetter

Monthly mapping changes in condition chart

General palliative care in PACE Steps to success programme

1. Advancecareplanning

2. Mapping changesinphysicalconditiontoanticipatedyingbetter

3. Palliativecareregister tobeusedduringmonthlymultidisciplinarymeeting,involvingstaffandGPs

General palliative care in PACE Steps to success programme

1. Advancecareplanning

2. Mapping changesinphysicalconditiontoanticipatedyingbetter

3. Palliativecareregister tobeusedduringmonthlymultidisciplinarymeeting,involvingstaffandGPs

4. Screeningofpainanddepression(PAIN-AD,GeriatricDepressionScale,Cornellfordementia)

General palliative care in PACE Steps to success programme

1. Advancecareplanning

2. Mapping changesinphysicalconditiontoanticipatedyingbetter

3. Palliativecareregister tobeusedduringmonthlymultidisciplinarymeeting,involvingstaffandGPs

4. Screeningofpainanddepression(PAIN-AD,GeriatricDepressionScale,Cornellfordementia)

5. Checklistlastdaysoflife

6. Reflectivedebriefing afterdeath

Cluster RCT in 7 countries 2016-2017BE, NL, ENG, PL, FI, IT, Switzerland

80 facilities randomizedOutcome, process, cost evaluation

By implementing PACE Steps to Success:• is quality of dying and quality of end-

of-life care of residents improved? • is staff knowledge of palliative care

improved compared to a control group?

80facilitiesrecruited

38Interventiongroup 37Controlgroup

Baselinemeasurementmonth0:deceasedresidentsandstaff

Postinterventionmeasurementmonth13andmonth17:deceasedresidentsandstaff

5dropouts

Staff knowledge of end-of-life care slightly improved (PC survey subscale)

Resultsforthcoming

Quality of care in last month of life as judged by staff improved (QOD-LTC)

Resident outcomes judged by staff

Resultsforthcoming

Symptoms last week of life CAD-EOLD

Resultsforthcoming

Process evaluation

7 country implementation of PACE Steps to Success in 78 LTCFs was very challenging and highly variable

• Diaries• Attendancelists• Nursinghomefilesreview• Evaluationquestionnaires• Interviews

Mean % of staff present at the trainings

0

10

20

30

40

50

60

70

80

90

1 2 3 4 5 6 2 3 6 7 9 11 2 3 4 5 8 13 1 2 4 9 10 12 1 2 3 4 2 3 6 11 14 1 2 5 6

BE FI IT NL PL EN SW

n° of residents with ACP documents / n°of beds

0

20

40

60

80

100

120

1 2 3 4 5 6 2 3 6 7 9 11 2 3 4 5 8 13 1 2 4 9 1012 1 2 3 4 2 3 6 1114 1 2 5 6

BE FI IT NL PL EN SW

Key recommendations for PACE Steps to Success

Stepwise implementation with facilitation of experienced trainersSelection and training of key PACE coordinators within the facilityActive management supportContinuous training, evaluation & monitoringTailoring intervention to local context and flexibility to adapt (timing/content of) intervention to changes in contextSpecialist palliative care services accessible

English, Dutch, Polish, Finnish, Italianhttp://www.eapcnet.eu/

PACEStepstoSuccessProgramme

Stepstowardsachievinghighqualitypalliativecareinyourcarehome

InformationPack

ThisprojecthasreceivedfundingfromtheEuropeanUnion’sSeventhFrameworkProgrammeforresearch,technologicaldevelopmentanddemonstrationundergrantagreementno.603111.

www.eupace.eulvdblock@vub.beAcknowledged