Informed Palliative Care in Nursing Homes Through the interRAI Palliative Care Instrument

Summary

BACKGROUND Nursing homes are important locations for palliative care. Through comprehensive geriatric assessments (CGAs), evaluations can be made of the palliative care needs of nursing home residents. The interRAI Palliative Care instrument (interRAI PC) is a CGA that evaluates diverse palliative care needs of adults in all healthcare settings. The evaluation results in Client Assessment Protocols (CAPs: indications of problems that need addressing) and Scales (e.g. Palliative Index for Mortality (PIM)) which can be used to design, evaluate and adjust care plans. This study aims to examine the effect of using the interRAI PC on the quality of palliative care in nursing homes. Additionally, it aims to evaluate the feasibility and validity of the interRAI PC.

METHODS This study covers phases 0, I and II of the Medical Research Council (MRC) framework for designing and evaluating complex interventions, with a longitudinal, quasi-experimental pretest-posttest design and with mixed methods of evaluation. In phase 0, a systematic literature search is conducted. In phase I, the interRAI PC instrument is adapted for use in Belgium and implemented on the BelRAI-website and a practical training is developed. In phase II, the intervention is tested in fifteen nursing homes. Participating nursing homes fill out the interRAI PC during one year for all residents receiving palliative care. Using a pretest-posttest design with quasi-random assignment to the intervention or control group, the effect of the interRAI PC on the quality of palliative care is evaluated with the Palliative care Outcome Scale (POS). Psychometric analysis is conducted to evaluate the predictive validity of the PIM and the convergent validity of the CAP 'Mood' of the interRAI PC. Qualitative data regarding the usability and face validity of the instrument are collected.

DISCUSSION This is the first study to evaluate the validity and effect of the interRAI PC in nursing homes, following a methodology based on the MRC framework. This approach improves the study design and implementation and will contribute to a higher generalizability of results. The final result will be a psychometrically evaluated CGA for nursing home residents receiving palliative care.

Conditions

• Nursing Home Residents With Palliative Care Needs

Interventions

OTHER

interRAI PC

PREPARATORY PHASE * Step 0: Introductory information * Step 1: Training on the interRAI PC and the BelRAI webapplication * Step 2: Introduction on the interRAI PC and the BelRAI webapplication in the organization IMPLEMENTATION PHASE * Step 3: Identification of residents with palliative care needs, based on the surprise question * Step 4: Informed consent signature requirements * Step 5: Login to the BelRAI webapplication * Step 6: Definitions of roles and functions * Step 7: Completion of the interRAI PC * Step 8: Interpretation of results * Step 9: Use of results

Sponsors & Collaborators

• Amsterdam UMC, location VUmc

  collaborator OTHER

• University Ghent

  collaborator OTHER

• Vrije Universiteit Brussel

  collaborator OTHER

• Agentschap voor Innovatie door Wetenschap en Technologie

  collaborator OTHER

• KU Leuven

  lead OTHER

Principal Investigators

• Kirsten Hermans · KU Leuven, LUCAS

• Nele Spruytte · KU Leuven, LUCAS

• Joachim Cohen · End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University

• Chantal Van Audenhove · KU Leuven, LUCAS

• Anja Declercq · KU Leuven, LUCAS

Study Design

Allocation

NON_RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

65 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2013-11-30

Primary Completion

2015-02-28

Completion

2015-02-28

Countries

• Belgium

Study Locations