Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK
Introduction Palliative and end-of-life care in care homes is often inadequate, despite high morbidity and mortality. Residents can experience uncontrolled symptoms, poor quality deaths and avoidable hospitalisations. Care home staff can feel unsupported to look after residents at the end of life. A...
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| Format: | Article |
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BMJ Publishing Group
2021-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/2/e049486.full |
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| author | Karen Spilsbury Barbara Hanratty Liz Forbat Brendan McCormack Margaret Ogden Aisha Macgregor Alasdair Rutherford Jo Hockley Irene Soulsby Maisie McKenzie |
| author_facet | Karen Spilsbury Barbara Hanratty Liz Forbat Brendan McCormack Margaret Ogden Aisha Macgregor Alasdair Rutherford Jo Hockley Irene Soulsby Maisie McKenzie |
| author_sort | Karen Spilsbury |
| collection | DOAJ |
| description | Introduction Palliative and end-of-life care in care homes is often inadequate, despite high morbidity and mortality. Residents can experience uncontrolled symptoms, poor quality deaths and avoidable hospitalisations. Care home staff can feel unsupported to look after residents at the end of life. Approaches for improving end-of-life care are often education-focused, do not triage residents and rarely integrate clinical care. This study will adapt an evidence-based approach from Australia for the UK context called ‘Palliative Care Needs Rounds’ (Needs Rounds). Needs Rounds combine triaging, anticipatory person-centred planning, case-based education and case-conferencing; the Australian studies found that Needs Rounds reduce length of stay in hospital, and improve dying in preferred place of care, and symptoms at the end of life.Methods and analysis This implementation science study will codesign and implement a scalable UK model of Needs Rounds. The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to identify contextual barriers and use facilitation to enable successful implementation. Six palliative care teams, working with 4–6 care homes each, will engage in two phases. In phase 1 (February 2021), stakeholder interviews (n=40) will be used to develop a programme theory to meet the primary outcome of identifying what works, for whom in what circumstances for UK Needs Rounds. Subsequently a workshop to codesign UK Needs Rounds will be run. Phase 2 (July 2021) will implement the UK model for a year. Prospective data collection will focus on secondary outcomes regarding hospitalisations, residents’ quality of death and care home staff capability of adopting a palliative approach.Ethics and dissemination Frenchay Research Ethics Committee (287447) approved the study. Findings will be disseminated to policy-makers, care home/palliative care practitioners, residents/relatives and academic audiences. An implementation package will be developed for practitioners to provide the tools and resources required to adopt UK Needs Rounds.Registration details Registration details: ISRCTN15863801. |
| format | Article |
| id | doaj-art-39d79d48b85f4a159c544ca975a2640e |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-39d79d48b85f4a159c544ca975a2640e2024-11-17T12:30:13ZengBMJ Publishing GroupBMJ Open2044-60552021-02-0111210.1136/bmjopen-2021-049486Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UKKaren Spilsbury0Barbara Hanratty1Liz Forbat2Brendan McCormack3Margaret Ogden4Aisha Macgregor5Alasdair Rutherford6Jo Hockley7Irene Soulsby8Maisie McKenzie9School of Healthcare, University of Leeds, Leeds, UKPatient Safety Research Collaboration, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UKFaculty of Social Sciences, University of Stirling, Stirling, UK3 School of Health Sciences, Queen Margaret University, Edinburgh, UKDepartment of Primary Care and Population Health, University College London, London, UKFaculty of Social Sciences, University of Stirling, Stirling, UKFaculty of Social Sciences, University of Stirling, Stirling, UK2University of Edinburgh, UK6 Public Contributor, Primary Care Research Centre, University of Southampton, Southampton, Hampshire, UKFaculty of Social Sciences, University of Stirling, Stirling, UKIntroduction Palliative and end-of-life care in care homes is often inadequate, despite high morbidity and mortality. Residents can experience uncontrolled symptoms, poor quality deaths and avoidable hospitalisations. Care home staff can feel unsupported to look after residents at the end of life. Approaches for improving end-of-life care are often education-focused, do not triage residents and rarely integrate clinical care. This study will adapt an evidence-based approach from Australia for the UK context called ‘Palliative Care Needs Rounds’ (Needs Rounds). Needs Rounds combine triaging, anticipatory person-centred planning, case-based education and case-conferencing; the Australian studies found that Needs Rounds reduce length of stay in hospital, and improve dying in preferred place of care, and symptoms at the end of life.Methods and analysis This implementation science study will codesign and implement a scalable UK model of Needs Rounds. The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to identify contextual barriers and use facilitation to enable successful implementation. Six palliative care teams, working with 4–6 care homes each, will engage in two phases. In phase 1 (February 2021), stakeholder interviews (n=40) will be used to develop a programme theory to meet the primary outcome of identifying what works, for whom in what circumstances for UK Needs Rounds. Subsequently a workshop to codesign UK Needs Rounds will be run. Phase 2 (July 2021) will implement the UK model for a year. Prospective data collection will focus on secondary outcomes regarding hospitalisations, residents’ quality of death and care home staff capability of adopting a palliative approach.Ethics and dissemination Frenchay Research Ethics Committee (287447) approved the study. Findings will be disseminated to policy-makers, care home/palliative care practitioners, residents/relatives and academic audiences. An implementation package will be developed for practitioners to provide the tools and resources required to adopt UK Needs Rounds.Registration details Registration details: ISRCTN15863801.https://bmjopen.bmj.com/content/11/2/e049486.full |
| spellingShingle | Karen Spilsbury Barbara Hanratty Liz Forbat Brendan McCormack Margaret Ogden Aisha Macgregor Alasdair Rutherford Jo Hockley Irene Soulsby Maisie McKenzie Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK BMJ Open |
| title | Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK |
| title_full | Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK |
| title_fullStr | Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK |
| title_full_unstemmed | Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK |
| title_short | Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK |
| title_sort | palliative and end of life care in care homes protocol for codesigning and implementing an appropriate scalable model of needs rounds in the uk |
| url | https://bmjopen.bmj.com/content/11/2/e049486.full |
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