Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-28T07:41:12.918Z Has data issue: false hasContentIssue false
  • English
  • Français

Does using the interRAI Palliative Care instrument reduce the needs and symptoms of nursing home residents receiving palliative care?

Published online by Cambridge University Press:  04 April 2017

Kirsten Hermans ,
Johanna De Almeida Mello ,
Nele Spruytte ,
Joachim Cohen ,
Chantal Van Audenhove  and
Anja Declercq
Kirsten Hermans*
Affiliation:
LUCAS Centre for Care Research and Consultancy, University of Leuven, Leuven, Belgium
Johanna De Almeida Mello
Affiliation:
LUCAS Centre for Care Research and Consultancy, University of Leuven, Leuven, Belgium
Nele Spruytte
Affiliation:
LUCAS Centre for Care Research and Consultancy, University of Leuven, Leuven, Belgium
Joachim Cohen
Affiliation:
End-of-Life Care Research Group, Vrije Universiteit Brussels and Ghent University, Brussels, Belgium
Chantal Van Audenhove
Affiliation:
LUCAS Centre for Care Research and Consultancy, University of Leuven, Leuven, Belgium
Anja Declercq
Affiliation:
LUCAS Centre for Care Research and Consultancy, University of Leuven, Leuven, Belgium
*
Address correspondence and reprint requests to: Kirsten Hermans, LUCAS Centre for Care Research and Consultancy, University of Leuven, Minderbroedersstraat 8, 5310 B-3000 Leuven, Belgium. E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

This study aimed to evaluate whether using the interRAI Palliative Care instrument (the interRAI PC) in nursing homes is associated with reduced needs and symptoms in residents nearing the end of their lives.

Method:

A quasi-experimental pretest–posttest study using the Palliative care Outcome Scale (POS) was conducted to compare the needs and symptoms of residents nearing the end of their lives in the control and intervention nursing homes. Care professionals at the intervention nursing homes filled out the interRAI PC over the course of a year for all residents aged 65 years and older who were nearing the end of their lives. This intervention was not implemented in the control nursing homes.

Results:

At baseline, POS scores in the intervention nursing homes were lower (more favorable) than in the control nursing homes on the items “pain”, “other symptoms”, “family anxiety”, and the total POS score. Posttest POS scores for “wasted time” were higher (less favorable) than pretest scores in the intervention nursing homes. In the intervention nursing homes where care professionals did not have prior experience with the interRAI Long-Term Care Facilities (LTCF) assessment instrument (n = 8/15), total POS scores were lower (more favorable) at posttest.

Significance of results:

One year after introducing the interRAI PC, no reduction in residents' needs and symptoms were detected in the intervention nursing homes. However, reductions in needs and symptoms were found in the subgroup of intervention nursing homes without prior experience with the interRAI LTCF instrument. This may suggest that the use of an interRAI instrument other than the interRAI PC specifically can improve care. Future research should aim at replicating this research with a long-term design in order to evaluate the effect of integrating the use of the interRAI PC in the day-to-day practices at nursing homes.

Keywords

the interRAI Palliative Care instrumentPalliative careComprehensive assessmentNursing homesOlder adults
Type
Original Articles
Information
Palliative & Supportive Care , Volume 16 , Special Issue 1: Special Instruments – Assessment and Measure Issues in Palliative Care , February 2018 , pp. 32 - 40
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Aspinal, F., Hughes, R., Higginson, I.J., et al. (2002). A User's Guide to the Palliative Care Outcome Scale. London: Palliative Care and Policy Publications.Google Scholar
Bajwah, S., Ross, J.R., Wells, A.U., et al. (2015). Palliative care for patients with advanced fibrotic lung disease: A randomised controlled phase II and feasibility trial of a community case conference intervention. Thorax, 70(9), 830–839. Epub ahead of print Jun 23.CrossRefGoogle ScholarPubMed
Bendelow, G.A. & Williams, S.J. (1995). Transcending the dualisms: Towards a sociology of pain. Sociology of Health & Illness, 17(2), 139–165. Available from http://onlinelibrary.wiley.com/doi/10.1111/j.1467-9566.1995.tb00479.x/pdf.Google Scholar
Bernabei, R., Landi, F., Onder, G., et al. (2008). Second- and third-generation assessment instruments: The birth of standardization in geriatric care. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 63(3), 308–313.CrossRefGoogle ScholarPubMed
Bolker, B.M., Brooks, M.E., Clark, C.J., et al. (2008). Generalized linear mixed models: A practical guide for ecology and evolution. Trends in Ecology & Evolution, 24(3), 127–135. Available from http://avesbiodiv.mncn.csic.es/estadistica/curso2011/regm26.pdf.Google Scholar
Brandt, H.E., Deliens, L., van der Steen, J.T., et al. (2005). The last days of life of nursing home patients with and without dementia assessed with the palliative care outcome scale. Palliative Medicine, 19(4), 334–342.Google Scholar
Carpenter, G.I. & Hirdes, J.P. (2013). Using interRAI assessment systems to measure and maintain quality of long-term care. In A Good Life in Old Age? Monitoring and Improving Quality in Long-Term Care, pp. 93–139. Paris: OECD Health Policy Studies, OECD Publishing.Google Scholar
Cicely Saunders Institute (2012). The Palliative Care Outcome Scale. London: The Cicely Saunders Institute. Available from http://pos-pal.org/maix/about-us.php.Google Scholar
Craig, P., Dieppe, P., Macintyre, S., et al. (2006). Developing and Evaluating Complex Interventions: New Guidance. London: Medical Research Council. Available from https://www.mrc.ac.uk/documents/pdf/complex-interventions-guidance/.Google Scholar
Declercq, A., Gosset, C., Paepen, B., et al. (2009). Actieproject BelRAI III: Haalbaarheid van de RAI-methode in België [in Dutch]. Brussels: Ministry of Health, Food Chain Safety and the Environment.Google Scholar
Devriendt, E., Wellens, N.I., Flamaing, J., et al. (2013). The interRAI Acute Care instrument incorporated in an eHealth system for standardized and web-based geriatric assessment: Strengths, weaknesses, opportunities and threats in the acute hospital setting. BMC Geriatrics, 13, 90. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766642/pdf/1471-2318-13-90.pdf.Google Scholar
Dimitrov, D.M. & Rumrill, P.D. Jr. (2003). Pretest–posttest designs and measurement of change. Work, 20(2), 159–165.Google Scholar
Ersek, M. & Carpenter, J.G. (2013). Geriatric palliative care in long-term care settings with a focus on nursing homes. Journal of Palliative Medicine, 16(10), 1180–1187. Epub ahead of print Aug 28. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3996937/pdf/jpm.2013.9474.pdf.Google Scholar
Freeman, S., Hirdes, J.P., Stolee, P., et al. (2014). Care planning needs of palliative home care clients: Development of the interRAI palliative care assessment clinical assessment protocols (CAPs). BMC Palliative Care, 13(1), 58. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4279598/.Google Scholar
Goldstein, N.E. & Morrison, R.S. (2012). Evidence-Based Practice of Palliative Medicine. New York: Elsevier Saunders.Google Scholar
Hearn, J. & Higginson, I.J. (1999). Development and validation of a core outcome measure for palliative care: The Palliative Care Outcome Scale. Quality in Health Care, 8(4), 219–227. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2483665/pdf/v008p00219.pdf.Google Scholar
Hermans, K., De Almeida Mello, J., Spruytte, N., et al. (2014 a). A comparative analysis of comprehensive geriatric assessments for nursing home residents receiving palliative care: A systematic review. Journal of the American Medical Directors Association, 15(7), 467–476. Epub ahead of print Feb 22.Google Scholar
Hermans, K., Spruytte, N., Cohen, J., et al. (2014 b). Informed palliative care in nursing homes through the interRAI Palliative Care instrument: A study protocol based on the Medical Research Council framework. BMC Geriatrics, 14, 132. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4280705/pdf/12877_2014_Article_1070.pdf.Google Scholar
Hermans, K., Cohen, J., Spruytte, N., et al. (2016 a). Palliative care needs and symptoms of nursing home residents with and without dementia: A cross-sectional study. Geriatrics & Gerontology International. Epub ahead of print Sep 16. Available from http://onlinelibrary.wiley.com/wol1/doi/10.1111/ggi.12903/full.Google Scholar
Hermans, K., Spruytte, N., Cohen, J., et al. (2016 b). Usefulness, feasibility and face validity of the interRAI Palliative Care instrument according to care professionals in nursing homes: A qualitative study. International Journal of Nursing Studies. Epub ahead of print Jul 26.CrossRefGoogle ScholarPubMed
Hirdes, J.P., Ljunggren, G., Morris, J.N., et al. (2008). Reliability of the interRAI suite of assessment instruments: A 12-country study of an integrated health information system. BMC Health Services Research, 8, 277. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631461/pdf/1472-6963-8-277.pdf.CrossRefGoogle ScholarPubMed
Hubbard, G. (2011). The “surprise question” in end-of-life care. British Journal of Community Nursing, 16(3), 109.Google Scholar
Mcllfatrick, S. & Hasson, F. (2014). Evaluating an holistic assessment tool for palliative care practice. Journal of Clinical Nursing, 23(7–8), 1064–1075. Epub ahead of print Sep 17, 2013.Google Scholar
Moss, A.H., Lunney, J.R., Culp, S., et al. (2010). Prognostic significance of the “surprise” question in cancer patients. Journal of Palliative Medicine, 13(7), 837–840.Google Scholar
National Institute for Health and Clinical Excellence (2007). Behaviour Change at Population, Community and Individual Levels. London: National Institute for Health and Clinical Excellence. Available from http://www.ncsct.co.uk/usr/pub/guidance-on-behaviour-change-at-population.pdf.Google Scholar
Rosser, M. & Walsh, H. (2014). Fundamentals of Palliative Care for Student Nurses. Hoboken, NJ: Wiley-Blackwell.Google Scholar
Smith, T.F., Steel, K., Fries, B.E., et al. (2010). interRAI Palliative Care (PC) Assessment Form and User's Manual. Washington, DC: interRAI.Google Scholar
Steel, K., Ljunggren, G., Topinková, E., et al. (2003). The RAI–PC: An assessment instrument for palliative care in all settings. The American Journal of Hospital & Palliative Care, 20(3), 211–219.Google Scholar
van Dijk, P.T., Mehr, D.R., Ooms, M.E., et al. (2005). Comorbidity and one-year mortality risks in nursing home residents. Journal of the American Geriatrics Society, 53(4), 660–665.CrossRefGoogle Scholar
Vanneste, D. & Declercq, A. (2014). The development of BelRAI, a web application for sharing assessment data on frail older people in home care, nursing homes and hospitals. In Beyond Silos: The Why and How of Integrated eCare. Müller, S. & Kubitschke, L. (eds.), pp. 202–226. Hershey, PA: IGI Global.Google Scholar
World Health Organization (2002). WHO Definition of Palliative Care. Geneva: World Health Organization. Available from http://www.who.int/cancer/palliative/definition/en/.Google Scholar
World Health Organization (2011). Palliative Care for Older People: Better Practices. London: World Health Organization. Available from http://www.euro.who.int/__data/assets/pdf_file/0017/143153/e95052.pdf.Google Scholar
Wowchuk, S.M., McClement, S. & Bond, J. Jr. (2007). The challenge of providing palliative care in the nursing home, part II: Internal factors. International Journal of Palliative Nursing, 13(7), 354–350.Google Scholar
Supplementary material: File

Hermans supplementary material

Appendix

Download Hermans supplementary material(File)
File 36.4 KB