Telehealth Palliative Care in Nursing Homes: A scoping Review
Many adults older than 65 spend time in a nursing home (NH) at the end of life where specialist palliative care is limited. However, telehealth may improve access to palliative care services. A review of the literature was conducted to synthesize the evidence for telehealth palliative care in NHs to provide recommendations for practice, research, and policy.
Identifying Nursing Home Residents with Unmet Palliative Care Needs: A Systematic Review of Screening Tool Measurement Properties
Despite common use of palliative care screening tools in other settings, the performance of these tools in the nursing home has not been well established; therefore, the purpose of this review is to (1) identify palliative care screening tools validated for nursing home residents and (2) critically appraise, compare, and summarize the quality of measurement properties.
High-Quality Nursing Home and Palliative Care--One and the SAME
Many individuals receiving post-acute and long-term care services in nursing homes have unmet palliative and end-of-life care needs. Hospice has been the predominant approach to meeting these needs, although hospice services generally are available only to long-term care residents with a limited prognosis who choose to forego disease-modifying or curative therapies. Two additional approaches to meeting these needs are the provision of palliative care. . .
Evaluating Implementation Strategies to Support Documentation of Veterans' Care Preferences
To evaluate the effectiveness of feedback reports and feedback reports + external facilitation on completion of life-sustaining treatment (LST) note the template and durable medical orders. This quality improvement program supported the national roll-out of the Veterans Health Administration (VA) LST Decisions Initiative (LSTDI), which aims to ensure that seriously-ill veterans have care goals and LST decisions elicited and documented.
Developing and implementing a novel program to prepare nursing home-based geriatric nurse practitioners in primary palliative care
Current palliative care workforce projections indicate that the growing palliative care needs of older adults in US nursing homes cannot be met by specialists, leaving them vulnerable and at risk for poor end-of-life outcomes. The purpose of this article is to describe the development, implementation, and initial evaluation of a program to support primary care nursing home nurse practitioners (NPs) in palliative care. The program aimed to improve. . .
Alternative Consent Models in Pragmatic Palliative Care Clinical Trials
Palliative care research raises a host of ethical concerns. Obtaining informed consent from seriously ill patients and their families is often perceived as an additional burden. Alternative approaches to traditional written informed consent reflect the changing nature of modern trial design, embracing real-world effectiveness and pragmatic clinical trials with those who are seriously ill. Ethicists, clinical investigators, and regulatory bodies have acknowledged the challenges to . . .
Nursing Home Star Ratings and End-of-Life Care Quality: Lessons Learned from the Veterans Health Administration.
Over 25% of deaths among older adults occur in nursing homes. Therefore, it is crucial that assessments of nursing home quality, such as the commonly used 5-star rating systems, adequately reflect the quality of end-of-life care. To investigate this relationship, we conducted a national, retrospective observational study to explore the relationship between Veterans Affairs nursing home star ratings and the quality of end-of-life care. We found no relationship between star ratings and bereaved families' experience at the end of life.
Palliative Care in Nursing Homes: A Qualitative Study on Referral Criteria and Implications for Research and Practice.
Palliative care is vital for nursing home residents to improve their quality of life and care, yet it is underutilized in nursing homes. Palliative care underutilization in nursing homes is associated with multifaceted barriers such as vague and ill-defined referral criteria. To improve palliative care utilization in nursing homes, we used a qualitative descriptive approach to examine existing referral practices, explored recommendations for ideal criteria, and integrated both to create a framework for palliative care referral in nursing homes.
A Nurse Practitioner Driven Palliative and Supportive Care Service in Nursing Homes: Evaluation of a Quality Improvement Project.
Post-acute and long-term care residents often face untreated pain, misalignment between care goals and treatments, and missed psychosocial support opportunities. Developing internal palliative care programs in these settings aims to address these unmet needs by enhancing skills within the facility. This quality improvement project describes the initial steps and experiences of nurse practitioners involved in implementing a palliative and supportive care service to enhance care quality in a national post-acute and long-term care organization.
Staff perspectives on dementia care in nursing homes: A pre-implementation, qualitative study guided by the PRISM.
Person-centered, nonpharmacological interventions for people living with dementia have been shown to enhance affect, engagement, and communication while reducing negative behaviors. Despite their effectiveness, many of these interventions struggle to reach routine clinical settings due to implementation barriers. This pre-implementation study uses the Practical, Robust Implementation, and Sustainability Model to evaluate factors influencing the implementation of Dementia Collaborative Coaching in nursing homes, aiming to improve access to person-centered communication interventions for people living with dementia.
Selecting Outcomes for Pragmatic Clinical Trials in Dementia Care: the IMPACT Collaboratory iLibrary
Pragmatic outcomes are relevant in caring for people living with Alzheimer's Disease and related dementias (ADRD), and their care partners. Additionally, pragmatic outcomes must be readily measured and interpreted by clinicians within clinical workflow. Existing administrative data sources are highly pragmatic; however, they fail to address many domains and settings in ADRD care. To facilitate ADRD pragmatic trials, we created the IMPACT Patient and Caregiver Relevant Outcomes (PCRO) iLibrary and this study aims to detail its development and structure and assess the pragmatic characteristics of the included measures.
Evaluating the Pragmatic Characteristics of Advance Care Planning Outcome Measures in Dementia Clinical Trials: A Scoping Review
Advance care planning is critical for persons living with dementia due to its incurable and progressive nature. Advance care planning outcome measures must be psychometrically strong, meaningful to key partners, and pragmatic to collect to ensure impact on real-world practices. Therefore, we conducted a scoping review of outcome measures used in advance care planning randomized controlled trials involving persons living with dementia or their care partners and evaluated their pragmatic characteristics.