Skip to main content
Top
Published in: BMC Health Services Research 1/2013

Open Access 01-12-2013 | Study protocol

Improving the quality of palliative and terminal care in the hospital by a network of palliative care nurse champions: the study protocol of the PalTeC-H project

Authors: Frederika E Witkamp, Lia van Zuylen, Paul J van der Maas, Helma van Dijk, Carin CD van der Rijt, Agnes van der Heide

Published in: BMC Health Services Research | Issue 1/2013

Login to get access

Abstract

Background

The quality of care of patients dying in the hospital is often judged as insufficient. This article describes the protocol of a study to assess the quality of care of the dying patient and the contribution of an intervention targeted on staff nurses of inpatient wards of a large university hospital in the Netherlands.

Methods/Design

We designed a controlled before and after study. The intervention is the establishment of a network for palliative care nurse champions, aiming to improve the quality of hospital end-of-life care. Assessments are performed among bereaved relatives, nurses and physicians on seven wards before and after introduction of the intervention and on 11 control wards where the intervention is not applied. We focus on care provided during the last three days of life, covered in global ratings of the quality of life in the last three days of life and the quality of dying, and various secondary endpoints of treatment and care affecting quality of life and dying.

Discussion

With this study we aim to improve the understanding of and attention for patients’ needs, and the quality of care in the dying phase in the hospital and measure the impact of a quality improvement intervention targeted at nurses.
Literature
1.
go back to reference Walling AM, Asch SM, Lorenz KA, Roth CP, Barry T, Kahn KL: The quality of care provided to hospitalized patients at the end of life. Arch Intern Med. 2010, 12: 1057-1063.CrossRef Walling AM, Asch SM, Lorenz KA, Roth CP, Barry T, Kahn KL: The quality of care provided to hospitalized patients at the end of life. Arch Intern Med. 2010, 12: 1057-1063.CrossRef
2.
go back to reference Teno JM, Clarridge BR, Casey V, Welch LC, Wetle T, Shield R: Family perspectives on end-of-life care at the last place of care. JAMA. 2004, 1: 88-93.CrossRef Teno JM, Clarridge BR, Casey V, Welch LC, Wetle T, Shield R: Family perspectives on end-of-life care at the last place of care. JAMA. 2004, 1: 88-93.CrossRef
3.
go back to reference Klinkenberg M, Willems DL, van der Wal G, Deeg DJ: Symptom burden in the last week of life. J Pain Symptom Manage. 2004, 1: 5-13.CrossRef Klinkenberg M, Willems DL, van der Wal G, Deeg DJ: Symptom burden in the last week of life. J Pain Symptom Manage. 2004, 1: 5-13.CrossRef
4.
go back to reference Curtis JR: Caring for patients with critical illness and their families: the value of the integrated clinical team. Respir Care. 2008, 4: 480-487. Curtis JR: Caring for patients with critical illness and their families: the value of the integrated clinical team. Respir Care. 2008, 4: 480-487.
5.
go back to reference Lynn J, Teno JM, Phillips RS, Wu AW, Desbiens N, Harrold J: Perceptions by family members of the dying experience of older and seriously ill patients. SUPPORT investigators. Study to understand prognoses and preferences for outcomes and risks of treatments. Ann Intern Med. 1997, 2: 97-106.CrossRef Lynn J, Teno JM, Phillips RS, Wu AW, Desbiens N, Harrold J: Perceptions by family members of the dying experience of older and seriously ill patients. SUPPORT investigators. Study to understand prognoses and preferences for outcomes and risks of treatments. Ann Intern Med. 1997, 2: 97-106.CrossRef
6.
go back to reference Rocque GB, Cleary JF: Palliative care reduces morbidity and mortality in cancer. Nat Rev Clin Oncol. 2013, 2: 80-89. Rocque GB, Cleary JF: Palliative care reduces morbidity and mortality in cancer. Nat Rev Clin Oncol. 2013, 2: 80-89.
7.
go back to reference Morrison RS: Health care system factors affecting end-of-life care. J Palliat Med. 2005, 8 (SUPPL. 1): S79-S87.PubMed Morrison RS: Health care system factors affecting end-of-life care. J Palliat Med. 2005, 8 (SUPPL. 1): S79-S87.PubMed
8.
go back to reference Gilewski T: The art of medicine: teaching oncology fellows about the end of life. Crit Rev Oncol Hematol. 2001, 2: 105-113.CrossRef Gilewski T: The art of medicine: teaching oncology fellows about the end of life. Crit Rev Oncol Hematol. 2001, 2: 105-113.CrossRef
9.
go back to reference Al-Qurainy R, Collis E, Feuer D: Dying in an acute hospital setting: the challenges and solutions. Int J Clin Pract. 2009, 3: 508-515.CrossRef Al-Qurainy R, Collis E, Feuer D: Dying in an acute hospital setting: the challenges and solutions. Int J Clin Pract. 2009, 3: 508-515.CrossRef
10.
go back to reference Simon S, Higginson IJ: Evaluation of hospital palliative care teams: strengths and weaknesses of the before-after study design and strategies to improve it. Palliat Med. 2009, 1: 23-28. Simon S, Higginson IJ: Evaluation of hospital palliative care teams: strengths and weaknesses of the before-after study design and strategies to improve it. Palliat Med. 2009, 1: 23-28.
11.
go back to reference A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT principal investigators. JAMA. 1995, 20: 1591-1598. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT principal investigators. JAMA. 1995, 20: 1591-1598.
12.
go back to reference Curtis JR, Nielsen EL, Treece PD, Downey L, Dotolo D, Shannon SE: Effect of a quality-improvement intervention on end-of-life care in the intensive care unit: a randomized trial. Am J Respir Crit Care Med. 2011, 3: 348-355.CrossRef Curtis JR, Nielsen EL, Treece PD, Downey L, Dotolo D, Shannon SE: Effect of a quality-improvement intervention on end-of-life care in the intensive care unit: a randomized trial. Am J Respir Crit Care Med. 2011, 3: 348-355.CrossRef
13.
go back to reference McCormick AJ, Curtis JR, Stowell-Weiss P, Toms C, Engelberg R: Improving social work in intensive care unit palliative care: results of a quality improvement intervention. J Palliat Med. 2010, 3: 297-304.CrossRef McCormick AJ, Curtis JR, Stowell-Weiss P, Toms C, Engelberg R: Improving social work in intensive care unit palliative care: results of a quality improvement intervention. J Palliat Med. 2010, 3: 297-304.CrossRef
14.
go back to reference Cheung W, Aggarwal G, Fugaccia E, Thanakrishnan G, Milliss D, Anderson R: Palliative care teams in the intensive care unit: a randomised, controlled, feasibility study. Crit Care Resusc. 2010, 1: 28-35. Cheung W, Aggarwal G, Fugaccia E, Thanakrishnan G, Milliss D, Anderson R: Palliative care teams in the intensive care unit: a randomised, controlled, feasibility study. Crit Care Resusc. 2010, 1: 28-35.
15.
go back to reference Costantini M, Beccaro M: Health services research on end-of-life care. Curr Opin Support Palliat Care. 2009, 3: 190-194. 10.1097/SPC.0b013e32832e67c3.CrossRefPubMed Costantini M, Beccaro M: Health services research on end-of-life care. Curr Opin Support Palliat Care. 2009, 3: 190-194. 10.1097/SPC.0b013e32832e67c3.CrossRefPubMed
16.
go back to reference Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D: Framework for design and evaluation of complex interventions to improve health. BMJ. 2000, 7262: 694-696.CrossRef Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D: Framework for design and evaluation of complex interventions to improve health. BMJ. 2000, 7262: 694-696.CrossRef
17.
go back to reference Fowell A, Johnstone R, Finlay IG, Russell D, Russell IT: Design of trials with dying patients: a feasibility study of cluster randomisation versus randomised consent. Palliat Med. 2006, 8: 799-804.CrossRef Fowell A, Johnstone R, Finlay IG, Russell D, Russell IT: Design of trials with dying patients: a feasibility study of cluster randomisation versus randomised consent. Palliat Med. 2006, 8: 799-804.CrossRef
18.
go back to reference Chan R, Webster J: End-of-life care pathways for improving outcomes in caring for the dying. Cochrane Database Syst Rev. 2010, 1: CD008006.PubMed Chan R, Webster J: End-of-life care pathways for improving outcomes in caring for the dying. Cochrane Database Syst Rev. 2010, 1: CD008006.PubMed
19.
go back to reference Ferrell BR: Overview of the domains of variables relevant to end-of-life care. J Palliat Med. 2005, 8 (Suppl 1): S22-S29.PubMed Ferrell BR: Overview of the domains of variables relevant to end-of-life care. J Palliat Med. 2005, 8 (Suppl 1): S22-S29.PubMed
20.
go back to reference Steinhauser KE: Measuring end-of-life care outcomes prospectively. J Palliat Med. 2005, 8 (Suppl 1): S30-S41.PubMed Steinhauser KE: Measuring end-of-life care outcomes prospectively. J Palliat Med. 2005, 8 (Suppl 1): S30-S41.PubMed
21.
go back to reference Teno JM: Measuring end-of-life care outcomes retrospectively. J Palliat Med. 2005, 8 (Suppl 1): S42-S49.PubMed Teno JM: Measuring end-of-life care outcomes retrospectively. J Palliat Med. 2005, 8 (Suppl 1): S42-S49.PubMed
22.
go back to reference Ching TY, Seto WH: Evaluating the efficacy of the infection control liaison nurse in the hospital. J Adv Nurs. 1990, 10: 1128-1131.CrossRef Ching TY, Seto WH: Evaluating the efficacy of the infection control liaison nurse in the hospital. J Adv Nurs. 1990, 10: 1128-1131.CrossRef
23.
go back to reference Collins M, Robinson D: Bridging the research-practice gap: the role of the link nurse. Nurs Stand. 1996, 25: 44-46. Collins M, Robinson D: Bridging the research-practice gap: the role of the link nurse. Nurs Stand. 1996, 25: 44-46.
24.
go back to reference Cooper T: Delivering an infection control link nurse programme: improving practice. Br J Infect Control. 2004, 6: 24-27. Cooper T: Delivering an infection control link nurse programme: improving practice. Br J Infect Control. 2004, 6: 24-27.
25.
go back to reference Dawson SJ: The role of the infection control link nurse. J Hosp Infect. 2003, 4: 251-257. quiz 320CrossRef Dawson SJ: The role of the infection control link nurse. J Hosp Infect. 2003, 4: 251-257. quiz 320CrossRef
26.
go back to reference Ross KA: A program for infection surveillance utilizing an infection control liaison nurse. Am J Infect Control. 1982, 1: 24-28.CrossRef Ross KA: A program for infection surveillance utilizing an infection control liaison nurse. Am J Infect Control. 1982, 1: 24-28.CrossRef
27.
go back to reference Bawn R, Matthews T: Improving palliative care. Nurs Times. 2002, 12: 34-35. Bawn R, Matthews T: Improving palliative care. Nurs Times. 2002, 12: 34-35.
28.
go back to reference Cotterell P, Lynch C, Peters D: Bridging the gap: can a link nurse initiative influence palliative care in an acute hospital?. Int J Palliat Nurs. 2007, 3: 102-108.CrossRef Cotterell P, Lynch C, Peters D: Bridging the gap: can a link nurse initiative influence palliative care in an acute hospital?. Int J Palliat Nurs. 2007, 3: 102-108.CrossRef
29.
go back to reference Jack BA, Gambles M, Saltmarsh P, Murphy D, Hutchison T, Ellershaw JE: Enhancing hospital nurses' knowledge of palliative care: a network nurse programme. Int J Palliat Nurs. 2004, 10: 502-506.CrossRefPubMed Jack BA, Gambles M, Saltmarsh P, Murphy D, Hutchison T, Ellershaw JE: Enhancing hospital nurses' knowledge of palliative care: a network nurse programme. Int J Palliat Nurs. 2004, 10: 502-506.CrossRefPubMed
30.
go back to reference Byron S, Moriarty D, O'Hara A: Macmillan nurse facilitators: establishing a palliative resource nurse network in primary care. Int J Palliat Nurs. 2007, 9: 438-444.CrossRef Byron S, Moriarty D, O'Hara A: Macmillan nurse facilitators: establishing a palliative resource nurse network in primary care. Int J Palliat Nurs. 2007, 9: 438-444.CrossRef
31.
go back to reference Aita M, Richer MC, Heon M: Illuminating the processes of knowledge transfer in nursing. Worldviews Evid Based Nurs. 2007, 3: 146-155.CrossRef Aita M, Richer MC, Heon M: Illuminating the processes of knowledge transfer in nursing. Worldviews Evid Based Nurs. 2007, 3: 146-155.CrossRef
32.
go back to reference Rycroft-Malone J: Theory and knowledge translation: setting some coordinates. Nurs Res. 2007, 4: S78-S85.CrossRef Rycroft-Malone J: Theory and knowledge translation: setting some coordinates. Nurs Res. 2007, 4: S78-S85.CrossRef
33.
go back to reference Grol R, Grimshaw J: From best evidence to best practice: effective implementation of change in patients' care. Lancet. 2003, 9391: 1225-1230.CrossRef Grol R, Grimshaw J: From best evidence to best practice: effective implementation of change in patients' care. Lancet. 2003, 9391: 1225-1230.CrossRef
34.
go back to reference Greenhalgh T, Russell J: Promoting the skills of knowledge translation in an online master of science course in primary health care. J Contin Educ Health Prof. 2006, 2: 100-108.CrossRef Greenhalgh T, Russell J: Promoting the skills of knowledge translation in an online master of science course in primary health care. J Contin Educ Health Prof. 2006, 2: 100-108.CrossRef
35.
go back to reference Cooper T: Educational theory into practice: development of an infection control link nurse programme. Nurse Educ Pract. 2001, 1: 35-41. 10.1054/nepr.2001.0007.CrossRefPubMed Cooper T: Educational theory into practice: development of an infection control link nurse programme. Nurse Educ Pract. 2001, 1: 35-41. 10.1054/nepr.2001.0007.CrossRefPubMed
36.
go back to reference Thurston J, Waterworth S: 'Making sense': nurses' experiences of changing practice in caring for dying patients in New Zealand. Int J Palliat Nurs. 2012, 10: 500-507.CrossRef Thurston J, Waterworth S: 'Making sense': nurses' experiences of changing practice in caring for dying patients in New Zealand. Int J Palliat Nurs. 2012, 10: 500-507.CrossRef
38.
go back to reference Boet S, Sharma S, Goldman J, Reeves S: Review article: medical education research: an overview of methods. Can J Anaesth. 2012, 2: 159-170.CrossRef Boet S, Sharma S, Goldman J, Reeves S: Review article: medical education research: an overview of methods. Can J Anaesth. 2012, 2: 159-170.CrossRef
39.
go back to reference Fritsche L, Greenhalgh T, Falck-Ytter Y, Neumayer HH, Kunz R: Do short courses in evidence based medicine improve knowledge and skills? validation of Berlin questionnaire and before and after study of courses in evidence based medicine. BMJ. 2002, 7376: 1338-1341.CrossRef Fritsche L, Greenhalgh T, Falck-Ytter Y, Neumayer HH, Kunz R: Do short courses in evidence based medicine improve knowledge and skills? validation of Berlin questionnaire and before and after study of courses in evidence based medicine. BMJ. 2002, 7376: 1338-1341.CrossRef
40.
go back to reference Cherny NI: Stigma associated with "palliative care". Cancer. 2009, 9: 1808-1812.CrossRef Cherny NI: Stigma associated with "palliative care". Cancer. 2009, 9: 1808-1812.CrossRef
41.
go back to reference Ferrell BR: Late referrals to palliative care. J Clin Oncol. 2005, 12: 2588-2589. Ferrell BR: Late referrals to palliative care. J Clin Oncol. 2005, 12: 2588-2589.
42.
go back to reference Johnson CE, Girgis A, Paul CL, Currow DC: Cancer specialists' palliative care referral practices and perceptions: results of a national survey. Palliat Med. 2008, 1: 51-57.CrossRef Johnson CE, Girgis A, Paul CL, Currow DC: Cancer specialists' palliative care referral practices and perceptions: results of a national survey. Palliat Med. 2008, 1: 51-57.CrossRef
43.
go back to reference Morita T, Akechi T, Ikenaga M, Kizawa Y, Kohara H, Mukaiyama T: Late referrals to specialized palliative care service in Japan. J Clin Oncol. 2005, 12: 2637-2644. Morita T, Akechi T, Ikenaga M, Kizawa Y, Kohara H, Mukaiyama T: Late referrals to specialized palliative care service in Japan. J Clin Oncol. 2005, 12: 2637-2644.
44.
go back to reference Curtis JR, Patrick DL, Engelberg RA, Norris K, Asp C, Byock I: A measure of the quality of dying and death. Initial validation using after-death interviews with family members. J Pain Symptom Manage. 2002, 1: 17-31.CrossRef Curtis JR, Patrick DL, Engelberg RA, Norris K, Asp C, Byock I: A measure of the quality of dying and death. Initial validation using after-death interviews with family members. J Pain Symptom Manage. 2002, 1: 17-31.CrossRef
45.
go back to reference Hales S, Zimmermann C, Rodin G: The quality of dying and death. Arch Intern Med. 2008, 9: 912-918.CrossRef Hales S, Zimmermann C, Rodin G: The quality of dying and death. Arch Intern Med. 2008, 9: 912-918.CrossRef
46.
go back to reference Lehr R: Sixteen S-squared over D-squared: a relation for crude sample size estimates. Stat Med. 1992, 8: 1099-1102.CrossRef Lehr R: Sixteen S-squared over D-squared: a relation for crude sample size estimates. Stat Med. 1992, 8: 1099-1102.CrossRef
47.
go back to reference Stewart AL, Teno J, Patrick DL, Lynn J: The concept of quality of life of dying persons in the context of health care. J Pain Symptom Manage. 1999, 2: 93-108.CrossRef Stewart AL, Teno J, Patrick DL, Lynn J: The concept of quality of life of dying persons in the context of health care. J Pain Symptom Manage. 1999, 2: 93-108.CrossRef
49.
go back to reference Singer PA, Martin DK, Kelner M: Quality end-of-life care: patients' perspectives. JAMA. 1999, 2: 163-168.CrossRef Singer PA, Martin DK, Kelner M: Quality end-of-life care: patients' perspectives. JAMA. 1999, 2: 163-168.CrossRef
50.
go back to reference Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, McIntyre L, Tulsky JA: Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA. 2000, 19: 2476-2482.CrossRef Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, McIntyre L, Tulsky JA: Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA. 2000, 19: 2476-2482.CrossRef
51.
go back to reference Engelberg RA, Patrick DL, Curtis JR: Correspondence between patients' preferences and surrogates' understandings for dying and death. J Pain Symptom Manage. 2005, 6: 498-509.CrossRef Engelberg RA, Patrick DL, Curtis JR: Correspondence between patients' preferences and surrogates' understandings for dying and death. J Pain Symptom Manage. 2005, 6: 498-509.CrossRef
52.
go back to reference Steinhauser KE, Clipp EC, Tulsky JA: Evolution in measuring the quality of dying. J Palliat Med. 2002, 3: 407-414.CrossRef Steinhauser KE, Clipp EC, Tulsky JA: Evolution in measuring the quality of dying. J Palliat Med. 2002, 3: 407-414.CrossRef
53.
go back to reference Fowler FJ, Coppola KM, Teno JM: Methodological challenges for measuring quality of care at the end of life. J Pain Symptom Manage. 1999, 2: 114-119.CrossRef Fowler FJ, Coppola KM, Teno JM: Methodological challenges for measuring quality of care at the end of life. J Pain Symptom Manage. 1999, 2: 114-119.CrossRef
54.
go back to reference Steinhauser KE, Bosworth HB, Clipp EC, McNeilly M, Christakis NA, Parker J: Initial assessment of a new instrument to measure quality of life at the end of life. J Palliat Med. 2002, 6: 829-841.CrossRef Steinhauser KE, Bosworth HB, Clipp EC, McNeilly M, Christakis NA, Parker J: Initial assessment of a new instrument to measure quality of life at the end of life. J Palliat Med. 2002, 6: 829-841.CrossRef
55.
go back to reference Mularski R, Curtis JR, Osborne M, Engelberg RA, Ganzini L: Agreement among family members in their assessment of the quality of dying and death. J Pain Symptom Manage. 2004, 4: 306-315.CrossRef Mularski R, Curtis JR, Osborne M, Engelberg RA, Ganzini L: Agreement among family members in their assessment of the quality of dying and death. J Pain Symptom Manage. 2004, 4: 306-315.CrossRef
56.
go back to reference Albers G, Echteld MA, de Vet HC, Onwuteaka-Philipsen BD, van der Linden MH, Deliens L: Content and spiritual items of quality-of-life instruments appropriate for use in palliative care: a review. J Pain Symptom Manage. 2010, 2: 290-300.CrossRef Albers G, Echteld MA, de Vet HC, Onwuteaka-Philipsen BD, van der Linden MH, Deliens L: Content and spiritual items of quality-of-life instruments appropriate for use in palliative care: a review. J Pain Symptom Manage. 2010, 2: 290-300.CrossRef
57.
go back to reference Mayland CR, Williams EMI, Ellershaw JE: How well do current instruments using bereaved relatives' views evaluate care, for dying patients?. Palliat Med. 2008, 2: 133-144.CrossRef Mayland CR, Williams EMI, Ellershaw JE: How well do current instruments using bereaved relatives' views evaluate care, for dying patients?. Palliat Med. 2008, 2: 133-144.CrossRef
58.
go back to reference Hales S, Zimmermann C, Rodin G: Review: the quality of dying and death: a systematic review of measures. Palliat Med. 2010, 2: 127-144.CrossRef Hales S, Zimmermann C, Rodin G: Review: the quality of dying and death: a systematic review of measures. Palliat Med. 2010, 2: 127-144.CrossRef
59.
go back to reference Mayland CR, Williams EM, Ellershaw JE: Assessing quality of care for the dying: the development and initial validation of a postal self-completion questionnaire for bereaved relatives. Palliat Med. 2012, 7: 897-901.CrossRef Mayland CR, Williams EM, Ellershaw JE: Assessing quality of care for the dying: the development and initial validation of a postal self-completion questionnaire for bereaved relatives. Palliat Med. 2012, 7: 897-901.CrossRef
60.
go back to reference Watts T: End-of-life care pathways as tools to promote and support a good death: a critical commentary. Eur J Cancer Care (Engl). 2012, 1: 20-30.CrossRef Watts T: End-of-life care pathways as tools to promote and support a good death: a critical commentary. Eur J Cancer Care (Engl). 2012, 1: 20-30.CrossRef
61.
go back to reference Medical Research Council: A framework for development and evaluation of RTC'S for complex interventions to improve health. 2000, MRC London Medical Research Council: A framework for development and evaluation of RTC'S for complex interventions to improve health. 2000, MRC London
62.
go back to reference Roberts C, Casey D: An infection control link nurse network in the care home setting. Br J Nurs. 2004, 3: 166-170.CrossRef Roberts C, Casey D: An infection control link nurse network in the care home setting. Br J Nurs. 2004, 3: 166-170.CrossRef
Metadata
Title
Improving the quality of palliative and terminal care in the hospital by a network of palliative care nurse champions: the study protocol of the PalTeC-H project
Authors
Frederika E Witkamp
Lia van Zuylen
Paul J van der Maas
Helma van Dijk
Carin CD van der Rijt
Agnes van der Heide
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2013
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-13-115

Other articles of this Issue 1/2013

BMC Health Services Research 1/2013 Go to the issue