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BMC Palliative Care
Published in: BMC Palliative Care 1/2017

Open Access 01-12-2017 | Study protocol

Pain Intervention for people with Dementia in nursing homes (PID): study protocol for a quasi-experimental nurse intervention

Authors: Andrea Koppitz, Georg Bosshard, Geneviève Blanc, Hannele Hediger, Sheila Payne, Thomas Volken

Published in: BMC Palliative Care | Issue 1/2017

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Abstract

Background

It is estimated that 19 to 83% of people with dementia suffer from pain that is inadequately treated in the last months of life. A large number of healthcare workers who care for these people in nursing homes lack appropriate expertise and may therefore not always recognise, assess and treat pain in those with dementia who have complex problems on time, properly and efficiently. The aim of this intervention trial is to identify care needs of people with dementia suffering from pain living in a nursing home.

Methods

A quasi-experimental nurse-led intervention trial based on a convenience sample of four nursing homes in the Swiss Canton of Zurich examines the effects on dementia patients (n = 411), the healthcare institution and the qualification level of the healthcare workers compared to historical controls, using an event analysis and a multilevel analysis. Healthcare workers will be individually trained how to assess, intervene and evaluate acute and chronic pain. There are three data-monitoring cycles (T0, T1, T2) and two intervention cycles (I1, I2) with a total study duration of 425 days. There is also a process evaluation based on Dobbins analyses that analyse in particular the potentials for change in clinical practice of change agents.

Discussion

The aim of the intervention trial is to improve pain management strategies in older people with dementia in nursing homes. Clinically significant findings will be expected that will help reduce suffering in the sense of “total pain” for people with dementia. The joint intra- and interdisciplinary collaboration between practice and supply-oriented (nursing) research will have both a lasting effect on the efficiency measurement and provide scientifically sound results. Nursing homes can integrate the findings from the intervention trial into their internal quality control process. The potential for improvements can be directly influenced by the nursing home itself.

Trial registration

Registration trial number: DRKS00009726 on DRKS, registered 10 January 2017, retrorespectively registered. Clearance certificate is available of the ethics committees of the canton of Thurgau, Switzerland, number: TG K201-02, and Zurich, Switzerland, number: ZH 01–2016.
Literature
1.
2.
Zuniga F, Ausserhofer D, Serdaly C, Bassal C, De Geest S, Schwendimann R. Schlussbericht zur Befragung des Pflege- und Betreuungspersonals in Alters- und Pflegeinstitutionen der Schweiz. Basel: Universität Basel; 2013.
3.
Di Giulio P, Toscani F, Villani D, Brunelli C, Gentile S, Spadin P. Dying with advanced dementia in long-term care geriatric institutions: a retrospective study. J Palliat Med. 2008;11(7):1023–8.CrossRefPubMed
4.
Fabbro ED, Dalal S, Bruera E. Symptom control in palliative care-Part II: Cachexia/anorexia and fatigue. J Palliat Med. 2006;9(2):409–21.CrossRefPubMed
5.
Förstl H, Bickel H, Kurz A, Borasio G. Sterben mit Demenz. Fortschritte der Neurologie · Psychiatrie. 2010;78(04):203–12.PubMed
6.
Hughes JC, Jolley D, Jordan A, Sampson EL. Palliative care in dementia: issues and evidence. Adv Psychiatr Treat. 2007;13(4):251–60.CrossRef
7.
8.
van der Steen JT. Dying with dementia: what we know after more than a decade of research. J Alzheimers Dis. 2010;22(1):37–55.CrossRefPubMed
9.
Chang E, Hancock K, Harrison K, et al. Palliative care for end-stage dementia: A discussion of the implications for education of health care professionals. Nurse Educ Today. 2005;25(4):326–32.CrossRefPubMed
10.
Reynolds K, Henderson M, Schulman A, Hanson LC. Needs of the dying in nursing homes. J Palliat Med. 2002;5(6):895–901.CrossRefPubMed
11.
Roger KS. A literature review of palliative care, end of life, and dementia. Palliat Support Care. 2006;4(03):295–303.CrossRefPubMed
12.
Wowchuk SM, McClement S, Bond Jr J. The challenge of providing palliative care in the nursing home: part 1 external factors. Int J Palliat Nurs. 2006;12(6):260–8.CrossRefPubMed
13.
Cervo FA, Bryan L, Farber S. To PEG or not to PEG: A Review of Evidence for Placing Feeding Tubes in Advanced Dementia and the Decision-making Process. Geriatrics. 2006;61(6):30–5.PubMed
14.
Zwakhalen SM, Koopmans RT, Geels PJ, Berger MP, Hamers JP. The prevalence of pain in nursing home residents with dementia measured using an observational pain scale. Eur J Pain. 2009;13(1):89–93.CrossRefPubMed
15.
Nourhashemi F, Gillette S, Cantet C, et al. End-of-life care for persons with advanced Alzheimer disease: design and baseline data from the ALFINE study. J Nutr Health Aging. 2012;16(5):457–61.CrossRefPubMed
16.
Sampson EL, Jones L, Thuné-Boyle IC, et al. Palliative assessment and advance care planning in severe dementia: an exploratory randomized controlled trial of a complex intervention. Palliat Med. 2010;25(3):197–209.CrossRef
17.
Morrison RS, Siu AL. A Comparison of Pain and Its Treatment in Advanced Dementia and Cognitively Intact Patients with Hip Fracture. J Pain Symptom Manage. 2000;19(4):240–8.CrossRefPubMed
18.
Goodman C, Evans C, Wilcock J, et al. End of life care for community dwelling older people with dementia: an integrated review. Int J Geriatr Psychiatry. 2010;25(4):329–37.CrossRefPubMed
19.
Koppitz A, Bosshard G, Händler Schuster D, Hediger H, Imhof L. Type and course of symptoms demonstrated in the terminal and dying phases by people with dementia in nursing homes. Zeitschrift Für Gerontologie und Geriatrie. 2015;48(2):176–83.CrossRefPubMed
20.
Husebo BS, Ballard C, Aarsland D. Pain treatment of agitation in patients with dementia: a systematic review. Int J Geriatr Psychiatry. 2011;26(10):1012–8.CrossRefPubMed
21.
Pieper MJ, van Dalen-Kok AH, Francke AL, et al. Interventions targeting pain or behaviour in dementia: A systematic review. Ageing Res Rev. 2013;12(4):1042–55.CrossRefPubMed
22.
23.
McAuliffe L, Brown D, Fetherstonhaugh D. Pain and dementia: an overview of the literature. Int J Older People Nurs. 2012;7(3):219–26.CrossRefPubMed
24.
Herr K, Bjoro K, Decker S. Tools for assessment of pain in nonverbal older adults with dementia: a state-of-the-science review. J Pain Symptom Manage. 2006;31(2):170–92.CrossRefPubMed
25.
Cohen-Mansfield J, Thein K, Marx MS, Dakheel-Ali M. What are the barriers to performing nonpharmacological interventions for behavioral symptoms in the nursing home? J Am Med Dir Assoc. 2012;13(4):400–5.CrossRefPubMed
26.
Cody M, Beck C, Svarstad BL. Challenges to the use of nonpharmacologic interventions in nursing homes. Psychiatr Serv. 2002;53(11):1402–6.CrossRefPubMed
27.
Jones RW. Barriers to optimal intervention and care for people with dementia. Int J Clin Pract. 2005;59(3):266–7.CrossRefPubMed
28.
Kovach CR, Kelber ST, Simpson M, Wells T. Behaviors of nursing home residents with dementia: examining nurse responses. J Gerontol Nurs. 2006;32(6):13–21.PubMed
29.
Bradford A, Shrestha S, Snow AL, et al. Managing pain to prevent aggression in people with dementia: a nonpharmacologic intervention. Am J Alzheimers Dis Other Demen. 2012;27(1):41–7.CrossRefPubMed
30.
Bartholomeyczik S, Holle D, Halek M. Herausforderndes Verhalten bei Menschen mit Demenz verstehen: die Verbesserung der Versorgung Demenzkranker durch Qualitätsinstrumente. Von der Arbeit beim Leuchtturmprojekt Demenz des Bundesgesundheitsministeriums. Weinheim; Basel: Beltz Juventa; 2013.
31.
Hamric AB, Hanson CM, Tracy MF, O’Grady ET. Advanced practice nursing : an integrative approach. St. Louis: Elsevier; 2014.
32.
Donald F, Martin‐Misener R, Carter N, et al. A systematic review of the effectiveness of advanced practice nurses in long‐term care. J Adv Nurs. 2013;69(10):2148–61.CrossRefPubMed
33.
Obsan SG. Gesundheitspersonal in der Schweiz – Bestandesaufnahme und Perspektiven bis 2020. . Neuchàtel 07 Mar 2009 2009.
34.
Aminoff BZ, Adunsky A. Dying dementia patients: too much suffering, too little palliation. Am J Alzheimers Dis Other Demen. 2004;19(4):243–7.CrossRefPubMed
35.
Aminoff BZ, Adunsky A. Their last 6 months: suffering and survival of end-stage dementia patients. Age Ageing. 2006;35(6):597–601.CrossRefPubMed
36.
Penfold RB, Zhang F. Use of Interrupted Time Series Analysis in Evaluating Health Care Quality Improvements. Acad Pediatr. 2013;13(6):S38–44.CrossRefPubMed
37.
Spring A, Eicher S, Riese F. Die Zürcher Verlaufsstudie zu Leben und Sterben mit fortgeschrittener Demenz (ZULIDAD). Palliative ch. 2013;4:41–4.
38.
Newhouse R, Stanik-Hutt J, White K, et al. Advanced practice nurse outcomes 1990–2008: a systematic review. Nurs Econ. 2011;29(Sep-Oct (5)):230–50.PubMed
39.
40.
Schuler M, Becker S, Kaspar R, Nikolaus T, Kruse A, Basler H. Psychometric properties of the German Pain Assessment in Dementia Scale (PAINAD-G) in nursing home residents. J Am Med Dir Assoc. 2007;8(6):388–95.CrossRefPubMed
41.
Hsieh FY, Lavori PW. Sample-Size Calculations for the Cox Proportional Hazards Regression Model with Nonbinary Covariates. Control Clin Trials. 2000;21(6):552–60.CrossRefPubMed
42.
43.
Dunphy LMH. Primary care: the art and science of advanced practice nursing. 2015.
44.
Zwakhalen SMG, Hof CE, Hamers JPH. Systematic pain assessment using an observational scale in nursing home residents with dementia: exploring feasibility and applied interventions. J Clin Nurs. 2012;21(21/22):3009–17.CrossRefPubMed
45.
Dobbins M, Ciliska D, Cockerill R, Barnsley J, DiCenso A. A framework for the dissemination and utilization of research for health-care policy and practice. Online J Knowl Synth Nurs. 2002;9:7.PubMed
46.
47.
Rabe-Hesketh S, Skrondal A. Multilevel and longitudinal modeling using Stata. 2, 2, vol. 1. College Station: Stata Press; 2012.
48.
ICH ewg. Guideline for good clinical practice. ICH Harmonised Tripartite Guideline. E6(R1). The International Conference on Harmonization of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH). (1996; 59 pages) 10 June 1996, 1996.
49.
World Medical Association W. World medical association declaration of helsinki: Ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–94. doi:10.​1001/​jama.​2013.​281053.
50.
Polit DFBCTPDF. Resource manual for nursing research : generating and assessing evidence for nursing practice. Philadelphia: Wolters Kluwer Health/lippincott Williams & Wilkins; 2012.
51.
SAMW (SAMS) SAoMS. Forschung mit Menschen. Ein Leitfaden für die Praxis. Bern: SAMS; 2015.
Metadata
Title
Pain Intervention for people with Dementia in nursing homes (PID): study protocol for a quasi-experimental nurse intervention
Authors
Andrea Koppitz
Georg Bosshard
Geneviève Blanc
Hannele Hediger
Sheila Payne
Thomas Volken
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Palliative Care / Issue 1/2017
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-017-0200-5

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