Agreement of Nursing Home Staff With Palliative Care Principles: A PACE Cross-sectional Study Among Nurses and Care Assistants in Five European Countries

Abstract

Context. To provide high-quality palliative care to nursing home residents, staff need to understand the basic principles of palliative care. Objectives. To evaluate the extent of agreement with the basic principles of palliative care of nurses and care assistants working in nursing homes in five European countries and to identify correlates. Methods. This is a cross-sectional study in 214 homes in Belgium, England, Italy, the Netherlands, and Poland. Agreement with basic principles of palliative care was measured with the Rotterdam MOVE2PC. We calculated percentages and odds ratios of agreement and an overall score between 0 (no agreement) and 5 (total agreement). Results. Most staff in all countries agreed that palliative care involves more than pain treatment (58% Poland to 82% Belgium) and includes spiritual care (62% Italy to 76% Belgium) and care for family or relatives (56% Italy to 92% Belgium). Between 51% (the Netherlands) and 64% (Belgium) correctly disagreed that palliative care should start in the last week of life and 24% (Belgium) to 53% (Poland) agreed that palliative care and intensive life-prolonging treatment can be combined. The overall agreement score ranged between 1.82 (Italy) and 3.36 (England). Older staff (0.26; 95% confidence interval [CI]: 0.09e0.43, P ¼ 0.003), nurses (0.59; 95% CI: 0.43e0.75, P < 0.001), and staff who had undertaken palliative care training scored higher (0.21; 95% CI: 0.08e0.34, P ¼ 0.002). Conclusions. The level of agreement of nursing home staff with basic principles of palliative care was only moderate and differed between countries. Efforts to improve the understanding of basic palliative care are needed.

Potentially Inappropriate Treatments at the End of Life in Nursing Home Residents: Findings From the PACE Cross-Sectional Study in Six European Countries

“…In Europe, an increasing number of older people spend their last months in nursing homes and up to 38% of people over 65 years die there (1). We conducted the PACE (Palliative Care for Older People) cross-sectional study in nursing homes in Belgium, England, Finland, Italy, the Netherlands and Poland(2), and demonstrated that residents in these countries die at a mean age of 85 years, often with advanced dementia, multiple comorbidities and clinical complications (1,3,4).…”

“…In Europe, an increasing number of older people spend their last months in nursing homes and up to 38% of people over 65 years die there (1). We conducted the PACE (Palliative Care for Older People) cross-sectional study in nursing homes in Belgium, England, Finland, Italy, the Netherlands and Poland(2), and demonstrated that residents in these countries die at a mean age of 85 years, often with advanced dementia, multiple comorbidities and clinical complications (1,3,4). This makes them a particularly vulnerable population for whom providing appropriate treatments at the end of life is crucial, albeit challenging (1,(3)(4)(5)(6)(7)(8).The difficulty of predicting death in older people complicates the decision on whether a treatment or medication is still appropriate (9); staff are sometimes too optimistic about the benefits of such treatments (10,11), and residents are often poorly informed of the possible complications (12).…”

Perception of the Care Concept by Nurses and the Factors Influencing Their Perception: A Qualitative Study

“…Various definitions in nursing literature commonly emphasize the importance of considering the physical, social, psychological, and cultural aspects when meeting an individual's needs. 4,[18][19][20][21][22][23][24][25] However, we observed that nurses who participated in our study tended to define care more narrowly than these literature definitions, viewing it predominantly as physical nursing care. This observation suggests that the prevailing medical model in Türkiye, which has historically dominated nursing care, may influence nurses to perceive patients primarily in physical terms and overlook the importance of individualized and holistic care.…”

NUrsing Homes End of Life care Program (NUHELP): developing a complex intervention

“…Firstly, a core element in the development of the program was training at nursing homes, which was intended to increase self-efficacy in palliative care and improve the attitudes of nursing home professionals towards end-of-life care. As noted by Honinx et al [ 42 ], for interventions to be successful, it is necessary to improve the training of nursing home professionals in palliative care. The project PACE [ 43 ] concluded that greater efforts were needed to increase understanding of palliative care in these institutions, albeit with different training strategies required depending on the country.…”