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Palliative Care Implementation in Long-Term Care Facilities: European Association for Palliative Care White Paper

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<mark>Journal publication date</mark>1/08/2020
<mark>Journal</mark>Journal of the American Medical Directors Association
Issue number8
Volume21
Number of pages7
Pages (from-to)1051-1057
Publication StatusPublished
Early online date28/02/20
<mark>Original language</mark>English

Abstract

Objectives
The number of older people dying in long-term care facilities (LTCFs) is increasing globally, but care quality may be variable. A framework was developed drawing on empirical research findings from the Palliative Care for Older People (PACE) study and a scoping review of literature on the implementation of palliative care interventions in LTCFs. The PACE study mapped palliative care in LTCFs in Europe, evaluated quality of end-of-life care and quality of dying in a cross-sectional study of deceased residents of LTCFs in 6 countries, and undertook a cluster-randomized control trial that evaluated the impact of the PACE Steps to Success intervention in 7 countries. Working with the European Association for Palliative Care, a white paper was written that outlined recommendations for the implementation of interventions to improve palliative and end-of-life care for all older adults with serious illness, regardless of diagnosis, living in LTCFs. The goal of the article is to present these key domains and recommendations.

Design
Transparent expert consultation.

Setting
International experts in LTCFs.

Participants
Eighteen (of 20 invited) international experts from 15 countries participated in a 1-day face-to-face Transparent Expert Consultation (TEC) workshop in Bern, Switzerland, and 21 (of 28 invited) completed a follow-up online survey.

Methods
The TEC study used (1) a face-to-face workshop to discuss a scoping review and initial recommendations and (2) an online survey.

Results
Thirty recommendations about implementing palliative care for older people in LTCFs were refined during the TEC workshop and, of these, 20 were selected following the survey. These 20 recommendations cover domains at micro (within organizations), meso (across organizations), and macro (at national or regional) levels addressed in 3 phases: establishing conditions for action, embedding in everyday practice, and sustaining ongoing change.

Conclusions and implications
We developed a framework of 20 recommendations to guide implementation of improvements in palliative care in LTCFs.