Increasing the Number of Patients Receiving Information About Transition to End-of-life Care

Study Overview
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Brief Summary
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Introduction: Honest prognostication and information for patients are important parts of end-of-life care. This study examined whether an educational intervention could increase the proportion of patients who received information about the transition to end-of-life care (ITEOL). Method: Two municipalities (in charge of nursing homes) and two hospitals were randomized to receive an interactive half-day course about ITEOL for physicians and nurses. The proportion of patients who received ITEOL was measured with data from the Swedish Register of Palliative Care (SRPC). Patients were only included if they died an expected death and maintained their ability to express their will until days or hours before their death. Four hospitals and four municipalities were assigned controls, matched by hospital size, population, and proportion of patients receiving ITEOL at baseline.

Official Title
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Increasing the Number of Patients Receiving Information About Transition to End-of-life Care: the Effect of a Half-day Physician and Nurse Training

Conditions
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Palliative Care, Disclosure

Intervention / Treatment
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* Other: Educative intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Hospitals and municipalities: Participation in the Swedish Register of Palliative Care. Patients: Reported from an included hospital or municipality during six months before to six months after intervention. Exclusion Criteria: Hospitals and municipalities: Exclusion criteria were more than 40% patients receiving ITEOL at start of study, too large for an intervention due to practical reasons (university hospitals or municipalities with over 100 000 inhabitants), and hospitals not containing both internal medicine and surgery departments. Patients were excluded when death was unexpected, when a forensic post mortem examination was performed, or when the patients had lost their ability to express their will and take part in decisions concerning the content of medical care one week or more before death.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Educative intervention<br>Two municipalities (in charge of nursing homes) and two hospitals were randomized to receive an interactive half-day course about ITEOL for physicians and nurses. | Other: Educative intervention<br>* Two municipalities (in charge of nursing homes) and two hospitals were randomized to receive an interactive half-day course about ITEOL for physicians and nurses.<br>|
| No Intervention: No intervention<br>No intervention. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The proportion of patients who received ITEOL | The proportion of patients who received ITEOL was measured with data from the Swedish Register of Palliative Care (SRPC). Six months after the intervention data were collected from the SRPC for all patients who had died at the included hospitals and municipalities. Data were collected from six months before the intervention to six months after the intervention. The outcome was compared before and after the intervention. | Six months after intervention |