Improving Quality of Care for the Dying Patient in Hospice: A Quasi Experimental Trial in Liguria Region

Study Overview
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Brief Summary
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This is a before-after phase II study, according to the Medical Research Council framework, investigating the feasibility of introducing the Liverpool Care Pathway for the dying patient (LCP) in 5 Ligurian hospices.

Conditions
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End-of-Life

Intervention / Treatment
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* Other: LCP Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients deceased in the hospice during the evaluation period Approval of ethics committee Exclusion Criteria: Prior use of LCP in the hospice Deceased was a relative of a hospice member of staff
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

Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: LCP Program<br>The LCP Program is continuous quality improvement program of end-of-life care implemented in hospice | Other: LCP Program<br>* The LCP Program is continuous quality improvement program of end-of-life care implemented in hospice<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| feasibility of LCP implementation | measured as proportion of hospices that complete the experimental phase of introducing the LCP Program and maintain the program in the 6 months subsequent the process of experimental LCP implementation | 6 months after the end of LCP implementation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| quality of information provided to patients and to family | measured with the scale 1 (Informing and promoting shared decision making) from the Toolkit After-death bereaved family member interview (Teno 2001). The Toolkit will be administered to non-professional caregivers 2-4 months after the patient's death | 2-4 months after the patient's death | 
| Level of advanced care planning among patients | measured with the scale 2 (Encouraging advance care planning) from the Toolkit After-death bereaved family member interview (Teno 2001). The Toolkit will be administered to non-professional caregivers 2-4 months after the patient's death | 2 - 4 months after the patient's death | 
| Provision of care focusing on patient's individual needs. | measured with the scale 3 (Focus on individual) from the Toolkit After-death bereaved family member interview (Teno 2001). The Toolkit will be administered to non-professional caregivers 2-4 months after the patient's death | 2 - 4 months after the patient's death | 
| Quality of emotional support to family members before an after the patient's death | measured with the scale 4 (Attending to the emotional and spiritual needs of the family) from the Toolkit After-death bereaved family member interview (Teno 2001). The Toolkit will be administered to non-professional caregivers 2-4 months after the patient's death | 2 - 4 months after the patient's death | 
| Level of care coordination | measured with the scale 5 (Providing coordination of care) from the Toolkit After-death bereaved family member interview (Teno 2001). The Toolkit will be administered to non-professional caregivers 2-4 months after the patient's death | 2 - 4 months after the patient's death | 
| Family support levels | measured with the scale 6 (Supporting the self-efficacy of the family) from the Toolkit After-death bereaved family member interview (Teno 2001). The Toolkit will be administered to non-professional caregivers 2-4 months after the patient's death | 2 - 4 months after the death of the patient | 
| Appropriateness of therapeutic and diagnostic procedures | measured with a specific tool in which all diagnostic and therapeutic procedures and drugs administered to the patient during the last 3 days of life are reported | the last 3 days of life | 
| Overall quality of care experience for patients and family | measured with the scale 7 (Overall quality of care provided to patients and family) from the Toolkit After-death bereaved family member interview (Teno 2001). The Toolkit will be administered to non-professional caregivers 2-4 months after the patient's death | 2 - 4 months after the death of the patient | 
| Quality of communication between General Practitioner and hospice | measured with a telephonic interview | an expected average of 2 months after the patient's death | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dying, Patients, Hospice, Liverpool Care Pathways