Large differences in the organization of palliative care in nursing homes in six European countries: findings from the PACE cross-sectional study
Creators
- 1. End-of-Life Care Research Group, Department of Family Medicine & Chronic Care, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium
- 2. Department of Geriatric Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
- 3. EMGO Institute for Health and Care Research, Department of Public and Occupational Health, Expertise Center for Palliative Care, VU University Medical Center, Van der Boechorstraat 7, 1081 BT, Amsterdam, The Netherlands
- 4. Faculty of Health And Medicine, Lancaster University, 46 Bardsea, Bailrigg, Lancaster, LA14YX, UK
- 5. Department of Sociology of Medicine, Chair of Epidemiology and Preventive Medicine, Medical Faculty, Jagiellonian University Medical College, ul. Kopernika 7a, 31-034, Kraków, Poland
- 6. Department of Internal Medicine, Istituto Di Medicina Interna E Geriatria, Università Cattolica del Sacro Cuore, Largo F. Vito, 1 – 00135, Rome, Italy
- 7. National Institute for Health and Welfare, Mannerheimintie 166, P.O. Box 30, 00271, Helsinki, Finland
Description
Background: To be able to provide high-quality palliative care, there need to be a number of organizational structures available in the nursing homes. It is unclear to what extent such structures are actually present in nursing homes in Europe. We aim to examine structural indicators for quality of palliative care in nursing homes in Europe and to evaluate the differences in terms of availability of and access to palliative care, infrastructure for residents and families, multidisciplinary meetings and quality improvement initiatives.
Methods: A PACE cross-sectional study (2015) of nursing homes in Belgium, England, Finland, Italy, the Netherlands and Poland. Nursing homes (N = 322) were selected in each country via proportional stratified random sampling. Nursing home administrators (N = 305) filled in structured questionnaires on nursing home characteristics. Organization of palliative care was measured using 13 of the previously defined IMPACT structural indicators for quality of palliative care covering four domains: availability of and access to palliative care, infrastructure for residents and families, multidisciplinary meetings and quality improvement initiatives. We calculated structural indicator scores for each country and computed differences in indicator scores between the six countries. Pearson's Chi-square test was used to compute the p-value of each difference.
Results: The availability of specialist palliative care teams in nursing homes was limited (6.1–48.7%). In Finland, Poland and Italy, specialist advice was also less often available (35.6–46.9%). Up to 49% of the nursing homes did not provide a dedicated contact person who maintained regular contact with the resident and relatives. The 24/7 availability of opioids for all nursing home residents was low in Poland (37.5%).
Conclusions: This study found a large heterogeneity between countries in the organization of palliative care in nursing homes, although a common challenge is ensuring sufficient structural access to specialist palliative care services. Policymakers and health and palliative care organizations can use these structural indicators to identify areas for improvement in the organization of palliative care.
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