Expired Study
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Omaha, Nebraska 68198


Purpose:

The purpose of this study is to examine key organizational structures and processes (leadership, teamwork, communication, palliative care) and their impact on the quality of end-of-life care for dying residents and their family members.


Study summary:

As the American population ages, nursing homes are rapidly becoming a dominant site for death. Currently, 25% of all deaths occur in nursing homes and 35% of all elders over the age of 85 die in nursing homes. By 2020, 40% of those over 65 will die in nursing homes. Nursing home residents die in pain with undue psychosocial suffering. For all permanently placed residents, death is inevitable. Nonetheless, how residents die, is not. There have been long standing concerns about the quality of care and quality of life in nursing homes. Although there is some evidence that the quality of care for nursing home residents has improved, serious problems continue in areas that potentially affect end-of-life such as dehydration, pressure ulcers, and pain. Efforts to improve care have rarely considered the dynamic nature of nursing home structure and process factors, such as staffing levels, leadership of the director of nursing, or communication and teamwork among staff that facilitate or impede the organization's ability to improve care processes. Findings from our preliminary studies in nursing homes indicate that organizational structure and process factors make a difference in end-of-life care for residents and their family members. More specifically, staff education, staffing levels, leadership of the DON and administrator, teamwork and communication among direct care staff, and incorporating palliative care clinical practices into day-to-day care had a profound impact on outcomes such as the honoring of end-of-life preferences, symptom management, and satisfaction with care. A more generalizable understanding of key structure and process factors and their relationship to resident care and outcomes at the end-of-life will provide a foundation for future intervention studies aimed at improving care.


Criteria:

Inclusion Criteria (Nursing Homes): - 60 beds or greater Exclusion Criteria (Nursing Homes): - less than 60 beds Inclusion Criteria (Nursing Home Staff): - 19 years of age or older - trained to provide resident care Exclusion Criteria (Nursing Homes): - less than 19 years of age - staff on units exclusively Medicare or average length of stay less than 30 days Inclusion Criteria (Family Member/Significant Other): - 19 years of age or older - somewhat to very involved in resident's care and decision-making Exclusion Criteria (Family Member/Significant Other): - not involved in resident's care and decision-making - resident was in the nursing home less than 31 days - resident was less than 65 years old


Study is Available At:


Original ID:

433-06


NCT ID:

NCT00616473


Secondary ID:

7 R01 NR009547-02


Study Acronym:


Brief Title:

Quality End-of-Life Care in Nursing Homes


Official Title:

The Impact of Quality End-of-Life Care in Nursing Homes


Overall Status:

Completed


Study Phase:

N/A


Genders:

Both


Minimum Age:

19 Years


Maximum Age:

N/A


Quick Facts

Healthy Volunteers
Oversight Has DMC
Study Is FDA Regulated
Study Is Section 801
Has Expanded Access

Study Source:

University of Nebraska


Oversight Authority:

United States: Institutional Review Board


Reasons Why Stopped:


Study Type:

Observational


Study Design:

Observational Model: Case-Only, Time Perspective:


Number of Arms:

0


Number of Groups:

2


Total Enrollment:

8500


Enrollment Type:

Anticipated


Overall Contact Information

Official Name:Sarah A Thompson, RN, PhD
Principal Investigator
University of Nebraska

Study Dates

Start Date:January 2007
Completion Date:January 2011
Completion Type:Actual
Primary Completion Date:January 2011
Primary Completion Type:Actual
Verification Date:February 2008
Last Changed Date:December 1, 2014
First Received Date:February 4, 2008

Study Outcomes

Outcome Type:Primary Outcome
Measure:The influence on palliative care of communication, leadership, and teamwork.
Time Frame:Nursing home staff: at beginning and end of study; family members: following the death of nursing ho
Safety Issues:False
Outcome Type:Secondary Outcome
Measure:Associations among structure (staffing), non-clinical (communication, leadership, teamwork) and clinical (palliative care) care processes and quality of end-of-life care.
Time Frame:Nursing home staff: at beginning and end of study; family members: following the death of nursing ho
Safety Issues:False
Outcome Type:Secondary Outcome
Measure:Unruh and Wan's expanded structure, process, and outcomes model in the context of nursing home palliative care.
Time Frame:Nursing home staff: at beginning and end of study; family members: following the death of nursing ho
Safety Issues:False

Study Interventions

There are no available Study Interventions

Study Arms

Study Arm Type:Other
Arm Name:1 Nursing Home Staff
Description:Direct care staff
Study Arm Type:Other
Arm Name:2 Family Members
Description:Family members/Significant other of nursing home resident.

Study Agencies

Agency Class:Other
Agency Type:Lead Sponsor
Agency Name:University of Nebraska
Agency Class:NIH
Agency Type:Collaborator
Agency Name:National Institutes of Health (NIH)

Samples and Retentions

Study Population: Nursing Homes in Nebraska and the Western half of Iowa, nursing home staff, and family members/significant other of nursing home residents
Sample Method:Non-Probability Sample

Study References

There are no available Study References

Data Source: ClinicalTrials.gov

Date Processed: October 09, 2019

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