Implementing a quality improvement programme in palliative care in care homes: a qualitative study

Area of Science:

• Gerontology
• Palliative Care
• Healthcare Quality Improvement

Background:

• Increasing number of older adults dying in care homes.
• Need for quality improvement in end-of-life care within these settings.

Purpose of the Study:

• To explore perceived benefits of the Gold Standards Framework for Care Homes (GSFCH).
• To identify barriers to GSFCH implementation in care homes.

Main Methods:

• Qualitative study using semi-structured interviews with care home managers, nurses, care assistants, residents, and family members.
• Framework approach to qualitative analysis, deductively based on GSFCH's 7Cs: communication, coordination, symptom control, continuity, continued learning, carer support, and care of the dying.

Main Results:

• Perceived benefits include improved symptom control, team communication, staff confidence, and resident choice.
• Identified barriers include increased paperwork, lack of end-of-life care knowledge, costs, and challenges with GP cooperation.
• Effective communication was noted, but concerns about discussing death and using tools like advance care planning registers were raised.

Conclusions:

• Barriers identified are common to other end-of-life care interventions in care homes.
• Further research needed on the impact and sustainability of quality improvement programs like GSFCH on resident and family outcomes.
• Investigating the specific impact of individual components within complex interventions is crucial.