Impact of the DEDICATED approach to optimizing palliative care for people with dementia: a multi-method study

Palliative care can improve the quality of life of people with dementia. However, nurses and other healthcare professionals often lack the confidence and skills to provide palliative care and struggle to initiate timely conversations about wishes and needs for palliative care. The DEDICATED approach aims to enhance the quality of palliative dementia care by improving knowledge, competencies, and interprofessional collaboration of healthcare professionals. This study explores its impact on palliative care provision from the perspectives of: (1) healthcare professionals implementing the approach; (2) their care team members; and (3) bereaved family caregivers.

This multi-method evaluation study used: (1) qualitative interviews with those who had acted as ambassadors in implementing the DEDICATED approach; (2) questionnaires measuring perceived self-efficacy, work engagement, and psychological empowerment among healthcare professionals working in these ambassadors' teams; and (3) questionnaires with bereaved family caregivers exploring the frequency of advance care planning discussion and their experiences with the end-of-life care provided to their relative with dementia.

The DEDICATED approach was implemented across 28 wards in three healthcare organizations. Interviews with ambassadors (n = 17) revealed that the approach raised awareness about person-centered palliative care and the importance of timely advance care planning (ACP) for people with dementia. DEDICATED showed no significant impact on healthcare professionals' self-efficacy, work engagement, and psychological empowerment. The frequency of ACP discussion and quality of end-of-life care showed no significant differences over time.

DEDICATED ambassadors found the DEDICATED approach to be of value in enhancing person-centered palliative care. Although quantitative assessments of healthcare professionals' competence did not fully capture this, the positive feedback received suggests that more time may be needed for the approach to be fully integrated into practice. This could explain the modest results observed among team members and bereaved family caregivers. Future research should explore the long-term impact of the DEDICATED approach using longitudinal study designs.