Improved Quality of Death and Dying in Care Homes: A Palliative Care Stepped Wedge Randomized Control Trial in Australia

70 Background: Improving quality of death (QOD) is a key goal in palliative care. No instruments to measure QOD have been validated in Spanish. The goal of this study was to validate the Spanish version of the quality of death and dying questionnaire (QODD) and to develop a shortened version of this instrument suitable to be completed by phone interview. Methods: Translation/back-translation and adaptation of the QODD was performed following established standards. One question was removed due to cultural inadequacy. We enrolled caregivers (CGs) of consecutive deceased cancer patients from a single palliative care clinic in Santiago, Chile. CGs were contacted by phone between 4 and 12 weeks after patients’ death. Participating CGs completed the adapted QODD (QODD-ESP) by phone interview. A global rating question assessing quality of life (QOL) during the last week of life was included. A shortened version of the QODD (QODD-ESP-12) based on the model by Downey et al. (J Pain Sympt Manage 2010;39) was created. Measures of reliability (Cronbach-alpha), convergent validity (correlation with global rating question) and construct validity (factorial analysis [FA]) were estimated for both versions of the instrument. Results: 150 (50%) out of 302 CGs completed the QODD-ESP. Patients mean (standard deviation [SD]) age was 67 (14), 71 (47%) female and 131 (87%) died at home. CGs mean (SD) age was 51 (13), 128 (85%) female. Mean QODD-ESP score was 69 (range 35-96) with an alpha = .829. Correlation with last week QOL was .434 (p < .01). Kaiser-Meyer-Olkin measure of sampling adequacy was .585, not supporting the existence of a unique underlying construct. Mean QODD-ESP-12 score was 69 (range 31-97) with a alpha = .728. Correlation with last week QOL was .306 (p < .01). Confirmatory FA of QODD-ESP-12 showed that data fitted well Downey’s model (Chi2 4.85 (60), p = .311 Comparative Fit ndex = .98; Tuker-Lewis Index = .977 and root mean square error of approximation (RMSEA) = .023 (CI: 0-.056). Conclusions: QODD-ESP-12 is a reliable and valid instrument with good psychometric properties and can be used to assess QOD in a Spanish speaking cancer palliative care population by phone interview.

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A Stepped Wedge Cluster Randomized Control Trial to Evaluate the Implementation and Effectiveness of Optimized Quality-Improvement Initiatives in Improving Quality of Care for Acute Cardiac Events in Response to the COVID-19 Outbreak

10.21203/rs.3.rs-239133/v1 ◽

2021 ◽

Author(s):

Shuduo Zhou ◽

Xuejie Dong ◽

Fangjing Liu ◽

Yan Zhang ◽

Dahai Yue ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Randomized Control Trial ◽

Scale Up ◽

Stepped Wedge ◽

Public Health Emergencies ◽

Cluster Randomized Control Trial ◽

Randomized Control ◽

Cluster Randomized

Abstract Background: The National Chest Pain Center Accreditation Program (CHANGE) is the first hospital-based, multifaceted, nationwide quality improvement (QI) initiative, to monitor and improve quality of ST-segment elevation myocardial infarction (STEMI) care in China. The QI initiatives, as implementation strategies, include a bundle of evidence-based interventions adapted for implementation in China. During the pandemic of coronavirus disease 2019 (COVID-19), fear of infection with severe acute respiratory syndrome coronavirus 2, national lockdowns, and altered health care priorities have highlighted the program’s importance in improving STEMI care quality. This study aims to minimize the adverse impact of the COVID-19 pandemic on the quality of STEMI care, by developing interventions that optimize the QI initiatives, implementing and evaluating the optimized QI initiatives, and developing scale-up activities of the optimized QI initiatives in response to COVID-19 and other public health emergencies.Methods: A stepped wedge cluster randomized control trial will be conducted in three selected cities of China: Wuhan, Suzhou, and Shenzhen. Two districts have been randomly selected in each city, yielding a total of 24 registered hospitals. This study will conduct a rollout in these hospitals every 3 months. The 24 hospitals will be randomly assigned to four clusters, and each cluster will commence the intervention (optimized QI initiatives) at one of the four steps. We will conduct hospital-based assessments, questionnaire surveys among health care providers, community-based household surveys, and key informant interviews during the trial. All outcome measures will be organized using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, including implementation outcomes, service outcomes (e.g., treatment time), and patient outcomes (e.g., in-hospital mortality and 1-year complication). The Consolidated Framework for Implementation Research framework will be used to identify factors that influence implementation of the optimized QI interventions.Discussion: The study findings could be translated into a systematic solution to implementing QI initiatives in response to COVID-19 and future potential major public health emergencies. Such actionable knowledge is critical for implementors of scale-up activities in low- and middle-income settings.Trial registration: This study was registered in the Chinese Clinical Trial Registry (ChiCTR 2100043319), registered 10 February 2021

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Correction: Palliative care team consultation and quality of death and dying in a university hospital: A secondary analysis of a prospective study

PLoS ONE ◽

10.1371/journal.pone.0208564 ◽

2018 ◽

Vol 13 (11) ◽

pp. e0208564 ◽

Cited By ~ 1

Author(s):

Arianne Brinkman-Stoppelenburg ◽

Frederika E. Witkamp ◽

Lia van Zuylen ◽

Carin C. D. van der Rijt ◽

Agnes van der Heide

Keyword(s):

Palliative Care ◽

Prospective Study ◽

Death And Dying ◽

Secondary Analysis ◽

Palliative Care Team ◽

Care Team ◽

University Hospital ◽

Quality Of Death ◽

A Prospective Study

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Palliative care team consultation and quality of death and dying in a university hospital: A secondary analysis of a prospective study

PLoS ONE ◽

10.1371/journal.pone.0201191 ◽

2018 ◽

Vol 13 (8) ◽

pp. e0201191 ◽

Cited By ~ 9

Author(s):

Arianne Brinkman-Stoppelenburg ◽

Frederika E. Witkamp ◽

Lia van Zuylen ◽

Carin C. D. van der Rijt ◽

Agnes van der Heide

Keyword(s):

Palliative Care ◽

Prospective Study ◽

Death And Dying ◽

Secondary Analysis ◽

Palliative Care Team ◽

Care Team ◽

University Hospital ◽

Quality Of Death ◽

A Prospective Study

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Place of Death and the Differences in Patient Quality of Death and Dying and Caregiver Burden

Journal of Clinical Oncology ◽

10.1200/jco.2014.55.7355 ◽

2015 ◽

Vol 33 (4) ◽

pp. 357-363 ◽

Cited By ~ 75

Author(s):

Hiroya Kinoshita ◽

Isseki Maeda ◽

Tatsuya Morita ◽

Mitsunori Miyashita ◽

Akemi Yamagishi ◽

...

Keyword(s):

Palliative Care ◽

Caregiver Burden ◽

Death And Dying ◽

Terminally Ill ◽

Place Of Death ◽

Good Death ◽

Patients With Cancer ◽

Quality Of Death ◽

Palliative Care Units

Purpose To explore the associations between place of death and quality of death and dying and caregiver burden in terminally ill patients with cancer and their families. Methods Two bereavement surveys were conducted in October 2008 and October 2011. A total of 2,247 family caregivers of patients with cancer who were deceased responded to the mail surveys (response rate, 67%). Family members reported patient quality of death and dying and caregiver burden by using the Good Death Inventory and Caregiving Consequences Inventory. Results Patient quality of death and dying was significantly higher at home relative to other places of dying after adjustment for patient and/or family characteristics (adjusted means): 5.0 (95% CI, 4.9 to 5.2) for home, 4.6 (95% CI, 4.5 to 4.7) for palliative care units, and 4.3 (95% CI, 4.2 to 4.4) for hospitals. For all combinations, pairwise P < .001; the size of the difference between home and hospital was moderate (Hedges' g, 0.45). Home was superior to palliative care units or hospitals with respect to “dying in a favorite place,” “good relationships with medical staff,” “good relationships with family,” and “maintaining hope and pleasure” (P < .001 for all combinations of home v palliative care units and home v hospitals). Home death was significantly associated with a lower overall (P = .03) and financial caregiver burden (P = .004) relative to hospital death. Conclusion Dying at home may contribute to achieving good death in terminally ill patients with cancer without causing remarkably increased caregiver burden. Place of death should be regarded as an essential goal in end-of-life care.

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