The more nursing home staff knows about palliative care, the less likely residents will suffer aggressive—and often futile—end-of-life interventions.
Palliative care focuses nursing home resources on providing comfort at the end of life, but how familiar nursing directors are with it varies widely.
When a nursing home patient is dying, aggressive actions such as inserting a feeding tube or sending the patient to the emergency room can futilely exacerbate, rather than relieve, their distress.
For a new study, researchers surveyed nursing directors at more than 1,900 nursing homes around the country between July 2009 and June 2010 to assess their knowledge of palliative care and their facility’s implementation of key palliative care practices.
More than one in five of the surveyed directors had little or no basic palliative care knowledge.
“While the Institute of Medicine has called for greater access to skilled palliative care across settings, the fact that one in five US nursing home directors of nursing had very limited palliative care knowledge demonstrates the magnitude of the challenge in many nursing homes,” says Susan C. Miller, professor (research) of health services, policy, and practice at Brown University and lead author of the study that is published in the Journal of Palliative Medicine.
“Improvement is needed as are efforts to facilitate this improvement, including increased Medicare/Medicaid surveyor oversight of nursing home palliative care and quality indicators reflecting provision of high-quality palliative care.”
Less aggressive care
In addition to quizzing directors, researchers also analyzed Medicare data on the 58,876 residents who died during the period to ascertain the treatments they experienced when they were dying.
When the researchers analyzed palliative care knowledge together with treatment at end of life, they found that the more directors knew about basic palliative care, the lower likelihood that nursing home patients would experience feeding tube insertion, injections, restraints, suctioning, and emergency room or other hospital trips.
Further, patients in higher-knowledge nursing homes had a higher likelihood of having a documented six-month prognosis. Most of these associations are highly statistically significant, but a few are marginally significant even after adjusting for a variety of factors including a nursing home’s extent of hospice use.
The study shows only an association between palliative care knowledge and less aggressive end-of-life care, the authors note. It could be that the knowledge leads to improved care, but it could also be that at nursing homes with better care in general, there is also greater knowledge.
Whether a causal relationship exists or not, it’s clear more knowledge about palliative care could benefit thousands of nursing home residents every year, the authors write.
“The need for improving nursing home staff palliative care knowledge and practice is generally agreed upon, and the efficacy of such improvement is supported by our study findings.”
Julie Lima of Brown and Sarah Thompson of University of Colorado School of Nursing are coauthors of the study.
The National Institute on Aging funded the work.
Source: Brown University