Aim To evaluate the impact of implementing advance care planning (ACP) with the “LetMeDecide” advance care directive (LMD-ACD) and a palliative care programme focusing on quality of care at end-of-life in long term care (LTC) facilities in Ireland. It is hypothesised that this intervention will improve quality of death and dying, reduce unnecessary heathcare utilisation and costs, and increase knowledge and awareness of palliative care strategies and advance care planning among healthcare professionals. Design An initial parallel-arm cluster randomized trial with subsequent incomplete cross-over, whereby the initial control arm converts to active. Six LTC facilities will be recruited to this pilot study and matched based on their clinical/demographic profile. Three will be randomly assigned to the control group and three to the intervention group.
Intervention LMD-ACD and an end-of-life palliative care education programme.
Ethics
Approval will be obtained from the Clinical Research Ethics Committee of the Cork Teaching Hospitals.
Data Collection
Data will be collected pre-intervention in all study sites. Data collected from staff at baseline and post-intervention will include attitudes and barriers to ACP and ACD, and staff PC training needs. Data will be collected on each death during baseline and post intervention periods using the following instruments: Quality of Dying and Death (QODD) questionnaire for relatives, chart data extraction tool based on the QODD, the Staff Perception of End of Life Experience (SPELE), and the Patient’s Experience of Pain and Symptoms at End of Life (PEPSEL).
Data Analysis
Data analysis will be performed using mixed models to take into account the clustering in the data, with patients clustered in homes. Mixed effects linear regression will be used to compare continuous outcomes and mixed effects logistic regression will be used to compare binary categorical outcomes between the intervention and control groups. Statistical analysis will be performed using Stata.
