The purpose of this study is to evaluate the effectiveness of the LCP-I Program in improving the quality of end-of-life care provided to cancer patients who die on hospital medical wards as compared to standard healthcare practices.
The availability of an effective quality improvement program for the care of dying patients in hospitals is particularly relevant to the healthcare scenario. The LCP-I Program has provided enough evidence to justify a randomized trial to evaluate its effectiveness. Although the core objective of the LCP-I is improving the quality of end of life care for dying patients, the Program targets the healthcare professionals working on the hospital ward. The only feasible method of assessing the effectiveness of this Program is by performing a cluster trial, where hospital wards are randomized to receive (or not to receive) the implementation of the LCP-I Program. Pairs of eligible medical wards from different hospitals will be randomized to receive the experimental intervention (the LCP-I Program) or no intervention at all for the duration of the study. The LCP-I Program will be implemented in the experimental ward by the PCU. The LCP-I Program has a duration of 6 months from the beginning of the intensive training. No intervention will be implemented in the control ward until the end of the evaluation. Quality of end-of-life care will be evaluated for each pair of randomized wards for all eligible cancer deaths occurring in the six months after the conclusion of the LCP-I Program in the experimental ward.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
308
The LCP-I Program is a continuous quality Improvement Program of end-of-life care implemented by a Palliative Care Unit (PCU) in a hospital Medical Ward.
National Cancer Research Institute
Genoa, Italy
Quality of end-of-life care provided to dying cancer patients and their families.
Measured through the Global Scale of the Italian version of the Toolkit "After-death Bereaved Family Member Interview" (Teno J, et al 2001).
Time frame: six months after the implementation of the LCP Program
quality of communication between the healthcare professionals, patients and families
Measured through the specific Scales of the Italian version of the Toolkit "After-death Bereaved Family Member Interview" (Teno J, et al 2001).
Time frame: six months after the implementation of the LCP Program
quality of emotional support to family members before and after the patients' death
Measured through the specific Scales of the Italian version of the Toolkit "After-death Bereaved Family Member Interview" (Teno J, et al 2001).
Time frame: six months after the implementation of the LCP Program
coordination of care
Measured through the specific Scales of the Italian version of the Toolkit "After-death Bereaved Family Member Interview" (Teno J, et al 2001).
Time frame: six months after the implementation of the LCP Program
provision of care focusing on patient's individual needs
Measured through the specific Scales of the Italian version of the Toolkit "After-death Bereaved Family Member Interview" (Teno J, et al 2001).
Time frame: six months after the implementation of the LCP Program
patient's physical well-being through a better control of physical symptoms
Symptom scales (pain, breathlessness and vomiting) from the Italian version of VOICES (Costantini M, 2005)
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Time frame: six months after the implementation of the LCP Program
quality of communication between hospital staff and GPs
interview with GPs
Time frame: six months after the implementation of the LCP Program
appropriateness of therapeutic and diagnostic procedures
Tool for recording all diagnostic and therapeutic procedures effectively performed during the last 3 days of life
Time frame: six months after the implementation of the LCP Program