On 2017 Jun 30, Cicely Saunders Institute Journal Club commented:

This paper was discussed at the Cicely Saunders Institute Journal Club on Wednesday 7th June.

This paper reports a well conducted trial of an intervention to improve end of life care in hospitalised elderly people. The authors are to be commended for addressing a clinical priority in a population where end of life care is under-researched.

We discussed this paper in a clinical-academic journal club. Our discussion of the paper was lively and generated a series of reflections on the methods used in the conduct of the trial as well as broader issues relating to the aims and processes of the study intervention.

The long study set up period was considered a strength, enabling participating wards to become accustomed to the data collection procedures before the commencement of the study. We discussed the challenges related to selecting the proxy-reported primary outcome measures, and the potential impact of the unblinded nurses assessing outcomes of care they themselves delivered.

We also discussed whether family recollection of symptom control several weeks into bereavement was a reliable measure of care quality, as it may not capture all the factors contributing to their experience of care, potentially confounding their report. It was suggested that collecting family members’ data via face to face interviews could enhance analysis of the quantitative findings.

The intervention, as reported in this paper, supported by previously published development work, represents a comprehensive effort to improve the quality of care for elderly people dying in hospital settings. The group recognised the challenges and the range of competencies required of hospital medical and nursing staff delivering end of life care. We wondered how the reported changes to the training components of the intervention addressed criticisms of the Liverpool Care Pathway in terms of improving competencies in compassionate communication with families. We discussed the possibility of measuring family care givers experience of receiving safe, compassionate care as an alternative outcome for this intervention.

In their discussion the authors report that qualitative work is to be conducted to explore the findings of the study in more depth, particularly those related to poorer family satisfaction with care in the intervention group. We felt this potential negative effect on families should be investigated before further roll out of the intervention We look forward to reading further outputs from this extensive and commendable body of work.

Commentary by Jo Bayly, Dr Simon Etkind and Dr Wei Gao

On 2017 Jun 30, Cicely Saunders Institute Journal Club commented:

This paper was discussed at the Cicely Saunders Institute Journal Club on Wednesday 7th June.

This paper reports a well conducted trial of an intervention to improve end of life care in hospitalised elderly people. The authors are to be commended for addressing a clinical priority in a population where end of life care is under-researched.

We discussed this paper in a clinical-academic journal club. Our discussion of the paper was lively and generated a series of reflections on the methods used in the conduct of the trial as well as broader issues relating to the aims and processes of the study intervention.

The long study set up period was considered a strength, enabling participating wards to become accustomed to the data collection procedures before the commencement of the study. We discussed the challenges related to selecting the proxy-reported primary outcome measures, and the potential impact of the unblinded nurses assessing outcomes of care they themselves delivered.

We also discussed whether family recollection of symptom control several weeks into bereavement was a reliable measure of care quality, as it may not capture all the factors contributing to their experience of care, potentially confounding their report. It was suggested that collecting family members’ data via face to face interviews could enhance analysis of the quantitative findings.

The intervention, as reported in this paper, supported by previously published development work, represents a comprehensive effort to improve the quality of care for elderly people dying in hospital settings. The group recognised the challenges and the range of competencies required of hospital medical and nursing staff delivering end of life care. We wondered how the reported changes to the training components of the intervention addressed criticisms of the Liverpool Care Pathway in terms of improving competencies in compassionate communication with families. We discussed the possibility of measuring family care givers experience of receiving safe, compassionate care as an alternative outcome for this intervention.

In their discussion the authors report that qualitative work is to be conducted to explore the findings of the study in more depth, particularly those related to poorer family satisfaction with care in the intervention group. We felt this potential negative effect on families should be investigated before further roll out of the intervention We look forward to reading further outputs from this extensive and commendable body of work.

Commentary by Jo Bayly, Dr Simon Etkind and Dr Wei Gao