End of Life Care Education for Care Homes

This project will develop an “end-of-life care” education, training and support programme with local care homes, to enhance the provision of care delivered to care home residents.

Aim: to enhance the end-of-life care provided in care homes.

Objectives:
To work in partnership with 4 care homes, to develop a set of core competencies.
To incorporate the core competencies into a 5 day education package, to be delivered to care home staff.
To assess the impact of the education package on end-of-life care provided for residents in the care homes

Research Design
The project will follow the framework for the development and evaluation of complex interventions (MRC 2000).  Complex interventions are defined as those built from a number of components, which may act both independently and inter-dependently (MRC 2000).  The components typically include behaviours, parameters of behaviours, and methods of organising and delivering those behaviours.  Successful evaluation of complex interventions aims to identify what is effective about the intervention so that is may be applied more widely and is replicable in a variety of settings.  The crucial stage for evaluation is to define the steps in the change process, rather than simply the components of the intervention.  By identifying the stages in the change process, the intervention can then be adapted to different settings (Hawe et al. 2004).     

Data Collection
Preclinical or Theoretical Phase - The first stage will be to establish the theory and evidence for the development of end-of-life competencies in care homes. A comprehensive literature review will be undertaken.  Existing evidence and theories will be reviewed including education and professional development, and theories of organisational learning and change. 

Phase I: Modelling - This phase will develop a set of end-of-life competencies.  The project team from St Catherine’s Hospice will work with staff from the 4 care homes, to develop the competency framework. 

Phase II: Exploratory trial - This phase will test the competency framework through a five day education programme.  Evaluation of the education programme will be ongoing.  Evidence collected during this phase will be reviewed and the education programme modified as necessary, for example the timing and duration of the programme, the specific taught element of the programme, the data collected to evaluate the programme.

Phase III: randomised controlled trial - The use of a randomised controlled trial may not be feasible during this phase. Following the completion of Phase II, decisions regarding the precise nature of the Phase III study will be made.  The design employed will evaluate the impact of the education programme for care home staff.  Attention will be given to the impact of the programme on the end-of-life care received by residents in a care home.  Those who attend the programme during phase II will be invited to participate in a focus group to discuss their feelings about the programme and the impact on their working practice.

Phase IV: assess impact over time – This phase will assess the replicability of the programme in another group of care homes.  This phase will also involve the wider dissemination of the competency framework.

Steering Group
A steering group will be formed and include representatives from the four care homes, St Catherine’s Hospice, care home residents, and a GP.  The steering group will meet six monthly, to monitor the progress of the study.