Educating Nursing Home Staff About the Progression of Dementia and the Comfort Care Option: Impact on Family Satisfaction with End-of-Life Care

Objective: There is a growing consensus on the relevance of a palliative care approach in end-stage dementia. The objective of this study was to assess the impact, in terms of family satisfaction with end-of-life care, of a nursing home (NH) pilot educational program for nursing staff and physicians on comfort care and advanced dementia. Methods: The intervention, implemented in one voluntary NH, consisted of an educational program that included providing an information booklet to all NH staff, and optionally to families. Satisfaction with care was compared using a validated instrument, the "After death bereaved family member interview" pre- and post-intervention. Pre and post groups were composed of close relatives of residents who died in the context of advanced dementia. Results: Twenty-seven contact persons were interviewed pre-intervention and 21 post-intervention (participation rate of 60% for both groups). Descriptive statistics showed better scores on satisfaction with pain control, emotional support, treating patient with respect, and information on what to expect while patient was dying, in the post-intervention group. Comparison of overall scale scores revealed no statistical differences between the 2 groups, although the post-intervention group expressed greater satisfaction in the area of communication with the health care team (8.0 versus 6.6, P = .109) and greater global satisfaction with care (8.3 versus 7.3, P = .087). Discussion: Although not significant, results as to the effectiveness of such an intervention to improve family satisfaction with end-of-life care are encouraging. Conclusion: The booklet, as support tool, and the educational program may have facilitated communication within the team, and between the team and family members. Replication of this intervention in a multicenter NH population is needed to adequately assess its effectiveness. Crown Copyright (C) 2009 Published by Elsevier, Inc. on behalf of the American Medical Directors Association. All rights reserved.