Acceptability and feasibility of end-of-life care pathways in Australian residential aged care facilities.
OBJECTIVE
To investigate the acceptability and feasibility of using end-of-life (EOL) care pathways in residential aged care facilities (RACFs).


METHODS
Multistage action research approach involving interviews, surveys and prospective audits of deaths and EOL care pathway use among residents and staff of RACFs and associated general practitioners from 14 RACFs in Victoria and South Australia between April 2009 and July 2010.


METHODS
Introduction of EOL care pathways.


METHODS
Evidence of acceptability was determined by the rate of pathway use in RACFs and through feedback from RACF managers, staff and GPs. Evidence of feasibility was determined by reductions in transfers to hospital for symptom management before death, length of time on pathways, and whether care was consistent with best practice at EOL.


RESULTS
The use of EOL care pathways across the RACFs fell into low-, moderate- and high-uptake groups (for 10%, 34% and 68% of all deaths at the facility, respectively). Feedback from RACF staff and GPs indicated that acceptability was critical to successful implementation. The use of EOL care pathways demonstrated improvements in care, sometimes over extended periods. There were fewer unnecessary admissions to hospital before death, although not all RACF staff and GPs were aware of the project.


CONCLUSIONS
EOL care pathways are feasible strategies for delivering EOL care consistent with best practice. However, their introduction into Australian RACFs needs to include strategies to facilitate acceptability by RACF staff and GPs.
La Trobe University, Melbourne, VIC.
Dell E
DE
Horey
Annette F
AF
Street
Alison F
AF
Sands
D000368:Aged; D001291:Attitude of Health Personnel; D054869:Clinical Audit; D019091:Critical Pathways / Q000706:statistics & numerical data; D005240:Feasibility Studies; D058005:General Practitioners; D019538:Health Care Surveys; D006707:Homes for the Aged; D006801:Humans; D007407:Interviews as Topic; D009726:Nurses; D010342:Patient Acceptance of Health Care; D013021:South Australia; D013727:Terminal Care / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D014739:Victoria