title: Improving end-of-life care in acute geriatric hospital wards using the Care Programme for the Last Days of Life: study protocol for a phase 3 cluster randomized controlled trial.
abstract: BACKGROUND
  The Care Programme for the Last Days of Life has been developed to improve the quality of end-of-life care in acute geriatric hospital wards. The programme is based on existing end-of-life care programmes but modeled to the acute geriatric care setting. There is a lack of evidence of the effectiveness of end-of-life care programmes and the effects that may be achieved in patients dying in an acute geriatric hospital setting are unknown. The aim of this paper is to describe the research protocol of a cluster randomized controlled trial to evaluate the effects of the Care Programme for the Last Days of Life.
  
  
  METHODS
  A cluster randomized controlled trial will be conducted. Ten hospitals with one or more acute geriatric wards will conduct a one-year baseline assessment during which care will be provided as usual. For each patient dying in the ward, a questionnaire will be filled in by a nurse, a physician and a family carer. At the end of the baseline assessment hospitals will be randomized to receive intervention (implementation of the Care Programme) or no intervention. Subsequently, the Care Programme will be implemented in the intervention hospitals over a six-month period. A one-year post-intervention assessment will be performed immediately after the baseline assessment in the control hospitals and after the implementation period in the intervention hospitals. Primary outcomes are symptom frequency and symptom burden of patients in the last 48 hours of life.
  
  
  CONCLUSIONS
  This will be the first cluster randomized controlled trial to evaluate the effect of the Care Programme for the Last Days of Life for the acute geriatric hospital setting. The results will enable us to evaluate whether implementation of the Care Programme has positive effects on end-of-life care during the last days of life in this patient population and which components of the Care Programme contribute to improving the quality of end-of-life care.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT01890239. Registered June 24th, 2013.
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium. rebecca.verhofstede@vub.ac.be.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Verhofstede
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium. tinne.smets@vub.ac.be.
authors.forename: Tinne
authors.initials: T
authors.lastname: Smets
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium. jcohen@vub.ac.be.
authors.forename: Joachim
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy. costantini.massimo@asmn.re.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Costantini
authors.affiliation: Department of Geriatrics, Ghent University Hospital, Ghent, Belgium. nele.vandennoortgate@uzgent.be.
authors.forename: Nele
authors.initials: N
authors.lastname: Van Den Noortgate
authors.affiliation: End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium. luc.deliens@vub.ac.be.|Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium. luc.deliens@vub.ac.be.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
mesh_terms: D000368:Aged; D017028:Caregivers; D002985:Clinical Protocols; D016000:Cluster Analysis; D005260:Female; D006299:Health Services for the Aged; D006757:Hospital Units; D006801:Humans; D008297:Male; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013727:Terminal Care