title: Effect of palliative care nurse champions on the quality of dying in the hospital according to bereaved relatives: A controlled before-and-after study.
abstract: BACKGROUND
  To improve the quality of end-of-life care, hospitals increasingly appoint palliative care nurse champions.
  
  
  OBJECTIVE
  We investigated the effect of nurse champions on the quality of life during the last 3 days of life and the quality of dying as experienced by bereaved relatives.
  
  
  METHODS
  A controlled before-and-after study (June 2009-July 2012). Halfway, in each of seven intervention wards, two nurse champions were appointed; 11 wards served as control wards. The quality of life during the last 3 days of life, quality of dying and multiple dimensions of quality of dying were compared before and after the introduction of nurse champions.
  
  
  METHODS
  In a university hospital, each death at non-intensive care units was followed up by an invitation to relatives (10-13 weeks later) to answer a questionnaire.
  
  
  RESULTS
  For the two periods, data were collected on 86 and 84 patients in intervention wards and on 108 and 118 patients in control wards (overall response: 52%). In the intervention wards, no differences were found in the quality of life during the last 3 days of life and the quality of dying scores: in both periods, median score for the quality of life during the last 3 days of life was 3.0 and for the quality of dying 7.0. No differences were found in multiple quality of dying dimensions. In control wards, the median quality of dying score was 7.0 pre-intervention and 6.0 post-intervention (p = 0.04). Other scores were comparable with those in intervention wards.
  
  
  CONCLUSIONS
  Performing a complex intervention study in palliative care proved to be feasible. This study showed no differences in the experiences of bereaved relatives after introduction of nurse champions. The complexity of palliative care in the hospital might require more intensive and longer training of nurse champions.
authors.affiliation: Department of Public Health, Erasmus MC: University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Medical Oncology, Erasmus MC: University Medical Center Rotterdam, Rotterdam, The Netherlands f.witkamp@erasmusmc.nl.
authors.forename: Frederika Erica
authors.initials: FE
authors.lastname: Witkamp
authors.affiliation: Department of Medical Oncology, Erasmus MC: University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Lia
authors.initials: L
authors.lastname: van Zuylen
authors.affiliation: Department of Medical Oncology, Erasmus MC: University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Carin C D
authors.initials: CC
authors.lastname: van der Rijt
authors.affiliation: Department of Public Health, Erasmus MC: University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065187:Controlled Before-After Studies; D005190:Family / Q000523:psychology; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000592:standards*; D010166:Palliative Care / Q000523:psychology / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology / Q000592:standards*
keywords: Terminal care (MESH); complex intervention; family (MESH); hospitals (MESH); quality of dying; quality of life