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dc.contributor.authorBrown, C.-
dc.contributor.authorLee, X.J.-
dc.contributor.authorFarrington, A.-
dc.contributor.authorShield, C.-
dc.contributor.authorCarter, H.E.-
dc.contributor.authorMcPhail, S.M.-
dc.contributor.authorCardona, M.-
dc.contributor.authorHillman, K.-
dc.contributor.authorCallaway, L.-
dc.contributor.authorWillmott, L.-
dc.contributor.authorWhite, B.P.-
dc.contributor.authorHarvey, G.-
dc.contributor.authorGraves, N.-
dc.contributor.authorBarnett, A.G.-
dc.identifier.citationBMC Geriatrics, 2022; 22(1):860-860-
dc.description.abstractBACKGROUND: Hospitalisation rates for older people are increasing, with end-of-life care becoming a more medicalised experience. Innovative approaches are warranted to support early identification of the end-of-life phase, communicate prognosis, provide care consistent with people's preferences, and improve the use of healthcare resources. The Intervention for Appropriate Care and Treatment (InterACT) trial aimed to increase appropriate care and treatment decisions for older people at the end of life, through implementation of a prospective feedback loop. This paper reports on the care review outcomes. METHODS: A stepped-wedge randomised controlled trial was conducted in three large acute hospitals in Queensland, Australia between May 2020 and June 2021. The trial identified older people nearing the end of life using two validated tools for detecting deterioration and short-term death. Admitting clinical teams were provided with details of patients identified as at-risk with the goal of increasing awareness that end of life was approaching to facilitate appropriate patient centred care and avoid non-beneficial treatment. We examined the time between when the patient was identified as 'at-risk' and three outcomes: clinician-led care review discussions, review of care directive measures and palliative care referrals. These were considered useful indicators of appropriate care at the end of life. RESULTS: In two hospitals there was a reduction in the review of care directive measures during the intervention compared with usual care at 21 days (reduced probability of - 0.08; 95% CI: - 0.12 to - 0.04 and - 0.14; 95% CI: - 0.21 to - 0.06). In one hospital there was a large reduction in clinician-led care review discussions at 21 days during the intervention (reduced probability of - 0.20; 95% CI: - 0.28 to - 0.13). There was little change in palliative care referrals in any hospital, with average probability differences at 21 days of - 0.01, 0.02 and 0.04. DISCUSSION: The results are disappointing as an intervention designed to improve care of hospitalised older people appeared to have the opposite effect on care review outcomes. The reasons for this may be a combination of the intervention design and health system challenges due to the pandemic that highlight the complexity of providing more appropriate care at the end of life. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry, ACTRN12619000675123 (registered 6 May 2019).-
dc.description.statementofresponsibilityChristine Brown, Xing J. Lee, Alison Farrington, Carla Shield, Hannah E. Carter, Steven M. McPhail, Magnolia Cardona, Kenneth Hillman, Leonie Callaway, Lindy Willmott, Ben P. White, Gillian Harvey, Nicholas Graves, and Adrian G. Barnett-
dc.publisherSpringer Science and Business Media LLC-
dc.rights© The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.-
dc.subjectNon-beneficial treatment-
dc.subjectProspective feedback loop intervention-
dc.subjectStepped-wedge trial-
dc.subjectAdvance care planning-
dc.subjectOlder people-
dc.subjectEnd of life-
dc.subject.meshPalliative Care-
dc.subject.meshTerminal Care-
dc.subject.meshProspective Studies-
dc.titleImpact of a prospective feedback loop on care review activities in older patients at the end of life. A stepped-wedge randomised trial-
dc.typeJournal article-
dc.identifier.orcidHarvey, G. [0000-0003-0937-7819]-
Appears in Collections:Nursing publications

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