Palliative Care in Nursing Homes: Discussion of a Multinational Trial with Lieve Van den Block
episode
GeriPal - A Geriatrics and Palliative Medicine Podcast
45 min
5 speakers
8 chapters
transcribed 5 hours ago
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What is the PACE multicomponent intervention and why was it needed in nursing homes?
Welcome to the Jerry Powell podcast. This is Eric Widera. This is Alex Smith. And Alex, we have a couple people in a room and one person Skyping over from across the pond. From across the pond, we have
Lieve
Vandenblok. Yes, perfect.
Lieve Vandenblok. Lieve Vandenblok, a psychologist and professor of aging and palliative care at the Free University in Brussels, Belgium. Welcome to the Jerry Powell podcast, Lieve.
Hello. Good evening for me. Good morning to you.
Thank you for joining us, Liva. We have a couple other people in our audience. Would you guys mind introducing yourselves?
Hi, this is Lauren Hunt. I'm an assistant professor in the School of Nursing Atlantic Fellow at the Global Brain Health Institute.
And I'm Evie Kalmar. I'm a geriatrics and palliative care fellow here at UCSF.
So we're going to be talking about your paper that was just published this week in JAMA Internal Medicine on, what was the title? The title was, I got it right here, The Effectiveness of a Palliative Care Program for Nursing Homes in Seven Countries, the PACE Cluster Randomized Control Trial, Seven Countries of Palliative Care Intervention. That's crazy. But before we talk about that, we always ask for a song recommendation. You have a song for Alex to sing.
Yes, I would love to hear Alloway Black's song on his mother, Mama Hold My Hand.
Mama Hold My Hand. Now this is a challenge, a little soul.
Mama hold my hand. I don't think I can cross this road by myself. Mama hold my hand. I don't think I can cross this road by myself Just a little bit of that.
That was a challenge.
Are we going to have a little bit more later?
We'll have more later. We'll do the last verse, which is this is a beautiful song, by the way. I was playing more of it last night. Starts out talking about how as a little boy, he would hold his mother's hand. And then he grew up and didn't want her to hold his hand anymore. And then at the end of the song, it comes back to it. And I'll just read a little bit of the lyrics here. My mama's near the end of her years and her hair is gray. Sometimes I call her to ask if she would like to spend the day. Mama used to be strong, but she ain't now and she can't make her way. That's why I'm always around when she needs help. And here's what I say. Mama, hold my hand. I don't think you can cross this road by yourself.
So now he's reaching out and holding her hand.
That's
really beautiful. Great. Is that
why you picked the song?
Yeah, it's a very easy song to understand, but still, I think it touches a lot of people.
So before we go into the topic of the JAMA IM paper, I'd love to hear from you. How did you get interested in palliative care in nursing home settings to set us up for this paper?
I think it started when I did my PhD. I did my PhD on palliative care in primary care, studying, doing epidemiological research mainly, using GP networks to register deceased patients and In the data that I analyzed then, I was constantly, I think also by the literature, confronted with these underserved groups in palliative care. So people with dementia, people who are aging, and of course people in nursing homes where the two come together. So I think that's where the seed was planted.
And you've done some preliminary work on this intervention. Maybe you could tell us about that preliminary work.
So the intervention originally was developed in the UK and it was called the route to success. And so there was mainly a lot of practice based evidence. And some people looking more at quantitative and qualitative research, but not really an RCT comparing this route to success with standard care.
How was the train‑the‑trainer model structured across seven European countries?
And so a lot of people in practice, we really felt this program was doing something in the UK. And a lot of people abroad said, yes, we can use this in this setting. So that's when we started to do the translation in all these different countries and and cultures. And we adapted the program cross-country and then called it the PACE Steps to Success program.
I wonder if you could tell us a little bit more about what are the... So my understanding is this is a train-the-trainer program.
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Chapters
8 chapters
1
What is the PACE multicomponent intervention and why was it needed in nursing homes?
0:00–4:07
2
How was the train‑the‑trainer model structured across seven European countries?
4:07–9:33
3
What were the six steps of the PACE program and how were they implemented?
9:33–15:48
4
Why did the primary outcome (comfort at end of life) show no significant change?
15:48–21:24
5
What secondary outcomes showed improvement and what do they mean for care quality?
21:24–27:40
6
How did staff turnover, cultural differences, and implementation fidelity affect results?
27:40–33:34
7
What policy, measurement, and quality‑metric lessons can improve palliative care in nursing homes?
33:34–39:06
8
What future strategies could move the needle on primary palliative care in nursing facilities?
39:06–45:35
Speakers
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