Implementing the compassion intervention, a model for integrated care for people with advanced dementia towards the end of life in nursing homes: a naturalistic feasibility study

Background Many people with dementia die in nursing homes, but quality of care may be suboptimal. We developed the theory-driven ‘Compassion Intervention’ to enhance end-of-life care in advanced dementia.Objectives To (1) understand how the Intervention operated in nursing homes in different health economies; (2) collect preliminary outcome data and costs of an interdisciplinary care leader (ICL) to facilitate the Intervention; (3) check the Intervention caused no harm. Design A naturalistic feasibility study of Interventionimplementation for 6 months. Settings Two nursing homes in northern London, UK. Participants Thirty residents with advanced dementia were assessed of whom nine were recruited for data collection; four of these residents’ family members were interviewed. Twenty-eight nursing home and external healthcare professionals participated in interviews at 7 (n=19), 11 (n=19) and 15 months (n=10). Intervention An ICL led two core Intervention components: (1) integrated, interdisciplinary assessment and care; (2)education and support for paid and family carers. Data collected Process and outcome data were collected.Symptoms were recorded monthly for recruited residents.Semistructured interviews were conducted at 7, 11 and 15months with nursing home staff and external healthcareprofessionals and at 7months with family carers. ICLhours were costed using Department of Health and HealthEducation England tariffs.Results Contextual differences were identified betweensites: nursing home 2 had lower involvement withexternal healthcare services. Core components wereimplemented at both sites but multidisciplinary meetingswere only established in nursing home 1. The Interventionprompted improvements in advance care planning, painmanagement and person-centred care; we observed noharm. Six-month ICL costs were £18 255.Conclusions Implementation was feasible to differingdegrees across sites, dependent on context. Our data informfuture testing to identify the Intervention’s effectiveness inimproving end-of-life care in advanced dementia.