Improving end-of-life care in long-term care. Results from a RCT ̶ effects on resident quality of life and symptoms

Pauli Lamppu, Marja-Liisa Laakkonen, Jouko Laurila, Harriet Finne-Soveri, Hannu Kautiainen, Kaisu Pitkälä

Keywords: nursing home, long term care, palliative care, end-of-life care, advance care planning, quality of life, quality of dying, symptoms


With increasing life expectancy, long-term care (LTC) facilities are a likely last home to an increasing number of senior citizens. The need for quality EOL care in this setting is widely recognized with various development projects to improve care conducted

Research questions:

Is it likely that we can influence LTC resident-level EOL outcomes with a light and feasible staff training?


20 LTC wards with 340 eligible residents were included in our cluster-randomized trial. Intervention wards got a four afternoon training in the principles of advance care planning, palliative and symptom care and various practical scenarios.


In the two-year follow-up, there were no differences between the groups in resident quality of life measured with 15D score. No differences were observed in the secondary outcomes of quality of dying approximated by proxy satisfaction and symptoms using the ESAS or PAINAD scores


While our results suggest a large variability in EOL care quality even in our fairly well developed geriatric care system, it seems that a light training is not able to influence resident level outcomes over a longer period. It is likely that reasons for not adapting to new strategies lie in several levels within the organizations. Future trials might benefit from better knowledge of the required EOL tools, skills and attitudes for a successful LTC facility.

Points for discussion: