The interRAI Palliative Care instrument – Better informed palliative care in nursing homes?

Nursing homes have become important locations for the provision of palliative care (Ersek and Carpenter, 2013). Quality palliative care in homes requires a comprehensive evaluation of the different care needs of nursing home residents (Jerant et al., 2004). Research shows that a comprehensive assessment tool can support the evaluation and identification of the resident’s needs in palliative care practice (Mcllfatrick & Hasson, 2014). In 2003, the interRAI Palliative Care instrument or interRAI PC was developed in Canada by the international consortium interRAI with the aim of identifying person-specific palliative care preferences, symptoms and needs and to support clinicians to address these needs (Freeman et al., 2014). The interRAI PC is a comprehensive assessment instrument that evaluates physical, cognitive, and psychosocial domains, as well as demographic, health service utilization, and care preferences to provide a comprehensive description of the client in order to inform the care planning process (interRAI.org, n.d.). In Belgium, the interRAI PC instrument is completed on the online, secured web application BelRAI (belrai.org).

This PhD covers phases 0, I and II of the Medical Research Council (MRC) framework for designing and evaluating complex interventions (Campbell et al., 2007), in order to answer the following research questions:

1. What are the most comprehensive geriatric assessments (CGAs) that have been validated for nursing home residents with palliative care needs and to what extent are these CGAs valid and reliable?
2. What are the needs and symptoms of Flemish (Belgian) nursing home residents anticipated to be in the last year of their lives and do these needs differ between residents with and without dementia?
3. Does using the interRAI Palliative Care instrument in nursing homes reduce the needs and symptoms of nursing home residents receiving palliative care?          
4. Is the interRAI PC instrument useful, feasible and face valid according to care professionals in nursing homes?

In the theoretical phase (phase 0), a systematic literature search was conducted in order to answer research question 1.  In the modeling phase (phase I), the interRAI PC was adapted for use in Belgium and implemented on the BelRAI-website. In phase II, the intervention was tested in fifteen nursing homes. Care professionals of the multidisciplinary nursing home staff received a training on the interRAI PC and the BelRAI web application and completed the interRAI PC during one year for all nursing home residents aged 65 or older, anticipated to be in the last year of their lives. Using a pretest-posttest design with quasi-random assignment to the intervention or control group, we evaluated whether the use of the interRAI PC reduced palliative care needs and symptoms of nursing home residents in the last year of their lives. Furthermore, qualitative data regarding the usefulness, feasibility and face validity of the instrument were collected through focus groups, interviews and notes.