Implementation of knowledge-based palliative care in nursing homes and pre-post post evaluation by cross-over design: a study protocol

Research output: Contribution to journalArticle


The demography of the world is changing as the population is ageing. Because of this change to a higher proportion of older people, the WHO has called for improved palliative care for older persons. A large number of all deaths in the industrialised world occur while older people are living in nursing homes and therefore a key question becomes how the principles of palliative care can be implemented in that context. The aims of this study are: a) to describe a model of an educational intervention with the goal of implementing knowledge-based palliative care in nursing homes, and b) to describe the design of the evaluation of the effectiveness regarding the implementation of knowledge-based palliative care.

A complex intervention is evaluated by means of a cross-over design. An educational intervention concerning palliative care consisting of five seminars during 6 months for staff and managers has been developed and conducted in 20 nursing homes in two counties. Before the intervention started, the feasibility was tested in a pilot study conducted in nursing homes not included in the main study. The intervention is evaluated through a non-randomized experimental design with intervention and control groups and pre- and post-assessments. The evaluation includes older persons living in nursing homes, next-of-kin, staff and managers. Data collection consists of quantitative methods such as questionnaires and register data and qualitative methods in the form of individual interviews, focus-group interviews and participant observations.

The research will contribute to new knowledge about how to implement knowledge-based palliative care in a nursing home setting. A strength of this project is that the Medical Research Council framework of complex intervention is applied. The four recommended stages, Development, Feasibility and piloting, Evaluation and Implementation, are combined for the educational intervention, which functions as a strategy to achieve knowledge-based palliative care in the nursing homes. Implementation is always a question of change and a good theoretical understanding is needed for drawing valid conclusions about the causal mechanisms of change. The topic is highly relevant considering the world’s ageing population. The data collection is completed and the analysis is ongoing.


External organisations
  • Linköping University
  • Linnaeus University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Nursing


  • Complex intervention, Cross-over design, Elderly care, Evaluation, Frail elderly, Implementation, Implementation theory, Palliative care, Quality improvement, Residential care home, Staff education
Original languageEnglish
Article number52
JournalBMC Palliative Care
Publication statusPublished - 2018 Mar 22
Publication categoryResearch

Related research output

Wallerstedt, B., Behm, L., Alftberg, Å., Sandgren, A., Benzein, E., Nilsen, P. & Gerd Ahlström, 2018 May 11, In : Healthcare (Basel, Switzerland). 6, 2, p. 1-16

Research output: Contribution to journalArticle

Nilsen, P., Wallerstedt, B., Behm, L. & Gerd Ahlström, 2018 Jan 4, In : Implementation Science. 13, 1, 12 p.

Research output: Contribution to journalArticle

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Related projects

Gerd Ahlström, Birgit Rasmussen, Lina Behm, Magnus C Persson, Helene Åvik Persson, Carl Johan Fürst, Birgitta Wallerstedt, Anna Sandgren, Eva Benzein, Per Nilsen, Anne Molina Tall, Christina Bökberg, Helena Rosén & Åsa Alftberg

Greta & Johan Kocks stiftelser, Vårdalstiftelsen, Swedish Research Council


Project: Research

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