In-Touch: Implementation of a person-centered palliative care iNtervention To imprOve comfort, QUality of Life and social engagement of people with advanced dementia in Care Homes

挑战.照顾欧洲越来越多的患有晚期痴呆症和姑息治疗需求的人住在护理院是困难和苛刻的。患有晚期痴呆症的人可能无法移动，无法言语，无法参加日常活动。他们可能会感到不安或焦虑，生活质量低，不适程度高。家庭成员可能会发现很难与他们的亲戚有意义地联系，并对未来感到焦虑。护理人员可能很难提供除了基本需求以外的护理，如喂养、排便和皮肤护理。溶液这是一个超越科学的道德解决方案，既提供“当下”的护理（使用Namaste Care），又规划未来的护理需求（使用家庭护理决策支持“舒适护理”方法）。我们称之为“接触式干预”。计划在7个国家的56家养老院开展一项InTouch干预的跨国随机对照试验，以确定其对舒适度、社会参与度和生活质量的影响。这得到了9个工作包的支持，以确保：干预措施得到了有力的规划，并根据不同国家的情况进行了调整;了解如何提供干预措施，以及人们对干预措施的体验和道德价值;了解成本效益;如果成功，我们有有效的计划来转移有关干预措施的知识。冲击这项干预措施可能预示着在整个欧洲为晚期痴呆症患者提供姑息治疗的方式发生重大变化。晚期痴呆症患者在接近死亡时应该有更好的生活质量，提高参与度，减少社会孤立。护理人员将有一个道德健全和循证的干预，是具有成本效益的实施，与家庭成员更多地参与，并了解，舒适护理和未来的护理计划。

Challenge. Caring for the increasing numbers of people across Europe with advanced dementia and palliative care needs who live in care homes is difficult and demanding. People with advanced dementia can be immobile, non-verbal and unable to take part in day-today activities. They can be unsettled or agitated, with low quality-of-life and elevated levels of discomfort. Family members can find it difficult to connect meaningfully with their relative and are anxious about the future. Care staff can struggle to provide care other than for basic needs such as feeding, toileting and skin care. Solution. An ethically sound solution which advances beyond the science, providing both care ‘in-the moment’ (using Namaste Care) and planning for future care needs (using the Family Carer Decision Support ‘ComfortCare’ approach). We call this the In-Touch intervention. Plan. To deliver a cross-country cluster randomised controlled trial of the InTouch intervention in 56 nursing care homes across 7 countries to determine its effect on comfort, social engagement and quality of life. This is supported by 9 work packages ensuring that: the intervention is robustly planned and contextualised for different country settings; there is understanding of how it is delivered, and what people experience and ethically value about the intervention; the cost-effectiveness is understood; we have effective plans to transfer knowledge about this intervention if it is successful. Impact. This intervention couldherald a major change in the way that care for people with advanced dementia, in the palliative phase of their illness, is provided across Europe. People with advanced dementia should have better quality of life as they approach death, improved engagement and reduced social isolation. Care staff will have an ethically sound and evidence-based intervention that is cost-effective to implement, with family members more involved in, and knowledgeable about, comfort care and future care plans.