Palliative and end of life care in care homes: Protocol for co-designing and implementing an appropriate scalable model of Needs Rounds in the United Kingdom

Aisha Macgregor (Lead Author), Alasdair Rutherford, Brendan McCormack, Jo Hockley, Margaret Ogden, Irene Soulsby, Maisie McKenzie, Karen Spilsbury, Barbara Hanratty, Liz Forbat

Research output: Contribution to journalArticlepeer-review


Introduction: Palliative and end of life care in care homes is often inadequate, despite high morbidity and mortality. Residents can experience uncontrolled symptoms, poor quality deaths, and avoidable hospitalisations. Care home staff can feel unsupported to look after residents at the end of life. Approaches for improving end of life care are often education-focused, do not triage residents and rarely integrate clinical care. This study will adapt an evidence-based approach from Australia for the UK context called ‘Palliative Care Needs Rounds’ (Needs Rounds). Needs Rounds combine triaging, anticipatory person-centred planning, case-based education, and case-conferencing; the Australian studies found that Needs Rounds reduce length of stay in hospital, and improve dying in preferred place of care, and symptoms at the end of life.
Methods and analysis: This implementation science study will co-design and implement a scalable UK model of Needs Rounds. The i-PARIHS framework will be used to identify contextual barriers and use facilitation to enable successful implementation. Six palliative care teams, working with 4-6 care homes each, will engage in two phases. In phase 1 (February 2021), stakeholder interviews (n=40) will be used to develop a programme-theory to meet the primary outcome of identifying what works, for whom in what circumstances for UK Needs Rounds. Subsequently a workshop to co-design UK Needs Rounds will be run. Phase 2 (July 2021) will implement the UK model for a year. Prospective data collection will focus on secondary outcomes regarding hospitalisations, residents’ quality of death, and care home staff capability of adopting a palliative approach.
Ethics and dissemination: Frenchay Research Ethics Committee (287447) approved the study. Findings will be disseminated to policy-makers, care home/palliative care practitioners, residents/relatives, and academic audiences. An implementation package will be developed for practitioners to provide the tools and resources required to adopt UK Needs Rounds.
Registration details: ISRCTN15863801
Original languageEnglish
Article numbere049486
Pages (from-to)1-9
Number of pages9
JournalBMJ Open
Publication statusPublished - 22 Feb 2021


  • palliative care, hospice care, implementation science, nursing homes

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