A large study found the more nursing directors knew about palliative care, the lower the likelihood that patients would experience aggressive interventions, such as inserting a feeding tube or sending a patient to accident and emergency.

The study authors said they found nursing directors varied widely in their knowledge of end of life and palliative care.

“The need for improving nursing home staff palliative care knowledge and practice is generally agreed upon”

Study authors

They surveyed nursing directors at more than 1,900 nursing homes across the US to assess their knowledge and their facility’s implementation of key care practices. The directors were given a score of 0 to 3, based on their answers.

More than one in five of the surveyed directors had little or no basic palliative care knowledge – a score of 1 or 0 – although 43% scored the maximum of 3. The average score was 2.2.

The researchers also analysed data on the 58,876 residents who died during the study period to ascertain the treatments they experienced when they were dying.

They found that the more directors knew about basic palliative care, the lower likelihood that nursing home patients would experience feeding tube insertion, injections, restraints, suctioning, and emergency room or other hospital trips.

Meanwhile, patients in higher-knowledge homes also had a higher likelihood of having a documented six-month prognosis.

The authors acknowledged that their study showed “only an association between palliative care knowledge and less aggressive end-of-life care”.

But if there is a causal relationship, then it could benefit nursing home residents for their nursing home caregivers to learn more about palliative care, the authors noted.

“The need for improving nursing home staff palliative care knowledge and practice is generally agreed upon, and the efficacy of such improvement is supported by our study findings,” they said.

Lead author Professor Susan Miller, from Brown University School of Public Health, added: “The fact that one in five US nursing home directors of nursing had very limited palliative care knowledge demonstrates the magnitude of the challenge in many nursing homes.”

The researchers said their study, published in the Journal of Palliative Medicine, was the first nationally representative sample of palliative care familiarity at US nursing homes.