University of Oulu

Pauli J Lamppu, Marja-Liisa Laakkonen, Harriet Finne-Soveri, Hannu Kautiainen, Jouko V Laurila, Kaisu H Pitkälä, Training Staff in Long-Term Care Facilities–Effects on Residents’ Symptoms, Psychological Well-Being, and Proxy Satisfaction, Journal of Pain and Symptom Management, Volume 62, Issue 4, 2021, Pages e4-e12, ISSN 0885-3924,

Training staff in long-term care facilities–effects on residents’ symptoms, psychological well-being, and proxy satisfaction

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Author: Lamppu, Pauli J.1,2; Laakkonen, Marja-Liisa2; Finne-Soveri, Harriet3;
Organizations: 1Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
2Department of Social Services and Health Care, Helsinki Hospital, Geriatric Clinic, Helsinki, Finland
3National Institute of Health and Welfare, Helsinki, Finland
4Center for Life Course Health Research, University of Oulu, Oulu, Finland
5Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
Persistent link:
Language: English
Published: Elsevier, 2021
Publish Date: 2021-11-15


Context: Long-term care facility (LTCF) residents have unmet needs in end-of-life and symptom care.

Objectives: This study examines the effects of an end-of-life care staff training intervention on LTCF residents’ pain, symptoms, and psychological well-being and their proxies’ satisfaction with care.

Methods: We report findings from a single-blind, cluster randomized controlled trial featuring 324 residents with end-of-life care needs in 20 LTCF wards in Helsinki. The training intervention included four 4-hour educational workshops on palliative care principles (advance care planning, adverse effects of hospitalizations, symptom management, communication, supporting proxies, challenging situations). Training was provided to all members of staff in small groups. Education was based on constructive learning methods and included participants’ own resident cases, role-plays, and small-group discussions. During a 12-month follow-up we assessed residents’ symptoms with the Edmonton Symptom Assessment Scale (ESAS), pain with the PAINAD instrument and psychological well-being using a PWB questionnaire. Proxies’ satisfaction with care was assessed using the SWC-EOLD.

Results: The change in ESAS symptom scores from baseline to 6 months favored the intervention group compared with the control group. However, the finding was diluted at 12 months. PAINAD, PWB, and SWC-EOLD scores remained unaffected by the intervention. All follow-up analyses were adjusted for age, gender, do-not-resuscitate order, need for help, and clustering.

Conclusion: Our rigorous randomized controlled trial on palliative care training intervention demonstrated mild effects on residents’ symptoms and no robust effects on psychological well-being or on proxies’ satisfaction with care.

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Series: Journal of pain and symptom management
ISSN: 0885-3924
ISSN-E: 1873-6513
ISSN-L: 0885-3924
Volume: 62
Issue: 4
Pages: e4 - e12
DOI: 10.1016/j.jpainsymman.2021.03.020
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This study was supported by Helsinki University Hospital and the City of Helsinki and received scholarships from the Uulo Arhio Foundation, the Finnish Medical Foundation, and the Foundation of General Practitioners in Finland. The funding sources had no role in the design or execution of the study; in the collection, analysis, or interpretation of data; or in the preparation, review, or approval of the manuscript.
Copyright information: © 2021 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. This is an open access article under the CC BY-NC-ND license (