A recent study undertaken in the Netherlands explored the efficacy of a novel advanced care planning model for dementia known as the Desired Dementia Care Towards End of Life model (DEDICATED). The investigation aimed to assess its impact on both families and health care providers involved in dementia care. Although the model demonstrated valuable enhancements in palliative care knowledge and interdisciplinary collaboration, it did not significantly improve the documentation of goals-of-care discussions.
The DEDICATED framework seeks to elevate the quality of life for patients with dementia by equipping health care professionals with the necessary skills and knowledge to engage in meaningful advance care planning (ACP). ACP is particularly critical in dementia care, as cognitive decline can impede effective communication regarding patients’ end-of-life preferences. “Advance care planning is an essential component of palliative dementia care, as cognitive decline and communication difficulties can hinder discussions about palliative care preferences, making timely ACP crucial for aligning care with the wishes and needs of the person with dementia,” the study authors wrote.
This innovative approach encompasses a variety of training formats and practical tools that address the entire course of the disease. Specifically, the findings suggest that different tools are optimal at various stages of dementia. For example, some tools are more applicable during the initial diagnosis and early stages, while others facilitate transitions to nursing homes later on.
The DEDICATED approach is built around six core themes, all designed to foster person-centered care:
1. Timely recognition of palliative care needs in dementia.
2. Understanding the individual histories, values, and behaviors of patients and their caregivers.
3. Communicating about future care preferences as part of ACP.
4. Encouraging interprofessional collaboration in ACP.
5. Supporting cooperation during care transitions.
6. Effectively managing pain and addressing challenging behaviors.
Additionally, the program includes a training initiative aimed at empowering providers with the necessary tools, with trained individuals designated as DEDICATED ambassadors responsible for disseminating their knowledge to fellow professionals.
The research employed qualitative interviews with DEDICATED ambassadors alongside questionnaire assessments from dementia care teams and families who had experienced bereavement. Conducted across 28 dementia care wards within three health care organizations, the findings indicated that while awareness of person-centered palliative care increased and the significance of timely ACP was recognized, there was no measurable improvement in professionals’ self-efficacy, work engagement, or psychological empowerment.
Notably, the study’s timing coincided with the COVID-19 pandemic, a factor the authors suggest may have affected outcomes. “While DEDICATED ambassadors found the approach valuable for enhancing person-centered palliative care, the unforeseen impacts of the pandemic may have inhibited more substantial results,” they noted. Consequently, the authors advocate for further longitudinal research to evaluate the DEDICATED approach’s long-term effects and integration into clinical practice, emphasizing the need for extended implementation periods to fully realize its potential benefits in dementia care.
