Vianen

Researchers are studying nursing home residents aged 65 and older who have a limited life expectancy of less than 1.5 to 2 years. The study aims to evaluate how training healthcare professionals in medication assessments affects the medication use of these residents. This training focuses on tailoring medication to the residents' palliative care treatment goals. The study is designed as a cluster randomized controlled trial involving six nursing home organizations and approximately 450 patients, lasting one year and three months, starting in September. The intervention involves training healthcare professionals—including medical practitioners, pharmacists, and care workers—in a method called Systematic Multidisciplinary Medication Review combined with Advance Care Planning (SMMR+). This training includes two parts: medication assessment using the ReNeWAL criteria (which are adapted STOPP/START criteria for patients with limited life expectancy) and discussions about medication aligned with advance care planning goals. Professionals receive supporting tools like pocket cards and educational materials, and intervision sessions are planned. The control group continues usual care, with an equal number of organizations assigned to each group. Participants will be assessed before the intervention starts, then again at six months and twelve months. Researchers will collect data on potential under- and overprescribing of medication as the primary outcome. Secondary outcomes include involvement in decision-making measured by a questionnaire, and tertiary outcomes such as quality of life, deaths, falls, hospital admissions or acute care visits, and pain. A process evaluation will run alongside the study to monitor implementation and effects.