Quality of life of older persons in nursing homes after the implementation of a knowledge-based palliative care intervention.

Only 52 residents were analysed at follow-up; 42% dropped out, mainly because of death, insufficient energy or lack of interest, which reduced statistical power. Residents had to speak Swedish, be 65 years or older, not have dementia and have enough energy for a one-hour interview, so many very frail residents were excluded. The reported outcome analyses were within-group comparisons, not a direct between-group comparison of follow-up scores. Nursing homes volunteered, so findings may not apply to all nursing homes. The intervention was a multi-component staff education package delivered to several staff groups, so the effect of any single seminar topic or staff discipline cannot be separated. Interviewers filled in the answers, and some residents had difficulty understanding the response options, which may have affected reliability. A WHOQOL-BREF item on sexual activity was removed for ethical reasons, reducing the validity of the social relationships domain.

The authors declared no conflicts of interest. Funding came from Region Skåne, Vetenskapsrådet, Greta och Johan Kocks stiftelser, Vårdalstiftelsen, Medicinska Fakulteten, Lunds Universitet, Ragnhild and Einar Lundströms Memorial Foundation and Linnéuniversitetet.

Do not read the lack of decline in the intervention group as proof that the staff education improved quality of life. The intervention group's total quality-of-life score did not change significantly, and the paper reports within-group comparisons rather than a direct between-group test of the primary outcome.