EPIC Trial – enhancing person centred care in Care homes
EPIC Trial – enhancing person centred care in Care homes
Evaluating the effectiveness and cost effectiveness of Dementia Care Mapping™ (DCM™ ) to enable person-centred care for people with dementia and their carers: A cluster randomised controlled trial in care homes (EPIC trial).
The project start date was 1 September 2013 and the project end date is 30 September 2017. We have recruited 741 residents to the EPIC trial. We have randomised 50 of the 50 Care Homes participating in the EPIC trial.
At least two-thirds of people living in care homes have dementia and many develop distressing behaviours such as agitation. This can be upsetting for them, for other residents and is difficult for care staff to support. People with these behaviours are more likely to be admitted to hospital and are often prescribed anti-psychotic drugs which can cause harmful side effects. The UK government has prioritised research into better support for care home staff to help them to be better equipped to meet the needs of people with dementia and to reduce the use of drugs to treat or manage behaviours.
Distressing behaviours such as agitation have been linked to unmet needs in people with dementia, and they can be reduced by delivering care that is more supportive of each individual’s specific and often complex needs. Research shows that care can be more supportive by tailoring each person’s care to the individual, taking into account their interests, likes and life history. This is known as person-centred care. Training staff in the principles of person-centred care provides them with the skills they need to prevent and support distressing behaviours. However, without extra support for staff to build on their training, these benefits soon disappear.
Dementia Care Mapping™ (DCM™) is a technique already widely used in the National Health Service (NHS) and in care homes to help staff apply their person-centred care training to their caring role. DCM™ involves observing the experience of care from the point of view of people with dementia and then feeding this back to staff, who use this information to look at ways they can improve care. This process is carried out every four to six months so changes can be monitored and new improvements identified.
To date, only a small number of studies have been conducted on how effective DCM™ is in care homes, and if it provides value for money. None have taken place in the UK. This study will build on these studies to look at whether DCM™ is any more effective and offers any more value for money than usual care in helping staff to implement person-centred care in care homes in the UK.
The study has completed recruitment of 50 care homes across West Yorkshire, London and Oxfordshire. The study is split into three main time points (baseline, six months and 16 months) in which researchers have been collecting data in care homes.
All 50 care homes taking part have so far completed initial baseline data collection and are approaching either the second time point (a six month follow-up of data collection) or third time point (16 month follow-up of data collection). Twenty homes are continuing to deliver their usual care, whereas, thirty care homes have randomly been selected to receive DCM™ through staff training from experts in addition to their usual care. Any success of DCM™ will be measured by comparing changes in behaviours such as agitation in residents, their quality of life, the number of NHS services they need, and the numbers and types of medications used to treat or manage distressing behaviours they are prescribed/given. We will look at these things at all three time points within the study.
The study will also investigate staff related outcomes including the quality of staff interactions with residents, how staff feel about their job, and the number of staff resignations and sickness.
What were the care home eligibility criteria?
To be considered for participation in the trial, care homes had to meet all of the following criteria:
- Have a minimum of 24 permanent residents.
- Have 60 per cent + permanent residents with dementia based on a formal diagnosis or Functional Assessment Staging of Alzheimer’s Disease (FAST) (score of 4+) rated with the home manager or another experienced member of staff.
- Have a manager or nominated person agreeing to sign up to the trial protocol as research lead for the duration of the project, based on appropriate discussions and permissions.
- Agree to release staff for DCM™ training and subsequent mapping processes.
- Be within catchment area (Yorkshire and the Humber, North West of England, London, Oxford and Thames valley).
Care homes would not have been eligible for this trial if the care home:
- In the view of the researchers, was not suitable for inclusion due to being subject to Care Quality Commission (CQC) enforcement notices, admission bans or relevant moderate or major CQC compliance breaches.
- Received other special support for specific quality concerns, such as being currently subject to, or have pending, any serious safeguarding investigations, or receiving voluntary or compulsory admissions bans, be in receipt of local commissioning special support due to quality concerns.
- Had used DCM™ as a practice development tool within the 18 months prior to randomisation or was planning to use DCM™ over the course trial involvement.
- Was taking part, had recently taken part in, or was planning to take part in another trial that conflicts with DCM™ or with the data collection during the course of their involvement in DCM-EPIC.
For more information about the study please contact Professor Claire Surr (Principal Investigator):
- 0113 812 4316