Trial reportJournal of general internal medicine2014
Intervention to improve care at life's end in inpatient settings: the BEACON trial.
Trial report in Journal of general internal medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Improving hospital-based end of life care processes and outcomes: a systematic review of research output, quality and effectiveness.BMC palliative care · 2017Pooled it
- Increasing Readiness for Early Integrated Palliative Oncology Care: Development and Initial Evaluation of the EMPOWER 2 Intervention.Journal of pain and symptom management · 2021Trial
- Comparison of Two Methods for Implementing Comfort Care Order Sets in the Inpatient Setting: a Cluster Randomized Trial.Journal of general internal medicine · 2021Trial
- The Relationship of Post-traumatic Stress Disorder to End-of-life Care Received by Dying Veterans: a Secondary Data Analysis.Journal of general internal medicine · 2020Trial
- Understanding multilevel influences on the adaptation of a complex intervention for oncology to palliative care transitions: a qualitative study across seven European countries.BMC palliative care · 2026Article
- Assessing for differences in opioid administration during inpatient end-of-life care for patients with limited English proficiency.Journal of hospital medicine · 2024Article
- Comparing Adherence with Best Practices in End-of-Life Care After Implementing the End-of-Life Order Set: A Quality Improvement Project in an Ottawa Academic Hospital.Palliative medicine reports · 2023Article
- The meaning of comfort measures only order sets for hospital-based palliative care providers.International journal of qualitative studies on health and well-being · 2022Article
- Type of Intensive Care Unit Matters: Variations in Palliative Care for Critically Ill Patients with Chronic, Life-Limiting Illness.Journal of palliative medicine · 2021Article
- The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature.Implementation science : IS · 2020Review
- Conceptualizing and Counting Discretionary Utilization in the Final 100 Days of Life: A Scoping Review.Journal of pain and symptom management · 2020Article
- Physician and Patient Characteristics Associated With More Intensive End-of-Life Care.Journal of pain and symptom management · 2019Article
- Outcomes of Palliative Care Consults With Hospitalized Veterans.Federal practitioner : for the health care professionals of the VA, DoD, and PHS · 2018Article
- Integrating Palliative and Oncology Care for Patients with Advanced Cancer: A Quality Improvement Intervention.Journal of palliative medicine · 2017Article
- Implementing communication and decision-making interventions directed at goals of care: a theory-led scoping review.BMJ open · 2017Article
- Does educating patients about the Early Palliative Care Study increase preferences for outpatient palliative cancer care? Findings from Project EMPOWER.Health psychology : official journal of the Division of Health Psychology, American Psychological Association · 2017Article
- Article
- Stepped wedge cluster randomised trials: a review of the statistical methodology used and available.BMC medical research methodology · 2016Review
- Racial Differences in Processes of Care at End of Life in VA Medical Centers: Planned Secondary Analysis of Data from the BEACON Trial.Journal of palliative medicine · 2016Article
- Predictors of Physical Restraint Use in Hospitalized Veterans at End of Life: An Analysis of Data from the BEACON Trial.Journal of palliative medicine · 2015Article
Corrections and comments
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Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWidespread implementation of palliative care treatment plans could reduce suffering in the last days of life by adopting best practices of traditionally home-based hospice care in inpatient settings.
objectiveTo evaluate the effectiveness of a multi-modal intervention strategy to improve processes of end-of-life care in inpatient settings.
designImplementation trial with an intervention staggered across hospitals using a multiple-baseline, stepped wedge design.
participantsSix Veterans Affairs Medical Centers (VAMCs).
interventionStaff training was targeted to all hospital providers and focused on identifying actively dying patients and implementing best practices from home-based hospice care, supported with an electronic order set and paper-based educational tools. MAIN MEASURES: Several processes of care were identified as quality endpoints for end-of-life care (last 7 days) and abstracted from electronic medical records of veterans who died before or after intervention (n = 6,066). Primary endpoints were proportion with an order for opioid pain medication at time of death, do-not-resuscitate order, location of death, nasogastric tube, intravenous line infusing, and physical restraints. Secondary endpoints were administration of opioids, order/administration of antipsychotics, benzodiazepines, and scopolamine (for death rattle); sublingual administration; advance directives; palliative care consultations; and pastoral care services. Generalized estimating equations were conducted adjusting for longitudinal trends. KEY
resultsSignificant intervention effects were observed for orders for opioid pain medication (OR: 1.39), antipsychotic medications (OR: 1.98), benzodiazepines (OR: 1.39), death rattle medications (OR: 2.77), sublingual administration (OR: 4.12), nasogastric tubes (OR: 0.71), and advance directives (OR: 1.47). Intervention effects were not significant for location of death, do-not-resuscitate orders, intravenous lines, or restraints.
conclusionsThis broadly targeted intervention strategy led to modest but statistically significant changes in several processes of care, indicating its potential for widespread dissemination to improve end-of-life care for thousands of patients who die each year in inpatient settings.
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